Symptoms of depression, posttraumatic stress, and substance use disorders commonly co-occur and are a tremendous health burden among the U.S. military veteran population. Acceptance and Commitment Therapy (ACT) is an evidence-based, transdiagnostic, integrated approach that has been used to treat these problems. Delivering psychotherapy via telehealth helps to break down barriers to care. This case study describes the application of ACT via telehealth with a male veteran with co-occurring symptoms of depression, PTSD and nicotine addiction. His depressive symptoms, PTSD symptoms, and nicotine use decreased substantially over the course of therapy. He demonstrated increased willingness to experience negatively evaluated internal experiences such as emotions and urges to use nicotine, defusion from self-critical and other unhelpful thoughts, more consistent engagement in values-consistent behaviors, and increased behavioral engagement in his social life. Treatment implications and unique aspects of the telehealth modality are discussed. Recommendations are made for training clinicians who may be considering providing services via telehealth or using ACT.

Abstract. Understanding the dynamics of multihost parasites and the roles of different host species in parasite epidemiology requires consideration of the whole animal community. Host communities may be composed of hundreds of interacting species, making it necessary to simplify the problem. One approach to summarizing the host community in a way that is relevant to the epidemiology of the parasite is to group host species into epidemiological functional groups (EpiFGs). We used EpiFGs to test our understanding of avian malaria ( Plasmodium and Haemoproteus) dynamics in four communities of wetland-associated birds in southern Africa. Bird counts and captures were undertaken every 2-4 months over 2 yr and malaria was diagnosed by nested PCR. One hundred and seventy-six bird species were allocated to a set of EpiFGs according to their assumed roles in introducing and maintaining the parasite in the system. Roles were quantified as relative risks from avian foraging, roosting, and movement ecology and assumed interaction with vector species. We compared our estimated a priori risks to empirical data from 3414 captured birds from four sites and 3485 half-hour point counts. After accounting for relative avian abundance, our risk estimates significantly correlated with the observed prevalence of Haemoproteus but not Plasmodium. Although avian roosting height (for both malarial genera) and movement ecology (for Plasmodium) separately influenced prevalence, host behavior alone was not sufficient to predict Plasmodium patterns in our communities. Host taxonomy and relative abundance were also important for this parasite. Although using EpiFGs enabled us to predict the infection patterns of only one genus of heamosporidia, our approach holds promise for examining the influence of host community composition on the transmission of vector-borne parasites and identifying gaps in our understanding of host-parasite interactions.

Due to occupational stress and exposure to potentially traumatic events, firefighters are at an increased risk for the development of many behavioral health conditions. While volunteer and career firefighters represent two distinct subgroups, little research has examined differences in the availability of, and barriers to, behavioral health care between these populations. This study examined perceived availability and barriers to behavioral health care services among 2,156 career and 227 volunteer firefighters. Volunteer firefighters were less likely to report availability of drug and alcohol or family and couple services, but more likely to report availability of a trained peer support system and follow-up care compared to career firefighters. Volunteer firefighters were over five times more likely to consider cost a barrier to accessing behavioral health services compared to career firefighters; however, they were less likely to report lack of support from leadership, fear of breach of confidentiality, and clinicians who are unaware of work culture as barriers. Volunteer and career firefighters were equally likely to report stigma as a barrier. These findings have important implications for understanding how to strengthen departmental resources and to design targeted interventions to increase access to behavioral health services. Impact StatementThis study suggests that there are meaningful differences in availability of behavioral health resources between career and volunteer. While cost was a greater barrier to accessing services among volunteer firefighters, stigma was a common barrier for both volunteer and career firefighters. These findings have important implications for understanding how to strengthen departmental resources and to design targeted interventions to increase access to behavioral health services.

Background While firefighter‐emergency medical responders (FF‐EMR) are important stakeholders in cities considering the implementation of a supervised injection facility (SIF), there is little information on perspectives of first responders who serve these communities. The aim of the present study was to identify FF‐EMR perspectives on working near a SIF. Methods FF‐EMRs from Vancouver Fire and Rescue Services completed an online survey that queried participant perspectives on working near a SIF. Results Four main themes were identified: positive effects, negative effects, duration of assignment, and sense of duty. Similar percentages of first responders reported positive (22.2%) and negative aspects (25.9%) of working near the SIF, while some (18.5%) indicated preference for a short‐term assignment to the SIF area. FF‐EMRs most commonly described a sense of duty (35.2%). Conclusions To our knowledge, our study is the first to identify FF‐EMR perspectives related to work near a SIF. Perspectives and concerns of first responders should be considered in policy debates about implementation of new SIFs to guarantee an adequately‐prepared first responder workforce.

LAY SUMMARY Behavioural health peer support connects individuals to needed professional services (e.g., counselling) and provides benefits in groups of people that might face more challenges, like military Veterans. Different training exists for peer supporters, but not a lot of information is available to demonstrate if these trainings, or checking in with trained peers, is helpful. This study took a peer support training program used in fire service and updated it to fit the needs of Veterans and Veteran family members (V/VFM) in Texas, United States. Texas has a lot of Veterans and lacks enough mental health providers (e.g., psychologists). In this study, V/VFM were trained in peer support skills and had six months of peer check-in calls after the training. The trainees completed a test before training asking about their engagement and confidence with helping others, as well as a test after training asking these questions again and assessing satisfaction with training. Results show training was appropriate and acceptable. V/VFM appreciated the check ins and showed increases in confidence in their ability to help others. They tried to help more peers and were more successful when they did reach out. This study describes one way peer support can improve mental health access.