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).

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).

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) 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).

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) 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).

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).

Academics are more likely to experience mental health difficulties like depression and anxiety. However, stigma remains a key barrier to help-seeking, and limited data exists on stigma reduction for academics. This study examines the acceptability of a first-person narrative-based antistigma program conducted by Dragonfly Mental Health at a large public university. This intervention used a multitiered approach that leverages education and contact strategies to reduce stigma among graduate students, postdoctoral fellows, staff, and faculty. Personal stories of six local faculty with lived experience of mental health struggles were shown in a short film during three separate departmental retreats, followed by moderated large and small group discussions. This study presents descriptive survey data from academics ( = 149) who attended one of these three programs. A thematic content analysis was conducted on open-ended responses from 86 participants. Overall, the Dragonfly Mental Health program was well-received: 95% of participants found the film beneficial, and over 92% felt the film and discussions reduced stigma. Qualitative analysis highlighted several themes on participants' experiences. Participants appreciated the open, honest disclosures of faculty members in the film but reported that the vague disclosures perpetuated stigma. Participants liked the normalization of mental illness but desired more representation from the mental health spectrum. Participants expressed frustration over an academic work culture that is defined by overwork and burnout. These findings suggest that sharing faculty stories is a powerful mechanism to build connectedness among academics, promote open communication, and foster change in academic culture around mental health. (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).

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) 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).

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).

The Veterans Health Administration (VHA) has rolled out evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD); however, reach has remained low, and there is a need for briefer interventions. The National Center for PTSD conducted a facilitated learning collaborative to train clinicians and support VHA PTSD teams in their adoption of an emerging best practice, written exposure therapy (WET). Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) evaluation framework, the present study utilized longitudinal data from 178 clinicians and 556 patients across seven training cohorts to evaluate key clinical and implementation outcomes and whether clinic (i.e., implementation climate) or clinician factors (i.e., treatment attitudes) were associated with effectiveness and implementation. Intent-to-treat analyses indicated WET was effective in reducing PTSD ( = 0.54) and depression symptoms ( = 0.39). Data indicated that 87.60% of clinicians reported using WET 6 months postconsultation. Clinic-wide reach was modest after training (14.53% of individuals with PTSD); however, WET-trained clinicians continued to offer WET to an average of 87.38% of their patients. Fidelity remained high after training, with essential session elements most often being offered "always" ( = 6.65 on a scale from 1 to 7). More positive postconsultation clinician treatment attitudes predicted higher posttraining rates of having patients engaged in WET. Clinician treatment attitudes and implementation climate did not predict any other implementation or effectiveness outcomes examined. Results suggest that WET implementation is advancing in VHA, with good clinical outcomes. Data provide evidence that a facilitated learning collaborative can be used to support and scale EBPs. (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).

The role of psychology (and ergo, psychologists) within the public sector has shifted considerably over the preceding decades to include increasingly versatile and psychology-adjacent leadership positions. This publication focuses on brief leadership stories within a state mental health system, with an emphasis on the unique roles that women psychologists have advocated for over the years. The authors provide foundational knowledge of this state's mental health system in order to spotlight the ongoing need for effective leadership within this organization, identifying common ethical and public administration challenges, and ultimately using a structured questionnaire with women psychologists within this system to highlight their leadership roles. These stories expand upon the education and training they felt foundational to their growth in these roles, how they advocated for change and navigated organizational challenges, and how they hope their role can inspire junior (women) psychologists to take increasingly active roles in public service leadership. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

This study examined mental health treatment nonutilization among sexual minority versus heterosexual Veterans with demonstrated psychiatric need. Data were analyzed from 820 Veterans with psychiatric need who participated in the National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of U.S. military Veterans. Results revealed that current mental health service nonutilization did not differ between sexual minority versus heterosexual Veterans (70.5% vs. 74.0%). Significant interactions between sexual orientation and sex assigned at birth, primary source of health care (Veteran Affairs [VA] vs. non-VA), and beliefs that peers would blame them for their mental health problems were observed in analyses predicting current mental health treatment utilization. Among Veterans primarily utilizing VA health care, sexual minority Veterans were less likely than heterosexual Veterans to engage in mental treatment; among those primarily using non-VA, this pattern was reversed. Sexual minority Veterans were significantly more likely than heterosexual Veterans to report not knowing where to get help, not having adequate transportation, and having difficulty scheduling an appointment. Taken together, the results of this study suggest that rates of mental health nonutilization are high for both sexual minority and heterosexual Veterans, and that factors that influence utilization may differ by sexual orientation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Across the United States, polarizing politics have contributed to the increased stigmatization of transgender (trans) and gender expansive (TGE) youth, reinforcing health inequities for this population. Although lesbian, gay, bisexual, transgender, queer, and/or questioning (LGBTQ+) youth centers have often served as places of refuge for young people across the gender spectrum, literature has yet to show how practices and strategies used in these settings promote TGE affirmation. This qualitative study explores youth and staff experiences within these settings; identifies the services, policies, and environments needed to support TGE community members; and ultimately calls for the expansion of the limited research on TGE experience and affirmation across such spaces. Using data collected in a larger study on affirming practices for LGBTQ+ youth, this article presents findings from in-depth, semistructured focus groups and interviews with TGE ( = 12) youth and staff ( = 12) across four LGBTQ+ community-based organizations in two large urban centers. Study findings show these organizations provide TGE affirmation through language, programming, and atmospheres of openness to identity exploration. Essential to these offerings are organizational policy mandates, such as correct pronoun usage and TGE-specific programming. Youth often juxtapose their experiences of affirmation within LGBTQ+ spaces with experiences of invalidation from the cisheteronormative cultures within their school or home environments. Implications for future practice and research include administering ongoing training on TGE-affirming language and developing comprehensive accountability measures (e.g., TGE-inclusive community guidelines). Institutions with these systems in place are well-equipped to contribute to the fight for trans liberation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Often in implementation science efforts, an intervention originated by research funding does not continue in clinical practice after funding ends, or if it does, the process by which it was sustained remains known only to the implementation research or clinical teams. From 2018 to 2020, we implemented a complex telehealth interdisciplinary behavioral health program supported by research funding. The intervention was Primary Care Mental Health Integration (PCMHI) delivered via televideo from a large parent medical facility to rural satellite clinics (tele-PCMHI) within the Veterans Health Administration. Two implementation facilitators worked closely with clinical leaders and staff to plan, launch, and sustain tele-PCMHI across four sites. The intervention is still maintained by the clinical service and has spread to eight sites. Based on ethnographic and qualitative data collected weekly over 2 years, we categorized sustainment strategies across distinct time periods for this complex program, theoretically grounded in the Dynamic Sustainability Framework, emphasizing changes to adapt intervention fit to rapidly changing context. To contextualize, we identified barriers and strengths, such as difficulty training staff to use new equipment, restructuring clinic workflow, and determining suicide risk management remotely. New barriers arose, and, thus, new strategies were needed to continue implementing at the onset of the COVID-19 pandemic in 2020. Different strategies at different stages of implementation allowed sustainment to be a dynamic and evolving process. Plus, proactive and persistent planning for sustainment early in the effort, along with alignment with performance metrics and national policy, supported continued delivery in real-world organized care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).