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Although prolonged exposure (PE) has been identified as a first-line treatment for posttraumatic stress disorder (PTSD), research has found that military service members and veterans have smaller reductions in symptom severity compared to civilians. The nature of trauma in a deployed combat setting and the unique complexities of military culture have been proposed as explanations for greater rates of PTSD and poorer treatment response to first-line psychotherapies in military and veteran populations. This paper presents a case study to highlight how a novel, intensive outpatient program utilizing prolonged exposure therapy (IOP-PE) may benefit military personnel with combat-related PTSD. The patient is a Caucasian man in his early 40s seeking treatment for PTSD after more than 10 years of enlisted, active duty military service across two branches and three combat deployments. The IOP-PE includes the standard PE components and eight, nonstandard treatment augmentations tailored for military personnel. In contrast to standard PE, which typically is delivered weekly over several months, IOP-PE consists of 15 daily, 90-minute PE sessions conducted over 3 weeks. The patient demonstrated large reductions on the Clinician-Administered PTSD Scale (28 points) and PTSD Checklist (48 points) by the 6-month posttreatment follow-up point. Findings provide support for conducting further research that determines whether IOP-PE is effective and tolerable in military and veteran populations.

Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) are pervasive consequences of the post-9/11 conflicts. Treatment of PTSD and mTBI has historically occurred separately and sequentially, which does not reflect the overlapping etiology of symptoms and may attenuate or delay recovery. This paper describes an integrated 2-week treatment program using prolonged exposure and cognitive symptom management and rehabilitation therapy to comprehensively treat PTSD and cognitive complaints attributed to mTBI, regardless of etiology. To minimize potential iatrogenic effects of treating presumed mTBI-related symptoms, a central focus of the program was to instill expectations of full recovery. Thirty patients with full or subclinical PTSD and self-reported TBI history completed the PTSD+TBI treatment program. Results indicated that self-reported PTSD, depression, and neurobehavioral symptoms significantly decreased following treatment, while satisfaction with participation in social roles increased. These preliminary effectiveness data indicate that PTSD complicated by mTBI history can be effectively treated within a 2-week intensive outpatient program.

Behavioral health services have been tasked with rapidly adopting and implementing teletherapy during the SARS-CoV-2/COVID-19 pandemic to assure patient and staff safety. Existing teletherapy guidelines were developed prior to the pandemic and do not capture the nuances of rapidly transitioning in-person individual and group-based treatments to a teletherapy format. In this paper, we describe our approach to quickly adapting to a teletherapy technology platform for an intensive outpatient program (IOP) guided by cognitive and behavioral modular principles for adults with serious mental illness. A review of existing guidelines was conducted and the staged approach for teletherapy implementation (Muir et al., 2020) was selected as the most appropriate model for our organizational context. We describe the most pertinent implementation strategies and report our preliminary findings detailing the feasibility of IOPs delivered via telehealth. This model of rapid teletherapy implementation offers practical clinical guidelines for administrators and clinicians seeking to transition traditional in-person behavioral health services to a teletherapy format.

A Performance Improvement project conducted within Army Behavioral Health identified significant challenges associated with treating service members diagnosed with posttraumatic stress disorder (PTSD) including unavailability of frequent and consistent therapy, a low completion rate of evidence-based treatment, and a high non-response rate. In response to these findings, clinical staff at Brooke Army Medical Center developed an intensive outpatient program for the treatment of PTSD and combined Acceptance and Commitment Therapy with Prolonged Exposure therapy to create an integrative and uniquely tailored intervention. This project included 311 active duty service members who had not made significant progress in individual outpatient therapy for PTSD. Each participant completed pre- and post-treatment measures of symptoms, functioning, and processes related to psychological flexibility. Program evaluation also included participant interviews, survey responses, and clinician reports. Overall, the program was tolerable and reviewed favorably by participants. Preliminary pre-post treatment analyses revealed, on average, large reductions in PTSD symptoms as well as significant changes in the target direction on nine of ten outcome measures. These findings encourage further investigation of process-outcome relationships and future, rigorous implementation studies of ACT and exposure integration and culturally and contextually sensitive treatments for military-related PTSD.

The purpose of this program evaluation was to investigate the effectiveness of a 10-day, group-based recovery-oriented intensive outpatient program (RIOP) offered at a VA Psychosocial Rehabilitation and Recovery Center in South Texas. The RIOP utilizes a multidisciplinary approach to treatment of veterans with acute mental health concerns, bridging cognitive-behavioral processes delivered in group format with other disciplinary approaches (e.g., recreation therapy, Chaplain services). The sample for this program evaluation consisted of 112 veterans who completed the RIOP during a twelve-month period. Ninety veterans (80.4%) had two or more recorded psychiatric diagnoses, and twenty-seven veterans had three or more recorded psychiatric diagnoses (24%). Eighty-five veterans were diagnosed with post-traumatic stress disorder (PTSD) or adjustment disorder (75.9%); seventy-two with major depressive disorder (64.3%); fifty-three (47.3%) with a borderline personality disorder and/or documented clinically significant cluster A or B personality traits; twenty-eight with an anxiety disorder (25%); twenty-one with a bipolar disorder (18.8%); and seven with a psychotic disorder (6.3%). Results indicated a statistically significant decrease in symptoms of depression, anxiety, and post-traumatic stress between pre- and post-treatment. Change in symptoms from baseline to post-treatment was not significantly correlated with age or number of psychiatric diagnoses. The results of the program evaluation suggest that a process-based cognitive-behavioral approach in combination with interventions from other recovery-oriented disciplines (delivered via group modality) can be an effective transdiagnostic treatment for veterans with complex trauma histories who meet criteria for more than one psychiatric diagnosis.

Objective Equine-assisted activities and therapies (EAATs) have been a growing adjunctive integrative health modality, as they allow participants to practice mindfulness, emotional regulation, and self-mastery or self-esteem building skills. Preliminary evidence suggests that these programs may be helpful in reducing posttraumatic stress disorder (PTSD), anxiety, and depressive symptoms. The current study examines the acceptability of integrating an EAAT program as part of a two-week, intensive clinical program for veterans with PTSD and/or traumatic brain injury (TBI). Methods A family member or support person could accompany veterans and participate in the program. One hundred and six participants (veteran n = 62, family n = 44) left the urban environment in an intensive outpatient program (IOP) to attend a two-day, weekend EAAT in rural New Hampshire. Satisfaction surveys were conducted on the last day of the program and examined using thematic analysis. Results The following themes were reported in the surveys: ability of horses to catalyze emotional rehabilitation, effectiveness of immersion in equine-assisted activities, program’s ability to foster interpersonal relationships and necessity of education about PTSD for staff. Participants also reported enjoying the program as highlighted by qualitative feedback, a mean score of 9.76 (standard deviation [SD] = 0.61) as reported by veterans and a mean score of 9.91 (SD = 0.29) as reported by family members on a 10-point visual analog scale with higher scores indicating a greater overall experience. Conclusion These data offer preliminary evidence that an adjunct EAAT program is acceptable for veterans with PTSD and/or TBI participating in an IOP.

Post-9/11 service members may return from military service with a complicated set of symptoms and conditions, such as posttraumatic stress disorder (PTSD), depression, substance misuse, and traumatic brain injury (TBI), that interfere with reintegration and impair functioning. Although evidence-based treatments that facilitate recovery exist, their successful delivery at a sufficient dose is limited. Barriers to accessing treatment combined with challenges compiling a comprehensive treatment team further delay delivery of effective evidence-based care for PTSD, TBI, and co-occurring mental health conditions. This paper describes the development of a comprehensive, multidisciplinary, 2-week intensive day program for post-9/11 veterans with complex mental health concerns. The treatment program combines skill building groups, family education, and integrative health approaches with evidence-based individual PTSD or TBI care. Initial results from the first 132 participants were notable for a 97% completion rate, as well as statistically significant and clinically meaningful reductions in PTSD, neurobehavioral, and depression symptom severity for the 107 veterans who completed the PTSD track and the 21 who completed the TBI track. These data suggest the intensive program approach is an effective, well-tolerated model of treatment for post-9/11 veterans with PTSD and/or TBI. Future controlled studies should examine the effectiveness of this intensive model compared to standard evidence-based therapy delivery, as well as longitudinal outcomes.

Objective Suicide is a leading cause of death in adolescents worldwide. There is an absence of effective and low cost treatment strategies for this growing public health problem. Current practice consists of brief hospitalization of acutely suicidal youth, but many get inadequate follow-up treatment. There are few alternatives to individual outpatient services offered at too low an intensity for an acutely distressed population. This paper describes the development, feasibility, acceptability, and preliminary clinical outcomes of an intensive outpatient program (IOP) for suicidal adolescents over a two-year period. Method 364 eligible adolescents (12–18 years) who had a worsening of suicidal ideation or a suicide attempt were enrolled in an IOP and attended at least 1 group session. Depressive symptoms and suicidality were assessed at baseline and discharge from the program and at one and six month follow-up. Results The majority of patients completed the IOP (81.0%; average of nine sessions). Over 95% of teens and parents responded that they were mostly or very satisfied with the IOP. The condition of patients improved at the time of discharge on depressive symptoms and suicidal ideation and behavior. 286 of the 364 youth (78.6%) completed the six-month follow-up. In total, 8.7% and 27.3% of the 286 respondents reported a suicide attempt and event, respectively, within six months of discharge from the IOP. Conclusions While limited by the lack of a control group, our findings suggest that an IOP for adolescents with suicidality is acceptable and feasible as either a step-down from or an alternative to inpatient treatment.

Background Unique aspects of military sexual trauma (MST) may result in specific maladaptive cognitions among survivors. Understanding which posttraumatic cognitions are particularly strong among MST survivors could help clinicians target and improve treatment for these individuals. This study explored the impact of experiencing MST on posttraumatic cognitions among veterans with posttraumatic stress disorder (PTSD). Methods Veterans enrolled in an Intensive Outpatient Program for PTSD (N = 226) were assessed for MST, PTSD severity, depression severity, and posttraumatic cognitions as part of a standard clinical intake. Multivariate analyses examined differences in posttraumatic cognitions between veterans who did and did not experience MST. Results MST survivors (n = 88) endorsed significantly stronger posttraumatic cognitions related to self-blame compared to non-MST counterparts (n = 138), even when accounting for current symptom severity. Specifically, MST predicted the following cognitions: “The event happened to me because of the sort of person I am,” “Somebody else would have stopped the event from happening,” “Somebody else would not have gotten into this situation,” and “There is something about me that made the event happen,” after controlling for severity of PTSD and depression. Limitations Study population was a treatment-seeking sample of veterans diagnosed with PTSD from a non-VA clinic. Veterans in MST group endorsed either sexual harassment, sexual assault, or both. Sample size of males who endorsed MST (n = 21) may be too small to generalize to all males. Conclusions Beliefs related to self-blame may be important treatment targets for MST survivors.

Several self-report rating scales have been developed to assess suicidal ideation, yet few examine other factors related to increased suicidal risk, and even fewer have been validated in both adolescents and adults. We evaluate the 14-item Concise Health Risk Tracking - Self Report (CHRT-SR), a measure previously validated in adults, in a sample of adolescents at risk for suicide.Data are from a retrospective chart review of adolescents treated in an intensive outpatient program for youth with severe suicidality. Teens completed the CHRT-SR and Quick Inventory of Depressive Symptomatology - Adolescents (QIDS-A) at baseline and discharge. The CHRT-SR was evaluated to determine the factor validity, internal consistency, construct validity, and sensitivity to change.Adolescents (n = 271) completed the CHRT-SR prior to treatment, and 231 completed the CHRT-SR at discharge. Three factors were identified with excellent model fit: Propensity, Impulsivity, and Suicidal Thoughts. Internal consistency reliability coefficients were good-to-excellent for the total score and all three factors at baseline (a = 0.774-0.915) and exit (a = 0.849-0.941). The total score and all three factors significantly correlated with overall depression severity and suicidal ideation as rated by teens and parent (p = .704-0.756, all p .001). The CHRT-SR was sensitive to change, with moderate to large effect sizes (Cohen's d = 0.599-1.062).Study limitations include generalizability, lack of a control group, and retrospective data from a sample of opportunity.The CHRT-SR is a reliable and valid measure for examining severity of suicidal thoughts and associated risk factors, and is sensitive to change following an intervention in adolescents.

Introduction Understanding for whom treatments exert their greatest effects is crucial for prescriptive recommendations that can improve overall treatment efficacy. Anxiety and substance use disorder comorbidity is prevalent and a significant public health concern. Little is known about who should receive specialized, integrated treatments to address both problems. This study aimed to examine baseline patient characteristics that predict differential outcome between typical treatment for substance use disorders (UC) compared to that treatment combined with cognitive behavioral therapy for anxiety disorders (UC + CALM ARC). Methods We examined several putative treatment moderators in a dataset of community-based participants (N = 75) from a randomized clinical trial at an outpatient community substance use disorder (SUD) specialty clinic. Participants who met criteria for any anxiety disorder and any SUD were randomized to UC (the Intensive Outpatient Program at the clinic) or UC + CALM ARC. Outcome measures included anxiety symptoms, drug use, and alcohol use, and were assessed at pre-treatment, post-treatment, and a 6-month follow-up assessment. Results Older age and female gender were associated with greater improvement on anxiety outcomes in UC + CALM ARC compared to UC. The presence of an alcohol use disorder was associated with greater improvement in alcohol use in UC + CALM ARC compared to UC. Higher opiate-related withdrawal symptoms and the presence of more SUDs were associated with greater improvement in drug use outcomes in UC + CALM ARC compared to UC. Conclusions Several pre-treatment characteristics are associated with a return of symptoms for those who receive only UC, whereas the addition of CALM ARC prevented the return of symptoms. Implications for future research and preliminary clinical recommendations are discussed.

Comprehensive Behavioral Intervention for Tics (CBIT) is an efficacious behavioral treatment for Tourette’s disorder. In its standard format, CBIT is completed in 8 sessions over a 10-week period. Unfortunately, significant obstacles (e.g., not having a provider nearby; inability to attend weekly sessions) prevent many individuals from participating in standard outpatient CBIT. An intensive outpatient program that compresses CBIT into a week may help overcome many of these barriers. The present clinical replication series examines treatment outcomes in 5 individuals with Tourette’s disorder. Importantly, 4 out of the 5 participants reported clinically meaningful tic reductions on the Yale Global Tic Severity Scale (YGTSS) at the posttreatment assessment, with an average decrease of 11.5 points across those 4 participants. This represents a 28% decrease in the average posttreatment YGTSS score from the average baseline YGTSS score. Of the 3 participants who completed the 1-month follow-up assessment, 2 participants continued to endorse reductions in their baseline tic severity on the YGTSS and were rated as having a positive response on the Clinician Global Impressions–Improvement subscale. Clinical implications are discussed.

Despite the 8–18.5% of returning Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF) and Operation New Dawn (OND) veterans who are suffering from posttraumatic stress disorder (PTSD), few receive empirically supported treatments. Among those that do, the dropout rate is high and more than 50% retain their diagnosis after treatment. This study evaluated the efficacy of Trauma Management Therapy (TMT), delivered in a 3-week intensive outpatient (IOP) format. TMT combines virtual-reality augmented individual exposure therapy with a group intervention to address social isolation, anger, and depression. One hundred twelve (112) OIF/OEF/OND veterans and active duty personnel participated. Assessment included measures of PTSD, sleep, depression, anger, guilt, and social isolation, administered at post-treatment, 3-month, and 6-month follow-up. The effect size for TMT delivered in an IOP format was 2.06, with 65.9% no longer meeting diagnostic criteria for PTSD. There were similar positive effects in other domains and treatment gains were maintained at 6-month follow-up. The results are discussed regarding the need for efficacious, multi-component interventions that can be delivered safely and rapidly, and the potential of this approach towards that end.

To investigate whether telephone-based continuing care (TEL) is a promising alternative to traditional face-to-face counseling for clients in treatment for substance abuse.Patients with alcohol and/or cocaine dependence who had completed a 4-week intensive outpatient program were randomly assigned through urn randomization into one of three 12-week interventions: standard continuing care (STD), in-person relapse prevention (RP), or telephone-based continuing care (TEL). This study performed cost, cost-effectiveness, and cost-benefit analyses of TEL and RP compared to STD, using results from the randomized clinical trial with two years of follow up (359 participants). In addition, the study examined the potential moderating effect of baseline patient costs on economic outcomes.The study found that TEL was less expensive per client from the societal perspective ($569) than STD ($870) or RP ($1684). TEL also was also significantly more effective, with an abstinence rate of 57.1% compared to 46.7% for STD (p0.05). Thus TEL dominated STD, with a highly favorable negative incremental cost-effectiveness ratio (-$1400 per abstinent year). TEL also proved favorable under a benefit-cost perspective.TEL proved to be a cost-effective and cost-beneficial contributor to long-term recovery over two years. Because TEL dominated STD care interventions, wider adoption should be considered.

This study examines the prospective relationship between insomnia symptoms and suicide attempts in high-risk youth. We obtained depressive symptoms, insomnia symptoms, and suicide ideation measures from clinical records of 206 adolescents ages 12–17 at entry and discharge from a suicide prevention intensive outpatient program. Information about whether the participant made a suicide attempt was available through six months after discharge. Patients were mainly girls (79.1%; n = 163) with depression (89.8%; n = 185). Associations between insomnia symptoms, attempts within 6 months of discharge, persistent insomnia symptoms, and suicide ideation at discharge were tested with multiple regression analyses. Entry insomnia symptoms were prospectively associated with attempts when controlling for age, sex, and previous attempts, but insomnia symptoms at discharge were not. Suicide ideation at discharge was associated both with entry insomnia symptoms and attempts within 6 months of discharge. When entry and discharge suicide ideation were controlled, the association between entry insomnia symptoms and attempts lost significance. However, the association between discharge ideation and attempts remained significant. Insomnia symptoms contribute indirectly to suicide attempt risk after discharge. Intensive treatment for ideation and reducing insomnia symptoms could reduce discharge suicide risk and subsequent suicide attempts.

Posttraumatic stress disorder (PTSD) resulting from military service is a common, yet often chronic condition. Treatment outcome often is attenuated by programs that are (a) lengthy in nature and (b) constricted in their target outcomes. These limitations leave much of the emotional and behavioral impairment that accompanies PTSD unaddressed and/or unassessed. Typical PTSD treatment programs are 3–4 months in length, which is challenging for the pace of the nation's military. In this investigation, we will compare two treatments, Trauma Management Therapy (TMT) and Prolonged Exposure (PE), both redesigned to address the needs of active duty personnel (300 participants at 3 military installations). Specifically, we will compare the TMT Intensive Outpatient Program (IOP; 3 weeks) to PE's compressed (2 week) format. Both interventions will be compared to a standard course of PE (12 weeks). In addition to PTSD symptomatology, outcome measurement includes other aspects of psychopathology as well as changes in social, occupational, and familial impairment. Potential negative outcomes of massed treatment, such as increased suicidal ideation or increased alcohol use, will be assessed, as will genetic predictors of PTSD subtype and treatment outcome. This study will inform the delivery of care for military-related PTSD and particularly the use of intensive or compressed treatments for active duty personnel. Keywords: Posttraumatic stress disorder, Exposure therapy, Active duty military, Massed treatment, Trauma Management Therapy

Emerging research highlights the potential cognitive benefits of physical exercise (PE) programs for schizophrenia (SCZ). The few recent efficacy studies that examined augmenting cognitive training (CT) with PE suggest superior effects of the combination. The next step is to consider strategies to enhance adherence in real-world settings if this type of combined treatment is going to be effective. We present the first community effectiveness data for PE and CT that included a motivationally-enhancing, self-determined approach to exercise, in lieu of participant payment. Eighty-five outpatients with schizophrenia attending an intensive outpatient program were randomized to 18 h of either (A) self-determined PE regimen with choice from a menu of different activities; (B) tablet-based neurofeedback CT focused on processing speed (PS) and working memory (WM), or (C) a time-matched combination of PE and CT. Assessments were conducted at baseline, post, and follow-up (2 mo). All groups improved in WM from baseline to post, with greatest gains in the PE only group. At follow-up, cognitive gains originally observed in the PE-only group disappeared, while the PE + CT group evidenced improvements in WM and psychotic symptoms. Notably, attrition for PE was only 7%. Our data shows that combining PE and CT leads to lasting effects that are superior to those of either intervention alone. The low PE drop-out rate suggests a self-determined approach to the exercise regimen was tolerable, and may be an important component of future community implementation efforts. Keywords: Schizophrenia, Motivation, Physical exercise, Cognitive training

Youth experiencing substance use disorders often are susceptible to relapse because traditional support systems can be expensive, geographically dispersed, operated on limited schedules and lacking in peer support. The continuity of care offered via the digital Addiction Comprehensive Health Enhancement Support System (ACHESS) system holds promise in preventing relapse because of its portability and capability to foster virtually anytime/anywhere, cost-effective access to supportive interventions. The aim of this mixed-methods study was to evaluate the utility and impact of ACHESS on treatment adherence among youth with substance use disorders in an intensive outpatient program in the US Midwest. Data on 28 clients using ACHESS during 2016–17 were compared to retrospective data on 28 carefully-matched others treated without ACHESS during 2014–16. Fifty-four percent of the study group successfully completed treatment as opposed to 42.9% of those in the comparison group. Staff focus group findings highlighted how some features of ACHESS were effectively integrated into the care model and appeared to positively impact outcomes, while other elements of the application offered little utility. We suggest further study of ACHESS among larger samples of youth with substance use disorders in intensive outpatient programs to assess its efficacy in supporting adherence to treatment.

Obsessive-Compulsive Disorder (OCD) is prevalent among children and adults across racial and ethnic groups, causing significant and pervasive impairment in home life, work, and relationships. This article includes a review of the literature surrounding utilization of mental health care and barriers to treatment for OCD in four specific ethnoracial minority groups, followed by an examination of minority participation in a large intensive/residential OCD treatment facility. Participants included 924 children or adults diagnosed with OCD at Rogers Memorial Hospital between 1999 and 2012. The overwhelming majority of participants were non-Hispanic White (93.3%), indicating a significant mental health disparity. Patients were: 2.4% Hispanic/Latino American, 1.2% Asian American, 0.9% African American, 0.8% biracial/multiracial, 0.7% Indian American, 0.6% other, 0.1% Native American, and 0.1% Pacific Islander. Minority patients required significantly longer stays, despite no differences in mean OCD severity pre- or post treatment. The percentage of minority patients significantly increased over a 13-year span. Implications of findings and recommendations for increasing minority participation are discussed.

Emerging adults (18–25 years old) are often poorly retained in substance use disorder treatment. Office-based buprenorphine often enhances treatment retention among people with opioid dependence. In this study, we examined the records of a collaborative care buprenorphine treatment program to compare the treatment retention rates of emerging adults versus older adults. Subjects were 294 adults, 71 (24%) aged 18–25, followed in treatment with buprenorphine, nurse care management, and an intensive outpatient program followed by weekly psychosocial treatment. Compared to older adults, emerging adults remained in treatment at a significantly lower rate at 3 months (56% versus 78%) and 12 months (17% versus 45%), and were significantly more likely to test positive for illicit opioids, relapse, or drop out of treatment. Further research into factors associated with buprenorphine treatment retention among emerging adults is needed to improve treatment and long-term outcomes in this group.

The goal of this study was to determine which cocaine dependent patients engaged in an intensive outpatient program (IOP) were most likely to benefit from extended continuing care (24 months). Participants (N=321) were randomized to: IOP treatment as usual (TAU), TAU plus Telephone Monitoring and Counseling (TMC), or TAU plus TMC plus incentives for session attendance (TMC+). Potential moderators examined were gender, stay in a controlled environment prior to IOP, number of prior drug treatments, and seven measures of progress toward IOP goals. Outcomes were: (1) abstinence from all drugs and heavy alcohol use, and (2) cocaine urine toxicology. Follow-ups were conducted at 3, 6, 9, 12, 18, and 24 months post-baseline. Results indicated that there were significant effects favoring TMC+ over TAU on the cocaine urine toxicology outcome for participants in a controlled environment prior to IOP and for those with no days of depression early in IOP. Trends were obtained favoring TMC over TAU for those in a controlled environment (cocaine urine toxicology outcome) or with high family/social problem severity (abstinence composite outcome), and TMC+ over TAU for those with high family/social problem severity or high self-efficacy (cocaine urine toxicology outcome). None of the other potential moderator effects examined reached the level of a trend. These results generally do not suggest that patients with greater problem severity or poorer performance early in treatment on the measures considered in this report will benefit to a greater degree from extended continuing care.

Research suggests a high comorbidity between chronic pain and substance use disorder (SUD), particularly within a military population. Optimal clinical treatment for those with chronic pain and SUD is believed to be multidisciplinary care. However, limited research has been conducted on this topic within the military health care system (MHS). This quality improvement project examines short-term outcomes for a joint-SUD and chronic pain intensive outpatient program (IOP). Active duty, veterans, and dependents were enrolled in a 6-week Joint-IOP at WRNMMC. The multidisciplinary team included addiction social workers, physical therapists, nurses, and clinical psychologists. Patients received a breathalyzer and urine drug screen at the time of treatment initiation and periodically throughout. Participants filled out the following validated questionnaires pre- and post-treatment: Defense and Veterans Pain Rating Scale (DVPRS), Pain Outcomes Questionnaire (POQ), Brief Addiction Monitor (BAM), World Health Organization Quality of Life-Brief (WHOQOL-BREF) and Pain Catastrophizing Scale (PCS). Fifty-eight patients completed the joint-IOP. Paired T-tests suggest a reduction in DVPRS worst pain scores (p=0.013), reduced POQ total impairment (p=0.034) and improved POQ vitality (p=0.024) from pre- to post-treatment. Paired T-tests suggest a trend toward decreased alcohol and substance use as measured by the BAM (p=0.056). Both WHO quality of life and pain catastrophizing showed no significant change. This project suggests that patients suffering from chronic pain and SUD within the MHS have improved pain and SUD outcomes at the completion of a 6-week joint-IOP. Implications of this project suggest the importance of concurrently treating chronic pain and SUD within the MHS.

Introduction Every eight seconds a Baby Boomer turns 60 (Rao, Praveena, & Rao, 2010). The number of people over age 65 in the United States with a mental illness is expected increase to 15 million persons in 2030 (McGovern, Lee, Johnson, & Morton, 2008). Mental health services in the U.S. are insufficient due to lack of providers and limited options. The scenario worsens when you add factors such as rural and geriatric populations. Mendenhall, MS is indicative of this phenomena. There are few mental health services in Simpson County and even fewer options for geriatric patients. The county has two hospitals with Simpson General Hospital (SGH) in Mendenhall housing a ten bed geriatric psychiatric unit but the need is much greater. Mendenhall's census is 2,509 residents with 17.7% being over age 64. Simpson county has a census of 27, 463 residents with 15.6% being over age 65 (United States Census Bureau, 2015). The hospital is plagued by a revolving door syndrome with multiple readmissions in the midst of congress’ mandate that the Centers for Medicare and Medicaid Services (CMS) penalize hospitals with 30-day readmission rates. An Intensive Outpatient Program was implemented in Mendenhall, MS in conjunction with SGH. The program provided outpatient mental health treatment for 12 geriatric patients with multiple 30 day readmissions throughout the previous year. Methods The subjects for this study were patients with 3 to 6 readmissions within 30 days within one year from the geriatric psychiatric unit. Twelve patients participated and were part of a convenience sample. The study was conducted by use of comparison of readmission rates in 30 days between the intervention(implementation of outpatient program) and pre-intervention archival data that showed readmission rates monthly for one year prior to readmission rates. Data during intervention were collected via daily sign in sheets and hospital daily census records. Results Prior to the intervention, the number of admissions per month ranged from 11 to 16 per month, and readmissions ranged from 4 to 8. The average pre-intervention readmission rate was 43.6%. During the month of the intervention program, only one readmission occurred relative to the 18 total admissions, which resulted in a clinically substantial reduced rate of only 5.6%. A Fisher's exact test was conducted to compare the average pre-intervention readmission rate to the intervention rate, and showed a statistically significant reduction in the 30-day readmission rate (p = 0.012). Conclusions Offering programs such as Intensive Outpatient Mental Health Services can reduce costly readmission rates and penalties while increasing available services to geriatric patients in rural Mendenhall, MS. This research was funded by Funding was supplied from host hospital, Simpson General Hospital in Mendenhall, MS. Participation in the program was paid through Medicare reimbursement. Monthly hospital readmission rates.

This study examined the moderating role of shyness mindset on the reduction of social anxiety during exposure-based treatment. Participants (N = 60) in an intensive outpatient program for anxiety disorders were assessed at pre- and post-treatment. Social performance anxiety decreased dramatically during treatment, but the amount of decrease differed as a function of pre-treatment shyness mindset. At one standard deviation above the mean on both the social performance anxiety and shyness mindset measures, an average reduction of 15 points on the social performance anxiety measure was observed. At one standard deviation above the mean on the social performance anxiety measure and one standard deviation below the mean on the shyness mindset measure, an average reduction of 27 points on the social performance anxiety measure was observed. These results suggest that targeting shyness mindset during exposure-based treatments for social anxiety disorder might increase the effectiveness of treatment for individuals with a high shyness mindset.

Compulsive hoarding patients have been found in previous studies to have substantial disability and functional impairment. However, no prior study has examined subjective and objective quality of life (QOL) in patients with compulsive hoarding. This present study compared compulsive hoarders and non-hoarding OCD patients across a variety of QOL domains. Subjects were 171 consecutive adult patients (34 compulsive hoarders, 137 non-hoarding patients with DSM-IV OCD) treated openly between 1998 and 2004 in the UCLA OCD Partial Hospitalization Program (OCD PHP), a specialized, intensive, multi-modal treatment program for treatment-refractory patients. Scores on the Quality of Life Scale and other symptom severity measures on admission were compared between compulsive hoarders and non-hoarding OCD patients. Compulsive hoarders were older and had lower global functioning than non-hoarding OCD patients. Both groups had low overall QOL scores across multiple domains. Compulsive hoarders had significantly lower levels of satisfaction with their safety than non-hoarding OCD patients, were more often the victims of both violent and non-violent crime, felt less safe in their neighborhoods, and felt less protected against attack. Compulsive hoarders were also much less satisfied with their living arrangements than non-hoarding OCD patients. No differences were found on financial variables, but the vast majority of patients in both groups were unemployed. Compulsive hoarders have lower QOL than non-hoarding OCD patients in the domains of safety and living situation. Psychosocial rehabilitation that focuses on problems with victimization, safety, employment, and financial areas may be a beneficial augmentation to treatment for compulsive hoarding.

Introduction/Background To compare the effectiveness of three treatment strategies for chronic low back pain with varying biomechanical intensity and multidisciplinary approach. Material and method A monocentric controlled trial with a 12-months follow-up, conducted in the French Valley Loire region from May 2009 to April 2013. Participants were working-aged patients with chronic low back pain referred to a French chronic low back pain care-network to support medical and occupational issues. Three treatment strategies, each for five weeks were compared: (i) intensive and multidisciplinary program conducted in a rehabilitation center; (ii) less intensive outpatient program conducted by a trained private physiotherapist; (iii) mixed strategy combining the same outpatient program associated with a weekly multidisciplinary intervention. The effects of treatment conditions were compared using an “intention to treat” approach: Number of days’ sick leave during the 12-months following treatment, and quality of life and social ability assessed by auto-questionnaires. Results A total of 349 patients (52.2% men, 42.5 ± 8.7 years old, median duration of sick leave = 206.0 days (92.0–301.0)) were included. Sick leave duration significantly decreased during the 12-months following treatment in the three groups. Physical capacity improved in intensive program and mixed strategy groups. There was no significant difference for the evolution of participants’ quality of life, social ability, and personal beliefs between the three groups. Conclusion This study confirms that disparate treatments might show similar effectiveness because they could all work through concomitant changes in beliefs, attitudes, and coping mechanisms. The original mixed strategy can treat a larger number of chronic low back pain patients, at a lower cost and provide local community-based care.

In an effort to identify instances of the non-problematic use of a drug concurrent with the problematic use of one or more other drugs, we used structured interviews to obtain comprehensive drug use histories from 48 clients admitted to an intensive outpatient program. We classified clients on the basis of whether they demonstrated evidence of concurrent problematic and non-problematic drug use (Index and Probable Index cases) or only problematic drug use patterns (Non-Index cases). Both Index and Non-Index drug use patterns were about equally common in our sample. Both Index and Probable Index cases used a variety of drugs in a non-problematic manner and were generally congruent in their self-labelling of their drug use relative to their DSM-IV status for each drug used. We discuss several limitations of the study, including our reliance on retrospective, self-report data; potential problems with generalization to other populations; and possible changes in drug use patterns over time.