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Oluwoye O, Nagendra A, Kriegel LS, Anglin DM, Santos MM, López SR. Reorienting the focus from an individual to a community-level lens to improve the pathways through care for early psychosis in the United States. SSM - MENTAL HEALTH 2023; 3:100209. [PMID: 37475775 PMCID: PMC10355221 DOI: 10.1016/j.ssmmh.2023.100209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
The implementation of coordinated specialty care in the U.S. over the past decade has led to the improvements of clinical and functional outcomes among individuals in the early stages of psychosis. While there have been advancements in the delivery of early intervention services for psychosis, it has almost exclusively focused on short-term change at the individual level. In light of these advancements, research has identified gaps in access to care and delivery of services that are driven by different levels of determinants and have the biggest impact on historically excluded groups (e.g., ethnoracial minoritized communities). Interventions or efforts that place an emphasis on community level (structural or sociocultural) factors and how they may influence pathways to care and through care, specifically for those who have been historically excluded, have largely been missing from the design, dissemination and implementation of early psychosis services. The present paper uses a structural violence framework to review current evidence related to pathways to care for early psychosis and the physical/built environment and conditions (e.g., urbanicity, residential instability) and formal and informal community resources. Suggestions on future directions are also provided, that focus on enriching communities and creating sustainable change that spans from pathways leading to care to 'recovery.' In all, this lays the groundwork for a proposed paradigm shift in research and practice that encompasses the need for an emphasis on structural competency and community-driven approaches.
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Affiliation(s)
- Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, Spokane 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA
| | - Arundati Nagendra
- Center of Excellence in Psychosocial and Systemic Research, Massachusetts General Hospital/Harvard Medical School, 151 Merrimac Street, Floor 6, Boston, MA, 02114, USA
| | - Liat S. Kriegel
- Elson S. Floyd College of Medicine, Washington State University, Spokane 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA
| | - Deidre M. Anglin
- City University of New York, Department of Psychology, 160 Convent Ave, NAC Building, Room 7/120, New York, NY, 10031, USA
| | - Maria M. Santos
- Department of Psychology, California State University, San Bernardino, 5500 University Parkway, San Bernardino, CA, 92407, USA
| | - Steven R. López
- Department of Psychology, University of Southern California, Seeley G. Mudd Room 501, 3620 S. McClintock, Los Angeles, CA, 90089, USA
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López SR, Kopelowicz A, Ullman J, Mayer D, Santos MM, Kratzer M, Vega WA, Barrio C, Calderon V. Toward reducing the duration of untreated psychosis in a Latinx community. J Consult Clin Psychol 2022; 90:815-826. [PMID: 35588388 PMCID: PMC9949997 DOI: 10.1037/ccp0000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To carry out and evaluate a communications campaign (La CLAve) to reduce the duration of untreated psychosis (DUP) in a U.S. Latinx community. METHOD We employed evidence-based messaging in multiple media outlets. We recruited 132 Latinxs with first-episode psychosis (FEP) and caregivers seeking mental health care within a high-density Latinx community. We evaluated the campaign's dissemination, the extent to which the community received the campaign message, and the campaign outcome. We tested whether DUP (number of weeks) changed across three time periods (16-month baseline, 2-year campaign, and 16-month postcampaign) and whether participants' language background (primarily Spanish speaking or English speaking) moderated change in DUP. RESULTS The campaign was disseminated widely. During the height of the campaign over a 1-year period, our team distributed 22,039 brochures and performed 740 workshops. The campaign message was received by the community as noted for example by increases in the number of unduplicated weekly calls to the campaign's 1-800 number. Applying square root transformations to DUP, we found a significant main effect for language background but not for campaign period nor their interaction. The unadjusted mean DUP for Spanish-speaking persons with FEP was more than twice as high as the mean DUP for English-speaking persons with FEP. CONCLUSION Spanish-speaking Latinxs with FEP are especially in need of early psychosis treatment. The campaign reached the community but additional steps are needed to reduce treatment delay. Greater attention is needed to increase access to early intervention services for communities of color. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Calderon V, Cain R, Torres E, Lopez SR. Evaluating the message of an ongoing communication campaign to reduce the duration of untreated psychosis in a Latinx community in the United States. Early Interv Psychiatry 2022; 16:147-152. [PMID: 33768718 DOI: 10.1111/eip.13140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/06/2021] [Indexed: 11/26/2022]
Abstract
AIM Initiatives aimed at reducing the duration of untreated psychosis (DUP) attempt to increase the community's level of psychosis literacy. Most of these efforts, however, have failed to reduce DUP. One plausible explanation is that the campaigns do not actually increase psychosis literacy. To date, there have been few efforts to assess whether the campaign messaging does indeed increase psychosis literacy prior to or during the campaign. This study evaluated whether the message of the La CLAve DUP reduction program delivered during the campaign increased the psychosis literacy of a U.S. Latinx community. METHODS The sample consisted of 81 Latinx community residents aged 15-84. Two community health educators of the La CLAve campaign facilitated workshops using a narrative film to initiate a conversation in the community about the signs of psychosis and the importance of professional help-seeking early in the illness course. Psychosis literacy was assessed via questionnaires pertaining to a hypothetical vignette administered before and after the workshops. RESULTS The psychosis literacy of participants increased after the workshops in several domains. Participants' knowledge of multiple psychotic symptoms, self-efficacy in their ability to recognize psychosis in others, and correct attributions of a hypothetical vignette's psychotic symptoms significantly increased. No changes were observed in recommendations for professional help-seeking. CONCLUSIONS These findings provide support for the effectiveness of the La CLAve messaging in increasing psychosis literacy of U.S. Latinx community residents. Evidence-based campaign messaging is needed to increase the success of DUP reduction programs especially among underserved communities.
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Affiliation(s)
- Vanessa Calderon
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Rosalba Cain
- USC Alzheimer's Disease Research Center, Los Angeles, California, USA
| | - Eva Torres
- Los Angeles County Department of Mental Health, Los Angeles, California, USA
| | - Steven R Lopez
- Department of Psychology, University of Southern California, Los Angeles, California, USA
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Friedman BR, Durán DK, Nestsiarovich A, Tohen M, Lenroot RK, Bustillo JR, Crisanti AS. Characteristics of Hispanics Referred to Coordinated Specialty Care for First-Episode Psychosis and Factors Associated With Enrollment. Psychiatr Serv 2021; 72:1407-1414. [PMID: 34074143 DOI: 10.1176/appi.ps.202000798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The primary objectives of this study were to examine referral sources and demographic, clinical, and socioenvironmental characteristics of Hispanics referred to and enrolled in a program of coordinated specialty care (Early CSC program) for first-episode psychosis, to compare them with characteristics of other referred and enrolled racial-ethnic groups, and to identify factors associated with enrollment in the program. METHODS A retrospective review was conducted for all individuals referred to and enrolled in the Early CSC program over a 2-year period. Extracted data included referral sources and demographic and clinical characteristics. Zip code-level data from publicly available sources were cross-referenced with individual records. Nonparametric tests and appropriate secondary analysis were used to determine significant differences across racial-ethnic groups referred to (N=180) or enrolled in (N=75) the Early CSC program. A random forest model was used to determine which factors or interacting factors were associated with enrollment among the eligible referrals (N=114). RESULTS Hispanic individuals were more likely to be referred from inpatient or outpatient mental health providers and not from other community sources. Among eligible Hispanic referrals, those who lived in areas with a lower percentage of Spanish speaking in the home were more likely to enroll in services, compared with those who lived in areas with a higher percentage of Spanish speaking. CONCLUSIONS Continued exploration of factors associated with referral and enrollment in CSC programs for the growing Hispanic ethnic group in the United States can help determine best steps for developing these programs.
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Affiliation(s)
- Bess Rose Friedman
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
| | - Danielle K Durán
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
| | | | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
| | - Rhoshel K Lenroot
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
| | - Juan R Bustillo
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
| | - Annette S Crisanti
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
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Hernandez M, Hernandez MY, Lopez D, Barrio C, Gamez D, López SR. Family processes and duration of untreated psychosis among US Latinos. Early Interv Psychiatry 2019; 13:1389-1395. [PMID: 30644163 PMCID: PMC6629522 DOI: 10.1111/eip.12779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/27/2018] [Accepted: 12/26/2018] [Indexed: 11/28/2022]
Abstract
AIM Little is known about family processes and treatment seeking among Latinos with first-episode psychosis (FEP) living in the United States. This study examined family processes prior to treatment and their relation to duration of untreated psychosis (DUP) among Latinos with FEP and their family caregivers. METHODS Thirty-three Latinos with FEP and their low-acculturated family caregivers (n = 33) participated in qualitative semi-structured interviews focused on treatment-seeking experience and family relationships. Transcripts were analysed using thematic analysis and themes were grouped based on short (n = 18) or long (n = 15) DUP. RESULTS Findings revealed differences based on DUP length. Patients with short DUP had stronger family relationships characterized by open communication and disclosure of symptoms that facilitated awareness and direct action by family caregivers. However, patients with long DUP had more troubled family relationships that often challenged early treatment seeking. CONCLUSIONS Findings highlight the relevance of family context in the provision of early treatment for Latinos with FEP. Family-based services are needed that increase awareness of symptoms and provide families with support that can facilitate ongoing patient treatment during this critical period.
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Affiliation(s)
- Mercedes Hernandez
- Department of Psychology, University of Southern California, Los Angeles, California
| | - Maria Y Hernandez
- Department of Psychology, University of Southern California, Los Angeles, California
| | - Daisy Lopez
- Department of Psychology, University of Southern California, Los Angeles, California
| | - Concepción Barrio
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Diana Gamez
- Department of Psychology, University of Southern California, Los Angeles, California
| | - Steven R López
- Department of Psychology, University of Southern California, Los Angeles, California
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Hernandez M, Franco R, Kopelowicz A, Hernandez MY, Mejia Y, Barrio C, López SR. Lessons Learned in Clinical Research Recruitment of Immigrants and Minority Group Members with First-Episode Psychosis. J Immigr Minor Health 2019; 21:123-128. [PMID: 29368059 DOI: 10.1007/s10903-018-0704-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recruitment of immigrants and racial and ethnic minorities with first-episode psychosis (FEP) for research studies presents numerous challenges. We describe methods used to recruit 43 U.S. Latinos with FEP and their family caregivers (n = 41) participating in a study to reduce duration of untreated psychosis. A key challenge was that patients were not continuing treatment at an outpatient clinic, as initially expected. To facilitate identification of patients prior to outpatient care, we collaborated with clinic and hospital administrators. Many patients and families were grappling with the aftermath of a hospitalization or adjusting to a diagnosis of a serious mental illness. A considerable amount of time was devoted to addressing participants' concerns and when possible, facilitating needed services. Our experience underscores the importance of establishing long-term relationships through multiple contacts with patients, families, and stakeholders to address recruitment barriers among underserved groups with FEP.
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Affiliation(s)
- Mercedes Hernandez
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Boulevard (D3500), Austin, TX, 78712-1405, USA.
| | - Richard Franco
- Department of Psychiatry & Behavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alex Kopelowicz
- Department of Psychiatry & Behavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Maria Y Hernandez
- School of Social Work, California State University, Los Angeles, Los Angeles, CA, USA
| | - Yesenia Mejia
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Concepción Barrio
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Steven Regeser López
- Department of Psychology, University of Southern California, 3620 S. McClintock Avenue, Los Angeles, CA, 90089-1061, USA.
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López SR, Gamez D, Mejia Y, Calderon V, Lopez D, Ullman JB, Kopelowicz A. Psychosis Literacy Among Latinos With First-Episode Psychosis and Their Caregivers. Psychiatr Serv 2018; 69:1153-1159. [PMID: 30220245 PMCID: PMC6408217 DOI: 10.1176/appi.ps.201700400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined psychosis literacy among Latinos with first-episode psychosis (FEP) and their caregivers. The authors tested a model that knowledge of psychosis and attribution of illness to psychosis predicted professional help seeking in a cross-sectional design. METHODS The sample (N=148) consisted of 79 Latino consumers who met criteria for a clinical diagnosis of a psychotic disorder and 69 family caregivers. Participants watched a four-minute narrative about a woman with psychosis and were asked to identify the symptoms of serious mental illness (knowledge of psychosis), describe the character's problem and whether she had a serious mental illness (illness attribution), and offer suggestions about what the parents should do (help seeking). Responses to the open-ended questions were reliably coded by two trained raters. RESULTS Consumers reported low psychosis literacy across all indices (e.g., only 8% included delusions in their knowledge of serious mental illness). Compared with consumers, caregivers reported significantly greater psychosis literacy across most indices, although relatively few reported knowledge of delusions (28%) and disorganized speech (36%). Logistic regression analyses found that caregivers were more than twice as likely as consumers to suggest that the parents seek professional help. Among both consumers and caregivers, greater knowledge of psychosis and attribution of symptoms to serious mental illness were associated with increased likelihood of recommending professional help seeking. CONCLUSIONS Community campaigns and psychoeducation interventions within clinical settings are needed to improve psychosis literacy among Latinos with FEP. Increasing knowledge of psychosis and facilitating attributions of psychotic symptoms to serious mental illness have the potential to promote professional help seeking.
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Affiliation(s)
- Steven R López
- Dr. López, Ms. Gamez, Ms. Calderon, and Ms. Lopez are with the Department of Psychology, University of Southern California, Los Angeles. Ms. Mejia is with the Department of Psychology, University of North Carolina, Greensboro. Dr. Ullman is with the Department of Psychology, California State University, San Bernardino. Dr. Kopelowicz is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Diana Gamez
- Dr. López, Ms. Gamez, Ms. Calderon, and Ms. Lopez are with the Department of Psychology, University of Southern California, Los Angeles. Ms. Mejia is with the Department of Psychology, University of North Carolina, Greensboro. Dr. Ullman is with the Department of Psychology, California State University, San Bernardino. Dr. Kopelowicz is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Yesenia Mejia
- Dr. López, Ms. Gamez, Ms. Calderon, and Ms. Lopez are with the Department of Psychology, University of Southern California, Los Angeles. Ms. Mejia is with the Department of Psychology, University of North Carolina, Greensboro. Dr. Ullman is with the Department of Psychology, California State University, San Bernardino. Dr. Kopelowicz is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Vanessa Calderon
- Dr. López, Ms. Gamez, Ms. Calderon, and Ms. Lopez are with the Department of Psychology, University of Southern California, Los Angeles. Ms. Mejia is with the Department of Psychology, University of North Carolina, Greensboro. Dr. Ullman is with the Department of Psychology, California State University, San Bernardino. Dr. Kopelowicz is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Daisy Lopez
- Dr. López, Ms. Gamez, Ms. Calderon, and Ms. Lopez are with the Department of Psychology, University of Southern California, Los Angeles. Ms. Mejia is with the Department of Psychology, University of North Carolina, Greensboro. Dr. Ullman is with the Department of Psychology, California State University, San Bernardino. Dr. Kopelowicz is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Jodie B Ullman
- Dr. López, Ms. Gamez, Ms. Calderon, and Ms. Lopez are with the Department of Psychology, University of Southern California, Los Angeles. Ms. Mejia is with the Department of Psychology, University of North Carolina, Greensboro. Dr. Ullman is with the Department of Psychology, California State University, San Bernardino. Dr. Kopelowicz is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Alex Kopelowicz
- Dr. López, Ms. Gamez, Ms. Calderon, and Ms. Lopez are with the Department of Psychology, University of Southern California, Los Angeles. Ms. Mejia is with the Department of Psychology, University of North Carolina, Greensboro. Dr. Ullman is with the Department of Psychology, California State University, San Bernardino. Dr. Kopelowicz is with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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Hernandez MY, Mejia Y, Mayer D, Lopez SR. Using a Narrative Film to Increase Knowledge and Interpersonal Communication About Psychosis Among Latinos. JOURNAL OF HEALTH COMMUNICATION 2016; 21:1236-1243. [PMID: 27858525 PMCID: PMC5508716 DOI: 10.1080/10810730.2016.1242670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Narrative communication is effective in increasing public awareness while generating dialogue about varied health topics. The current study utilized narrative communication in the form of a 15-minute motivational film titled La CLAve to help Latinos recognize symptoms of psychosis and begin a discussion about serious mental illness. The study aimed to explore the participants' response to the film and whether the film led to further dialogue about psychosis. Four focus groups were conducted with 40 Spanish-speaking participants, mostly foreign-born Latinas, with a mean age of 49 years. Results indicate that participants engaged with the film as reflected in their ability to recall the storyline in detail. Reports of psychosis knowledge gains included recognition of key symptoms, such as hallucinations and disorganized speech. Participants attributed symptoms of psychosis, observed in a film character, to social stressors and other previously constructed views of mental illness. Many participants discussed the content of the film within their immediate social networks. Other findings include discussions of key barriers and facilitators to seeking mental health treatment among Latino families, such as denial and family support. Results suggest that narrative films offer a promising strategy to stimulate dialogue about serious mental illness among Latinos.
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Affiliation(s)
- Maria Y. Hernandez
- School of Social Work, California State University, Los Angeles, Los Angeles, California, USA
| | - Yesenia Mejia
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Doe Mayer
- School of Cinematic Arts, Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, California, USA
| | - Steven R. Lopez
- Department of Psychology, University of Southern California, Los Angeles, California, USA
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