Browsing by Author "Bell, Lauren A."

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Examining the Efficacy of Project ECHO to Improve Clinicians’ Knowledge and Preparedness to Treat Adolescent Vaping
    (Sage, 2022) Oliver, Alexander P.; Bell, Lauren A.; Agley, Jon; Bixler, Kristina; Hulvershorn, Leslie A.; Adams, Zachary W.; Psychiatry, School of Medicine
    As adolescent vaping reaches epidemic rates in the United States, it is imperative that pediatric clinicians have access to medical knowledge on best practices for screening, assessing, and treating vaping-related substance use. The Teen Vaping ECHO (Extension for Community Healthcare Outcomes) program was developed to offer practical learning sessions focused on clinical management of adolescent vaping. This study describes the development, implementation, and evaluation of the program’s impact on participants’ knowledge, attitudes, and practices regarding treatment of adolescent vaping from registration to the end of the series. Participants were generally knowledgeable about vaping at registration and reported significant increases in comfort talking with patients about vaping, counseling patients on nicotine replacement products, and frequency of implementing best-practice screening strategies at the end of the series. This study suggests ECHO programs focused on improving clinical management of adolescent vaping may increase accessibility of evidence-based care and reduce harms associated with vaping in youth.
  • Thumbnail Image
    Item
    Preferences and Experiences Regarding Pregnancy Options Counseling in Adolescence and Young Adulthood: A Qualitative Study
    (Elsevier, 2023) Bell, Lauren A.; Tyler, Crystal P.; Russell, Margaret R.; Szoko, Nicholas; Harrison, Elizabeth I.; Kazmerski, Traci M.; Syed, Tahniat; Kirkpatrick, Laura; Pediatrics, School of Medicine
    Purpose: Perspectives of adolescents and young adults (AYAs) experiencing pregnancy options counseling (POC) are absent from the literature. This study explores AYA experiences and preferences related to POC to inform best practice guidelines. Methods: We conducted semistructured phone interviews in 2020-2021 among US-based individuals, 18-35 years old, who experienced a pregnancy less than 20 years of age. We performed qualitative descriptive analysis of positive and negative attributes of AYA's experiences with POC. Results: Fifty participants reported 59 pregnancies (16 parenting, 19 abortions, 18 adoptions, three miscarriages) between the ages of 13 and 19 years. Positive attributes of POC experienced included: (1) provider communication that was compassionate, respectful, supportive, and attentive to nonverbal cues; (2) provider neutrality; (3) discussion of all pregnancy options; (4) asking about feelings, choice, life plans, and additional supports; (5) provision of informational materials; and (6) warm handoffs/follow-up facilitation. Negative attributes of POC experienced included: (1) judgmental, impersonal, or absent communication; (2) lack of counseling on all options and/or coercive/directive counseling; (3) insufficient time and supportive resources; and (4) confidentiality concerns. We identified no differences in these perspectives across pregnancy outcomes reported. Participants generally desired counseling about all options, with rare exceptions of ambivalence. Discussion: Individuals who experienced an adolescent pregnancy described similar positive and negative attributes of POC regardless of preferred pregnancy outcome. Their perspectives highlight how crucial interpersonal communication skills are for effective POC for AYA. POC training across health care specialties should emphasize confidential, compassionate, and nonjudgmental care for AYA patients.
  • Thumbnail Image
    Item
    Unintentional Overdoses: Understanding the Fentanyl Landscape and Reducing Harm
    (Wolters Kluwer, 2023) Bell, Lauren A.; Hadland, Scott E.; Pediatrics, School of Medicine
    Purpose of review: Adolescent and young adult overdoses and overdose fatalities continue to increase despite reductions in self-reported substance use. This review aims to explore factors contributing to this overdose epidemic, highlight signs of overdose and the role of the overdose reversal medication naloxone, and provide recommendations for practice change to support patients and decrease their risk of unintentional overdose. Recent findings: The potent opioid fentanyl is a common contaminant in nonopioid substances, as well as in heroin and counterfeit pills, heightening risk of fatal overdose. Adolescents and young adults who die of overdose are rarely engaged in substance use disorder treatment. Medications for opioid use disorder are effective at reducing risk of fatal overdose but are underutilized, as is the opioid reversal medication naloxone. Summary: Pediatric clinician engagement in harm reduction with adolescents and young adults, starting with screening through a confidential interview, may enhance pathways to care and reduce the risk of overdose.
  • Thumbnail Image
    Item
    Use of Project ECHO to promote evidence based care for justice involved adults with opioid use disorder
    (Sage, 2022) Adams, Zachary W.; Agley, Jon; Pederson, Casey A.; Bell, Lauren A.; Aalsma, Matthew C.; Jackson, TiAura; Grant, Miyah T.; Ott, Carol A.; Hulvershorn, Leslie A.; Psychiatry, School of Medicine
    Background: People with opioid use disorders (OUDs) are at heightened risk for involvement with the criminal justice system. Growing evidence supports the safety and effectiveness of providing empirically supported treatments for OUD, such as medications for OUD (M-OUD), to people with criminal justice involvement including during incarceration or upon reentry into the community. However, several barriers limit availability and accessibility of these treatment options for people with OUDs, including a shortage of healthcare and justice professionals trained in how to implement them. This study evaluated a novel education program, the Indiana Jail OUD Treatment ECHO, designed to disseminate specialty knowledge and improve attitudes about providing M-OUD in justice settings. Methods: Through didactic presentations and case-based learning (10 bimonthly, 90-min sessions), a multidisciplinary panel of specialists interacted with a diverse group of community-based participants from healthcare, criminal justice, law enforcement, and related fields. Participants completed standardized surveys about OUD knowledge and attitudes about delivering M-OUD in correctional settings. Thematic analysis of case presentations was conducted. Results: Among 43 participants with pre- and post-series evaluation data, knowledge about OUD increased and treatment was viewed as more practical after the ECHO series compared to before. Cases presented during the program typically involved complicated medical and psychiatric comorbidities, and recommendations addressed several themes including harm reduction, post-release supports, and integration of M-OUD and non-pharmacological interventions. Conclusions: Evaluation of future iterations of this innovative program should address attendance and provider behavior change as well as patient and community outcomes associated with ECHO participation.