Police Encounters for Behavioral Health-Related Reasons in Rural and Remote Communities: A Canadian Study☆

Evidence suggests police officers are increasingly called upon to respond to incidents related to mental health issues, emotional problems, and substance abuse. Many have raised concerns regarding their involvement in such incidents. Yet, little is known about these encounters in rural and remote communities despite evidence suggesting that the context of non-urban areas should matter. Accordingly, this article proposes to examine variations in self-reported encounters with the police for behavioral health-related reasons across urban, rural, and remote communities. Using data from the 2014 General Social Survey, a representative sample of the Canadian population, we assess these self-reported encounters from two different angles: encounters for one's own behavioral health crisis and encounters for a family member's behavioral health needs. While findings on the former are inconclusive, those examining police contacts for a family member suggest that living in rural or remote communities is significantly associated with a greater probability of experiencing such situations relative to living in urban areas. Furthermore, this probability increases with the relative geographical isolation of communities. These results are discussed in light of the rising concerns regarding our reliance on the police for such incidents and the need to account for the situation of rural and remote communities.     

Community Readiness Assessment: The Scoring Process Revisited

The Community Readiness Model is an innovative and widely embraced approach to determining a community's stage of readiness to address a particular community issue and match that stage with an appropriate intervention. The current study used this approach in five communities experiencing cancer health disparities. In each community, leaders were interviewed and their qualitative data scored to determine the community's stage of readiness. Two methods of triangulation, investigator and interdisciplinary, were used to increase the scoring process's rigor. In order to gain a deeper understanding of the consensus portion of the scoring process, these meetings were content analyzed. The results have important implications for scoring team composition, provide insight into consensus reaching strategies, and offer recommendations for addressing potential challenges.     

UPSTREAM! Together evaluation results from community efforts to prevent mental,emotional, and behavioral health problems

Mental, emotional, and behavioral (MEB) health problems are prevalent globally. Despite effective programs that can prevent MEB problems and promote mental health, there has not been widespread adoption. UPSTREAM! Together was a planning project in three Colorado communities. Communities partnered with academic and policy entities to 1) translate evidence about MEB problem prevention into locally-relevant messages and materials and 2) develop long-term plans for broad implementation of interventions to prevent high-priority MEB problems. Community members recognized the need to talk about MEB problems to prevent them. The UPSTREAM! communities localized messages designed to start conversations and sustain attention on preventing MEB problems. The communities understood that prevention takes sustained community attention and advocacy, knowing that important outcomes may be years away. Long-term implementation plans aimed to strengthen families and enhance social connections among youth. Despite community readiness and capacity to implement evidence-based programs, there were few funding opportunities, delaying program implementation and revealing gaps between funding policies and community readiness. This community-engaged experience suggests an achievable approach, acceptable to communities, and worthy of further development and testing. Policies that cultivate and support local expertise may help to increase wider community adoption of evidence-based programs that promote mental health among youth.     

REFOCUSING FROM CHILD TO MARITAL PROBLEMS USING THE MARRIAGE CONTRACT GAME

Couples experiencing marital distress often request treatment for child behavior problems. These families have been found to respond poorly to behavioral parent-training programs and to reject offers of marital therapy. The Marriage Contract Game (MCG) structures and teaches problem-solving and communication skills; the game can be used to improve the skills of distressed couples and to refocus their attention away from their children and toward their own marriages. A multiple-baseline design was applied to four distressed couples who requested treatment for a target child. Results showed that game play improved couple's problem-solving and positive feeling statements in home discussions of problems, parents' ratings of target children's problems, and, in three cases, couples' perceptions of the difficulty of resolving their problems. Therapists untrained in behavioral methods were able to use the game with success and comfort. While four sessions of the MCG were not sufficient treatment for this population, intervention improved couples' skills and shifted their focus away from child problems and toward their own.     

Behavioral health correlates of exposure to community violence among African-American adolescents in Chicago

AimsThough public health researchers are more aware of behavioral health concerns among African American youth, few studies have explored how exposure to community violence may be related to adverse youth concerns. This study examines the relationship between exposure to community violence and mental health problems, substance use, school engagement, juvenile justice involvement, and STI risk behaviors.MethodsA total of 638 African American adolescents living in predominantly low-income, urban communities participated in the study by completing self-report measures on exposure to community violence, mental health, school engagement proxies, substance use, delinquency markers and sexual risk behaviors.ResultsAdolescents who reported higher rates of exposure to community violence were significantly more likely to report poorer mental health, delinquent behaviors, a history of juvenile justice involvement, lower school bonding and student-teacher connectedness. These youth were also significantly more likely to use alcohol, cigarettes, and illicit substances, and engage in sexual risk behaviors.ConclusionsFindings suggest that there is a critical need for culturally relevant prevention and intervention efforts for African American adolescents who are frequently exposed to community violence.     

The Community Readiness Survey. Development and initial validation

This article reports on the development and evaluation of a mail survey measuring population attitudes toward substance use of potential receptivity of communities to different prevention efforts. The Community Readiness Survey was designed through a series of prevention practitioner and consultant meetings and focus groups. Psychometric evaluation revealed five distinct domains: perception of alcohol, tobacco, or other drug problem; support for prevention; permissive attitudes toward teen substance use; perception of adolescent access; and perception of community commitment. Evidence of construct validity was demonstrated by the small but significant relationships between selected scale scores and community readiness as evaluated by prevention planners.     

The Evolution of Community Mental Health Services in Asian American Communities

This paper explores the history of Asian immigration to the United States, and its intersections with the mental health system. As mental health care have evolved since the 1960s from institutions to the community, public mental health services for Asian Americans have become increasingly culturally relevant. Major policy shifts, trends in immigration, and mental health practice will be presented with a focus on the Bridge Program at the Charles B. Wang Community Health Center. Integrative practice and research models that extend evidence-based knowledge to Asian American communities and practice implications are discussed.     

Hospital Community Benefit in Rural Appalachia: One More Gap*

Non‐profit hospitals are important anchors in Appalachian communities, in part because of the concentration of health care dollars within these institutions. Community benefit efforts of these hospitals, therefore, have the potential to fill gaps in public health and social service provision in underserved areas with documented health disparities and access barriers. To date, however, we do not fully understand how community benefit practices vary by hospital setting. Employing hierarchical linear modeling using a multilevel mixed‐effects approach, this study analyzes data from the years 2010 to 2016 to assess community benefit practices and spending between hospitals in Appalachia and non‐Appalachian counties. Findings indicate that hospitals within Appalachian counties, and rural hospitals in this region, in particular, spent less on community benefit than hospitals, not in this region. Given the potential for community benefit to impact health outcomes and access to care, this disparity is important to state and local public health efforts and suggests the need for additional support for hospitals to engage their communities around critical health needs.     

Primary care for young African American men

Young African American men in the inner city have higher rates of mortality and morbidity from potentially preventable causes than other American men of the same age. They suffer disproportionately high rates of preventable illness from violence, sexually transmitted diseases, and HIV infection. These young men present with problems related to sexual concerns, mental health issues, substance abuse, and violence. They also report substantial risk-taking behaviors, including unprotected sex, substance use, and weapon carrying, as well as exposure to violence. Access to and use of preventive primary care services has been limited for these patients in the past because of financial barriers and competing social issues. Racism and historical oppression have created barriers of mistrust for young men of color. Factors that contribute to their adverse health status, as well as ways to address these problems, are discussed.     

Global Mental Health in Action: Reducing Disparities One Community at a Time

There are great disparities in mental health care around the world. Traditional approaches to mental health care have not been found to be transferrable to many parts of the world and are inadequate to address these disparities. Unconventional approaches are needed that match the traditions of care‐seeking and care‐giving within the communities where they are delivered. The authors review the global mental health literature and discuss how marriage and family therapists are in a particularly good position to have worldwide impact on mental health disparities. Five principles of global mental health are presented along with an example of how these principles are applied through the Reducing Mental Health Disparities One Community at a Time (RD1CT) model.     

Alternative Practicum in Health Education

Abstract

Young African American men in the inner city have higher rates of mortality and morbidity from potentially preventable causes than other American men of the same age. They suffer disproportionately high rates of preventable illness from violence, sexually transmitted diseases, and HIV infection. These young men present with problems related to sexual concerns, mental health issues, substance abuse, and violence. They also report substantial risk-taking behaviors, including unprotected sex, substance use, and weapon carrying, as well as exposure to violence. Access to and use of preventive primary care services has been limited for these patients in the past because of financial barriers and competing social issues. Racism and historical oppression have created barriers of mistrust for young men of color. Factors that contribute to their adverse health status, as well as ways to address these problems, are discussed.     

Model CBAs and Community Benefits Ordinances as Tools for Negotiating Equitable Development: Three Critical Cases

Community benefits agreements (CBAs) allow coalitions of labor and grassroots organizations to negotiate for concessions in the development process. One goal of a CBA is to more broadly distribute the benefits of new development to distressed communities and historically disenfranchised groups. Since their emergence in the 1990s, CBAs have not been well institutionalized. To date, there have been roughly 30 CBAs adopted across the United States. A relatively new development in the CBA movement has been the push to adopt model CBAs and community benefits ordinances, that outline all of the linkages that local government expects a developer to include in a project and require developers to negotiate linked development agreements as part of the project approval process. Although the emergence of model CBAs and CBA ordinances is promising for local groups interested in promoting equitable development, little research has been done on them. This article examines three critical cases in the United States (Portland, OR; Cleveland, OH; Detroit, MI) and evaluates the degree to which they serve as tools to institutionalize equitable development in the urban planning process. This analysis is based on content analysis and semi-structured interviews with key stakeholders.     

Community,Family, and Race/Ethnic Differences in Health Status in Rural Areas1

Abstract Many race-specific differences in health outcomes that have been observed in previous research have been attributed to class and racebased group differences which either facilitate or constrain health opportunities and behaviors. These include such variables as different rates of poverty, health insurance coverage, and access to medical care. However, these relationships have been inadequately examined in rural communities where minority status may be even more detrimental to health than in urban areas, due to various constraints on access to health care. We present an analysis that assesses the effects of community, family structure, sociodemographic, and medical care variables on self-reported health status among Hispanics, Mrican Americans, and non-Hispanic whites in six rural communities in Florida. Community structural characteristics had a significant effect on self-reported health, as did some of the measures of how respondents “experience” community. These relationships held even when other sets of variables were added to the models. Family/household characteristics and sociodemographic and medical care variables were less important in explaining self-reported health status. These findings suggest that community continues to be important in explaining differences in health status in rural areas.     

Tobacco Control and Smoking Cessation Efforts in an Inner-City African American Community

This paper describes the conceptual framework that guided the development and implementation of a large-scale, community-based health initiative to lower the prevalence of smoking in an urban African American community. This project developed culturally-sensitive approaches to reducing smoking in the community and to promoting tobacco control efforts developed and implemented by community members. A randomized clinical-trial methodology was used to test the efficacy of the culturally-sensitivey community-developed smoking cessation interventions in lowering smoking rates as compared with a self-help approach. Two theoretical models guided the intervention strategies: a macro-level model applicable to the community as a whole, and a psychological process model applicable to individuals. The community model was based on community systems theory and incorporated the Readiness for Change Model which was applied in both the individual and organizational models. In addition, culturally-sensitive data collection methods were developed to improve the reliability and validity of project data, especially in determining the smoking prevalence rates and smoking behaviors of hard-to-reach, inner-city African Americans. Since the health of individuals is related to the health of their communities, smoking cessation and tobacco control activities that are integrated into the framework of the community (Le., churches, city-council, housing developments, community organizations), and incorporate culturally-relevant and specific interventions can be effective methods for achieving behavioral and societal change.     

Comprehensive behavioral medicine in community mental health. A needs assessment that needs assessment.

It is suggested that the massive costs incurred nationally in health care are in large part a fitting concern of Community Mental Health (CMH). There is considerable data available to suggest that as much as half of the variance in common health disorders is associated with behavioral factors. There is a rapidly growing movement to provide interventions geared toward these behavioral components in health disorders, but much of this has occurred outside of the traditional mental health environment. There are arguments to suggest that CMH should be more involved in the development of comprehensive behavioral medicine services, both in terms of the expertise and resources that it can bring to bear upon these problems, and its potential to reach segments of the population which are otherwise likely to be underserved, if served at all. Implications for CMH planning and financing are discussed, drawing upon a selective literature review and clinical illustrations.     

Selected Websites for High-to-Low End NPO Website Development

ABSTRACT

SubstanceAbusePrevention.org, a virtual Community, is a 3.5-year project initially funded by the US Department of Commerce, Technology Opportunity Program. Its purpose was “to determine what proven components of substance abuse prevention in ‘real’ communities can be effectively transferred into ‘virtual’ communities.” Teens in drug treatment helped university researchers translate resiliency-based prevention practices into a Web site that would appeal to their peers. The 24 strategies tested fall in the categories of prevention exercises, games, multimedia, and information. This article describes the development process along with the lessons learned and future directions. The information is useful for those wanting to design and develop interactive Websites that address human service problems.     

Adolescents’ Subjective Social Status Predicts Day‐to‐Day Mental Health and Future Substance Use

Adolescents’ subjective social status (SSS) is associated with mental and behavioral health outcomes, independent of socioeconomic status (SES). Many previous findings, however, come from cross‐sectional studies. We report results from a longitudinal study with 151 adolescents identified as at risk for early substance use and behavioral problems sampled from low‐SES neighborhoods. We examined whether adolescent's SSS predicted mental health (depression, anxiety, and inattention/impulsivity) measured over 30 days via ecological momentary assessment and risk for substance use at an 18‐month follow‐up. Results showed that with each perceived step “up” the SSS ladder, adolescents experienced fewer mental health symptoms in daily life and lower future substance use risk after adjusting for objective SES and previous psychopathology. Implications of these findings are discussed.