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Development, Pre-Testing and Feasibility Testing of Multi-Component Interventions, Critical for Mental Health Promotion in Primary Care among Mexican-American Adolescents Living in Rural America. CHILDREN 2023; 10:children10030465. [PMID: 36980023 PMCID: PMC10047234 DOI: 10.3390/children10030465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/02/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023]
Abstract
Rural America is often viewed as bereft of social problems facing urban America. Rural families, however, experience stressors due to low employment rates, fewer educational opportunities, a relatively increased incidence of poverty and limited access to mental health care. These families are at increased risk for substance use, violence and associated psychological distress that occurs when failing to cope with stress. Rural children, experiencing these stressors and affected by barriers of culture, poverty and remote access to mental health care, are at higher risk for these negative health outcomes. The need for culturally appropriate intervention tailored to the target population, rural Mexican-American adolescent women, is consistently supported by evidence. A one-size-fits-all approach most likely will not effectively impact behavior and health outcomes. The fact that few studies evaluated effects of mental health interventions on multiple outcomes including substance use, violence, unintended pregnancy and STI is problematic given previously noted associations. Evidence is needed to evaluate associations between mental health interventions and these outcomes. This manuscript presents results of preliminary studies, conducted using a multi-method research approach for development, pre-testing and feasibility testing of interventions for rural primary care settings. This methodology is appropriate when dealing with the complexity of social phenomena. It provides a look at an issue from all angles and thereby the cultural context and perspective informing intervention development. These multi-component interventions are critical for mental health promotion among Mexican-American adolescent women living in rural America.
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Cultural competence and derivatives in substance use treatment for migrants and ethnic minorities: what’s the problem represented to be? SOCIAL THEORY & HEALTH 2019. [DOI: 10.1057/s41285-019-00113-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Olcoń K, Gulbas LE. "Because That's the Culture": Providers' Perspectives on the Mental Health of Latino Immigrant Youth. QUALITATIVE HEALTH RESEARCH 2018; 28:1944-1954. [PMID: 30160197 DOI: 10.1177/1049732318795674] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Immigrant youth experience a combination of stressors, such as isolation and discrimination, that put them at a greater risk for negative mental health outcomes. Relying on interviews with 24 service providers who work with Latino immigrant youth, this article examines how they construct and intervene in the worlds of immigrant youth to improve youth's mental health outcomes. Inductive thematic analysis revealed providers' reliance on cultural interpretations of the psychosocial circumstances facing immigrant youth. Providers alternated between drawing on discourses that reproduced stereotypes, assumptions, and biases, while simultaneously striving to transcend sociocultural differences to focus on the lived experiences of their clients. Although providers acknowledged the importance of structural barriers, such as poverty and discrimination, they "bracketed" these issues when recommending interventions. The article highlights that as cultural competence increasingly becomes part of social services, this professional discourse may distract providers' attention from more relevant targets of intervention.
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Affiliation(s)
- Katarzyna Olcoń
- 1 University of Wollongong, Liverpool, New South Wales, Australia
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Yang Y, Perkins DR, Stearns AE. Barriers and Facilitators to Treatment Engagement Among Clients in Inpatient Substance Abuse Treatment. QUALITATIVE HEALTH RESEARCH 2018; 28:1474-1485. [PMID: 29683040 DOI: 10.1177/1049732318771005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There is a call for drawing on client voice to provide a rich, nuanced understanding of factors influencing substance treatment engagement as to maximizing treatment benefits. We interviewed 60 clients in a short-term inpatient substance treatment program and examined facilitators and barriers to treatment engagement. Thematic analysis yielded four themes, including perceived treatment needs, trust and counselor rapport, peer inspiration, and organizational factors. Perceived treatment needs serve as both a facilitator and a barrier wherein the acknowledgment of needs led to greater treatment engagement whereas a lack of perceived needs hindered treatment engagement. The establishment of trust and counselor rapport and peer inspiration facilitated treatment engagement. Clients rated several organizational factors including a lack of treatment provision, gender-responsive treatment and infrastructure, and ineffective communication with nonclinical staff as barriers to treatment engagement. Clinical implications include enhancing treatment motivation and counselor rapport, establishing gender-responsive treatment programs, and providing trainings for staff.
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Affiliation(s)
- Yang Yang
- 1 University of Louisiana at Lafayette, Lafayette, Louisiana, USA
| | - David R Perkins
- 1 University of Louisiana at Lafayette, Lafayette, Louisiana, USA
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Hartmann WE, St Arnault DM, Gone JP. A Return to "The Clinic" for Community Psychology: Lessons from a Clinical Ethnography in Urban American Indian Behavioral Health. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:62-75. [PMID: 29266300 DOI: 10.1002/ajcp.12212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Community psychology (CP) abandoned the clinic and disengaged from movements for community mental health (CMH) to escape clinical convention and pursue growing aspirations as an independent field of context-oriented, community-engaged, and values-driven research and action. In doing so, however, CP positioned itself on the sidelines of influential contemporary movements that promote potentially harmful, reductionist biomedical narratives in mental health. We advocate for a return to the clinic-the seat of institutional power in mental health-using critical clinic-based inquiry to open sites for clinical-community dialogue that can instigate transformative change locally and nationally. To inform such works within the collaborative and emancipatory traditions of CP, we detail a recently completed clinical ethnography and offer "lessons learned" regarding challenges likely to re-emerge in similar efforts. Conducted with an urban American Indian community behavioral health clinic, this ethnography examined how culture and culture concepts (e.g., cultural competence) shaped clinical practice with socio-political implications for American Indian peoples and the pursuit of transformative change in CMH. Lessons learned identify exceptional clinicians versed in ecological thinking and contextualist discourses of human suffering as ideal partners for this work; encourage intense contextualization and constraining critique to areas of mutual interest; and support relational approaches to clinic collaborations.
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Affiliation(s)
- William E Hartmann
- School of Interdisciplinary Arts and Sciences, University of Washington Bothell, Bothell, WA, USA
| | | | - Joseph P Gone
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
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Zanjani F, Crook L, Smith R, Antimisiaris D, Schoenberg N, Martin C, Clayton R. Community pharmacy staff perceptions on preventing alcohol and medication interactions in older adults. J Am Pharm Assoc (2003) 2016; 56:544-8. [PMID: 27594107 DOI: 10.1016/j.japh.2016.04.561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 04/13/2016] [Accepted: 04/15/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To examine rural and urban pharmacy staff perceptions on messaging, barriers, and motivators for preventing alcohol and medication interactions (AMI) in older adults (≥65 years of age). METHODS A survey was distributed through the local pharmacist association and statewide pharmacy registry in Kentucky. A total of 255 responses were received from pharmacists, pharmacy technicians, and pharmacy students. RESULTS Across rural and urban regions alike, among the AMI prevention messages provided, participants identified the most important messages to be: AMI can be potentially dangerous and life threatening; emergency rooms should be used when experiencing an AMI; and doctors and pharmacists should be consulted about AMI. The most common AMI prevention barriers indicated were stigma, costs, and low perceived risks. The most common AMI prevention motivators indicated were physical health improvement, promoting a healthy lifestyle, convenient setting, and financial incentives. CONCLUSION Regardless of geography, participants similarly rated the presented AMI prevention messages, barriers, and motivators. With the use of these findings, the development of an AMI prevention program is suggested to use messaging about AMI threat, behavioral management, and behavioral prevention.
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Fischer EP, McSweeney JC, Wright P, Cheney A, Curran GM, Henderson K, Fortney JC. Overcoming Barriers to Sustained Engagement in Mental Health Care: Perspectives of Rural Veterans and Providers. J Rural Health 2016; 32:429-438. [DOI: 10.1111/jrh.12203] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/27/2016] [Accepted: 07/19/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Ellen P. Fischer
- Center for Mental Healthcare & Outcomes Research; Central Arkansas Veterans Healthcare System; North Little Rock Arkansas
- Department of Psychiatry, College of Medicine; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Jean C. McSweeney
- College of Nursing; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Patricia Wright
- College of Nursing; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Ann Cheney
- Department of Social Medicine & Population Health, University of California; Riverside School of Medicine; Riverside California
| | - Geoffrey M. Curran
- Center for Mental Healthcare & Outcomes Research; Central Arkansas Veterans Healthcare System; North Little Rock Arkansas
- Department of Psychiatry, College of Medicine; University of Arkansas for Medical Sciences; Little Rock Arkansas
- Department of Pharmacy Practice, College of Pharmacy; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Kathy Henderson
- Center for Mental Healthcare & Outcomes Research; Central Arkansas Veterans Healthcare System; North Little Rock Arkansas
| | - John C. Fortney
- Center of Innovation for Veteran-Centered and Value-Driven Care; VA Puget Sound Health Care System; Seattle Washington
- Department of Psychiatry; University of Washington School of Medicine; Seattle Washington
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Champion JD, Young C, Rew L. Substantiating the need for primary care-based sexual health promotion interventions for ethnic minority adolescent women experiencing health disparities. J Am Assoc Nurse Pract 2016; 28:487-92. [PMID: 26887630 DOI: 10.1002/2327-6924.12346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 12/28/2015] [Indexed: 11/12/2022]
Abstract
PURPOSE Assess the context of psychological distress, violence, and substance use among African- and Mexican-American adolescent women with a history of STI, violence, or high sexual risk behavior. These adolescents experience multiple health disparities, limited access to care, and are at particularly high risk of adverse sexual health outcomes. The results will inform sexual health promotion interventions provided by advanced practice nurses in primary care-based settings for women experiencing these disparities. METHODS Analysis of self-report data obtained at study entry from African- and Mexican-American adolescent women (n = 559) enrolled in a randomized trial of a behavioral intervention for sexual risk reduction. CONCLUSIONS High levels of psychological distress, sexual risk behavior, sexually transmitted infection (STI), personal and friend/peer substance use, alcohol use, and violence were reported by women at study entry. Analyses found that STI, physical violence, and substance-using friends were twice as likely associated with personal substance use. Alcohol users were five times more likely to use other substances. Mexican Americans were three times more likely than African Americans to use substances. IMPLICATIONS FOR PRACTICE Recommendation is made for integration of multicomponent sexual health promotion interventions as advanced practice nurse provider services addressing these health disparities within primary care-based settings.
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Affiliation(s)
| | - Cara Young
- School of Nursing, The University of Texas at Austin, Austin, Texas
| | - Lynn Rew
- School of Nursing, The University of Texas at Austin, Austin, Texas
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Aguiar MIFD, Lima HDP, Braga VAB, Aquino PDS, Pinheiro AKB, Ximenes LB. Nurse competencies for health promotion in the mental health context. ACTA PAUL ENFERM 2012. [DOI: 10.1590/s0103-21002012000900025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To identify the competencies of nurses to health promotion in psychiatric and mental health context. METHODS: Integrative review of literature performed through search using the keywords: "mental health" and "professional competence", in the databases SciELO, LILACS, CINAHL, PubMed, Scopus and Cochrane, in the period of 2003 to 2011. 215 studies were identified, of these, six followed the inclusion criteria. RESULTS: Based on the National Panel for Psychiatric Mental Health NP Competencies, the competencies were identified on the evaluated studies: Monitoring and ensuring the quality of health care practice, management of patient health/illness status, cultural competence, managing and negotiating health care delivery systems, the nurse practitioner-patient relationship. CONCLUSION: The studies analysis evidenced the need for education and training so that nurses may develop the competencies of health promotion in diverse psychiatric care and mental health contexts, in order to broaden knowledge and skills.
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Chipp C, Dewane S, Brems C, Johnson ME, Warner TD, Roberts LW. "If only someone had told me…": lessons from rural providers. J Rural Health 2011; 27:122-30. [PMID: 21204979 DOI: 10.1111/j.1748-0361.2010.00314.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Health care providers face challenges in rural service delivery due to the unique circumstances of rural living. The intersection of rural living and health care challenges can create barriers to care that providers may not be trained to navigate, resulting in burnout and high turnover. Through the exploration of experienced rural providers' knowledge and lessons learned, this study sought to inform future practitioners, educators, and policy makers in avenues through which to enhance training, recruiting, and maintaining a rural workforce across multiple health care domains. METHODS Using a qualitative study design, 18 focus groups were conducted, with a total of 127 health care providers from Alaska and New Mexico. Transcribed responses from the question, "What are the 3 things you wish someone would have told you about delivering health care in rural areas?" were thematically coded. FINDINGS Emergent themes coalesced into 3 overarching themes addressing practice-related factors surrounding the challenges, adaptations, and rewards of being a rural practitioner. CONCLUSION Based on the themes, a series of recommendations are offered to future rural practitioners related to community engagement, service delivery, and burnout prevention. The recommendations offered may help practitioners enter communities more respectfully and competently. They can also be used by training programs and communities to develop supportive programs for new practitioners, enabling them to retain their services, and help practitioners integrate into the community. Moving toward an integrative paradigm of health care delivery wherein practitioners and communities collaborate in service delivery will be the key to enhancing rural health care and reducing disparities.
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Affiliation(s)
- Cody Chipp
- Center for Behavioral Health Research and Services, University of Alaska Anchorage, Anchorage, Alaska 99508, USA
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Alegria M, Carson NJ, Goncalves M, Keefe K. Disparities in treatment for substance use disorders and co-occurring disorders for ethnic/racial minority youth. J Am Acad Child Adolesc Psychiatry 2011; 50:22-31. [PMID: 21156267 PMCID: PMC3488852 DOI: 10.1016/j.jaac.2010.10.005] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 08/28/2010] [Accepted: 10/18/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To review the literature on racial and ethnic disparities in behavioral health services and present recent data, focusing on services for substance use disorders (SUD) and comorbid mental health disorders for children and adolescents. METHOD A literature review was conducted of behavioral health services for minority youth. Articles were included if specific comparisons in receipt of SUD services for youth were made by race or ethnicity. The review was organized according to a sociocultural framework. RESULTS Compared with non-Latino Whites with SUD, Black adolescents with SUD reported receiving less specialty and informal care, and Latinos with SUD reported less informal services. Potential mechanisms of racial and ethnic disparities were identified in federal and economic health care policies and regulations, the operation of the health care system and provider organization, provider level factors, the environmental context, the operation of the community system, and patient level factors. Significant disparity decreases could be achieved by adoption of certain state policies and regulations that increase eligibility in public insurance. There is also a need to study how the organization of treatment services might lead to service disparities, particularly problems in treatment completion. Institutional and family characteristics linked to better quality of care should be explored. Because treatments appear to work well independent of race/ethnicity, translational research to bring evidence-based care in diverse communities can bolster their effectiveness. CONCLUSIONS This review suggests promising venues to decrease ethnic and racial disparities in behavioral health services for ethnic and racial minority youth.
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Affiliation(s)
- Margarita Alegria
- Center for Multicultural Mental Health Research, Cambridge Health Alliance and Harvard Medical School, 120 Beacon Street, Somerville, MA 02143, USA.
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Ishikawa RZ, Cardemil EV, Falmagne RJ. Help seeking and help receiving for emotional distress among Latino men and women. QUALITATIVE HEALTH RESEARCH 2010; 20:1558-72. [PMID: 20448272 DOI: 10.1177/1049732310369140] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In this study, we examined help-seeking pathways and help-receiving experiences among Latinos, a population that has been shown to under-utilize mental health services. We used the qualitative approach of dual mode of analysis to explore the experiences of 13 Latino men and women who utilized formal as well as informal treatment and support resources. We explored three specific themes: (a) individual and family help-seeking perspectives intersecting with Latino cultural norms; (b) referral source and style, needs identification, and prior help-seeking experiences as key motivational factors for help seeking; and (c) client-therapist match and client-therapist relational style as integral to mental health treatment satisfaction. We discuss clinical implications for efforts to improve the cultural sensitivity and accessibility of mental health services.
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Affiliation(s)
- Rachel Zack Ishikawa
- Frances L. Hiatt School of Psychology, Clark University, 950 Main St., Worcester, MA 01610, USA.
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Millender EI. Stress experienced by Guatemalan-Mayan immigrants. Arch Psychiatr Nurs 2010; 24:212-4. [PMID: 20488347 DOI: 10.1016/j.apnu.2009.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 04/02/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Eugenia I Millender
- Florida Atlantic Univeristy, Christine E. Lynn College of Nursing, Boca, Raton, FL 33431, USA.
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Beagan BL, Etowa J. The Impact of Everyday Racism on the Occupations of African Canadian Women. The Canadian Journal of Occupational Therapy 2009; 76:285-93. [DOI: 10.1177/000841740907600407] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Occupational therapy has increasingly explored the impact of cultural differences on occupations but has not yet begun to explore the impact of racism on human occupation. Purpose. This study with 50 African Canadian women used mixed methods to explore the effects of racism on their occupational experiences. Methods. Women aged 40–65 were interviewed in-depth about everyday experiences with racism and overall well-being. Three standardized instruments assessed frequency and stressfulness of race-related experiences. Findings. Everyday racism had subtle, almost intangible, impacts, shaping women's engagement with and the meaning of leisure, productive, and caring occupations. Implications. As occupational therapy increasingly attends to issues of cultural difference, it is critical to also attend to racism. This means learning to ask thoughtful questions about how racism may shape clients' occupations. Attention to this aspect of the social environment will enhance practice with African-heritage clients and clients from other racial minority groups.
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Willging CE, Waitzkin H, Lamphere L. Transforming administrative and clinical practice in a public behavioral health system: an ethnographic assessment of the context of change. J Health Care Poor Underserved 2009; 20:866-83. [PMID: 19648713 DOI: 10.1353/hpu.0.0177] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In July 2005, New Mexico placed all publicly funded behavioral health services under the management of one private corporation. This reform emphasized the provision of evidence-based, culturally competent services. Methods. Participant observation and semi-structured interviews with 189 administrators, staff, and providers were carried out in 14 behavioral health safety-net institutions (SNIs) during the transition period. Results. New administrative requirements led to substantial paperwork demands, payment problems, and financial stress within SNIs. Personnel at the SNIs often lacked knowledge about and training in evidence-based practices and culturally competent care, and viewed the costs of delivering such services as prohibitive. Discussion. Policymakers must account for the challenges that SNIs face as the reform continues to unfold. The financial stability of SNIs is of critical importance. Efforts are needed to increase training and development opportunities in evidence-based care and cultural competency; SNIs typically lack resources to pursue these opportunities on their own.
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Garcia de Cortazar AR, Cabrera Leon A, Hernan Garcia M, Jimenez Nunez JM. Attitudes of adolescent Spanish Roma toward noninjection drug use and risky sexual behavior. QUALITATIVE HEALTH RESEARCH 2009; 19:605-620. [PMID: 19299254 DOI: 10.1177/1049732309333813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Our objective with this study was to analyze the opinions of a potentially socially marginalized group of Spanish Roma adolescents and young adults about noninjection drug use, HIV infection, and risky sexual behavior. Descriptive qualitative research was conducted through focus groups with Roma participants and semistructured interviews with professionals who work with them in areas such as education and health promotion. Results were triangulated by cross analysis among researchers. Declared drug consumption is lower among females than males. The former claim they do not maintain sporadic sexual relations, and link risky sexual practices to being in love and involved in a stable relationship. Males only use condoms in sporadic sexual relations. They attribute their lack of condom use to lost sensitivity, perceiving sex as something uncontrollable, and not having condoms available when using drugs. Results suggest the need to improve actions aimed at preventing the sexual transmission of HIV among the Roma population.
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Semansky RM, Altschul D, Sommerfeld D, Hough R, Willging CE. Capacity for delivering culturally competent mental health services in New Mexico: results of a statewide agency survey. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2009; 36:289-307. [PMID: 19370410 DOI: 10.1007/s10488-009-0221-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Accepted: 03/25/2009] [Indexed: 11/25/2022]
Abstract
The Federal government has promoted National Standards for Culturally and Linguistically Appropriate Services (CLAS) to reduce mental health disparities among Hispanic and Native American populations. In 2005, the State of New Mexico embarked upon a comprehensive reform of its behavioral health system with an emphasis on improving cultural competency. Using survey methods, we examine which language access services (i.e., capacity for bilingual care, interpretation, and translated written materials) and organizational supports (i.e., training, self-assessments of cultural competency, and collection of cultural data) mental health agencies in New Mexico had at the onset of a public sector mental health reform (Office of Minority Health 2001).
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Affiliation(s)
- Rafael M Semansky
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, NM 87102, USA.
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Willging CE, Waitzkin H, Nicdao E. Medicaid managed care for mental health services: the survival of safety net institutions in rural settings. QUALITATIVE HEALTH RESEARCH 2008; 18:1231-1246. [PMID: 18689536 DOI: 10.1177/1049732308321742] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Few accounts document the rural context of mental health safety net institutions (SNIs), especially as they respond to changing public policies. Embedded in wider processes of welfare state restructuring, privatization has transformed state Medicaid systems nationwide. We carried out an ethnographic study in two rural, culturally distinct regions of New Mexico to assess the effects of Medicaid managed care (MMC) and the implications for future reform. After 160 interviews and participant observation at SNIs, we analyzed data through iterative coding procedures. SNIs responded to MMC by nonparticipation, partnering, downsizing, and tapping into alternative funding sources. Numerous barriers impaired access under MMC: service fragmentation, transportation, lack of cultural and linguistic competency, Medicaid enrollment, stigma, and immigration status. By privatizing Medicaid and contracting with for-profit managed care organizations, the state placed additional responsibilities on "disciplined" providers and clients. Managed care models might compromise the rural mental health safety net unless the serious gaps and limitations are addressed in existing services and funding.
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Affiliation(s)
- Cathleen E Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
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