Despite strong evidence of effectiveness, exposure therapy is an underutilized treatment for anxiety disorders at a time when effective treatment for anxiety is greatly needed. The significant worldwide prevalence and negative impact of anxiety are documented and highlight the importance of increasing therapist and patient use of effective treatment. Obstacles to the use of exposure therapy are explored and steps to lessen these obstacles are proposed. In particular, virtual reality (VR) technology is discussed as a way to increase the availability of exposure therapy. Incorporating VR in therapy can increase the ease, acceptability, and effectiveness of treatment for anxiety. VR exposure therapy (VRET) permits individualized, gradual, controlled, immersive exposure that is easy for therapists to implement and often more acceptable to patients than in vivo or imaginal exposure. VR is presented as a scalable tool that can augment access to and effectiveness of exposure therapy thus improving treatment of anxiety disorders. VR also has the potential to help with assessment and with therapist training standardization. The authors advocate for providing continuing education in VRET to practicing clinicians and including training in exposure therapy and VRET in training programs. Ongoing development of VR applications for clinical use is encouraged, especially when developed in collaboration with software developers, clinical users, therapists who are experienced in VRET, and researchers.
Suicide is a significant issue in the United States and worldwide, and its prevention is a public health imperative. The Suicide Prevention Toolkit for Rural Primary Care was developed to address gaps in education and tools to assist primary care providers and other clinic staff in identifying and managing patients at risk for suicide. Given the high suicide rates in rural areas, coupled with the evidence that many people who die by suicide visit their primary care provider in the month prior to their death, primary care health settings offer an important prevention and intervention opportunity for patients at varying levels of risk for suicide. This article details (a) the evolution of a project that began with identifying a need for tools and training in suicide prevention and brief intervention by rural primary care providers, (b) the development of the Suicide Prevention Toolkit for Rural Primary Care, (c) the effectiveness of a training based the toolkit to improve suicide prevention knowledge and skills of primary care providers and other employees in health care settings, and (d) recommendations for future research and dissemination strategies of suicide prevention and intervention in primary care and other health settings.
Objective Low mental health literacy (MHL) is widespread in the general population and even more so among racial and ethnic minority groups. Mental Health First Aid (MHFA) aims to improve MHL. The objective of this study was to determine the impact of MHFA on perceptions of confidence about MHL in a large national sample and by racial and ethnic subgroup. Methods The self-perceived impact of MHFA on 36,263 people who completed the 12-hour training and a feedback form was examined. Results A multiple regression analysis showed that MHFA resulted in high ratings of confidence in being able to apply various skills and knowledge related to MHL. Perceived impact of MHFA training differed among some racial and ethnic groups, but the differences were small to trivial. Conclusions Future research on MHFA should examine changes in MHL pre-post training and the extent to which perceived increases in MHL confidence among trainees translate into action.
A large proportion of the health and social service workforce is comprised of direct care workers who have no formal preservice education and receive a limited amount of on-the-job training. These workers are essential in all geographic areas and are especially critical in rural and frontier regions where access to advanced health care professionals is limited. Driven by stakeholder demand, the State of Alaska launched the multiyear Alaskan Core Competencies initiative to strengthen the training of its direct care workforce. This article details the development of a set of cross-sector core competencies relevant to workers in the fields of mental health, addictions, developmental and physical disabilities, and the long-term care of older adults. Also described are the related assessment tools, curriculum, and train-the-trainer learning communities, which were developed to enable the dissemination of the competencies. The authors conclude by discussing the growing interest nationally in competencies for this workforce, the challenges of adapting one set of competencies for varied jobs in diverse health and social service sectors, and the financial barriers to widespread adoption of competency-based worker training.
Suicide is a significant issue in the United States and worldwide, and its prevention is a public health imperative. Primary care practices are an important setting for suicide prevention, as primary care providers have more frequent contact with patients at risk for suicide than any other type of health-care provider. The Western Interstate Commission for Higher Education, in partnership with the Suicide Prevention Resource Center, has developed a Suicide Prevention Toolkit and an associated training curriculum. These resources support the education of primary care providers in evidence-based strategies for identifying and treating patients at risk for suicide. The application of this curriculum to post-graduate medical training is presented here.
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