Many veterans who begin evidence-based therapies for posttraumatic stress disorder (PTSD) discontinue care prior to treatment completion. Examination of individual-level factors as predictors of dropout has been inconclusive, and it may be important to examine organizational factors as predictors. The present study investigates the role of both individual variables (i.e., gender identity, age, racial background, ethnicity, perceived barriers to treatment) and organizational variables (i.e., time from evaluation to individual treatment, number of preparatory sessions, and inclusion of family in an informational session) in predicting treatment discontinuation. Participants consisted of 557 veterans who presented to a Veterans Affairs PTSD specialty clinic and began trauma-focused treatment (86.89% male, 50.99% White, 47.94% Operation Iraqi Freedom/Operation Enduring Freedom). Most veterans reported at least one barrier to treatment (85.10%). A total of 53.32% of veterans completed a course of evidence-based trauma-focused therapy, while 46.68% discontinued. In a series of logistic regression models, older age significantly predicted treatment completion ( = 1.017, = .007), and longer time from evaluation to treatment initiation significantly predicted treatment discontinuation ( = 0.992, = .045). Findings highlight older age as a reliable predictor of treatment completion among veterans. Findings add to the existing literature by demonstrating that improving organizational-level variables (i.e., reducing wait time from evaluation to treatment initiation) may be particularly helpful in facilitating treatment completion across demographic groups, even in the presence of barriers to treatment. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The aim of the present systematic review was to evaluate the outcome of law enforcement officer (LEO) trainings on mental health (MH) stigma and other outcomes. A systematic search of Pubmed, APA PsycInfo, and Cochrane Central Register of Controlled Trials was conducted to identify studies examining MH stigma trainings implemented within the LEO profession. Both randomized and nonrandomized studies were considered. Risk of bias was assessed via the Cochrane Risk-of-Bias tool for randomized trials and the Risk of Bias in Non-Randomized Study of Intervention (Version 2). The present review identified 18 studies comprised of 2,399 participants ( = 37.37, = 4.76). Samples were predominantly composed of police officers ( = 16), followed by correctional officers ( = 2) and both ( = 1). Although the review aimed to investigate trainings targeting institutional, public, and self-stigma, all studies implemented trainings intended to decrease public stigma. Outcomes evaluated across studies included attitudes toward MH, knowledge about MH, self-efficacy/confidence, behavioral responses/de-escalation skills, social distance, and awareness, support, and utilization of MH resources. Although the outcomes evaluated were somewhat consistent across studies, there was variability in how variables were defined and measured. Due to this, data could not be compared across studies, and thus, conclusions could not be drawn regarding which trainings demonstrated the most effectiveness in reducing MH. Despite the increased research investigating the outcomes of trainings on stigma within the LEO population, the variability in methodology and the high rate of bias exhibited across studies suggest that more rigorous and better quality evaluations are warranted. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Engagement in psychosocial mental health services has been found to support and facilitate the process of recovery in individuals with serious mental illness. However, many individuals eligible for these services are not receiving them. Presently, little is known about the factors that contribute to treatment engagement. This study aimed to identify attitudes related to treatment engagement among veterans with serious mental illness enrolled at a large VA medical center. Thirty-six veterans participated in individual qualitative interviews about their beliefs about the efficacy and purpose of mental health care; their perceptions of societal attitudes regarding mental health; and their experiences accessing mental health care. Based on their level of treatment engagement in the last year, veterans were classified as either engaged in psychosocial mental health services ( = 15), engaged in psychiatric medication management only ( = 14), or not engaged in VA mental health services ( = 7). Attitudes associated with level of service usage were examined to identify factors that might improve engagement in treatment and quality of mental health services. Results suggest that provider expertise and rapport were critical to engagement. Our findings also suggest that barriers to accessing care included beliefs about when it was appropriate to request services, stigmatizing attitudes within one's social network, the complexity of the mental health system, and failures of providers and the treatment system to address the needs of a diverse patient population. Implications for clinical training and practice are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Numerous studies have investigated the predictive validity of the Hare Psychopathy Checklist (PCL), but the majority have used samples from North America. The PCL may inform important decisions about people's futures; recognition has been growing of the importance of ensuring that its psychometric properties are established in each jurisdiction where it is used, especially for Indigenous and non-European populations. The present study examined the predictive properties of the Hare Psychopathy Checklist: Screening Version (PCL:SV; Hart et al., 1995) in 371 New Zealand (NZ) male prisoners, including NZ European and NZ Māori subsamples. Discrimination analyses showed that PCL:SV total scores had moderate predictive accuracy for any new conviction within 5 years of release; no significant differences were detected for Māori versus NZ European on this outcome. PCL:SV Factor 2 (Lifestyle/Antisocial) scores were moderately predictive of violent recidivism within 5 years of release. In a second, independent sample of male prisoners ( = 102), both PCL:SV total and Factor 2 scores showed moderate predictive accuracy for serious institutional violence. Additionally, PCL:SV Facets 1 (Interpersonal) and 2 (Affective) scores were uniquely associated with time to sexual and violent recidivism, respectively. Understanding the predictive performance of clinical risk measures across diverse ethnic groups is an important step toward identifying and addressing ethnic disparities in criminal justice outcomes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

This special section underscores the importance of psychologists in improving and enhancing care for individuals with serious mental illnesses (SMIs). People with diagnoses typically included in the category of SMIs-schizophrenia, schizoaffective disorder, bipolar disorder, and other diagnoses with symptoms severely impacting functioning-typically have layered marginalities and experience significant social stigma in addition to mental health symptoms. The complexity of challenges commonly experienced by individuals with SMI requires that treatment providers have specialized knowledge, training, and skills to provide specialty care needed to support mental health recovery. The included articles illustrate the breadth of the impact of psychologists on care for this population to date as well as the need to address growing care gaps for people with SMI through specialized training support to increase the provision of evidence-based practices and high-quality care. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Public service psychologists engage their research competencies to explore the psychological health needs of underserved populations and the justice systems that deliver them psychological services. In late June 2023. the Criminal Justice Section of Division 18 of the American Psychological Association cosponsored the Fifth North American Correctional and Criminal Justice Psychology Conference: Towards a Justice System That Works, Toronto, Canada. This is the fourth time our journal, , has engaged to develop a section of peer-reviewed articles from the original empirical research presented at the North American Correctional and Criminal Justice Psychology Conference. Supplemented with additional justice-related articles featuring a theme of responsivity, this brief introduction outlines the importance of responsivity research-knowledge that informs unique aspects of a subpopulation so clinicians might better inform the services they deliver. Articles span a range of justice settings domestically and internationally and examine issues of gender, ethnicity, and the workforce to increase the empirically informed responsivity factors that deepen provider understandings of treatment needs. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Although jails are the largest provider of mental health care nationally, access to treatment in U.S. jails is limited. Limited empirical information on factors impacting the implementation of mental health services in jail may be contributing to low treatment rates. We documented potential barriers impacting the provision of a brief cognitive-behavioral group-based intervention for people with serious mental illness in jail, including the rates of participants' recruitment, as well as starting and completing the intervention; time required for each group from recruitment to completion; and the types and frequencies of obstacles encountered during treatment sessions. We organized the barriers according to the Consolidated Framework for Implementation Research. All potential treatment recipients' questions prior to treatment, and reasons provided for not starting the treatment, were also logged and analyzed using content analysis and frequency counts; tables of the themes, frequencies, and examples of participant concerns are presented. These results suggest that although many participants were interested in and incarcerated for sufficient time to complete the intervention, relatively few participants were able to begin the groups (44%). Over 150 obstacles to treatment were encountered during treatment provision (including recurring issues with client transportation within the facility and facility lockdown). Understanding participants' progression through the study (recruitment, start, completion), their questions and reasons for not participating, and interruptions to the sessions provide important information for increasing the usability of mental health care in jails. The current findings can improve the implementation of needed evidence-based treatment in this carceral setting. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Depression can be effectively treated with internet-based computerized cognitive behavioral therapy (cCBT). The Veterans Health Administration (VHA) provided cCBT free to all veterans nationally as of 2013; however, its uptake has been limited. This study aimed to examine VHA primary care clinicians' and patients' perspectives regarding cCBT treatment for depression. We conducted semistructured interviews with 12 primary care clinicians (September-November 2020) and four focus groups involving 15 patients with depression (March-May 2021). Interview guides were developed using the Consolidated Framework for Implementation Research; questions addressed depression treatment barriers and facilitators, cCBT awareness and acceptability, target patient population for cCBT, and integration into depression management pathways. Data were analyzed for overarching themes using matrix analysis techniques. Few primary care clinicians and patients were aware of cCBT and its availability for veterans. Clinicians stressed the importance of identifying appropriate patients for cCBT use, specifically veterans with mild-to-moderate severity depression. Clinicians believed cCBT could potentially engage patients in depression treatment who may not otherwise engage and envisioned cCBT use to be guided by integrated VHA mental health personnel. Patients spoke of multiple treatment barriers (e.g., long wait times) and, correspondingly, viewed cCBT as facilitating access to mental health treatment. While patients raised some technical questions, they expressed interest in cCBT. Though relatively unknown to participants, cCBT was widely perceived to be acceptable and with the potential to increase access to depression treatment within VHA primary care settings. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Suicide comprises nearly one third of jail deaths, but strategies for effectively supporting implementation of suicide prevention education in jails are understudied. Here, we aimed to identify and pilot strategies to promote uptake of a brief suicide prevention education program, developed by the American Foundation for Suicide Prevention, in jails. Applying community-engaged dissemination and implementation principles, we conducted a statewide survey of jail leadership in a mid-Southern state ( = 65 jails) to (a) understand the preimplementation landscape of suicide prevention education efforts and (b) assess the perceived feasibility and helpfulness of possible strategies to promote TSL-C uptake. With continuous input from our community advisory board, we then partnered with two jails to select and tailor implementation strategies via a rigorous Evidence-Based Quality Improvement process and pilot TSL-C. Statewide survey results revealed insufficient rates of foundational (50.8%) and refresher (27.7%) suicide prevention training; however, receptivity to proposed implementation strategies was very high. Through the Evidence-Based Quality Improvement process, partnering sites selected both overlapping (i.e., identifying local champions, tailoring materials, and providing train-the-trainer training) and divergent strategies. A primary difference between the sites was their implementation teams' structure. Both sites successfully piloted the TSL-C program facility-wide by the end of the study period, though one site significantly revised their implementation plan due to staffing shortages and financial barriers. Together, our results indicate that although carceral settings face barriers to implementing and sustaining health-focused interventions, community-developed implementation strategies can help support uptake in these underresourced but high-need contexts. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The purpose of this investigation is to provide descriptive information on veteran response styles for compensation and pension (C&P) evaluations Veterans Affairs (VA) referral types using the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), which has well-supported embedded validity scales capturing invalid response styles. The total sample included 356 veterans from a single VA psychological testing clinic who were administered the MMPI-2-RF during a broader psychological evaluation, with 201 veterans undergoing C&P evaluations. This study examines frequencies of protocol invalidity based on the MMPI-2-RF's validity scales and provides comprehensive descriptive findings on validity scale scores across appointment types (i.e., C&P and non-C&P). Three distinct trends emerged: (1) Veterans generally produced valid MMPI-2-RF profiles, (2) when more than one elevation emerges, it is likely to be thematically consistent (e.g., overreporting scales), and (3) overreporting generally captured the highest frequency of validity scale elevations relative to underreporting or noncontent-based invalid responding. Implications and limitations for practice and the utility of the MMPI-2-RF within VA testing clinics are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Artificial intelligence is a useful tool for examining suicidality on social media, where people share their thoughts. However, existing research has primarily focused on text analysis to predict risk in single posts and raised privacy concerns. This study aimed to use text, images, and user features on Instagram to predict the risk of each user in Hawaii with user permission. One hundred forty-two participants completed online questionnaires about their current suicidal ideation. With their consent, their Instagram data were collected to train Artificial intelligence model to predict suicidal ideation of each user. Thirty-three (23.2%) participants reported having current suicidal ideation. The best model predicts suicidal ideation with 52% sensitivity, 92% specificity, 65% positive predictive value, and 82% accuracy. The significant predictors were negative description, lower hue and more red in an image, fewer nature and sky images, more art, fashion, a close-up of a body part, and spoof content in an image. These findings highlight the potential of suicide prediction on social media, which help mental health providers plan patient online interventions and appointments. Additionally, the influence of Hawaii's unique social-cultural context on significant predictors, helping gatekeepers to recognize signs of suicide on the social media of people in Hawaii. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Despite research and treatment advances in health care, the implementation of research evidence into practice remains a challenge, especially for historically marginalized populations. There have been numerous calls to action to integrate health equity into implementation science frameworks, models, and theories. Yet, progress toward better integration of these approaches has been hampered by the theoretical and aspirational nature of calls to action up to the present time, which poses a challenge as it remains unclear how to specifically move from rhetoric to action. We present three case examples from our work to illustrate how to synergize health equity research and implementation science into our approach to "equity-grounded implementation science" focused on processes and practices located at the intersection of these fields. These three distinct studies focused on reducing mental health inequities in historically marginalized communities, namely, Latino and Black individuals in mainland United States and Puerto Rico. For each study, we describe the study aim, methodology, setting in which activities were carried out, the health equity elements, and the implementation science aspects. We articulate how each study bridged implementation science and health equity research by (a) situating the study activities in community settings; (b) codesigning interventions to ensure their cultural, linguistic, and contextual relevance; and (c) weaving mixed methods and community-engaged approaches to draw community insights. Finally, we illustrate how to address key implementation outcomes in these health equity studies, representing a significant step toward turning rhetoric into actionable solutions for reducing mental health inequities in marginalized communities. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Today's workplace continually requires organizations to empower employees to go beyond their job description to help maintain a competitive edge in the market. Developing transformational leadership in an organization is one means in which a company can attempt to empower and inspire their employees. However, thus far there are a limited number of tools to assist in the development of transformational leadership. The following exploratory review sought to examine the potential use of an assessment center as a means to develop transformational leadership. The topic was examined by analyzing both the assessment center and transformational leadership literatures. The literatures were obtained via a search on Ebscohost and Google scholar databases. The intersection of the literatures was used to develop a proposed framework for the transformational leadership development center that includes suggested dimensions, exercises, and future approaches. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The U.S. Department of Veterans Affairs (VA) developed evidence-informed mental health mobile applications (MH apps) to supplement treatment and serve as self-care resources for veterans. However, lack of awareness and understanding of how to integrate MH apps into care pose barriers to uptake. The VA Mobile Mental Health Apps Project was conducted from 2019 to 2021 to train and support VA health care staff in integrating VA MH apps into practice using implementation facilitation. Interdisciplinary staff ( = 1,110) from 19 VA sites, led by local site champions, and supported by project Facilitators, participated. The training phase successfully equipped staff with key knowledge and skills for MH app integration (McGee-Vincent et al., 2023), but training is not sufficient for practice change (Schueller & Torous, 2020). The current article summarizes results from a mixed methods evaluation of the preimplementation planning and active implementation phases of the project. Survey data from 3-month posttraining ( = 362) and qualitative interview data ( = 27) assessed within the Consolidated Framework for Implementation Research (Damschroder et al., 2022b) were analyzed to highlight facilitators and barriers to implementation. Results showed positive perceptions, meaningful adoption, and expanded reach of MH apps for veterans by staff across VA. Given that the project was well-received and perceived to be sustainable, the adaptability of the innovation and implementation model, and the relatively limited number of perceived barriers, this project may serve as a model for other practice changes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Partial hospitalization programs (PHPs) are increasingly relied upon to provide intensive mental health treatment for youth with acute and severely impairing mental health symptoms, yet very few interventions have been adapted to fit this unique delivery context. Transdiagnostic treatments hold promise for addressing the complex clinical presentations and workflow needs of PHP programs, but more work is needed to understand factors that influence successful implementation. We conducted a formative implementation process evaluation to identify barriers and facilitators of acceptability, appropriateness, and feasibility of implementing an evidence-based transdiagnostic intervention in a PHP setting and further targets for intervention and implementation adaptation. Seventeen PHP clinical providers completed a survey about the implementation of the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A). Providers completed measures on the UP-C/A's characteristics, acceptability, appropriateness, feasibility, leadership implementation support, and open-ended questions about the UP-C/A implementation. A mixed methods approach was used to analyze and integrate data. Ratings of acceptability, appropriateness, and feasibility were high. The most influential implementation facilitators were positive views of the innovation characteristics, while the most influential barriers were insufficient access to knowledge and information as well as limited processes for reflecting on implementation. Aspects of intervention design (e.g., low complexity, observability, adaptability) contributed to high levels of acceptability. Barriers to appropriateness and feasibility included perceived deficiencies in leadership and training supports and perceived needs of some intervention recipients not matching the intervention. Key adaptations included translating the UP-C/A, increasing interactive group components, providing additional supervision, and a process for receiving implementation feedback. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Chronic insomnia is one of the most common health problems among veterans and can significantly impact health, function, and quality of life. Brief behavioral treatment for insomnia (BBTI), an adaptation of cognitive behavioral therapy for insomnia (CBT-I), was developed to help increase access to care outside of specialty settings. However, training providers alone is rarely sufficient, and implementation strategies are needed for successful uptake, adoption, and sustainable delivery of care. The current analysis compares the impact of providing BBTI training alone (BBTI) versus training plus implementation strategies (BBTI + IS) on veteran engagement in BBTI (i.e., reach) in Primary Care Mental Health Integration clinics. Providers from four Veterans Affairs (VA) medical centers completed BBTI training and then were given access to and support for implementation strategies. Core strategies implemented across all sites included developing an implementation blueprint, organizing implementation and educational meetings, developing and distributing educational materials, developing tools for quality monitoring, and facilitation. Veteran engagement in BBTI, CBT-I, insomnia diagnoses, and prescription sleep medication was measured using retrospective data from the VA Corporate Data Warehouse. Analyses were conducted using generalized linear models. Overall, sites significantly increased veteran engagement in BBTI (reach) from training alone and achieved further engagement with implementation strategies. At the site level, there was variability by phase, with three sites increasing BBTI only with training and one site increasing BBTI with training plus implementation support. These results are promising-increasing access to evidence-based behavioral insomnia care can be accomplished via BBTI training and easily implementable strategies. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

With the rise in demand for mental health services and the changed landscape of post-COVID-19 therapy delivery, examining both therapy modality (e.g., individual, group) and delivery methods (e.g., in-person, remote) has become increasingly important. While empirical evidence generally supports equivalency of outcomes across modalities and delivery methods, there is less evidence regarding comparative preferences and perceptions of these variables. To begin to answer these questions, we surveyed a random sample of 777 university students at a large, western university. Congruent with the previous literature, results suggest that there is a strong preference for in-person individual therapy, in spite of the increased experience with teletherapy. We also found a strong reluctance to engage with group therapy. Demographic factors predicting modality and delivery preferences indicated that being older and a woman were associated with increased likelihood to prefer individual therapy (both in-person and teletherapy), and lower class standing was associated with a stronger preference for group therapy. The only symptoms predictor for preferences included higher levels of social anxiety being associated with a higher preference for online self-help. While those who had previously engaged in a particular type of therapy were typically two to three times more likely to prefer it in the future, those who had attended in-person group therapy were over five times more likely to prefer it in the future. Finally, perceptions of past experiences with in-person therapy were significantly more positive than experiences with teletherapy. We discuss the implications of these findings for future research and practice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Suicide occurs at high rates in both military and veteran populations. The Interpersonal Theory of Suicide is a widely applied framework incorporating the requisite construct of acquired capability for suicide, which is the ability to engage in suicidal behaviors developed through painful and provocative life experiences. The Acquired Capability for Suicide Scale (ACSS) was developed to assess this construct. Despite substantial literature examining Interpersonal Theory of Suicide in military samples, many versions of ACSS have been used without adequate validation. The goal of this study was to examine the factor structure of the ACSS and derive a version of the ACSS with initial validity for use in military populations. We also examined the stability of acquired capability over time. Data were collected among Wisconsin Army National Guard service members, who were deployed to the Middle East from 2008 to 2010, at three assessment points: before deployment ( = 714), immediately after return from deployment ( = 2,553), and 6-9 months postdeployment ( = 646). Exploratory and confirmatory factor analyses of postdeployment data suggest adoption of a novel, abbreviated 15-item, four-factor version of the ACSS. Analyses provided preliminary support for discriminant and predictive validity. Results also revealed that acquired capability for suicide increases after deployment and remains stable for at least 6-9 months after return from the combat. The four-factor version of the ACSS shows promise as a theory-relevant and empirically supported instrument for research and clinical applications in the military population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Two thirds of military personnel diagnosed with posttraumatic stress disorder (PTSD) do not engage in treatment. We examined the degree that prejudicial beliefs about people with PTSD negatively affected psychiatric medication acceptance. Public stigma is best defined as negative stereotypes regarding individuals being judged as inferior or weak for having PTSD. In comparison, self-stigma includes internalized negative prejudices about illness control and stability. An important preliminary stage in developing self-stigma is first developing prejudicial beliefs about those with an illness. Active duty soldiers on a U.S. Army post completed surveys of prejudicial beliefs, public stigma, negative beliefs about psychiatric medications, and PTSD symptoms. Soldiers' Post Deployment Health Reassessment and medical records were accessed to determine the relation between their survey answers and responses to a later offer of psychiatric medication. Importantly, increased prejudicial beliefs (but not public stigma) that oneself is to blame for having PTSD were associated with a reduced likelihood of accepting psychiatric medication. Increased age was also associated with increased likelihood of accepting medication. Antistigma efforts to date may have limited effectiveness by targeting public-stigma rather than self-stigma prejudicial beliefs about personal responsibility in the development of PTSD. The relevance of this finding is vital to developing public health campaigns that maximize treatment acceptance. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Veterans deployed in the post-9/11 wars in Iraq and Afghanistan (Operations Enduring Freedom, Iraqi Freedom, and New Dawn) face a multitude of challenges reintegrating into civilian life after military service. There is a need for evidence-based support programs to address the wide-reaching cognitive, psychological, and physical symptoms that can impede civilian reintegration. The present study incorporates quantitative and qualitative methods to assess veterans' experiences with two reintegration treatments (Short-Term Executive Plus-Home [SH] and Present Centered Group Therapy for Reintegration [PCGT-R]) within the context of a larger randomized clinical trial. A total of 131 veterans ages 24-65 years, drawn from the SH ( = 66) and PCGT-R ( = 65) treatment arms, completed quantitative feedback forms and qualitative interviews. Quantitative surveys indicated SH was more highly rated than PCGT-R in terms of program satisfaction ( < .01), helpfulness ( = .03), and connection to other Veterans Affairs (VA) services (s < .05). Thematic qualitative analysis indicated that both interventions provided beneficial social support and that both groups appreciated online implementation. They also revealed that SH veterans acquired more emotion regulation and impulse control skills and reported greater willingness to engage in further VA treatments, than PCGT-R veterans. Dropout did not differ significantly between groups, and the most highly cited reasons for dropout among both groups were scheduling conflict and dislike of group formats. Findings emphasize the opportunity for group and skills-based interventions focused on reintegration to increase support and access to VA care among veterans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Peer specialists (PS) in the Veterans Health Administration are veteran employees with lived mental health experience supporting others in recovery. While PS worked in traditional mental health settings for many years and demonstrated benefits to veteran engagement and satisfaction with health care, little is known about the best strategies to support implementation in novel, complex settings like primary care (PC). Implementation facilitation, which combined external facilitation plus national resources, was chosen to promote uptake when the VA MISSION Act of 2018 required the Veterans Health Administration to implement PS into PC. Using a mixed-methods, formative program evaluation approach, we examined the effects of implementation facilitation across two cohorts of 15 sites. Due to startup timing, Cohort 1 received minimal implementation facilitation during preimplementation compared with Cohort 2. Outcome measures included qualitative evaluation of facilitator notes, time to attain implementation milestones, and PS productivity and program fidelity (percent of total PS encounters in PC). Results suggested that overall productivity was similar across cohorts, but Cohort 2 demonstrated high program fidelity in Month 1 of implementation, while Cohort 1 required 12 months to attain similar fidelity. Qualitative findings indicated implementation facilitation that fostered team cohesion, clarified roles, supported supervisor training, and encouraged sites to guard against competing demands smoothed transitions for PS into PC. During preimplementation, implementation facilitation that focused on these findings resulted in the rapid attainment of program fidelity. Policymakers should consider the value of investing in preimplementation support for speeding the attainment of high-fidelity implementation of novel and complex practices such as PS in PC. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Research on the implementation of community gatekeeper training interventions for suicide prevention in Spanish-speaking countries is limited. Gatekeepers identify warning signs of suicidal behavior in at-risk population and refer them to specialized mental health care. To identify factors that influence the implementation of evidence-based practices, standardized measures are needed in Spanish. We culturally adapted and evaluated the factor structure and reliability of two measures for use in the Mexican population: the final version of Acceptability, Appropriateness, and Feasibility of the Intervention (Weiner et al., 2017), and the Organizational Readiness for Implementing Change (ORIC; Shea et al., 2014). Our study consisted of two consecutive phases. The first addressed the cross-cultural adaptation. In the second phase, we administered an online survey to a nonrandom sample of 453 middle school personnel and performed a confirmatory factor analysis (CFA). Participants were 73.95% female, 25.17% male, and 0.88% nonbinary/other and came from the 32 Mexican states. CFA indices for the Mexican Spanish version of the acceptability, appropriateness, and feasibility measure yielded values of comparative fit index (CFI) = 0.96, Tucker-Lewis fit index (TLI) = 0.94, root-mean-square error of approximation (RMSEA) = 0.05, and standardized root-mean-square residual (SRMR) = 0.03. Internal consistency was Ω = 0.95. CFA indices of the Mexican Spanish version of the ORIC were CFI = 0.95, TLI = 0.93, RMSEA = 0.08, and SRMR = 0.03, and internal consistency was Ω = 0.94. We conclude that both instruments show preliminary psychometric properties that support their validity and reliability in the Mexican Spanish-speaking context. These findings promise to drive research on the implementation of gatekeeper interventions and other evidence-based practices in Spanish-speaking school settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cognitive remediation (CR) for schizophrenia has been extensively studied and has proven effective in improving both cognition and functioning. Yet, implementation into mental health services is poor, with implementation and engagement barriers and facilitators not understood. The present study aimed to assess expert opinions on CR barriers and facilitators that pertain to staff, mental health services, and consumers. Thirty-seven international CR experts (clinicians/researchers) responded to Likert-scale questions on implementation and engagement facilitators, essential CR components, barriers in mental health facilities, barriers for clinicians, and barriers for consumer access and engagement across three rounds of a Delphi survey. The main barriers to CR implementation were (a) lack of staff training, (b) lack of perceived relevance/lack of knowledge about cognitive deficits in schizophrenia and CR usefulness in both clinicians and consumers, as well as (c) lack of staff employed in cognitive rehabilitation roles. The presence of defeatist beliefs and difficulty in accessing the place of delivery were both barriers to consumer engagement and access. The most important facilitators for CR were a good therapeutic alliance, CR delivered as part of integrated rehabilitation services, psychoeducation provided to families and stakeholders, and CR focusing on generalization of learning to everyday life. This study highlights the barriers to CR implementation from experts. A multitude of factors were identified that need attention. It is also apparent that CR cost-effectiveness studies are needed to facilitate organizational change and national guideline recommendations for improving mental health services policy around serious mental illness/schizophrenia health care provisions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Veterans with a history of military sexual trauma (MST) often experience poorer social, psychological, and physical outcomes compared with civilians and veterans who have experienced sexual assault outside of the military. Studies suggest some differences in endorsement of MST and its symptoms based on ethnoracial, age, sexuality, and gender-related factors. However, investigations into potential diversity-related patterns of functioning are sparse. This study examined the associations between identity factors and psychosocial functioning among veterans seeking mental health treatment following MST. During intake assessments, veterans ( = 144) completed semistructured clinical interviews and the World Health Organization Disability Assessment Schedule 2.0 as part of routine clinical care at a Midwestern Veterans Healthcare Administration hospital. Psychosocial functioning domains (cognition, mobility, self-care, getting along, life activities, and participation in society) were analyzed across veterans' race, age, sex, and sexual identity. Results revealed differences in participation in society based on sex and race and in mobility based on race and age. No significant differences were observed in functional domains for sexual identity. These findings highlight the importance of assessing salient identity factors and delivering culturally sensitive trauma-focused care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Three evidence-based psychotherapies for depression (D-EBPs)-cognitive behavioral therapy for depression, acceptance and commitment therapy for depression, and interpersonal psychotherapy-are available in Veterans Health Administration (VHA) through its training initiative. However, training initiatives are not sufficient to move effective treatments into routine practice. Patient and clinic factors can impact evidence-based psychotherapies use. As part of a larger explanatory sequential mixed methods study, we assessed D-EBP use across VHA's outpatient general mental health (GMH) clinics and examined associations between patient- and clinic-level factors and D-EBP use. We identified all patients with a depression diagnosis seen in a VHA GMH clinic in fiscal year 2022. Patient-level variables included demographics, psychiatric medication for depression, and comorbid mental health diagnoses. Clinic-level variables included patient volume, D-EBP clinician capacity, and location. 635,653 patients with a diagnosis of depression were seen in a GMH clinic. 2.8% of those patients had a D-EBP session identified in their medical record, and 77.4% received a depression medication. Being male, older, having certain comorbidities, and using depression medication was associated with lower D-EBP use. Clinics with lower psychotherapy patient volume and in the Continental and Midwest districts had higher D-EBP use. D-EBP use was strikingly lower than depression medication use. Findings suggest clinicians may be challenged by patient comorbidities and high patient volume in practice. Further research on how these factors play out in clinical practice can shed light on whether there is a need for additional implementation strategies to increase D-EBP use. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Individualized Positive Psychosocial Interaction (IPPI) is an evidence-based program that supports engaging people living with dementia and their care partners in the nursing home (NH). IPPIs are brief, one-to-one, preference-based activities to improve well-being and decrease behavioral and psychological symptoms of dementia. The purpose of this study was to understand barriers and facilitators to implementing the IPPI program from the perspective of NH provider champions. Semistructured interviews ( = 62) were completed with implementation champions ( = 20) who led a quality improvement project to implement the IPPI with three to five residents per NH. Interviews were audio recorded, transcribed verbatim, and coded using the Innovation Domain of the updated Consolidated Framework for Implementation Research. Constructs coded included cost, design, complexity, adaptability, relative advantage, trialability, and evidence base. Implementation champions spoke about the IPPI program's relative advantage of effectively reducing resident's behavioral and psychological symptoms of dementia based on meaningful, personalized content. Champions voiced that the IPPI program was cost-effective, adaptable to their local contexts, and provided training to staff to support residents experiencing distress. Champions acknowledged the complexity of identifying implementation team members and completing initial education and training. In addition, they appreciated the chance to build capacity by trialing IPPIs with a small number of residents for initial efforts (e.g., trialability). Utilizing the Consolidated Framework for Implementation Research allowed for the systematic identification of facilitators and barriers to IPPI implementation. Overall, the IPPI program goals are aligned with nursing home organization goals, supporting staff in providing comfort to residents communicating distress, and can be feasibly implemented. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

For rural women veterans, significant barriers exist in accessing high-quality, multicomponent behavioral pain self-management interventions. As such, a telehealth behavioral pain self-management intervention designed specifically for rural-dwelling women veterans with chronic pain was piloted for this study. This mixed methods, single-arm preliminary study examined the feasibility and acceptability of this intervention and completed a responder analysis. Participants completed surveys before and 1-month following the intervention, and they completed a qualitative interview following the intervention. About one quarter (24%) of potentially eligible participants who were sent a letter about the study consented to participate ( = 44). All participants identified as female and were rural dwelling, with mean age of 56 years (range = 34-80), and the majority of the sample (81%) self-identified as White and non-Hispanic or Latino. Average baseline scores on the Pain, Enjoyment of Life, and General Activity three-item scale (PEG-3) measure indicated severe pain and functional interference ( = 6.88, = 1.62). Of the 44 participants who consented, 70% completed the intervention. About half of treatment completers (47%, 14/30) were deemed responders, reporting ≥ 30% reduction on their PEG-3 total scores. On the Global Impression of Change scale, 87% reported improvement. Study completers indicated that the telehealth platform facilitated their engagement and that they perceived the intervention to be beneficial and credible. Qualitative data emphasized themes of connection with other women veterans who experienced chronic pain while perceiving a retained sense of individual identity. These preliminary data support feasibly of this intervention for rural-dwelling women veterans with chronic pain. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

We examined beliefs and practices regarding firearm assessment and lethal means safety counseling (LMSC) among U.S. Air Force (USAF) mental health providers (MHPs) and behavioral health technicians (BHTs). Data were collected from 204 USAF MHPs (74.0%; = 151) and BHTs (26.0%; = 53) via an anonymous, voluntary survey. A modest proportion indicated they believe that firearm ownership (42.2%) and storage practices (58.3%) are related to suicide risk. A minority indicated they "strongly"/"extremely" believe that LMSC will yield changes in storage practices (30.9%) and decreases in suicide risk (29.9%). Across patient scenarios, most indicated that "most of the time"/"always" they assess for firearm access (74.5%-99.5%) and provide LMSC (57.8%-95.6%). About half (52.5%) reported having distributed cable locks. Most (59.3%) indicated they are in receiving additional training on LMSC. MHPs, compared with BHTs, were significantly more likely to report believing a link between firearm ownership and storage practices and suicide risk, believing LMSC is effective at reducing suicide risk, providing LMSC to female patients and patients with current suicidal ideation, and having distributed cable locks. Findings suggest that there is not widespread agreement among USAF MHPs and BHTs that personal firearm ownership and nonsecure storage practices are associated with elevated suicide risk, and there were low levels of confidence in the effectiveness of LMSC. Yet, most USAF MHPs and BHTs reported they integrate firearm access assessment and LMSC as part of their routine clinical care, particularly for patients with identified suicide risk. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

U.S. Latino/a/x adolescents experience inequities in depression treatment use in comparison to non-Latino/a/x White peers. The purpose of this study was to describe barriers to depression treatment use and implementation strategy preferences to address these barriers among Latinx teens. A qualitative descriptive study was conducted with Latino/a/x teens diagnosed with depression ( = 7), their parents ( = 7), and health care providers ( = 18) from across the United States. Qualitative content analysis was conducted to determine common barriers and preferences across groups. Family-level barriers included parents' knowledge and beliefs about depression treatment, parents' own stress, and generational gaps between parents and teens. Provider-level barriers were related to the lack of a bilingual and bicultural health care workforce, and health care system-level barriers included difficulties paying for and scheduling care, inadequate systems for follow-up, and policies limiting innovation and adolescent consent to treatment. Participants emphasized that family involvement was crucial and the importance of tailoring implementation strategies to meet the specific needs of individual Latino/a/x teens. Social support, psychoeducation about depression, and resource navigation support were preferred strategy components that should be facilitated by a bilingual Latinx individual with relevant lived experience and address cultural context. Multilevel implementation strategies will need to be developed to address the multilevel barriers to depression treatment use. Future research will further refine and test an implementation strategy package to determine the effect on the use of depression treatment among Latinx teens screening positive for depression in primary care settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Trauma-focused psychotherapies can be effectively delivered using a massed delivery format. Telehealth treatment for posttraumatic stress disorder (PTSD) using evidence-based interventions has been shown to be as effective as in-person treatment. However, the effectiveness of evidence-based treatments for PTSD over telehealth using the massed delivery format requires further examination. To examine the effectiveness of telehealth massed PTSD treatment, we report on a quality improvement study of 33 veterans (75.8% male; = 42.3, = 11.0) who participated in a virtual 4-week massed PTSD program at a Department of Veterans Affairs (VA) medical center. Twenty-seven (81.8%) veterans completed the treatment and reported large reductions in PTSD ( = 1.48) and depressive symptoms ( = 1.08) at Week 4 and at 1-month follow-up (PTSD, = 1.34; depression, = 0.70). Results suggested that evidence-based treatment for PTSD can be effectively delivered in a massed format over telehealth in a VA medical setting. (PsycInfo Database Record (c) 2024 APA, all rights reserved).