Disruption to Substance and Opioid Use Disorder: The Deep South Substance and Opioid Use Rural Training Grant

Abstract The primary objective of this symposium is to describe our integrated, interprofessional behavioral health training program in substance use and opioid use disorders (SUD/OUD) across the adult lifespan (19 to 80) within our clinical psychology graduate program in the Deep South. Due to the COVID-19 pandemic, our assessment, treatment, and prevention delivery has occurred via telehealth. The first paper describes our Clinical Training Model in two federally qualified health centers (one peri-urban and one rural) and one residential drug and alcohol rehabilitation program. Graduate and undergraduate students provide prevention, assessment, and treatment with an emphasis on 1) mindfulness-based relapse prevention, 2) literacy-adapted treatment for chronic pain, and 3) trauma and recovery. The second paper describes the participant population. Specifically, participants (N = 105) receiving prevention, assessment and treatment services report high levels of substance and opioid use and are underserved, impoverished, and have low levels of education and health/mental health literacy. The third paper explores the relation of age, adverse childhood experiences, and PTSD symptoms within the context of substantial or severe SUD/OUD. The final paper describes issues surrounding telehealth delivery in the rural south with underserved populations. The discussant, an expert in integrated, interprofessional telehealth delivery across the adult lifespan, will provide insight on program sustainability and dissemination. Given the pronounced need for SUD/OUD treatment in underserved populations with attention to the intersection of age and urban/rural residence, this project is poised to make a substantive impact across the adult lifespan.

redundancy and pathways to retirement.Themes arising from the data were experience of retirement, planning, health (physical and psychological), and levels of social participation.This review provides information for policy makers, health workers and employers to assist individuals with retirement, emphasising the need to maintain competency in a complex set of skills to improve health literacy and decrease psychological stress/ suicidal behaviours in older adults.

TESTING ONLINE MEN'S GROUPS TO PROMOTE PSYCHOLOGICAL WELL-BEING AND REDUCE DESPAIR DURING THE COVID-19 PANDEMIC
Marnin Heisel, 1 Paul Links, 2 Sisira Sarma, 3 Gordon Flett, 4 Kimberly Wilson, 5 Simon Hatcher, 6 Sylvie Lapierre, 7 and David Conn, 8 1. Schulich School of Medicine & Dentistry,  The University of Western Ontario, London, Ontario,  Canada, 2. McMaster University, Hamilton, Ontario,  Canada, 3. The University of Western Ontario, London,  Ontario, Canada, 4. York University, Toronto, Ontario,  Canada, 5. University of Guelph, Guelph, Ontario, Canada,  6.University of Ottawa, Ottawa, Ontario, Canada,  7. Universite du Quebec a Trois-Rivieres, Trois-Rivieres,  Quebec, Canada, 8. Baycrest; University of Toronto,  Toronto, Ontario, Canada  Suicide prevention is a healthcare and social justice priority.Older adults have the highest rates of suicide and the highest COVID-19 fatality rates in North America.The combined impacts of social isolation, fear of infection, apathy, and hopelessness could amplify suicide risk among older adults, as appears to have been the case during the 2003 SARS epidemic in Hong Kong.Innovative interventions are thus needed to promote social interaction and reduce risk for suicide in these challenging times.We are currently testing an online version of our Meaning-Centered Men's Group (MCMG; Heisel  et al., 2020), an upstream psychological intervention designed to promote psychological well-being and reduce suicide risk among men struggling with the transition to retirement, in the context of pandemic-related public health restrictions.This presentation will focus on adaptations to MCMG for online delivery, and share participant experiences and findings on positive and negative psychological outcomes.

DISRUPTION TO SUBSTANCE AND OPIOID USE DISORDER: THE DEEP SOUTH SUBSTANCE AND OPIOID USE RURAL TRAINING GRANT
Chair: Rebecca Allen Co-Chair: Lindsey Jacobs Discussant: Bruce Rybarczyk The primary objective of this symposium is to describe our integrated, interprofessional behavioral health training program in substance use and opioid use disorders (SUD/ OUD) across the adult lifespan (19 to 80) within our clinical psychology graduate program in the Deep South.Due to the COVID-19 pandemic, our assessment, treatment, and prevention delivery has occurred via telehealth.The first paper describes our Clinical Training Model in two federally qualified health centers (one peri-urban and one rural) and one residential drug and alcohol rehabilitation program.Graduate and undergraduate students provide prevention, assessment, and treatment with an emphasis on 1) mindfulness-based relapse prevention, 2) literacy-adapted treatment for chronic pain, and 3) trauma and recovery.The second paper describes the participant population.Specifically, participants (N = 105) receiving prevention, assessment and treatment services report high levels of substance and opioid use and are underserved, impoverished, and have low levels of education and health/mental health literacy.The third paper explores the relation of age, adverse childhood experiences, and PTSD symptoms within the context of substantial or severe SUD/ OUD.The final paper describes issues surrounding telehealth delivery in the rural south with underserved populations.The discussant, an expert in integrated, interprofessional telehealth delivery across the adult lifespan, will provide insight on program sustainability and dissemination.Given the pronounced need for SUD/OUD treatment in underserved populations with attention to the intersection of age and urban/rural residence, this project is poised to make a substantive impact across the adult lifespan.

INTEGRATING PSYCHOLOGICAL SERVICES INTO COMMUNITY-BASED CLINICS Lindsey Jacobs, The University of Alabama, The University of Alabama, Alabama, United States
In Alabama, where mental health stigma is a critical barrier to care, integrated behavioral health services are vital to address the mental health needs that underlie substance use disorder (SUD) and opioid use disorder (OUD).Since October 2019, our team has developed partnerships with one rural and two peri-urban primary care clinics to offer behavioral health services with an emphasis on SUD/ OUD prevention, screening, and treatment.The patient populations receiving services at these three facilities are under-resourced with multiple disadvantages placing them at risk for morbidity, mortality, SUD/OUD, and poor behavioral and mental health outcomes.Behavioral health services have been delivered primarily via telehealth due to the COVID-19 pandemic.This presentation will describe the process, current status, and future goals for implementing integrated behavioral health care, with a focus on identifying the barriers and facilitators during the COVID-19 pandemic era.

CHARACTERISTICS OF OUR PATIENT POPULATION Kyrsten Hill, The University of Alabama, Tuscaloosa, Alabama, United States
To date, 106 patients have completed behavioral health assessments across three sites: a rural primary care clinic (n = 32), urban federally qualified health center (n = 33), and state-certified residential rehabilitation facility (n = 41).Patients ranged from 18 to 65 years of age (M = 38.6,SD = 11.4).Approximately 51% were female and 75% were non-Hispanic White (followed by 22% African American).Over 60% had a high school degree or less and found it at least somewhat difficult to pay for basic needs.Most patients endorsed substantial (44%) or severe (39%) drug use, with 40% endorsing opioid use.There were no significant differences in substance use by age group.Moderate to severe symptoms of depression (43%) and anxiety (49%) were common.Approximately 70% endorsed adverse childhood experiences, and 44% reported clinically significant post-traumatic stress symptoms.Measures of cognitive functioning and objective health literacy are currently being collected.

AGE, CHILDHOOD TRAUMA, POST-TRAUMATIC STRESS DISORDER, AND SUBSTANCE USE DISORDER IN THE DEEP SOUTH
Candice Reel, 1 and Rebecca Allen, 2 1.The University of Alabama, Tuscaloosa, Alabama, United States, 2. University of Alabama, Tuscaloosa, Alabama, United States We examined the relationship of reported childhood trauma and PTSD symptoms in a sample (N = 105) of individuals aged 19 to 80 receiving treatment for substance use and opioid use disorders in federally qualified health centers.Fifty-two percent of the sample was age 39 or younger, 30% were in their 40s and 18% were aged 50 and older.Thirtytwo percent did not graduate high school and 36% had a high school education or equivalent.Seventy percent reported experiencing adverse childhood experiences (ACES).Although harmful alcohol use was low, 83% of the sample reported substantial or severe substance use, with 41% of the total reporting opioid use.ACES predicted current PTSD symptoms.Telehealth treatment considerations include: 1) internet access, 2) health and mental health literacy, and 3) monitoring for dissociation when using mindfulness-based relapse prevention treatment.

DIVERSITY AND VARIATION IN ASSISTED LIVING CARE, NATIONALLY AND OVER TIME Chair: Portia Cornell Discussant: Tetyana Shippee
Assisted living is generally understood to offer a greater degree of privacy and independence than a nursing home; most residents pay privately, with some receiving support from state subsidies and Medicaid; regulation and oversight are the purview of state agencies.Within these broad parameters, however, one assisted living community may look quite different from another across the country, or down the street, in its resident population and the regulations that govern its operating license.The purpose of this symposium is to explore that variation.The papers leverage an in-depth review of changes in assisted-living regulation from 2007 to 2019 and a methodology to identify Medicare beneficiaries in assisted living using ZIP codes.To set the stage, the first paper examines variation across assisted living licenses to identify six regulatory types and compare their populations' characteristics and health-care use.The second paper analyzes trends over time in the clinical acuity of assisted living residents associated with changes in nursing home populations.The third paper investigates racial disparities in assisted living associated with memory-care designations and proportions of Medicaid recipients.The fourth investigates how regulation of hospice providers in assisted living affect end-of-life care and place of death.The final paper describes requirements related to care for the residents with mental illness in seven states.The symposium concludes with an