Recommended first-line treatment with atypical antipsychotic medication for management of schizophrenia and other psychotic disorders is contributory to weight gain and associated comorbidities. Beyond comorbid conditions – weight gain can lead to poor self-image, poor compliance and treatment outcomes in an already stigmatized population. Caregivers were selected as participants as they are a primary support in this population. In alignment with the Health Belief Model the purpose of this evidence-based intervention was to increase risk awareness, increase knowledge of strategies to offset risk, increase confidence and self-efficacy and empower health related behaviors among caregivers.

Participants were identified by providers in an outpatient mental health clinic as caregivers of patients prescribed atypical anti-psychotic medications adults aged 18 and above, able to read and understand English, and agree to provide consent. They were asked to:

1. Complete a demographic and knowledge pre-test, gauge perceived knowledge/confidence.
2. View an educational PowerPoint focused on atypical anti-psychotic medications, benefits, risks and strategies to mitigate weight-gain.
3. Complete a knowledge post-test and gauge perceived knowledge/confidence.

Descriptive statistics were used to examine distribution of variables, due to small sample size, Wilcoxon Signed Ranks test was used to compare outcomes. Qualitative data was also gathered to further develop interventions and inform practice. Comparison between pre- and post-test analysis demonstrated improvement in all areas of knowledge, perceived knowledge, and perceived confidence. Statistical analysis demonstrated statistical significance and high practical significance. One-hundred percent of participants recommended the intervention and provided qualitive feedback, and suggestions that may be used to inform practice.

The utilization of suicide risk assessment tools is a critical component of a comprehensive approach to suicide risk assessment. However, some professionals hesitate to utilize screening tools routinely in practice. A project was undertaken to determine if the utilization of the Columbia-Suicide Severity Scale (C-SSRS) improved staff confidence in assessing suicide risk. Professionals within a psychiatric urgent care in Scottsdale, Arizona were provided with
training on the C-SSRS. Participants then utilized the C-SSRS at triage with patients presenting with depression and/or suicidality over a two-month period.

Self confidence in assessing suicide risk was evaluated utilizing The Efficacy in Assessing and Managing Suicide Risk Scale (SETSP-S). The acceptability and usability of the C-SSRS was evaluated utilizing The System Usability Scale (SUS). Findings of the Wilcoxon Signed Ranks test indicated changes in pre and posttest assessment scores as significant in seven of the eight assessment parameters. In addition, Cohen's effect size value suggested medium or large clinical significance in these same assessment parameters.

Evidence suggests that efficient and effective assessment can improve staff confidence in assessing for suicidality and may improve morbidity and mortality rates for patients. The utilization of tools such as the C*SSRS could reduce health care costs associated with unnecessary hospital admissions as well as rehospitalizations. The routine utilization of assessment tools such as the C-SSRS many also be beneficial to healthcare specialties outside of behavioral health such as emergency departments and urgent care settings.

Background: The cost of substance use (SU) in the United States (U.S.) is estimated at $1.25 trillion annually. SU is a worldwide health concern, impacting physical and psychological health of those who use substances, their friends, family members, communities and nations. Screening, Brief Intervention (BI) and Referral to Treatment (SBIRT) provides an evidence-based (EB) framework to detect and treat SU. Evidence shows that mental health (MH) providers are not providing EB SU management. Federally grant-funded SBIRT demonstrated evidence of decreased SU and prevention of full disorders. Implementation outcomes in smaller-scale projects have included increased clinician knowledge, documentation and interdisciplinary teamwork.

Objective: To improve quality of care (QOC) for adolescents who use substances in the inpatient psychiatric setting by implementing EB SBIRT practices.

Methods: Research questions focused on whether the number of SBIRT notes documented (N=170 charts) increased and whether training of the interdisciplinary team (N=26 clinicians) increased SBIRT knowledge. Individualized interventions used existing processes, training and a new SBIRT Note template. An SBIRT knowledge survey was adapted from a similar study. A pre-and post-chart audit was conducted to show increase in SBIRT documentation. The rationale for the latter was not only for compliance, but also so that all team members can know the status of SBIRT services. Thus, increased interdisciplinary teamwork was an intentional, though indirect, outcome.

Results: A paired-samples t-test indicated clinician SBIRT knowledge significantly increased, with a large effect size. The results suggest that a short, 45-60-minute tailored education module can significantly increase clinician SBIRT knowledge. Auditing screening & BI notes both before and after the study period yielded important patient SU information and which types of SBIRT documentation increased post-implementation. The CRAFFT scores of the patients were quite high from a SU perspective, averaging over 3/6 both pre- and post-implementation, revealing over an 80% chance that the adolescent patient had a SU disorder. Most patients were positive for at least one substance (pre- = 47.1%; post- = 65.2%), with cannabis and alcohol being the most commonly used substances. Completed CRAFFT screenings increased from 62.5% to 72.7% of audited patients. Post-implementation, there were two types of BI notes: the preexisting Progress Note BI (PN BI) and the new Auto-Text BI (AT BI), part of the new SBIRT Note template introduced during implementation. The PN BIs not completed despite a positive screen increased from 79.6% to 83.7%. PN BIs increased 1%. The option for AT BI notes ameliorated this effect. Total BI notes completed for a patient positive for a substance increased from 20.4% to 32.6%, with 67.4% not receiving a documented BI. Total BIs completed for all patients was 21.2% post-implementation.

Conclusion: This project is scalable throughout the U.S. in MH settings and will provide crucial knowledge about positive and negative drivers in small-scale SBIRT implementations. The role of registered nurses (RNs), social workers and psychiatrists in providing SBIRT services as an interdisciplinary team will be enhanced. Likely conclusions are that short trainings can significantly increase clinician knowledge about SBIRT and compliance with standards. Consistent with prior evidence, significant management involvement, SBIRT champions, thought leaders and other consistent emphasis is necessary to continue improving SBIRT practice in the target setting.

Keywords: adolescents, teenagers, youth, alcohol, behavioral health, cannabis, crisis, documentation, drug use, epidemic, high-risk use, illicit drugs, implementation, mental health, opiates, opioid, pilot study, psychiatric inpatient hospital, quality improvement, SBIRT, Screening, Brief Intervention and Referral to Treatment, substance use, unhealthy alcohol use, use disorders