Barriers to the implementation of medication-assisted treatment for substance use disorders: the importance of funding policies and medical infrastructure

Despite growing interest in the use of evidence-based treatment practices, adoption of pharmacotherapies for treating substance use disorders (SUDs) remains modest. Using data from telephone interviews with 250 administrators of publicly funded SUD treatment programs, this study estimated a model of adoption of medication assisted treatment (MAT) for SUDs and examined the relative importance of regulatory, cultural, medical resource, patient-level, and funding barriers to MAT implementation. MAT-adopting programs had significantly greater medical resources, as measured by the employment of physicians and nurses, than non-adopting programs. Administrators of non-adopting programs were asked to rate the importance of 18 barriers to MAT implementation. The most strongly endorsed barriers were regulatory prohibitions due to the program's lack of medical staff, funding barriers to implementing MAT, and lack of access to medical personnel with expertise in delivering MAT. Barriers related to insufficient information about MAT and unsupportive staff attitudes were not widely endorsed. These findings suggest that efforts to promote the implementation of MAT that are inattentive to funding barriers and weaknesses in medical infrastructure may achieve sub-optimal results.     

Perceived Stigma and Depression among Black Adolescents in Outpatient Treatment

Despite the high prevalence of depression among children and adolescents, most that need mental health treatment do not seek care. This is especially true for ethnic minority adolescents. Prior research has shown that perceived stigma may act as a barrier to the initiation of and adherence to depression treatment, yet few studies have examined the relationship between stigma and depression among Black adolescents. This exploratory study examined the relationship between Black adolescents' depression severity and their current level of perceived stigma in an outpatient sample. Face-to-face interviews were conducted with a clinical sample of adolescents referred for mental health services at a community-based outpatient clinic (n =108), participating in a prospective pilot study on adolescents' patterns of mental health service use. The analyses revealed that greater depression severity was significantly associated with higher perceived stigma (p < .05), particularly among females. The results also suggest that Black adolescents appear to exhibit an appropriate level of self-assessment regarding their need for mental health services. These results are interpreted in relation to previous literature, and limitations and directions for future research are discussed.     

On constructing ageing rural populations: ‘Capturing’ the grey nomad

The world’s population is ageing, with forecasts predicting this ageing is likely to be particularly severe in the rural areas of more developed countries. These forecasts are developed from nationally aggregated census and survey data and assume spatial homogeneity in ageing. They also draw on narrow understandings of older people and construct the potential impact of ageing (such as increased dependence on the health care system) as negative. The construction and reinforcement of such stereotypes have obscured public policy debate about ageing and also the rural. This paper considered how, through using a mixed method approach, narrow understandings of rural ageing could be extended and refined. Using a case study of grey nomads in rural Australia, the strengths and weaknesses of various research approaches were reviewed. The investigation concluded that both quantitative and qualitative data could be used to extend contemporary understandings of rural population ageing and move constructions of this phenomenon beyond an impending rural crisis.     

The protective role of religious coping in adolescents' responses to poverty and sexual decision-making in rural Kenya

In this study, we explored how adolescents in rural Kenya apply religious coping in sexual decision-making in the context of high rates of poverty and Human Immunodeficiency Virus (HIV). Semi-structured interviews were conducted with 34 adolescents. One-third (13) reported religious coping related to economic stress, HIV, or sexual decision-making; the majority (29) reported religious coping with these or other stressors. Adolescents reported praying for God to partner with them to engage in positive behaviors, praying for strength to resist unwanted behaviors, and passive strategies characterized by waiting for God to provide resources or protection from HIV. Adolescents in Sub-Saharan Africa may benefit from HIV prevention interventions that integrate and build upon their use of religious coping.     

Risk management project for work with precast concrete shells

This paper describes a project with the aim of reducing the risk of injury when using precast concrete shells in the Swedish construction industry by identifying injury risks, developing and implementing solutions. An interactive research approach was used. Three major injury risks were identified and a system consisting of three tools and a handbook was developed, evaluated, and implemented at one company and made available to the construction industry.