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Abu K, Bedard-Gilligan M, Moodliar R, Bulger EM, Hernandez A, Knutzen T, Shoyer J, Birk N, Conde C, Engstrom A, Ryan P, Wang J, Russo J, Zatzick DF. Can stepped collaborative care interventions improve post-traumatic stress disorder symptoms for racial and ethnic minority injury survivors? Trauma Surg Acute Care Open 2024; 9:e001232. [PMID: 38287923 PMCID: PMC10824071 DOI: 10.1136/tsaco-2023-001232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/07/2024] [Indexed: 01/31/2024] Open
Abstract
Objectives No large-scale randomized clinical trial investigations have evaluated the potential differential effectiveness of early interventions for post-traumatic stress disorder (PTSD) among injured patients from racial and ethnic minority backgrounds. The current investigation assessed whether a stepped collaborative care intervention trial conducted at 25 level I trauma centers differentially improved PTSD symptoms for racial and ethnic minority injury survivors. Methods The investigation was a secondary analysis of a stepped wedge cluster randomized clinical trial. Patients endorsing high levels of distress on the PTSD Checklist (PCL-C) were randomized to enhanced usual care control or intervention conditions. Three hundred and fifty patients of the 635 randomized (55%) were from non-white and/or Hispanic backgrounds. The intervention included care management, cognitive behavioral therapy elements and, psychopharmacology addressing PTSD symptoms. The primary study outcome was PTSD symptoms assessed with the PCL-C at 3, 6, and 12 months postinjury. Mixed model regression analyses compared treatment effects for intervention and control group patients from non-white/Hispanic versus white/non-Hispanic backgrounds. Results The investigation attained between 75% and 80% 3-month to 12-month follow-up. The intervention, on average, required 122 min (SD=132 min). Mixed model regression analyses revealed significant changes in PCL-C scores for non-white/Hispanic intervention patients at 6 months (adjusted difference -3.72 (95% CI -7.33 to -0.10) Effect Size =0.25, p<0.05) after the injury event. No significant differences were observed for white/non-Hispanic patients at the 6-month time point (adjusted difference -1.29 (95% CI -4.89 to 2.31) ES=0.10, p=ns). Conclusion In this secondary analysis, a brief stepped collaborative care intervention was associated with greater 6-month reductions in PTSD symptoms for non-white/Hispanic patients when compared with white/non-Hispanic patients. If replicated, these findings could serve to inform future American College of Surgeon Committee on Trauma requirements for screening, intervention, and referral for PTSD and comorbidities. Level of evidence Level II, secondary analysis of randomized clinical trial data reporting a significant difference. Trial registration number NCT02655354.
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Affiliation(s)
- Khadija Abu
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Michelle Bedard-Gilligan
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rddhi Moodliar
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Alexandra Hernandez
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Tanya Knutzen
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jake Shoyer
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Navneet Birk
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Cristina Conde
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Allison Engstrom
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Paige Ryan
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jin Wang
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Joan Russo
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas F Zatzick
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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La Rosa A, Abu K, Hernandez A, Zatzick D. Advancing Concerns of Spanish-Speaking Physical Injury Survivors: Equitable Trauma Care System Service Delivery. Psychiatry 2023; 86:364-371. [PMID: 37540791 DOI: 10.1080/00332747.2023.2238573] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
Objective: Few investigations have focused specifically on engaging Spanish-speaking patients in early post-injury comparative effectiveness trials. The goal of this study was to identify and categorize hospitalized Spanish-speaking injury survivors' posttraumatic concerns. Method: A secondary analysis of baseline data collected as part of a larger randomized comparative effectiveness trial was conducted. Participants were 22 male and female Spanish, non-English, speaking survivors of intentional and unintentional injuries, ages ≥ 18. At baseline, while hospitalized, each patient was asked to describe the nature and severity of their post-injury concerns. Patient concern narratives were audio-recorded and later transcribed. Raters coded patients' transcribed concerns into content domains. The associations between patient self-reported concern severity and posttraumatic stress disorder symptoms assessed with the PTSD Checklist and depressive symptoms assessed with the PHQ-9 were also ascertained. Results: The concerns of Spanish-speaking patients were reliably categorized into previously described content domains (i.e., work and finance, physical health, social, psychological, medical, and legal domains). The composite Kappa statistic across domains was 0.83 (95% Confidence Interval = 0.74, 0.92). Spanish-speaking patients also expressed novel concerns, including immigration, discriminatory experiences, and Coronavirus pandemic, related concerns. The number of severe patient concerns was highly correlated with PHQ-9 depressive symptom levels (r = 0.52, p < .05). Conclusions: The concerns of Spanish-speaking trauma survivors can be readily elicited and reliably interpreted. Future research could integrate concern narrative elicitation and amelioration into stepped care intervention procedures in order to engage diverse Spanish-speaking injury survivors and advance equitable trauma care system service delivery.
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Herron JL, Venner KL. A Systematic Review of Trauma and Substance Use in American Indian and Alaska Native Individuals: Incorporating Cultural Considerations. J Racial Ethn Health Disparities 2023; 10:603-632. [PMID: 35089579 PMCID: PMC9329482 DOI: 10.1007/s40615-022-01250-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/20/2022] [Accepted: 01/23/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Disproportionate rates of psychiatric disorders, like substance use and posttraumatic stress disorders (SUD and PTSD), exist among American Indian and Alaska Native (AI/AN) individuals. This review examines substance use and trauma in existing AI/AN literature and utilizes an AI/AN-specific model to culturally inform the relationship between these factors and provide recommendations for future research. METHODS We searched three databases through April 2021 for peer-reviewed articles that examined substance use and trauma in AI/AN individuals. RESULTS The search identified 289 articles and of those, 42 were eligible for inclusion, including 36 quantitative and 6 qualitative studies. Rates of lifetime trauma exposure varied from 21 to 98% and were correlated with increased rates of SUDs. A dose response of traumatic events also increased the likelihood of an SUD among reservation-based AI populations. Factors from the Indigenist Stress Coping model included cultural buffers such as traditional healing and cultural identity, which aided in recovery from SUD and trauma, and social stressors like boarding school attendance, discrimination, and historical loss. CONCLUSIONS SUD and trauma are highly correlated among AI/AN individuals though rates of PTSD are lower than might be expected suggesting resilience. However, this pattern may not be consistent across all AI/AN groups and further research is needed to better explain the existing relationship of SUD and PTSD and relevant historical and cultural factors. Further research is needed to culturally tailor, implement, and validate PTSD and SUD assessments and treatments to ameliorate these health inequities.
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Affiliation(s)
- Jalene L Herron
- Psychology Department, University of New Mexico, MSC03-2220, Albuquerque, NM, 87131, USA.
- Center On Alcohol, Substance Use, & Addiction, University of New Mexico, Albuquerque, NM, 87131, USA.
| | - Kamilla L Venner
- Psychology Department, University of New Mexico, MSC03-2220, Albuquerque, NM, 87131, USA
- Center On Alcohol, Substance Use, & Addiction, University of New Mexico, Albuquerque, NM, 87131, USA
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Lee RS, Brown HK, Salih S, Benoit AC. Systematic review of Indigenous involvement and content in mental health interventions and their effectiveness for Indigenous populations. Aust N Z J Psychiatry 2022; 56:1230-1251. [PMID: 35379008 PMCID: PMC9513504 DOI: 10.1177/00048674221089837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the effects of psychological, psychosocial, educational and alternative interventions on mental health outcomes of Indigenous adult populations in Australia, Canada, New Zealand and the United States and the Indigenous involvement and content in each study. METHODS We systematically searched databases, key journals and gray literature, for records until June 2020. Eligible studies were in English or French and examined the impact of interventions on mental health outcomes including anxiety disorders, posttraumatic stress disorder, depression, psychological distress or stress for Indigenous adults (⩾16 years). Data were extracted using a modified Cochrane Data Extraction Form and the Template for Intervention Description and Replication. Quality was evaluated using the Effective Public Health Practice Project quality assessment form. RESULTS In total, 21 studies were eligible, comprising 8 randomized controlled trials, 10 single-group pre-post studies and 3 pre-post studies with comparison groups. Twenty studies had Indigenous individuals or organizations involved in some decision-making capacity, though extent of involvement varied widely. In total, 9 studies were rated moderate and 12 weak in the Effective Public Health Practice Project quality assessment. Eight studies measuring depression, three measuring posttraumatic stress disorder, three measuring psychological distress and two measuring stress showed statistically significant improvements following the intervention. CONCLUSION A wide range of interventions demonstrated mental health improvements. However, it is difficult to draw generalizable conclusions on intervention effectiveness, given heterogeneity among studies. Studies should employ a thorough assessment of the Indigenous involvement and content of their interventions for reporting and for critical consideration of the implications of their research and whether they address Indigenous determinants of mental health.
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Affiliation(s)
- Rachel Seungyun Lee
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Hilary K Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Department of Health and Society, University of Toronto Scarborough, Scarborough, ON, Canada,Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - Sarah Salih
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Anita C Benoit
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Department of Health and Society, University of Toronto Scarborough, Scarborough, ON, Canada,Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, ON, Canada,Anita C Benoit, Department of Health and Society, University of Toronto Scarborough, 1265 Military Trail, Toronto, ON M1C 1A4, Canada.
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Pride T, Lam A, Swansburg J, Seno M, Lowe MB, Bomfim E, Toombs E, Marsan S, LoRusso J, Roy J, Gurr E, LaFontaine J, Paul J, Burack JA, Mushquash C, Stewart SH, Wendt DC. Trauma-informed Approaches to Substance Use Interventions with Indigenous Peoples: A Scoping Review. J Psychoactive Drugs 2021; 53:460-473. [PMID: 34895091 DOI: 10.1080/02791072.2021.1992047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Indigenous Peoples experience disproportionately higher rates of problematic substance use. These problems are situated in a context of individual and intergenerational trauma from colonization, residential schools, and racist and discriminatory practices, policies, and services. Therefore, substance use interventions need to adopt a trauma-informed approach. We aimed to synthesize and report the current literature exploring the intersection of trauma and substance use interventions for Indigenous Peoples. Fourteen databases were searched using keywords for Indigenous Peoples, trauma, and substance use. Of the 1373 sources identified, 117 met inclusion criteria. Literature on trauma and substance use with Indigenous Peoples has increased in the last 5 years (2012-2016, n = 29; 2017-2021, n = 48), with most literature coming from the United States and Canada and focusing on historical or intergenerational trauma. Few articles focused on intersectional identities such as 2SLGBTQIA+ (n = 4), and none focused on veterans. There were limited sources (n = 25) that reported specific interventions at the intersection of trauma and substance use. These sources advocate for multi-faceted, trauma-informed, and culturally safe interventions for use with Indigenous Peoples. This scoping review illuminates gaps in the literature and highlights a need for research reporting on trauma-informed interventions for substance use with Indigenous Peoples.
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Affiliation(s)
- T Pride
- Faculty of Health, Dalhousie University, Halifax, Canada
| | - A Lam
- Centre de Recherche du Chum, Université de Montréal, Montreal, Canada
| | - J Swansburg
- Centre de Recherche du Chum, Université de Montréal, Montreal, Canada.,Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | - M Seno
- Centre de Recherche du Chum, Université de Montréal, Montreal, Canada.,Psychology and Neuroscience, Dalhousie University, Halifax, Canada.,Maastricht University, Psychology and Neuroscience, Maastricht, The Netherlands
| | - M B Lowe
- Health and Human Performance, Dalhousie University, Halifax, Canada
| | - E Bomfim
- Educational and Counselling Psychology, McGill University, Montreal, Canada.,Psychology, Concordia University, Montreal, Canada
| | - E Toombs
- Psychology, Lakehead University, Thunder Bay, Canada
| | - S Marsan
- Family and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - J LoRusso
- Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | - J Roy
- Social Work, McGill University, Montreal, Canada
| | - E Gurr
- Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - J LaFontaine
- Integrated Studies in Education, McGill University, Montreal, Canada
| | - J Paul
- Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | - J A Burack
- Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - C Mushquash
- Psychology, Lakehead University, Thunder Bay, Canada
| | - S H Stewart
- Psychology and Neuroscience, Dalhousie University, Halifax, Canada.,Psychiatry, Dalhousie University, Halifax, Canada
| | - D C Wendt
- Educational and Counselling Psychology, McGill University, Montreal, Canada
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Zatzick D, Moloney K, Palinkas L, Thomas P, Anderson K, Whiteside L, Nehra D, Bulger E. Catalyzing the Translation of Patient-Centered Research Into United States Trauma Care Systems: A Case Example. Med Care 2021; 59:S379-S386. [PMID: 34228020 PMCID: PMC8263139 DOI: 10.1097/mlr.0000000000001564] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The expedient translation of research findings into sustainable intervention procedures is a longstanding health care system priority. The Patient-Centered Outcomes Research Institute (PCORI) has facilitated the development of "research done differently," with a central tenet that key stakeholders can be productively engaged throughout the research process. Literature review revealed few examples of whether, as originally posited, PCORI's innovative stakeholder-driven approach could catalyze the expedient translation of research results into practice. OBJECTIVES This narrative review traces the historical development of an American College of Surgeons Committee on Trauma (ACS/COT) policy guidance, facilitated by evidence supplied by the PCORI-funded studies evaluating the delivery of patient-centered care transitions. Key elements catalyzing the guidance are reviewed, including the sustained engagement of ACS/COT policy stakeholders who have the capacity to invoke system-level implementation strategies, such as regulatory mandates linked to verification site visits. Other key elements, including the encouragement of patient stakeholder voice in policy decisions and the incorporation of end-of-study policy summits in pragmatic comparative effectiveness trial design, are discussed. CONCLUSIONS Informed by comparative effectiveness trials, ACS/COT policy has expedited introduction of the patient-centered care construct into US trauma care systems. A comparative health care systems conceptual framework for transitional care which incorporates Research Lifecycle, pragmatic clinical trial and implementation science models is articulated. When combined with Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE), employed as a targeted implementation strategy, this approach may accelerate the sustainable delivery of high-quality patient-centered care transitions for US trauma care systems.
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Affiliation(s)
- Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Lawrence Palinkas
- Department of Children, Youth and Families, USC Suzanne Dworak-Peck School of Social Work, Los Angeles, CA
| | - Peter Thomas
- Powers Pyles Sutter and Verville PC, Washington, DC
| | - Kristina Anderson
- The Koshka Foundation and Department of Psychiatry and Behavioral Sciences
| | | | - Deepika Nehra
- Surgery, University of Washington School of Medicine, Seattle, WA
| | - Eileen Bulger
- Surgery, University of Washington School of Medicine, Seattle, WA
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Plessas A, Billot MW, Tamatea A, Medvedev ON, McCormack J, Anderson A. Barriers and Facilitators of Access to Psychological Services for Indigenous Populations: A Scoping Review and Thematic Analysis. Front Psychiatry 2021; 12:747054. [PMID: 34712157 PMCID: PMC8545819 DOI: 10.3389/fpsyt.2021.747054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/13/2021] [Indexed: 11/21/2022] Open
Abstract
Background: The extent to which behavior-analytic interventions are offered to Indigenous populations across CANZUS in accessible and culturally appropriate ways is unknown. We conducted a scoping review with a thematic analysis of the extant literature to find: (1) what are the barriers and facilitators for providing effective and equitable delivery of psychological services (with a behavioral component) to Indigenous populations; and (2) what tools and practices exist for an effective and equitable service delivery. Methods: We systematically reviewed Medline, CINAHL, PubMed, PsycInfo, Web of science, Ovid and INNZ databases between 1990 and 2020. For the scoping review, we adhered to the JBI methodological approach (2015) and the PRISMA strategy for the identification, selection, and appraisal of the reviewed articles. A total of 1265 unique articles met the criteria for the screening by title; 238 by abstract; 57 were included for full text assessment; and 37 were included in the final analysis. Results: Three themes were revealed to account for the barriers and facilitators of culturally friendly practices: (1) connecting practices are about interactions shaping the relationship between service provider and service client; (2) innovative practices test new approaches and innovations that could facilitate access to psychological services and overcome barriers, and (3) reflective practices are about critically examining the processes and actions undertaken toward effective cultural adaptation of services. Conclusions: Our analysis suggests that the level of success in bringing together services and the recipients of treatment (connection), showing flexibility and persistence in finding solutions (innovation) and examining the role of our behaviors in reaching our goals (reflection) is determined by the providers' action in the aforementioned three dimensions of practice.
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Affiliation(s)
- Anna Plessas
- School of Psychology, Division of Arts, Law, Psychology, and Social Sciences, University of Waikato, Hamilton, New Zealand
| | - Moana W Billot
- School of Psychology, Division of Arts, Law, Psychology, and Social Sciences, University of Waikato, Hamilton, New Zealand
| | - Armon Tamatea
- School of Psychology, Division of Arts, Law, Psychology, and Social Sciences, University of Waikato, Hamilton, New Zealand
| | - Oleg N Medvedev
- School of Psychology, Division of Arts, Law, Psychology, and Social Sciences, University of Waikato, Hamilton, New Zealand
| | - Jessica McCormack
- National Institute for Health Innovation, Pacific Health, University of Auckland, Auckland, New Zealand
| | - Angelika Anderson
- School of Psychology, Division of Arts, Law, Psychology, and Social Sciences, University of Waikato, Hamilton, New Zealand
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Cook BL, Hou SSY, Lee-Tauler SY, Progovac AM, Samson F, Sanchez MJ. A Review of Mental Health and Mental Health Care Disparities Research: 2011-2014. Med Care Res Rev 2019; 76:683-710. [PMID: 29877136 DOI: 10.1177/1077558718780592] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2024]
Abstract
Racial/ethnic minorities in the United States are more likely than Whites to have severe and persistent mental disorders and less likely to access mental health care. This comprehensive review evaluates studies of mental health and mental health care disparities funded by the National Institute of Mental Health (NIMH) to provide a benchmark for the 2015 NIMH revised strategic plan. A total of 615 articles were categorized into five pathways underlying mental health care and three pathways underlying mental health disparities. Identified studies demonstrate that socioeconomic mechanisms and demographic moderators of disparities in mental health status and treatment are well described, as are treatment options that support diverse patient needs. In contrast, there is a need for studies that focus on community- and policy-level predictors of mental health care disparities, link discrimination- and trauma-induced neurobiological pathways to disparities in mental illness, assess the cost effectiveness of disparities reduction programs, and scale up culturally adapted interventions.
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Affiliation(s)
- Benjamin Lê Cook
- Cambridge Health Alliance, Cambridge, MA, USA
- Uniformed Services University of the Health Sciences, North Bethesda, MD, USA
| | | | - Su Yeon Lee-Tauler
- Uniformed Services University of the Health Sciences, North Bethesda, MD, USA
| | - Ana Maria Progovac
- Cambridge Health Alliance, Cambridge, MA, USA
- Uniformed Services University of the Health Sciences, North Bethesda, MD, USA
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Brave Heart MYH, Chase J, Elkins J, Martin J, Nanez J, Mootz J. Women finding the way: American Indian women leading intervention research in Native communities. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2017; 23:24-47. [PMID: 27383085 DOI: 10.5820/aian.2303.2016.24] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although there is literature concentrating on cross-cultural approaches to academic and community partnerships with Native communities, few address the process and experiences of American Indian women leading federally funded and culturally grounded behavioral health intervention research in Native communities. This paper summarizes relevant literature on community-engaged research with Native communities, examines traditional roles and modern challenges for American Indian women, describes the culturally grounded collaborative process for the authors' behavioral health intervention development with Native communities, and considers emergent themes from our own research experiences navigating competing demands from mainstream and Native communities. It concludes with recommendations for supporting and enhancing resilience.
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10
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Trauma and Cultural Safety: Providing Quality Care to HIV-Infected Women of Aboriginal Descent. J Assoc Nurses AIDS Care 2014; 25:S70-8. [DOI: 10.1016/j.jana.2013.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 05/23/2013] [Indexed: 11/17/2022]
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Bassett D, Tsosie U, Nannauck S. "Our culture is medicine": perspectives of Native healers on posttrauma recovery among American Indian and Alaska Native patients. Perm J 2012; 16:19-27. [PMID: 22529755 DOI: 10.7812/tpp/11-123] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
American Indian and Alaska Native (Native) people experience more traumatic events and are at higher risk for developing posttraumatic stress disorder compared with the general population. We conducted in-depth interviews with six Native healers about their perspectives on traumatic injury and healing. We analyzed the interviews using an inductive approach to identify common themes. We categorized these themes into four categories: causes and consequences of traumatic injury, risk factors, protective factors, and barriers to care. The implications of our study include a need for improving cultural competence among health care and social services personnel working with Native trauma patients. Additional cumulative analyses of Native healers and trauma patients would contribute to a much-needed body of knowledge on improving recovery and promoting healing among Native trauma patients.
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Affiliation(s)
- Deborah Bassett
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
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12
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Zatzick D, Rivara F, Jurkovich G, Russo J, Trusz SG, Wang J, Wagner A, Stephens K, Dunn C, Uehara E, Petrie M, Engel C, Davydow D, Katon W. Enhancing the population impact of collaborative care interventions: mixed method development and implementation of stepped care targeting posttraumatic stress disorder and related comorbidities after acute trauma. Gen Hosp Psychiatry 2011; 33:123-34. [PMID: 21596205 PMCID: PMC3099037 DOI: 10.1016/j.genhosppsych.2011.01.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 12/30/2010] [Accepted: 01/03/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of the study was to develop and implement a stepped collaborative care intervention targeting posttraumatic stress disorder (PTSD) and related comorbidities to enhance the population impact of early trauma-focused interventions. METHOD We describe the design and implementation of the Trauma Survivors Outcomes and Support study. An interdisciplinary treatment development team was composed of trauma surgical, clinical psychiatric and mental health services "change agents" who spanned the boundaries between frontline trauma center clinical care and acute care policy. Mixed method clinical epidemiologic and clinical ethnographic studies informed the development of PTSD screening and intervention procedures. RESULTS Two hundred seven acutely injured trauma survivors with high early PTSD symptom levels were randomized into the study. The stepped collaborative care model integrated care management (i.e., posttraumatic concern elicitation and amelioration, motivational interviewing and behavioral activation) with cognitive behavioral therapy and pharmacotherapy targeting PTSD. The model was feasibly implemented by frontline acute care masters in social work and nurse practioner providers. CONCLUSIONS Stepped care protocols targeting PTSD may enhance the population impact of early interventions developed for survivors of individual and mass trauma by extending the reach of collaborative care interventions to acute care medical settings and other nonspecialty posttraumatic contexts.
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Affiliation(s)
- Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, WA 98104, USA.
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