Utilization of Nurse-Administered Screening, Brief Intervention, and Referral to Treatment in a Brief Psychiatric Inpatient Unit.

BACKGROUND: Screening, Brief Intervention, and Referral to Treatment (SBIRT) has been established as an effective screening tool for providing interventions for patients with risky substance use. OBJECTIVES: The objectives of this project were to train and coach staff nurses in the use of SBIRT, offer SBIRT to all admissions of a brief psychiatric inpatient unit, and decrease readmission rates. DESIGN: Using the Iowa Model for Implementing Evidence-Based Practices, SBIRT was implemented on the unit. Data were collected on the frequency of patients offered SBIRT and readmission rates. RESULTS: Fifty-nine percent of all admissions were offered SBIRT. The average readmission rates decreased by 18.3% for the first 2 months of implementation and by 67.5% for Days 16-31 postdischarge. CONCLUSIONS: SBIRT is an effective tool for nurses on psychiatric units to address substance use and to decrease readmission rates.

A Historical and Contemporary Review of the Contextualization and Social Determinants of Health of Micronesian Migrants in the United States.

Hawai'i's Pacific Islander (PI) population has suffered a higher burden of coronavirus disease 2019 (COVID-19) infections, hospitalizations, and deaths compared to other groups in the state. The Hawai'i Emergency Management Agency Community Care Outreach Unit conducted an assessment across the state to gain an understanding of the impact of the COVID-19 pandemic on the health and social welfare of households. Survey data was collected from individuals across the state during a period of 3 weeks (August 12-September 5, 2020). The following are resulting recommendations from the Pacific Island community to mitigate the impact and disparities of the pandemic as immediate and medium-term structural requests: (1) ensure that Pacific Island communities are proactively represented in state and county committees that develop health interventions to ensure that relevant language and culturally tailored communications and strategies are included, (2) provide consistent funding and community centered support to ensure consistent COVID-19 impact services for the Pacific Island families, (3) enhance the capacity of PI health care navigators and interpreters through increased funding and program support, and (4) engage state policy makers immediately to understand and address the systemic structural barriers to health care and social services for Pacific Islanders in Hawai'i. These recommendations were developed to address the generational inequities and disparities that exist for Pacific islanders in Hawai'i which were exacerbated by the COVID-19 pandemic.

Protecting Youth in the Mental Health Service Settings.

The authors present the development of the field of psychiatry with the evolution of patient safeguards. They address the recent publicized events involving sexual harassment and abuse perpetrated by mental health service providers who have harmed youth who were under their direct psychiatric care. Recommendations are provided for primary care physicians and parents and legal guardians to further ensure patient safety.

A Qualitative Evaluation of the Impacts of a Strength-based and Youth-driven Approach to Suicide Prevention in Rural and Minority Communities in Hawai'i.

Suicide is a serious public health issue, particularly for Native Hawaiians and Other Pacific Islander youth living in rural communities in Hawai'i. The Hawai'i's Caring Communities Initiative (HCCI) for Youth Suicide Prevention was implemented to address these concerns and used a strength-based, youthleadership approach to suicide prevention. A qualitative study was completed with youth leaders and adult community coordinators to evaluate the impacts of participating in HCCI. Participants included 9 adult community coordinators and 17 youth leaders ages 13-18 years. Coordinator interviews took place at a location of the interviewee's convenience, and youth leader focus groups were conducted at 1 of 6 rurally-based community organizations. A team of university staff members coded transcripts using a narrative approach and grouped codes into themes. Five themes emerged that fit with an adapted socio-ecological model framework, which included increased knowledge in suicide risk, pride in leadership identity, sense of positive relationships, positive affirmation from community members, and sustainability. Future efforts that focus on youth-related issues are encouraged to integrate a youth leadership model and preventive approach while considering implications such as long-term funding and capitalizing on community strengths and resources.

Change Pathways in Indigenous and Nonindigenous Youth Suicide.

Multivariate dynamic relationships among suicide attempts, anxiety and/or depressive symptoms, hope, and help-seeking were examined across time in Native Hawaiian and non-Hawaiian adolescents, using data from a 5-year longitudinal cohort study (N = 7,317). The rate of suicide attempts decreased over time, but this reduction was significantly less among Native Hawaiian youth than their non-Hawaiian peers. There were also significant differences between groups in hope and help-seeking, with Native Hawaiian youth increasing help-seeking and decreasing hope to a greater degree. Youth-centered, cultural approaches to suicide prevention are essential in enhancing well-being in indigenous communities.

Longitudinal Prediction of Suicide Attempts for a Diverse Adolescent Sample of Native Hawaiians, Pacific Peoples, and Asian Americans.

The objective of this study was to determine the longitudinal predictors of past-6-month suicide attempts for a diverse adolescent sample of Native Hawaiians, Pacific peoples, and Asian Americans. The study used longitudinal data from the Hawaiian High Schools Health Survey (N = 2,083, 9th to 11th graders, 1992-1993 and 1993-1994 school years). A stepwise multiple logistic regression was conducted. The final model consisted of three statistically significant predictors: (1) Time 1 suicide attempt, odds ratio = 30.6; (2) state anxiety, odds ratio = 4.9; and (3) parent expectations, odds ratio = 1.9. Past suicide attempt was by far the strongest predictor of future suicide attempts. Implications are discussed, including the need for screening of prior suicide attempts and focused interventions after suicide attempts.

A model for evaluating academic research centers: Case study of the Asian/Pacific Islander Youth Violence Prevention Center.

OBJECTIVES: To provide one model for evaluating academic research centers, given their vital role in addressing public health issues. METHODS: A theoretical framework is described for a comprehensive evaluation plan for research centers. This framework is applied to one specific center by describing the center's Logic Model and Evaluation Plan, including a sample of the center's activities. RESULTS: Formative and summative evaluation information is summarized. In addition, a summary of outcomes is provided: improved practice and policy; reduction of risk factors and increase in protective factors; reduction of interpersonal youth violence in the community; and national prototype for prevention of interpersonal youth violence. CONCLUSIONS: Research centers are important mechanisms to advance science and improve people's quality of life. Because of their more infrastructure-intensive and comprehensive approach, they also require substantial resources for success, and thus, also require careful accountability. It is therefore important to comprehensively evaluate these centers. As provided herein, a more systematic and structured approach utilizing logic models, an evaluation plan, and successful processes can provide research centers with a functionally useful method in their evaluation.

Understanding the Role of School Connectedness and Its Association With Violent Attitudes and Behaviors Among an Ethnically Diverse Sample of Youth.

Interpersonal youth violence is a growing public health concern in the United States. Having a high sense of school connectedness has been found to be a protective factor for youth violence. A high school course that aims to enhance school connectedness was developed and evaluated to investigate the students' sense of school connectedness and its association with violent attitudes and behaviors. Survey data from 598 students from a predominately Asian and Pacific Islander student body were analyzed to assess their level of school connectedness and violent attitudes and behaviors. Analysis of Variance was used to identify differences in the school connectedness and violence scores related to students' demographic characteristics. The role of school connectedness in the relationship between student demographic characteristics and violent attitudes and behaviors was examined with structural equation modeling. Overall, students reported a moderately high sense of school connectedness. School connectedness was found to be negatively associated with violent attitudes but not self-reported violent behaviors. Multiple-group analyses were conducted across the ethnic groups, which found differential associations between the school connectedness and violence variables. These results highlight the value of disaggregating the Asian and Pacific Islander category and the need for future research to further contextualize and clarify the relationship between school connectedness and interpersonal youth violence. This will help inform the development of evidence-based strategies and prevention programming that focus on school connectedness to address disparities in interpersonal youth violence outcomes.

One Model of Residency Journal Clubs With Multifaceted Support.

PROBLEM: The field of medical education is represented by a fairly wide variety of models for utilizing journal clubs as an effective teaching tool, each with varying levels of empirical support. Our own prior attempts at developing and implementing an effective journal club required improvements. INTERVENTION: Our intervention consisted of an innovative, effective journal club model that has more well-defined elements that are readily adaptable for other residency programs. The collective strategies were based on the previous literature and our own experiences. CONTEXT: Our intervention was implemented in a department of psychiatry within a university-based medical school. Study participants came from a psychiatry department's residency programs (N = 36) during academic year 2011-2012 with senior residents having the option to attend journal club. Using a multifaceted approach, measures included attendance, presession quizzes, postsession evaluations, and a final postcourse evaluation of 11 dimensions (e.g., goals, objectives). OUTCOME: Thirty-one (86%) trainees attended journal club-a substantial increase from previous years. The presession-quiz median was 4.4 total correct out of 6 questions (range = 3.3-5.3), indicating that the articles were generally read before the session. The postsession-evaluation median was 4.6 (1-5 scale, 5 the highest; range = 4.1-4.8), indicating sessions were well received. The final postcourse-evaluation overall mean was 3.9 (1-5 scale, 5 the highest; subscale M range = 3.4-4.5). Qualitative and quantitative analyses of the postcourse evaluation indicated the following positive aspects: educational objectives generally met, overall structured format, quality of discussions, individuals involved (e.g., course directors, trainees, faculty facilitators), and availability of food. Areas of possible improvement included time management within the sessions, more contemporary and clinically relevant articles, consistency in faculty moderators, and evaluation process. Engagement in learning appeared to have been dramatically increased through five strategies: (a) meaningful incentives; (b) assigned, engaged consistently prepared faculty; (c) meaningful evaluation; (d) prejournal club preparations that helped residents assimilate critical appraisal with time-and-task-management skills; and (e) a planning group that developed and improved curricula and instruction to meet the objectives of the course. LESSONS LEARNED: Overall, effective, and successful journal clubs require systematic planning, implementation, modification, and refinement.

Interpersonal youth violence perpetration and victimization in a diverse Asian American and Pacific Islander adolescent sample.

This study was the first to examine ethnic, sex, and ethnicity-by-sex differences for under-researched, Asian American and Pacific Islander, adolescent groups on youth violence outcomes other than cyberbullying. This effort included the less researched, emotional violence, and included socioeconomic status (SES) measures as covariates. The sample size from 2 high schools in spring 2007 was 881, using an epidemiologic survey design. The pattern of results was higher rates of violence victimization for ethnic groups, with lower representation in the 2 schools' population, and ethnic groups that more recently moved or immigrated to Hawai'i. For emotional victimization, girls of European American and "other", ethnicities self-reported higher rates than boys. Several implications (e.g., need for ethnically and gender-based approaches) and further research (e.g., ethnocultural identity) are discussed.

Developing a comprehensive school connectedness scale for program evaluation.

BACKGROUND: Evidence show that school connectedness is important to youth wellness. However, considerable inconsistency in the concepts and measures of school connectedness exists across studies. In addition, many measures do not capture the multifaceted dimensions of the school connectedness construct. This study examined the psychometric properties of a school connectedness scale that aimed to measure comprehensively the key constructs of school connectedness. METHODS: The scale was developed with teachers and tested with an ethnically diverse sample of 717 high school students enrolled in a school connectedness course using confirmatory factor analysis. RESULTS: Confirmatory factor analyses demonstrated the association of the 15 items with the 5 factors identified in the literature-school involvement, academic motivation, school attachment, teacher support, and peer relations (χ(2) = 439.99, df = 83, p < .0001, Comparative Fit Index = 0.991, Tucker-Lewis index = 0.988, root mean square error of approximation = 0.077). Cronbach coefficient alphas for the factors ranged from 0.73 to 0.93. CONCLUSIONS: Although further tests need to be conducted to assess its validity and reliability, this newly developed scale may provide researchers a tool to measure comprehensively school connectedness for program evaluation.

Understanding students' perceptions of a high school course designed to enhance school connectedness.

BACKGROUND: This study was a part of an evaluation of a 4-year high school course to enhance students' school connectedness from freshman to senior year with primarily an Asian and Pacific Islander student body in Hawai'i. The purpose of this study was to understand how the course may impact students' sense of school connectedness and identify factors important in course effectiveness. METHODS: Focus group guides were developed in collaboration with course instructors. Approximately 70 students from each grade level were randomly selected to participate in focus groups. All focus groups occurred during the 30-minute lunch period and lunch was provided. RESULTS: Focus groups conducted with 67 students revealed that students perceive teachers to play an essential role in the effectiveness of the course. Students also viewed the small class size and staying in the same class for all 4 years as important components in supporting the relationship-building aspect of the course, which enhances students' level of academic motivation and school involvement. Suggestions for ways that teachers can help build students' sense of school connectedness through the course included integrating their personal experiences into the lessons and facilitating more interactive discussions and team-building activities. CONCLUSION: Our findings suggest that students recognize the course as a valuable opportunity to build personal relationships that are essential to their sense of school connectedness. Schools should make more effort at incorporating strategies that build students' sense of school connectedness by providing relationship-building opportunities.

Changes in PTSD symptomatology and mental health during pregnancy and postpartum.

Changes in mental health symptoms throughout pregnancy and postpartum may impact a woman's experience and adjustment during an important time. However, few studies have investigated these changes throughout the perinatal period, particularly changes in posttraumatic stress disorder (PTSD) symptoms. The purpose of this study was to examine longitudinal changes in PTSD, depression, and anxiety symptomatology during pregnancy and postpartum. Pregnant women of ethnically diverse backgrounds receiving services for prenatal care at an outpatient obstetric-gynecology clinic or private physicians' office were assessed by interview on symptoms of PTSD, depression, anxiety, and general stress up to four times, including their first, second, and third trimester, and postpartum visits. Overall, during pregnancy there was a declining trend of PTSD symptoms. For anxiety, there was no overall significant change over time; however, anxiety symptoms were individually variable in the rate of change. For both depression and general stress symptoms, there was a declining trend, which was also variable in the individual rate of change among women during their pregnancy. Visual and post hoc analyses also suggest a possible peak in PTSD symptoms in the weeks prior to delivery. While most mental health symptoms may generally decrease during pregnancy, given the individual variability among women in the rate of change in symptoms, screening and monitoring of symptom fluctuations throughout the course of pregnancy may be needed. Further studies are needed to examine potential spiking of symptoms in the perinatal period.

A confirmatory model for substance use among Japanese American and part-Japanese American adolescents.

Few studies have examined the effect of ethnicity and cultural identity on substance use among Asian and Pacific Islander adolescents. A cross-sequential study conducted in Hawai'i with 144 Japanese and part-Japanese American adolescents assessed a model integrating Japanese ethnicity, cultural identity, substance use, major life events, and social support. Japanese American adolescents scored higher on the Japanese Culture Scale and on the Peers' Social Support than the part-Japanese American adolescents. Significant associations for substance use and impairment included culturally intensified events and Japanese cultural identity-behavior subset. Models had good overall fits and suggested that conflict surrounding cultural identity may contribute to substance use.

Diversifying residents' outpatient psychiatry experience: a contemporary model for academic outpatient psychiatry clinics.

A diversified, outpatient experience is an important part of psychiatric training, yet challenging to attain. We describe a multiple, subspecialty psychiatry clinic model for 3rd year psychiatry residents. Evaluation findings based on its initial implementation indicated improved resident supervision, better therapeutic alliance and an overall increase in satisfaction. This model facilitates resident exposure to diverse patients and treatment modalities as well as faculty development of expertise. It also promotes academic training excellence.

Moving toward comprehensiveness and sustainability in a social ecological approach to youth violence prevention: lessons from the Asian/Pacific islander youth violence prevention center.

Youth violence is a serious public health problem affecting communities across the United States. The use of a social ecological approach has helped reduce its prevalence. However, those who have put the approach into practice often face challenges to effective implementation. Addressing social ecology in all its complexity presents one obstacle; the ability of private non-profit and public agencies to sustain such comprehensive efforts presents another. Here, we provide an example of our efforts to prevent youth violence. We worked with the Asian/Pacific Islander Youth Violence Prevention Center (APIYVPC) and two communities on O'ahu. We provide a case example from the Asian/Pacific Islander Youth Violence Prevention Center (APIYVPC) of our work, in collaboration with two communities on O;ahu, to develop and implement a youth violence prevention initiative that is becoming both comprehensive and sustainable. We illustrate the incremental nature of what it means to be comprehensive and we underscore the importance of reaching sustainability as the project unfolds.