Does ethno-cultural betrayal in trauma affect Asian American/Pacific Islander college students' mental health outcomes? An exploratory study

Objectives: Interpersonal trauma has deleterious effects on mental health, with college students experiencing relatively high rates of lifetime trauma. Asian American/Pacific Islanders (AAPIs) have the lowest rate of mental healthcare utilization. According to cultural betrayal trauma theory, societal inequality may impact within-group violence in minority populations, thus having implications for mental health. In the current exploratory study, between-group (interracial) and within-group (ethno-cultural betrayal) trauma and mental health outcomes were examined in AAPI college students. Participants: Participants (N = 108) were AAPI college students from a predominantly white university. Data collection concluded in December 2015. Methods: Participants completed online self-report measures. Results: A multivariate analysis of variance revealed that when controlling for interracial trauma, ethno-cultural betrayal trauma significantly impacted dissociation, hallucinations, posttraumatic stress symptoms, and hypervigilance. Conclusions: The results have implications for incorporating identity, discrimination, and ethno-cultural betrayal trauma victimization into assessments and case conceptualizations in therapy.     

Parents,friends, and depression: A multi-country study of adolescents in South Asia

PurposeThis study investigates the association between social support networks, as measured by parental involvement and close friendships, and depression among adolescents in South Asia.MethodsNationally representative samples of adolescents between the ages of 12 and 16 + years (n = 16,592) from the Global School Based Health Surveys from India, Sri Lanka, Pakistan, and Myanmar were analyzed to provide prevalence rates of depression. Additionally, differences in past year depressive symptoms were compared cross-sectionally by social support from parents and friends, separately. This was done by computing prevalence ratios adjusting for potential confounders and demographic factors.ResultsOf all adolescent respondents in the study, 14.5% met the criteria to be screened for depression, while 50% reported having three or more close friends, and 80% reported having very involved parents. Adjusted prevalence ratios indicated that those with close friendships were much less likely to be screened for depressive symptoms compared to their counterparts, as were adolescents with very involved parents. However, low and moderate levels of parent involvement were not found to be significantly associated with adolescents' propensity for being screened for depressive.ConclusionSocial support is a social determinant of adolescent mental health in South Asia that has received little scholarly attention to date. This study highlights the importance of research and interventions involving parents and close friends in building programs for adolescents that target mental health.     

AsianWORKs

ABSTRACT

Achieving economic self-sufficiency through employment is the ultimate goal of recent changes to the welfare program. The Asian American and Pacific Islander (AAPI) population is most vulnerable to failing in this goal because of language difficulty, low education levels and lack of job skills in the labor market. Many AAPI immigrants, and Southeast Asian Americans in particular, suffer from adjustment and mental health problems due to their experiences as refugees. These are but a few of the obstacles for AAPI welfare recipients to become self-sufficient, making them one of the most “hard-to-serve” populations. The goal of self-sufficiency through employment can be reached if culturally appropriate and adequate support services are provided to meet the unique needs of the population. Few programs, however, are targeted at AAPIs. Using key-informant interviews and the case material review method, this article highlights the difficulties of AAPI welfare recipients and describes a unique program serving the Southeast Asian American, particularly the Cambodian, population. The article focuses on the program components of outreach and engagement, day socialization and job readiness, and family support services, and it discusses improvement to service access and lessons learned for the practice of cultural competence.     

Psychological aspects op physical handicap

Abstract

The promotion of home management of asthma has increased the popularity of education programs amongst health professionals. Our clinical experience has led us to believe presently available asthma education programs are inadequately used by parents of children with asthma. The authors summarise the results of a survey of program attendance and discuss relevant issues, including the opportunities for social workers to improve the current situation.     

Personal control and service connection as paths to improved mental health and exiting homelessness among severely marginalized homeless youth

ObjectiveNon-service connected, continuously homeless youth are arguably one of the most vulnerable populations in the U.S. These youth reside at society's margins experiencing an accumulation of risks over time. Research concludes that as vulnerabilities increase so do poor long-term outcomes. This study tested the mediating effects of service connection and personal control as mediators of cumulative risk and housing, health and mental health outcomes. By understanding the processes associated with therapeutic change among those with the most vulnerabilities, service providers and researchers can target those factors to enhance positive outcomes.MethodSeventy-nine, non-service connected, substance using homeless youth were offered a strengths-based outreach and engagement intervention and were assessed at baseline 3, 6 and 9 months post-baseline.ResultsPersonal control mediated the effects of cumulative risk on housing stability, and service utilization mediated the effects of cumulative risk on mental health.ConclusionsThis study specifies important targets of intervention for a population at high risk for continuing homelessness. In particular, service providers should target youths' sense of personal control and link them to needed community-based services in order to help them exit street life and improve mental health outcomes.     

Mental health service navigation: a scoping review of programmatic features and research evidence

ABSTRACT

Service navigation is a care coordination approach that is designed to resolve barriers and facilitate access to needed services. Originating within primary and specialty health care sectors, navigation models have recently emerged to support engagement with mental health services. Presently little is known about the nature, extent, and research evidence for mental health service navigation programs. To address this gap in knowledge, this study undertook a scoping review to identify, describe, and appraise current models of mental health service navigation. Data sources included PsychINFO, Medline, CINAHL, and Google Scholar. Inclusion eligibility required studies to describe a study design, recruitment strategy, navigation approach, sample characteristics, and study outcomes. Searches were constrained to English language and published after January 1, 2000. Twenty-five studies met the inclusion criteria. Navigation programs targeted diverse populations and were delivered in-person, by telephone, and online. Navigators included peers, paraprofessionals, clinicians, teams, and web applications. Eleven studies reported results from randomized trials, remaining programs employed program evaluation, qualitative, or CBPR methodologies. Common features of navigation programs included engagement, assessment, service identification, referral, and monitoring/follow-up. Current evidence for mental health service navigation is promising, although additional rigorous randomized controlled trials are needed.     

Undergraduate students survey their peers on mental health: Perspectives and strategies for improving college counseling center outreach

Abstract

Objective: The purpose of the study was to examine student perspectives about college mental health including the primary mental health issues affecting students, common college student stressors, student awareness of campus mental health resources, and mental health topics students want more information about. Participants: Participants were 822 undergraduate and graduate students enrolled in a private university. The study was conducted during September 2016. Methods: As part of a public health course in program planning, undergraduate students surveyed their peers about their experience with mental health and mental health resources. Results: Stress was perceived as the largest mental health issue. Students most wanted more information about school/work/life balance followed by stress management. Electronic newsletters, social media, and on-campus seminars were the top strategies that students suggested as ways to reach them. Conclusions: The results provide student perspectives on mental health that may be useful in developing effective outreach efforts.     

Applying RE-AIM to evaluate two community-based programs designed to improve access to eye care for those at high-risk for glaucoma

IntroductionGlaucoma is a leading cause of vision loss and blindness in the U.S. Risk factors include African American race, older age, family history of glaucoma, and diabetes. This paper describes the evaluation of a mobile eye health and a telemedicine program designed to improve access to eye care among people at high-risk for glaucoma.MethodsThe RE-AIM (reach, efficacy, adoption, implementation, and maintenance) evaluation framework was used to harmonize indicators. Both programs provided community-based eye health education and eye services related to glaucoma detection and care. Each program reported data on participants and community partners. An external evaluator conducted site visit interviews with program staff and community partners. Quantitative and qualitative data were integrated and analyzed using the RE-AIM dimensions.DiscussionBy targeting high-risk populations and providing comprehensive eye exams, both programs detected a large proportion of new glaucoma-related cases (17–19%) – a much larger proportion than that found in the general population (<2%). The educational intervention increased glaucoma knowledge; evidence that it led people to seek eye care was inconclusive.ConclusionsEvaluation findings from the mobile eye health program and the telemedicine program may provide useful information for wider implementation in public health clinics and in optometrist clinics located in retail outlets.     

Including At-Risk Adolescents in Their Own Health and Mental Health Care

Summary

As urban adolescents encounter serious health and mental health risks, they present the allied health professions with important opportunities for health promotion and risk reduction interventions. However, the prevailing emphasis on adolescents' risk behaviors rather than on their vulnerability has limited our capacity to understand and serve them. Further limiting are the widely held myths that adolescents as a whole have few health problems and that they are poor judges of their own needs. This article presents an overview of current theories of adolescent risk and vulnerability and suggests Youth Development as an overarching framework for understanding both. Experience within a comprehensive, adolescent health and mental health center demonstrates how to meaningfully engage adolescents in their own health care from the start.     

How local health departments work towards health equity

BackgroundHealth inequities are exacerbated when health promotion programs and resources do not reach selected populations. Local health departments (LHDs)¹ have the potential to address health equity via engaging priority populations in their work. However, we do not have an understanding of what local agencies are doing on this front.MethodsIn the summer of 2016, we collaborated with informants from thirteen LHDs across North Carolina. Via semi-structured interviews, the research team asked informants about their LHD’s understanding of health equity and engaging priority populations in program planning, implementation, and evaluation.FindingsAll informants discussed that a key function of their LHD was to improve the health of all residents. LHDs with a more comprehensive understanding of health equity engaged members of priority populations in their organizations’ efforts to a greater extent than LHDs with a more limited understanding. Additionally, while all LHDs identified similar barriers to engaging priority populations, LHDs that identified facilitators more comprehensively engaged members of the priority population in program planning, implementation, and evaluation.ConclusionsLHDs are ideally situated between the research and practice worlds to address health equity locally. To promote this work, we should ensure LHDs hold an understanding of health equity, have the means to realize facilitators of health equity work, and recognize the complex context in which health equity work exists.     

The Power of Peer Support: The Development of the Empowerment Center

ABSTRACT

This article discusses the events and influences that led to the author’s contribution to the development of a mental health consumer-run organization, The Empowerment Center in Mount Vernon, NY. The author traces some events that influenced him personally and the evolution of the Empowerment Center from an organization that provided advocacy services (to those with mental health problems who were hospitalized) and community-based support services to people in mental health recovery, to an organization focusing on economic empowerment and economic development for the community of those in recovery. The transition of the Empowerment Center into an organization focused on economic empowerment underscores the importance of economic independence for people in recovery and the consumer-run organizations that support them. The Empowerment Center endeavors to demonstrate that mental health consumer-survivors can take control of their economic health as well as their physical and mental health.     

Sexual Health Education in OB-Gyn Residencies—The Program Directors’ Survey

Abstract

Objective: To evaluate U.S. obstetrics-gynecology (OB-Gyn) program Director appraisal of resident physician female sexual health training. Methods: An OB-Gyn resident sexual health curriculum survey was developed and sent to 237?U.S. OB-Gyn program directors. University/military programs were compared to community-based programs. Results: 115 OB-Gyn residency program directors responded (48.5% participation); 37.9% university/military and 43.2% community OB-Gyn Program Directors appraise the resident curriculum as “not well” preparing residents to manage sexual health therapies upon graduation. Topics not sufficiently covered include human sex trafficking, sexual health for women with disabilities, and cultural competency. Conclusions: This study identifies opportunities in OB-Gyn residency female sexual health education.     

Understanding innovation in health program planning and development

IntroductionA need for innovative public health programs is evident as the field adapts to address changes in health priorities and target populations. The Innovative Teen Pregnancy Prevention Program (iTP₃) was created to support and enable innovation in teenage pregnancy prevention, developing programs to reach the most at risk youth.MethodsA formative evaluation was conducted to understand what innovation means in the context of program development, and examine the process of innovation. Qualitative data was collected through baseline interviews with program development teams, referred to as Innovators, prior to the start of the project period and follow-up interviews conducted at the end of a 12-month funding period. Additional open-ended written responses were collected in the middle of the funding cycle. A thematic analysis with an open-coding scheme was used to identify emergent themes.ResultsInnovators considered programs innovative because of the target population of focus, program delivery mechanism, and/or program development approach. They specifically identified that a “culture” of innovation must be present if new programs are to be developed. Over time, Innovators began to shift their definition of innovation toward unique design processes and ecological approaches.DiscussionThrough creating a culture of innovation and utilizing systems thinking, this project provides important insights in how to develop innovations in public health.     

Outcomes Measurement

SUMMARY

Outcomes measurement in health and mental health should be of vital concern to social workers since public support and financing will follow evidence of effectiveness. Social work in health and mental health requires a framework for conceptualizing outcomes measurement so that the profession can focus clearly on the work to be done in outcomes measurement. This framework should distinguish among the various ways that outcomes measurement can be used to advance policy, program and practice. This article discusses two applications of outcomes measurement, namely for improving policies and programs, and, second, for conducting outcomes research. Other dimensions that could be included in an outcomes measurement framework for social work in health and mental health are identified but not elaborated. The author's objective is to make a strong case for the role that outcomes measurement can play in both the improvement of social work policies and programs in health care, through performance measurement, as well as in advancing the healthcare knowledge base, through outcomes research.     

Formative evaluation on a physical activity health promotion program for the group home setting

Physical inactivity and high rates of chronic conditions is a public health concern for adults with intellectual disability. Few health promotion programs target the group home setting which is the pre-dominant form of residential accommodation for persons with intellectual disability. A process evaluation of a physical activity health promotion program, Menu-Choice, was conducted with five group home sites for adults with intellectual and developmental disabilities. Menu-Choice assists group home staff in including physical activity goals within resident schedules. The physical activity program was designed based on theoretical frameworks, community-based participatory approaches, and established health promotion guidelines for adults with disabilities. Fourteen program coordinators (age M 39; 77% females), 22 staff (age M 39; 82% females), and 18 residents (age M 59; 72% females; 56% ambulatory) participated. Results from the fidelity survey and program completion highlight potential challenges with implementation. Findings will assist with the refinement of the program for continued implementation trials in the group home community.