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Fenwick K, Dossett EC, Gitlin R, Cordasco K, Hamilton AB, Goodsmith N. Addressing Pregnancy And Parenting In Mental Health Care: Perspectives Of Women With Serious Mental Illness. Health Aff (Millwood) 2024; 43:582-589. [PMID: 38560791 DOI: 10.1377/hlthaff.2023.01450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Women living with serious mental illness (SMI) are at increased risk for adverse pregnancy and parenting outcomes. However, little is known about the experiences and preferences of women with SMI related to addressing pregnancy and parenting with their mental health providers. We conducted semistructured interviews with twenty-two reproductive-age cisgender women patients living with SMI. Participants characterized discussions about pregnancy and medication teratogenicity with their mental health providers as limited or unsatisfactory. Participants' openness to discussing pregnancy varied by topic and its perceived relevance to their individual circumstances, and it hinged on participants' trust in their providers. Participants characterized discussions about parenting with their mental health providers as helpful and identified additional opportunities for parenting support. Our findings highlight critical gaps in the delivery of information, support, and resources that can inform efforts to increase providers' capacity to address pregnancy and parenting with women living with SMI.
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Affiliation(s)
- Karissa Fenwick
- Karissa Fenwick, Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, California
| | - Emily C Dossett
- Emily C. Dossett, University of Southern California, Los Angeles, California
| | - Rebecca Gitlin
- Rebecca Gitlin, Los Angeles County Department of Mental Health, Los Angeles, California
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Goodsmith N, Dossett EC, Gitlin R, Fenwick K, Ong JR, Hamilton A, Cordasco KM. Acceptability of reproductive goals assessment in public mental health care. Health Serv Res 2023; 58:510-520. [PMID: 36478352 PMCID: PMC10012232 DOI: 10.1111/1475-6773.14111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess patient and provider perspectives on the acceptability of reproductive goals assessment in public mental health clinics and inform potential tailoring for these settings. DATA SOURCES AND STUDY SETTING Primary qualitative data from patients and providers at four clinics in an urban public mental health system serving individuals with chronic mental illness (collected November 2020-October 2021). STUDY DESIGN This was an exploratory qualitative study with patients (English-speaking women of reproductive age, primarily Black or Latina) and mental health providers (psychiatrists, psychotherapists, case managers, nurses). We examined the acceptability of reproductive goals assessment within mental health care and obtained feedback on two reproductive goals assessment conversation guides: PATH (Pregnancy Attitudes, Timing, and How Important is Pregnancy Prevention) and OKQ (One Key Question). DATA COLLECTION We conducted semi-structured telephone interviews with 22 patients and 36 providers. We used rapid qualitative analysis to summarize interview transcripts and identified themes using matrix analysis. PRINCIPAL FINDINGS Perceptions of reproductive goals assessment were generally positive. Providers said the conversation guides would "open the door" to important discussions, support a better understanding of patients' goals, and facilitate medication counseling and planning. A minority of patients expressed discomfort or ambivalence; several suggested providers ask permission or allow patients to raise the topic. Additional themes included the need for framing to provide context for these personal questions, the need to build rapport before asking them, and the challenge of balancing competing priorities. Many participants found both PATH and OKQ prompts acceptable; some preferred the "conversational" and "open-ended" PATH phrasing. CONCLUSIONS Participants perceived reproductive goals assessment as a promising practice in mental health care with unique functions in this setting. Areas of discomfort highlight the sensitivity of these topics for some women with chronic mental illness and suggest opportunities to tailor language, framing, and provider training to support effective and appropriate implementation.
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Affiliation(s)
- Nichole Goodsmith
- Department of Veterans Affairs, HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,VA Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Emily C Dossett
- Departments of Psychiatry and Behavioral Sciences and of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Los Angeles County Department of Mental Health, Los Angeles, California, USA
| | - Rebecca Gitlin
- Los Angeles County Department of Mental Health, Los Angeles, California, USA
| | - Karissa Fenwick
- Department of Veterans Affairs, HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Jessica R Ong
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Alison Hamilton
- Department of Veterans Affairs, HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kristina M Cordasco
- Department of Veterans Affairs, HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Goodsmith N, Cohen AN, Pedersen ER, Evans E, Young AS, Hamilton AB. Predictors of Functioning and Recovery Among Men and Women Veterans with Schizophrenia. Community Ment Health J 2023; 59:110-121. [PMID: 35643881 DOI: 10.1007/s10597-022-00979-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/29/2022] [Indexed: 01/07/2023]
Abstract
Gender differences may play a role in functional outcomes for individuals with schizophrenia. To better understand differences, an exploratory secondary analysis was conducted using data from a large, multi-site study of individuals with schizophrenia in treatment at Veterans Affairs medical centers. Participants completed surveys at baseline (n = 801; 734 men, 67 women) to assess demographics, symptoms, social supports, and recovery; and one year (n = 662; 604 men, 58 women) to assess quality of life and functioning. Hierarchical linear regressions examined interactions of baseline factors with functioning and quality of life. Women and men did not differ significantly in baseline social support, psychiatric symptoms, or recovery. Female gender predicted higher occupational functioning, while social functioning in men was inversely related to baseline symptom severity. Being married predicted higher quality of life for women, but not men. These findings may inform gender tailoring of services for schizophrenia.
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Affiliation(s)
- Nichole Goodsmith
- VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (206), Los Angeles, CA, 90073, USA.
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (210A), Los Angeles, CA, 90073, USA.
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90095, USA.
| | - Amy N Cohen
- American Psychiatric Association, 800 Maine Avenue, S.W., Suite 900, Washington, DC, 20024, USA
| | - Eric R Pedersen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 311 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA
| | - Alexander S Young
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (210A), Los Angeles, CA, 90073, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Alison B Hamilton
- VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (206), Los Angeles, CA, 90073, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
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Barceló NE, Castillo EG, Ijadi-Maghsoodi R, Goodsmith N, Tang L, Okikawa D, Jones F, Williams P, Benitez C, Chung B, Wells KB. Multi-Sector Assessment and Client-Perception of Social Need at Long-Term Follow-Up of a Group-Randomized Trial of Community-Engaged Collaborative Care for Adults with Depression. Int J Environ Res Public Health 2022; 19:10212. [PMID: 36011843 PMCID: PMC9407841 DOI: 10.3390/ijerph191610212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
Understanding client perceptions of need for underlying social determinant support may improve services for depression care. This secondary analysis examines perceptions of "social needs" related to housing and employment, financial, and legal (EFL) concerns among individuals with depression. Data were analyzed from Community Partners in Care, a randomized comparative effectiveness trial of multi-sector collaborative care for depression among a sample of people who were predominantly racial/ethnic minorities and low-income. Adults with depression (n = 980) in both interventions were surveyed at 36-month follow-up for (1) being asked about and (2) having social needs for housing or EFL concerns. In multivariate models, life difficulty and mental health visits in non-healthcare sectors predicted being asked about housing and EFL. Lower social determinants of health-related life satisfaction increased the odds of having unmet housing and EFL needs. These findings underscore the role of non-healthcare organizations as community resources for depression care and in screening and addressing social needs.
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Affiliation(s)
| | - Enrico G. Castillo
- Center for Social Medicine and Humanities, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024, USA
- Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Roya Ijadi-Maghsoodi
- Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Nichole Goodsmith
- Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Lingqi Tang
- Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024, USA
| | - David Okikawa
- UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA 90008, USA
| | - Pluscedia Williams
- Healthy African American Families II, Los Angeles, CA 90008, USA
- The Practice of Community Faculty, Charles R. Drew University of Science and Medicine, Los Angeles, CA 90059, USA
- Lundquist Institute, Harbor-UCLA Medical Center, Los Angeles, CA 90502, USA
- Emergency Medicine Palliative Care Access (EMPallA), NYU—Langone Health Care, New York City, NY 10016, USA
| | | | - Bowen Chung
- Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024, USA
- Los Angeles County Department of Mental Health, Los Angeles, CA 90020, USA
- Department of Psychiatry, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, Los Angeles, CA 90502, USA
| | - Kenneth B. Wells
- UCLA National Clinician Scholars Program, Los Angeles, CA 90024, USA
- Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024, USA
- UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
- Greater Los Angeles Veterans Administration Health System, Los Angeles, CA 90073, USA
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Goodsmith N, Cruz M. Mental Health Services Research and Community Psychiatry. Textbook of Community Psychiatry 2022:411-425. [DOI: 10.1007/978-3-031-10239-4_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Goodsmith N, Moore EM, Siddiq H, Barceló SE, Ulloa-Flores E, Loera G, Jones F, Aguilar-Gaxiola S, Wells K, Arevian A. Community-Partnered Development of a Digital Mental Health Resource Website to Support Diverse Communities During the COVID-19 Pandemic. J Health Care Poor Underserved 2022; 33:506-516. [PMID: 35153238 PMCID: PMC10036170 DOI: 10.1353/hpu.2022.0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A state-academic-community partnership formed in response to the mental health needs fueled by the COVID-19 pandemic and the disproportionate effects on marginalized communities. Taking a community-partnered approach and using a health equity lens, the partnership developed a website to guide users through digital mental health resources, prioritizing accessibility, engagement, and community needs.
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Abstract
For people experiencing homelessness, COVID-19 underscores existing health and social inequities, introduces additional threats to health and safety, and calls for rapid and creative solutions to reduce risk. This column focuses on the particular challenges of two frequently intersecting subpopulations of individuals experiencing homelessness: pregnant women and survivors of domestic violence. The authors describe rapid efforts and cross-agency collaboration in Los Angeles-home to the nation's largest number of unsheltered individuals-to provide these groups with safe interim housing in the context of COVID-19. The authors discuss gaps in care and recommendations for the future, calling attention to the unique mental health and social needs of these highly vulnerable women.
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Affiliation(s)
- Nichole Goodsmith
- VA Greater Los Angeles Healthcare System, Los Angeles, and National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles; HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles; and Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Ijadi-Maghsoodi); East Los Angeles Women's Center, Los Angeles (Melendez); Los Angeles County Department of Mental Health, Los Angeles; and Department of Psychiatry and Biobehavioral Sciences and Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles (Dossett). Ruth S. Shim, M.D., M.P.H., and Michael T. Compton, M.D., M.P.H., are editors of this column
| | - Roya Ijadi-Maghsoodi
- VA Greater Los Angeles Healthcare System, Los Angeles, and National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles; HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles; and Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Ijadi-Maghsoodi); East Los Angeles Women's Center, Los Angeles (Melendez); Los Angeles County Department of Mental Health, Los Angeles; and Department of Psychiatry and Biobehavioral Sciences and Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles (Dossett). Ruth S. Shim, M.D., M.P.H., and Michael T. Compton, M.D., M.P.H., are editors of this column
| | - Rebeca M Melendez
- VA Greater Los Angeles Healthcare System, Los Angeles, and National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles; HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles; and Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Ijadi-Maghsoodi); East Los Angeles Women's Center, Los Angeles (Melendez); Los Angeles County Department of Mental Health, Los Angeles; and Department of Psychiatry and Biobehavioral Sciences and Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles (Dossett). Ruth S. Shim, M.D., M.P.H., and Michael T. Compton, M.D., M.P.H., are editors of this column
| | - Emily C Dossett
- VA Greater Los Angeles Healthcare System, Los Angeles, and National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles; HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles; and Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Ijadi-Maghsoodi); East Los Angeles Women's Center, Los Angeles (Melendez); Los Angeles County Department of Mental Health, Los Angeles; and Department of Psychiatry and Biobehavioral Sciences and Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles (Dossett). Ruth S. Shim, M.D., M.P.H., and Michael T. Compton, M.D., M.P.H., are editors of this column
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Goodsmith N, Cohen AN, Flynn AWP, Hamilton AB, Hellemann G, Nowlin-Finch N, Young AS. Computerized Conjoint Analysis of the Weight Treatment Preferences of Individuals With Schizophrenia. Psychiatr Serv 2021; 72:288-294. [PMID: 33430650 PMCID: PMC7920898 DOI: 10.1176/appi.ps.202000068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Innovative approaches are needed for assessing treatment preferences of individuals with schizophrenia. Conjoint analysis methods may help to identify preferences, but the usability and validity of these methods for individuals with schizophrenia remain unclear. This study examined computerized conjoint analysis for persons with schizophrenia and whether preferences for weight management programs predict service use. METHODS A computerized, patient-facing conjoint analysis system was developed through iterative consultation with 35 individuals with schizophrenia enrolled at a community mental health clinic. An additional 35 overweight participants with schizophrenia then used the system to choose among psychosocial weight management programs varying in four attributes: location (community or clinic), delivery mode (Internet or in person), leader (clinician or layperson), and training mode (individual or group). A multilevel logit model with partial preference data determined contributions of each attribute to groupwide preferences. Associations were studied between preferences and use of a psychosocial weight management group. RESULTS Conjoint analysis system usability was rated highly. Groupwide preferences were significantly influenced by location (p<0.001; clinic was preferred), leader (p=0.02; clinician was preferred), and training mode (p<0.001; group was preferred) but not delivery mode (p=0.68). Preferences did not correlate with age, gender, body mass index, illness severity, or subsequent program use. Participants described barriers to program attendance, including transportation, scheduling, privacy, psychiatric illness, and lack of motivation. CONCLUSIONS Computerized conjoint analysis can produce valid assessments of treatment preferences of persons with schizophrenia and inform treatment development and implementation. Although preferences may affect treatment use, they are one of multiple factors.
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Affiliation(s)
- Nichole Goodsmith
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
| | - Amy N Cohen
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
| | - Anthony W P Flynn
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
| | - Alison B Hamilton
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
| | - Gerhard Hellemann
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
| | - Nancy Nowlin-Finch
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
| | - Alexander S Young
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
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Goodsmith N, Zhang L, Ong MK, Ngo VK, Miranda J, Hirsch S, Jones F, Wells K, Chung B. Implementation of a Community-Partnered Research Suicide-Risk Management Protocol: Case Study From Community Partners in Care. Psychiatr Serv 2021; 72:281-287. [PMID: 33502218 PMCID: PMC7920897 DOI: 10.1176/appi.ps.202000095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Suicidality is common among participants in clinical trials and health services research, but approaches to suicide risk assessment and mitigation vary widely. Studies involving vulnerable populations with limited access to care raise additional ethical concerns. The authors applied a community-partnered approach to develop and implement a suicide-risk management protocol (SRMP) in a depression study in an underresourced setting in Los Angeles. METHODS Using a community-partnered participatory research framework, the authors designed and adapted the SRMP. Qualitative data regarding SRMP implementation included notes from SRMP development meetings and from study clinicians conducting outreach calls to study participants. Analyses included baseline and 6- and 12-month telephone survey data from 1,018 enrolled adults with moderate to severe depressive symptoms (8-item Patient Health Questionnaire score ≥10), of whom 48% were Black and 40% Latino. RESULTS Community stakeholders prioritized a robust SRMP to ensure participant safety. Features included rapid telephone outreach by study clinicians in all cases of reported recent suicidality and expedited treatment access. Using a suicidality timeframe prompt of "in the past 2 weeks," endorsement of suicidality was common (15% at baseline, 32% cumulative). Midway through the study, the SRMP was modified to assess for present suicidality, which reduced the frequency of clinician involvement. Overall, 318 outreach calls were placed, with none requiring an emergency response. Treatment referrals were provided in 157 calls, and outreach was well received. CONCLUSIONS SRMP implementation in research involving underresourced and vulnerable communities merits additional considerations. Partnering with community stakeholders can facilitate the development of acceptable and feasible SRMP procedures.
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Affiliation(s)
- Nichole Goodsmith
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Lily Zhang
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Michael K Ong
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Victoria K Ngo
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Jeanne Miranda
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Susan Hirsch
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Felica Jones
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Kenneth Wells
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Bowen Chung
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
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10
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Isom J, Jordan A, Goodsmith N, Medlock MM, DeSouza F, Shadravan SM, Halbert E, Hairston D, Castillo E, Rohrbaugh R. Equity in Progress: Development of Health Equity Curricula in Three Psychiatry Residency Programs. Acad Psychiatry 2021; 45:54-60. [PMID: 33452664 DOI: 10.1007/s40596-020-01390-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Affiliation(s)
| | - Ayana Jordan
- Yale University School of Medicine, New Haven, CT, USA
| | | | | | | | | | | | | | - Enrico Castillo
- Los Angeles County Department of Mental Health, Los Angeles, CA, USA
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11
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Barceló NE, Shadravan S, Wells CR, Goodsmith N, Tarrant B, Shaddox T, Yang Y, Bath E, DeBonis K. Reimagining Merit and Representation: Promoting Equity and Reducing Bias in GME Through Holistic Review. Acad Psychiatry 2021; 45:34-42. [PMID: 33111187 DOI: 10.1007/s40596-020-01327-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study aims to evaluate the capacity of a holistic review process in comparison with non-holistic approaches to facilitate mission-driven recruitment in residency interview screening and selection, with particular attention to the promotion of race equity for applicants underrepresented in medicine (URM). METHODS Five hundred forty-seven applicants to a psychiatry residency program from US allopathic medical schools were evaluated for interview selection via three distinct screening rubrics-one holistic approach (Holistic Review; HR) and two non-holistic processes: Traditional (TR) and Traditional Modified (TM). Each applicant was assigned a composite score corresponding to each rubric, and the top 100 applicants in each rubric were identified as selected for interview. Odds ratios (OR) of selection for interview according to URM status and secondary outcomes, including clinical performance and lived experience, were measured by analysis of group composition via univariate logistic regression. RESULTS Relative to Traditional, Holistic Review significantly increased the odds of URM applicant selection for interview (TR-OR: 0.35 vs HR-OR: 0.84, p < 0.01). Assigning value to lived experience and de-emphasizing USMLE STEP1 scores contributed to the significant changes in odds ratio of interview selection for URM applicants. CONCLUSIONS Traditional interview selection methods systematically exclude URM applicants from consideration without due attention to applicant strengths or potential contribution to clinical care. Conversely, holistic screening represents a structural intervention capable of critically examining measures of merit, reducing bias, and increasing URM representation in residency recruitment, screening, and selection.
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Affiliation(s)
| | | | | | - Nichole Goodsmith
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA, USA
| | | | - Trevor Shaddox
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Yvonne Yang
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Eraka Bath
- University of California, Los Angeles, Los Angeles, CA, USA
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12
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Arevian AC, Jones F, Moore EM, Goodsmith N, Aguilar-Gaxiola S, Ewing T, Siddiq H, Lester P, Cheung E, Ijadi-Maghsoodi R, Gabrielian S, Sugarman OK, Bonds C, Benitez C, Innes-Gomberg D, Springgate B, Haywood C, Meyers D, Sherin JE, Wells K. Mental Health Community and Health System Issues in COVID-19: Lessons from Academic, Community, Provider and Policy Stakeholders. Ethn Dis 2020; 30:695-700. [PMID: 32989370 PMCID: PMC7518533 DOI: 10.18865/ed.30.4.695] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The coronavirus pandemic of 2019 (COVID-19) has created unprecedented changes to everyday life for millions of Americans due to job loss, school closures, stay-at-home orders and health and mortality consequences. In turn, physicians, academics, and policymakers have turned their attention to the public mental health toll of COVID-19. This commentary reporting from the field integrates perceptions of academic, community, health system, and policy leaders from state, county, and local levels in commenting on community mental health needs in the COVID-19 pandemic. Stakeholders noted the broad public health scope of mental health challenges while expressing concern about exacerbation of existing disparities in access and adverse social determinants, including for communities with high COVID-19 infection rates, such as African Americans and Latinos. They noted rapid changes toward telehealth and remote care, and the importance of understanding impacts of changes, including who may benefit or have limited access, with implications for future services delivery. Needs for expanded workforce and training in mental health were noted, as well as potential public health value of expanding digital resources tailored to local populations for enhancing resilience to stressors. The COVID-19 pandemic has led to changes in delivery of health care services across populations and systems. Concerns over the mental health impact of COVID-19 has enhanced interest in remote mental care delivery and preventive services, while being mindful of potential for enhanced disparities and needs to address social determinants of health. Ongoing quality improvement across systems can integrate lessons learned to enhance a public mental well-being.
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Affiliation(s)
- Armen C. Arevian
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Health Services and Society, Los Angeles, CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Elizabeth M. Moore
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA National Clinician Scholars Program, Los Angeles, CA
| | - Nichole Goodsmith
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA National Clinician Scholars Program, Los Angeles, CA
| | - Sergio Aguilar-Gaxiola
- Department of Clinical Internal Medicine, School of Medicine, and Center for Reducing Health Disparities, UC Davis, Davis, CA
| | - Toby Ewing
- California Mental Health Services Oversight and Accountability Commission, Sacramento, CA
| | - Hafifa Siddiq
- UCLA National Clinician Scholars Program, Los Angeles, CA
- UCLA Resource Center for Minority Aging Research, Resource Centers for Minority Aging and for Health Improvement of Minority Elderly, Los Angeles, CA
| | - Patricia Lester
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Division of Population Behavioral Health, Los Angeles, CA
| | - Erick Cheung
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Roya Ijadi-Maghsoodi
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Division of Population Behavioral Health, Los Angeles, CA
- UCLA/VA Center of Excellence for Veteran Resilience and Recovery, Los Angeles, CA
| | - Sonya Gabrielian
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA/VA Center of Excellence for Veteran Resilience and Recovery, Los Angeles, CA
| | - Olivia K. Sugarman
- Louisiana State University Health Sciences Center – New Orleans School of Medicine and School of Public Health, New Orleans, LA
| | - Curley Bonds
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Los Angeles County Department of Mental Health, Los Angeles, CA
| | - Christopher Benitez
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Los Angeles County Department of Mental Health, Los Angeles, CA
| | | | - Benjamin Springgate
- Louisiana State University Health Sciences Center – New Orleans School of Medicine and School of Public Health, New Orleans, LA
| | | | | | - Jonathan E. Sherin
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Los Angeles County Department of Mental Health, Los Angeles, CA
- University of Southern California, Los Angeles, CA
| | - Kenneth Wells
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Division of Population Behavioral Health, Los Angeles, CA
- UCLA/VA Center of Excellence for Veteran Resilience and Recovery, Los Angeles, CA
- UCLA Fielding School of Public Health, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Health Services and Society, Los Angeles, CA
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13
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Castillo EG, Ijadi-Maghsoodi R, Shadravan S, Moore E, Mensah MO, Docherty M, Aguilera Nunez MG, Barcelo N, Goodsmith N, Halpin LE, Morton I, Mango J, Montero AE, Koushkaki SR, Bromley E, Chung B, Jones F, Gabrielian S, Gelberg L, Greenberg JM, Kalofonos I, Kataoka SH, Miranda J, Pincus HA, Zima BT, Wells KB. Community Interventions to Promote Mental Health and Social Equity. Focus (Am Psychiatr Publ) 2020; 18:60-70. [PMID: 32015729 PMCID: PMC6996071 DOI: 10.1176/appi.focus.18102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
(Reprinted with permission from Current Psychiatry Reports (2020) 21: 35).
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14
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Castillo EG, Ijadi-Maghsoodi R, Shadravan S, Moore E, Mensah MO, Docherty M, Aguilera Nunez MG, Barcelo N, Goodsmith N, Halpin LE, Morton I, Mango J, Montero AE, Rahmanian Koushkaki S, Bromley E, Chung B, Jones F, Gabrielian S, Gelberg L, Greenberg JM, Kalofonos I, Kataoka SH, Miranda J, Pincus HA, Zima BT, Wells KB. Community Interventions to Promote Mental Health and Social Equity. Curr Psychiatry Rep 2019; 21:35. [PMID: 30927093 PMCID: PMC6440941 DOI: 10.1007/s11920-019-1017-0] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW We review recent community interventions to promote mental health and social equity. We define community interventions as those that involve multi-sector partnerships, emphasize community members as integral to the intervention, and/or deliver services in community settings. We examine literature in seven topic areas: collaborative care, early psychosis, school-based interventions, homelessness, criminal justice, global mental health, and mental health promotion/prevention. We adapt the social-ecological model for health promotion and provide a framework for understanding the actions of community interventions. RECENT FINDINGS There are recent examples of effective interventions in each topic area. The majority of interventions focus on individual, family/interpersonal, and program/institutional social-ecological levels, with few intervening on whole communities or involving multiple non-healthcare sectors. Findings from many studies reinforce the interplay among mental health, interpersonal relationships, and social determinants of health. There is evidence for the effectiveness of community interventions for improving mental health and some social outcomes across social-ecological levels. Studies indicate the importance of ongoing resources and training to maintain long-term outcomes, explicit attention to ethics and processes to foster equitable partnerships, and policy reform to support sustainable healthcare-community collaborations.
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Affiliation(s)
- Enrico G Castillo
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
- Center for Social Medicine and Humanities, UCLA, Los Angeles, CA, USA.
- Los Angeles County Department of Mental Health, Los Angeles, CA, USA.
| | - Roya Ijadi-Maghsoodi
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Division of Population Behavioral Health, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Sonya Shadravan
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Elizabeth Moore
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Michael O Mensah
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Mary Docherty
- Harkness Fellow in Healthcare Policy and Practice, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Maria Gabriela Aguilera Nunez
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Nicolás Barcelo
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Nichole Goodsmith
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Laura E Halpin
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Isabella Morton
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Joseph Mango
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
| | - Alanna E Montero
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
| | - Sara Rahmanian Koushkaki
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
| | - Elizabeth Bromley
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- UCLA Department of Anthropology, Los Angeles, CA, USA
- Rand Corporation, Santa Monica, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Bowen Chung
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Rand Corporation, Santa Monica, CA, USA
- Los Angeles Biomedical Research Institute, Los Angeles, CA, USA
- Healthy African American Families II, Los Angeles, CA, USA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA, USA
| | - Sonya Gabrielian
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Lillian Gelberg
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- UCLA Jonathan Fielding School of Public Health, Los Angeles, CA, USA
| | - Jared M Greenberg
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Ippolytos Kalofonos
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Social Medicine and Humanities, UCLA, Los Angeles, CA, USA
- UCLA International Institute, Los Angeles, CA, USA
| | - Sheryl H Kataoka
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Division of Child and Adolescent Psychiatry, UCLA, Los Angeles, CA, USA
| | - Jeanne Miranda
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- UCLA Jonathan Fielding School of Public Health, Los Angeles, CA, USA
| | - Harold A Pincus
- Rand Corporation, Santa Monica, CA, USA
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, NewYork-Presbyterian Hospital, Irving Institute for Clinical and Translational Research, New York, NY, USA
| | - Bonnie T Zima
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Division of Child and Adolescent Psychiatry, UCLA, Los Angeles, CA, USA
| | - Kenneth B Wells
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Rand Corporation, Santa Monica, CA, USA
- UCLA Jonathan Fielding School of Public Health, Los Angeles, CA, USA
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15
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Goodsmith N, Guo XV, Vandal OH, Vaubourgeix J, Wang R, Botella H, Song S, Bhatt K, Liba A, Salgame P, Schnappinger D, Ehrt S. Disruption of an M. tuberculosis membrane protein causes a magnesium-dependent cell division defect and failure to persist in mice. PLoS Pathog 2015; 11:e1004645. [PMID: 25658098 PMCID: PMC4450064 DOI: 10.1371/journal.ppat.1004645] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 12/28/2014] [Indexed: 01/17/2023] Open
Abstract
The identification of Mycobacterium tuberculosis genes necessary for persistence in vivo provides insight into bacterial biology as well as host defense strategies. We show that disruption of M. tuberculosis membrane protein PerM (Rv0955) resulted in an IFN-γ-dependent persistence defect in chronic mouse infection despite the mutant's near normal growth during acute infection. The perM mutant required increased magnesium for replication and survival; incubation in low magnesium media resulted in cell elongation and lysis. Transcriptome analysis of the perM mutant grown in reduced magnesium revealed upregulation of cell division and cell wall biosynthesis genes, and live cell imaging showed PerM accumulation at the division septa in M. smegmatis. The mutant was acutely sensitive to β-lactam antibiotics, including specific inhibitors of cell division-associated peptidoglycan transpeptidase FtsI. Together, these data implicate PerM as a novel player in mycobacterial cell division and pathogenesis, and are consistent with the hypothesis that immune activation deprives M. tuberculosis of magnesium.
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Affiliation(s)
- Nichole Goodsmith
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, New York, United States of America
| | - Xinzheng V. Guo
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, New York, United States of America
| | - Omar H. Vandal
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, New York, United States of America
| | - Julien Vaubourgeix
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, New York, United States of America
| | - Ruojun Wang
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, New York, United States of America
| | - Hélène Botella
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, New York, United States of America
| | - Shuang Song
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, New York, United States of America
| | - Kamlesh Bhatt
- Department of Medicine, Center for Emerging Pathogens, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, New Jersey, United States of America
| | - Amir Liba
- Agilent Technologies, Wilmington, Delaware, United States of America
| | - Padmini Salgame
- Department of Medicine, Center for Emerging Pathogens, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, New Jersey, United States of America
| | - Dirk Schnappinger
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, New York, United States of America
| | - Sabine Ehrt
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, New York, United States of America
- * E-mail:
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16
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Kulkarni A, Francis ER, Clark T, Goodsmith N, Fein O. How we developed a locally focused Global Health Clinical Preceptorship at Weill Cornell Medical College. Med Teach 2014; 36:573-7. [PMID: 24597684 PMCID: PMC8052984 DOI: 10.3109/0142159x.2014.886764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND Global health educational programs within U.S. medical schools have the opportunity to link their "global" focus with local circumstances by examining the challenges underserved communities face in the United States. AIM Students in Weill Cornell Medical College's Global Health Clinical Preceptorship (GHCP) learn history-taking and physical examination skills while gaining exposure to local health care disparities and building cultural competency. METHODS First-year medical students in the program are placed in the office of a physician who works with underserved patient populations in New York City. Students receive an orientation session, shadow their preceptors one afternoon per week for seven weeks, complete weekly readings and assignments on topics specific to underserved populations, attend a reflection session, and write a reflection paper. RESULTS In three years, 36% of first-year students (112 of 311) opted into the elective GHCP program. Students reported gaining a better understanding of the needs of underserved patient populations, being exposed to new languages and issues of cultural competency, and having the opportunity to work with role model clinicians. CONCLUSIONS The GHCP is a successful example of how global health programs within medical schools can incorporate a domestic learning component into their curricula.
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Affiliation(s)
| | | | | | - Nichole Goodsmith
- Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program
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Francis ER, Goodsmith N, Michelow M, Kulkarni A, McKenney AS, Kishore SP, Bertelsen N, Fein O, Balsari S, Lemery J, Fitzgerald D, Johnson W, Finkel ML. The global health curriculum of Weill Cornell Medical College: how one school developed a global health program. Acad Med 2012; 87:1296-302. [PMID: 22929431 PMCID: PMC8052981 DOI: 10.1097/acm.0b013e3182628edb] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Since 2009, a multidisciplinary team at Weill Cornell Medical College (WCMC) has collaborated to create a comprehensive, elective global health curriculum (GHC) for medical students. Increasing student interest sparked the development of this program, which has grown from ad hoc lectures and dispersed international electives into a comprehensive four-year elective pathway with over 100 hours of training, including three courses, two international experiences, a preceptorship with a clinician working with underserved populations in New York City, and regular lectures and seminars by visiting global health leaders. Student and administrative enthusiasm has been strong: In academic years 2009, 2010, and 2011, over half of the first-year students (173 of 311)participated in some aspect of the GHC, and 18% (55 of 311) completed all first-year program requirements.The authors cite the student-driven nature of GHC as a major factor in its success and rapid growth. Also important was the foundation previously established by WCMC global health faculty, the serendipitous timing of the GHC's development in the midst of curricular reform and review, as well as the presence of a full-time, nonclinical Global Health Fellow who served as a program coordinator. Given the enormous expansion of medical student interest in global health training throughout the United States and Canada over the past decade, the authors hope that medical schools developing similar programs will find the experience at Weill Cornell informative and helpful.
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