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McGovern's overarching goal is to improve access to the most effective care possible for anyone who needs it. His primary research focus is implementation science, with a specific emphasis on integrated behavioral health services for persons with co-occurring substance use and psychiatric disorders, as they present in both primary care and specialty settings. Presently, he le national, State of California, and local efforts to combat the US opioid epidemic. McGovern's work is focused on scaling up access to FDA-approved medications, in specialty care and in primary care and other general medical practice settings.
He is also actively collaborating with health systems, including Stanford Health Care and Intermountain Healthcare, on implementable and sustainable models of integrated behavioral health in primary care practice.
The overarching goal of this network is the implementation and sustainment of evidence-based mental health prevention and treatment practices across US states and territories. McGovern has been actively involved in the education of medical students, psychiatric residents and fellows, and clinical psychology interns at Stanford, and ly at the medical schools at Dartmouth Lebanon, New Hampshire and Northwestern University Chicago, Illinois.
From tohe served as the Editor-In-Chief for the Journal of Substance Abuse Treatment JSATthe leading scientific journal dedicated to addiction treatment services and implementation research. Our translational research portfolio is deed to directly benefit patients and families by improving their chances of receiving evidence-based treatments at the right time and the right place--whenever and wherever needed.
Funding support may also provided by the entities wherein the projects take place. At present, the content of implementation and sustainment projects includes: a integrating a unified model of behavioral health mental health, addiction, chronic disease management into routine medical practice settings such as primary care or emergency departments; b integrating mental health and addiction services into routine specialty care practices; and c expanding the access to and quality of using addiction medications for opioid use disorders in primary care and specialty practice settings.
All projects are co-deed and co-produced with key stakeholders involved in the implementation process, from top level leaders to care providers to patients and families. Precision in measurement, procedural documentation, and transparency in data analyses and reporting ensure scientific reproducibility and public health impact brought to scale. The Network for the Improvement of Addiction Treatment NIATx was hypothesized to be an effective strategy to implement and sustain integrated mental health and Adult dating McGovern use care in addiction treatment programs.
This study examined sustainment of integrated services for up to 2 years after the active implementation phase. The Dual Diagnosis Capability in Addiction Treatment Index was used to evaluate organizations' capability to provide integrated care. Linear mixed-effects modeling was used to evaluate changes from baseline to end of the sustainment period.
Both groups achieved successful implementation and sustained integrated services to a similar degree, regardless of sustainment year. Sustainment did not vary as a function of NIATx adherence.
Future research should consider how contextual factors may predict, mediate, and moderate sustainment outcomes. View details for DOI View details for Adult dating McGovern Programs with residential components have been particularly impacted as they try to keep infection from spreading in facilities and contributing to further community spread of the virus.
This crisis highlights the ongoing daily trade-offs that organizations must weigh as they balance the risks and benefits of individual patients with those of the group of patients, staff and the community they serve. While guidance documents from federal, state, and trade groups aimed to support such decision making, they often lagged pandemic dynamics, and provided too little detail to translate into front line decision making. In the context of incomplete knowledge to make informed decisions, we present a way to integrate guidelines and local data into the decision process and discuss the ethical dilemmas faced by provider organizations in preventing infections and responding to COVID positive patients or staff.
While useful, guidance documents may not be capable of providing support with the nuance that local data and simulation modeling may be able to provide. Primary care provides a treatment opportunity for many persons with opioid use disorder OUD. The push to integrate and expand reach and adoption of medications for opioid use disorder MOUD within primary care has been a major focus of national, state and health systems endeavors. The research team has developed IMAT along similar lines to Adult dating McGovern organizational measures of integrated services capability.
We present the development and validation of the measure, and suggest its applicability for systems and organizations, as well as for process improvement and implementation research. Forty-one primary care clinics completed the IMAT at two time points: baseline and 9-month follow-up. It has good internal consistency, as well as concurrent and predictive validity. The IMAT has the potential to support both scientific and public health care activities.
The return on investment in public health benefit is therefore low. Implementation research is deed to deepen understanding of how best to scale-up proven treatments. This study assessed how implementation research has been deployed in the National Institute on Drug Abuse NIDA efforts to address the opioid and stimulant epidemics.
Key study characteristics were abstracted and coded by two independent reviewers. Of these, One-hundred-and-thirty-four Of these, 28 4. Over the five-year period, there was a gradual increase in both IP and IR studies. To more effectively respond to contemporary overdose epidemics, implementation research must take on an even more ificant role. View details for Web of Science ID Behavioral health conditions such as anxiety, depression, and substance use disorders can often be effectively managed.
The majority of patients in need of behavioral health care are seen in primary care, which often has difficulty responding. Some primary care practices are providing integrated behavioral health care IBHwhere primary care and behavioral health providers work together, in one location, using a team-based approach.
Research suggests there may be an association between IBH and improved patient outcomes. However, it is often difficult for practices to achieve high levels of integration. The Adult dating McGovern Behavioral Health and Primary Care study responds to this need by testing the effectiveness of a comprehensive practice-level intervention deed to improve outcomes in patients with multiple chronic medical and behavioral health conditions by increasing the practice's degree of behavioral health integration.
Forty-three practices will be randomized to the intervention or usual care arm, while 2 practices will be considered "Vanguard" pilot practices for developing the intervention. The intervention is a month supported practice change process including an online curriculum, a practice Adult dating McGovern and implementation workbook, remote quality improvement coaching services, and an online learning community.
Each practice's degree of behavioral health integration will be measured using the Practice Integration Profile. Approximately 75 patients with both chronic medical and behavioral health conditions from each practice will be asked to complete a series of surveys to measure patient-centered outcomes. Change in practice degree of behavioral health integration and patient-centered outcomes will be compared between the two groups.
Practice-level case studies will be conducted to better understand the contextual factors influencing integration. This study will demonstrate the effectiveness of one such intervention in a pragmatic, real-world setting. Registered on August 16, These funds are deed to increase access to medications for addiction treatment, reduce unmet treatment need, reduce overdose death rates, and provide and sustain effective prevention, treatment and recovery activities.
It is unclear whether or not the services developed using these funds will be sustained beyond the start-up period. We found variable commitment to sustainability across response plans with less than half the states adequately describing sustainability plans. States with higher proportions of opioid prescribing, opioid misuse, and poverty had somewhat higher scores on sustainment. Because life saving evidence-based programs and services may be lost, intentional commitment to sustainment beyond the bolus of start-up funding is essential.
With the onset of the COVID crisis, many federal agencies relaxed policies regulating opioid use disorder treatment. The impact of these changes has been minimally documented. The abrupt nature of these shifts provides a naturalistic opportunity to examine adaptations for opioid use disorder treatment in primary care. To examine change in medical and behavioral health appointment frequency, visit type, and management of patients with opioid use disorder in response to COVID A item survey queried primary care practices that were enrolled in a medications for opioid use disorder statewide expansion project.
The survey was open for 18 days. We surveyed clinicians from 57 primary care clinics located in California, including federally qualified health centers and look-alikes.
The survey consisted of seven dimensions of practice: medical visits, behavioral health visits, medication management, urine drug screenings, workflow, perceived patient demand, and staff experience. A total of 52 of 57 Many clinics indicated that both medical Two-thirds The majority Over half Many adaptations in the primary care approach to patients with opioid use disorder may be temporary reactions to COVID Further evaluation of the impact of these adaptations on patient outcomes is needed to determine whether changes should be maintained post-COVID Currently, little is known about optimal strategies for sustaining these programs beyond this start-up funding.
Status in state government structure, public support, and spending flexibility were noted as key facilitators. Effective levers to increase chances for sustainment included strong partnerships with other state agencies, workforce and credentialing changes, and marshalling advocacy through public awareness campaigns. Yet rampant variation exists in models and approaches. Adult dating McGovern ificant question is whether frontline providers perceive that behavioral health includes substance use.
The current study examined front line providers': 1.Adult dating McGovern
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