Downward National Trends in Mental Health Treatment Offered in Spanish: State Differences by Proportion of Hispanic Residents.

Objective: This study aimed to determine how the prevalence of mental health treatment facilities that offer services in Spanish has changed over time in the United States. Methods: Data from the National Mental Health Services Survey conducted in 2014 (N=13,015 facilities) and 2019 (N=12,345 facilities) were used to measure changes in the proportions of facilities that offered treatment in Spanish overall and by year, state, and proportion of Hispanic residents. Descriptive statistics were used to illustrate state-level changes in services offered in Spanish. Results: Between 2014 and 2019, the national Hispanic population increased by 4.5%, or 5.2 million people. During the same period, the proportion of facilities that offered treatment in Spanish declined by 17.8%, or a loss of 1,163 Spanish-speaking mental health facilities. Overall, 44 states saw a decline in the availability of services in Spanish, despite growth in Hispanic populations across all states. Among states with the fastest Hispanic population growth, several also experienced the greatest reduction in Spanish-language services. Conclusions: The findings indicate that availability of Spanish-language mental health services decreased in most U.S. states during 2014­2019. Promoting mental health service delivery in Spanish is critical for reducing barriers to treatment and ensuring health equity across populations.

Formative evaluation of Zero Suicide in the emergency department: Identifying strategies to overcome implementation barriers.

BACKGROUND: Zero Suicide has been widely promoted as a comprehensive suicide prevention approach in healthcare systems, yet less is known about the barriers to implementing this approach in the emergency department. OBJECTIVES: This developmental evaluation aimed to assess emergency department providers' perceived knowledge and self-efficacy regarding suicide prevention practices, as well as apply the Consolidated Framework for Implementation Research to explore potential facilitators and barriers to implementing Zero Suicide and identify strategies to overcome barriers. METHODS: A sequential mixed methods approach was used, including a survey assessing emergency department providers' perceived knowledge and attitudes and semi-structured interviews exploring potential determinants of implementation. RESULTS: Survey respondents (n = 43) perceived that they have the knowledge and self-efficacy to implement clinical elements of Zero Suicide; however, interview participants (n = 18) revealed that some clinical elements are not implemented consistently and perceive implementation barriers across multiple levels, including limited training on suicide risk assessment and limited resources needed to engage and re-engage at-risk patients in their suicide care management plan and provide follow-up supportive contacts during patients' transitions in care. CONCLUSION: To overcome identified barriers in this setting, targeted implementation strategies are needed, including integration in electronic health record systems, leadership advocacy, and ongoing staff training.

African American Clergy Recommendations to Enhance the Federal Plan to End the HIV Epidemic: A Qualitative Study.

African Americans in the southern United States continue to be disproportionately affected by HIV. Although faith-based organizations (FBOs) play important roles in the social fabric of African American communities, few HIV screening, care, and PrEP promotion efforts harness the power of FBOs. We conducted 11 focus groups among 57 prominent African American clergy from Arkansas, Mississippi, and Alabama. We explored clergy knowledge about the Ending the HIV Epidemic: A Plan for America (EHE); normative recommendations for how clergy can contribute to EHE; and how clergy can enhance the HIV care continua and PrEP. We explored how clergy have responded to the COVID-19 crisis, and lessons learned from pandemic experiences that are relevant for HIV programs. Clergy reported a moral obligation to participate in the response to the HIV epidemic and were willing to support efforts to expand HIV screening, treatment, PrEP and HIV care. Few clergy were familiar with EHE, U = U and TasP. Many suggested developing culturally tailored messages and were willing to lend their voices to social marketing efforts to destigmatize HIV and promote uptake of biomedical interventions. Nearly all clergy believed technical assistance with biomedical HIV prevention and care interventions would enhance their ability to create partnerships with local community health centers. Partnering with FBOs presents important and unique opportunities to reduce HIV disparities. Clergy want to participate in the EHE movement and need federal resources and technical assistance to support their efforts to bridge community activities with biomedical prevention and care programs related to HIV. The COVID-19 pandemic presents opportunities to build important infrastructure related to these goals.

Characterizing Firearm Assault Injury Among Young Black Men Using Arkansas Hospital Discharge Data.

Using statewide hospital discharge data from 2005 to 2014, this study aimed to describe and identify predictors of firearm assault among young Black men ages 18 to 44 in Arkansas. Descriptive analyses of data were performed for patient demographics (age, marital status, residential location, etc.), injury, and health care information (hospital charges, length of stay, mortality, time, day and season of injury, etc.). Logistic regression analysis was performed to identify significant predicting factors for firearm assault among this population. Most of the sample survived firearm assault injury, were ages 18-35, were not married, resided in Central Arkansas, and were admitted to a Central Arkansas hospital during night hours on weekends. The majority had a short hospital stay, and total charges exceeded $34 million during the study observation years. Most patients had no diagnosis of a mental disorder, and a little less than half had drug use disorders. Being ages 18-25, living in the Central region of Arkansas, and being married were all significant predictors of firearm assault for this population. Death was also significantly associated with firearm assault. Our findings lay the groundwork for understanding firearm assault injury among young Black men in Arkansas. Research should be expanded to examine other important data sources for firearm assault and to further explore the context of predicting factors, in order to provide a more comprehensive understanding of firearm assault and to better inform future prevention efforts.

Identifying community needs of the Hispanic faith community to develop a research agenda.

OBJECTIVE: To conduct a community health needs assessment among the Hispanic faith community population to develop a community-partnered research agenda. DESIGN: A cross-sectional design was used to conduct a community needs assessment using a community-based participatory research approach SAMPLE: Hispanic faith community members in Central Arkansas. MEASUREMENT: Data collection was led by Hispanic faith leaders using an audience response system at places of worship. An 88-item Community Health Needs Assessment survey was used that included demographic questions and questions related to five domains including community concerns, community resources, healthcare access, health concerns, and hunger and nutrition. RESULTS: There were a total of 100 participants in the community needs assessment. Hunger and nutrition was the highest ranking community concern followed by healthcare access. CONCLUSION: Based upon the results of the study, the university researchers and Hispanic faith community members have begun the initial steps to developing a research agenda to address the major concerns of the community.

A Qualitative Exploration of Women's Lives and Resilience in Substance Use Disorder Recovery.

OBJECTIVE: This study sought to explore constructs of the Whole Health resilience model to identify potential intervention and local research opportunities as a precursor to intervention development, as well as to describe women's resilience in Substance Use Disorder (SUD) recovery including current strengths, coping, self-care, needs and priorities in the context of their everyday lives. METHODS: Qualitative data were collected from December 2018 to January 2020 in the Mid-South United States. In-depth interviews of 17 women age 25 to 65 years in SUD recovery for 2 weeks or longer were conducted in 9 different settings including a Medication Assisted Treatment (MAT) hospital setting, a MAT pilot program in a community corrections setting, an incarceration re-entry residential program, community-based peer support organizations (eg, Narcotics Anonymous, Alcoholics Anonymous), a residential SUD treatment facility and a yoga teachers' online group. These data were analyzed with a hybrid approach (inductive and deductive coding). RESULTS: The major themes that emerged from the analysis included social support, individual-level cognitive and spiritual strategies; self-care; stressors, priorities, needs, and self-care barriers and trauma. In this context, women needed a wide range of support including treatment of severe physical injuries, professional psychological support, help with restoring relationships, SUD treatment and recovery services, job training and coaching, health insurance advice, transportation, intimate partner violence (IPV) counseling and housing. Peer-support groups and faith communities were instrumental in many (but not all) of these women's lives in recovery-a gap was identified for women who did not have social support from these groups. CONCLUSION: These data highlight the need for developing interventions for women in SUD recovery that take a holistic view of resilience life areas, as well as integrate professional services, family support, community support and approach care as wrap-around support that includes integration of social services to meet women's basic needs.

An Exploratory Study of the Acceptability and Feasibility of Yoga Among Women in Substance Use Disorder Recovery.

Objectives: This qualitative study explored the acceptability and feasibility of yoga among women in substance use disorder (SUD) recovery. Design: Seventeen women in SUD recovery for 2 weeks or longer were recruited from nine sites in the mid-South, including a Medication-Assisted Treatment clinic in a hospital setting, prison re-entry housing, community-based peer support organizations (e.g., Alcoholics Anonymous [AA], Narcotics Anonymous [NA]), a residential SUD treatment facility, a yoga teachers' online group, and through referrals. The median age of participants was 41.5, with ages ranging from 25 to 65. We used an interpretive description approach to explore both the perceptions of women without yoga experience and the experiences of women with yoga experience to collect formative data for intervention development and implementation. The interviews were recorded and transcribed verbatim. A hybrid analysis (i.e., inductive and deductive coding) was applied to the data. Results: Women's narratives included a high prevalence of trauma exposure. Overall, women in this sample were interested in either beginning or continuing yoga. Barriers to participation included perceived lack of self-efficacy of yoga, weight, and physical injuries. Additional environmental barriers included balancing care of self with caring for others, including partners, children, and NA/AA sponsees; as well as prioritizing finances, housing, employment, and transportation. Conclusion: High prevalence of trauma exposure among women in SUD recovery necessitates careful consideration of co-occurring psychiatric disorders such as post-traumatic stress disorder, anxiety and depression and the necessary professional psychological support, as well as serious physical injuries that require modification in yoga asana classes. As transportation and balancing care needs were salient in these data, rural SUD populations could be served with telehealth interventions that provide SUD recovery support with integrative health practices such as adjunctive yoga interventions.

Lessons learned from using an audience response system in a community setting for research data collection.

OBJECTIVES: A community-academic team implemented a study involving collection of quantitative data using a computer-based audience response system (ARS) whereby community partners led data collection efforts. The team participated in a reflection exercise after the data collection to evaluate and identify best practices and lessons learned about the community partner-led process. DESIGN & SAMPLE: The methods involved a qualitative research consultant who facilitated the reflection exercise that consisted of two focus groups-one academic and one community research team members. The consultant then conducted content analysis. Nine members participated in the focus groups. RESULTS: The reflection identified the following themes: the positive aspects of the ARS; challenges to overcome; and recommendations for the future. CONCLUSION: The lessons learned here can help community-academic research partnerships identify the best circumstances in which to use ARS for data collection and practical steps to aid in its success.

Reducing depressive symptoms through behavioral activation in churches: A Hybrid-2 randomized effectiveness-implementation design.

Rural African Americans are disproportionately exposed to numerous stressors such as poverty that place them at risk for experiencing elevated levels of depressive symptoms. Effective treatments for decreasing depressive symptoms exist, but rural African Americans often fail to receive adequate and timely care. Churches have been used to address physical health outcomes in rural African American communities, but few have focused primarily on addressing mental health outcomes. Our partnership, consisting of faith community leaders and academic researchers, adapted an evidence-based behavioral activation intervention for use with rural African American churches. This 8-session intervention was adapted to include faith-based themes, Scripture, and other aspects of the rural African American faith culture (e.g. bible studies) This manuscript describes a Hybrid-II implementation trial that seeks to test the effectiveness of the culturally adapted evidence-based intervention (Renewed and Empowered for the Journey to Overcome in Christ: REJOICE) and gather preliminary data on the strategies necessary to support the successful implementation of this intervention in 24 rural African American churches. This study employs a randomized one-way crossover cluster design to assess effectiveness in reducing depressive symptoms and gather preliminary data regarding implementation outcomes, specifically fidelity, associated with 2 implementation strategies: training only and training+coaching calls. This project has the potential to generate knowledge that will lead to improvements in the provision of mental health interventions within the rural African American community. Further, the use of the Hybrid-II design has the potential to advance our understanding of strategies that will support the implementation of and sustainability of mental health interventions within rural African American faith communities. TRIAL REGISTRATION: NCT02860741. Registered August 5, 2016.

Measuring HIV-related stigma among healthcare providers: a systematic review.

In the United States, HIV-related stigma in the healthcare setting is known to affect the utilization of prevention and treatment services. Multiple HIV/AIDS stigma scales have been developed to assess the attitudes and behaviors of the general population in the U.S. towards people living with HIV/AIDS, but fewer scales have been developed to assess HIV-related stigma among healthcare providers. This systematic review aimed to identify and evaluate the measurement tools used to assess HIV stigma among healthcare providers in the U.S. The five studies selected quantitatively assessed the perceived HIV stigma among healthcare providers from the patient or provider perspective, included HIV stigma as a primary outcome, and were conducted in the U.S. These five studies used adapted forms of four HIV stigma scales. No standardized measure was identified. Assessment of HIV stigma among providers is valuable to better understand how this phenomenon may impact health outcomes and to inform interventions aiming to improve healthcare delivery and utilization.

Community Building Community: The Distinct Benefits of Community Partners Building Other Communities' Capacity to Conduct Health Research.

BACKGROUND: Academic partners typically build community capacity for research, but few examples exist whereby community partners build community research capacity. This paper describes the benefits of communities sharing their "best practices" with each other for the purpose of building health research capacity. METHODS: In the context of a grant designed to engage African American communities to address health disparities (Faith Academic Initiatives Transforming Health [FAITH] in the Delta), leaders of two counties exchanged their "best practices" of creating faith-based networks and community health assessment tools to conduct a collective health assessment. LESSONS LEARNED: There were numerous strengths in engaging communities to build each other's capacity to conduct research. Communities identified with each other, perceived genuineness, conveyed legitimacy, and provided insider knowledge. CONCLUSIONS: Engaging communities to build each other's research capacity is a potentially valuable strategy.

Addressing Mental Health Needs: Perspectives of African Americans Living in the Rural South.

OBJECTIVE: Rural African Americans are disproportionately affected by social stressors that place them at risk of developing psychiatric disorders. This study aimed to understand mental health, mental health treatment, and barriers to treatment from the perspective of rural African-American residents and other stakeholders in order to devise culturally acceptable treatment approaches. METHODS: Seven focus groups (N=50) were conducted with four stakeholder groups: primary care providers, faith community representatives, college students and administrators, and individuals living with mental illness. A semistructured interview guide was used to elicit perspectives on mental health, mental health treatment, and ways to improve mental health in rural African-American communities. Inductive analysis was used to identify emergent themes and develop a conceptual model grounded in the textual data. RESULTS: Stressful living environments (for example, impoverished communities) and broader community-held beliefs (for example, religious beliefs and stigma) had an impact on perceptions of mental health and contributed to barriers to help seeking. Participants identified community-level strategies to improve emotional wellness in rural African-American communities, such as providing social support, improving mental health literacy, and promoting emotional wellness. CONCLUSIONS: Rural African Americans experience several barriers that impede treatment use. Strategies that include conceptualizing mental illness as a normal reaction to stressful living environments, the use of community-based mental health services, and provision of mental health education to the general public may improve use of services in this population.

Rural African Americans' Perspectives on Mental Health: Comparing Focus Groups and Deliberative Democracy Forums.

A number of approaches have been used to obtain community members' health perspectives. Health services researchers often conduct focus groups while political scientists and community groups may hold forums. To compare and contrast these two approaches, we conducted six focus groups (n = 50) and seven deliberative democracy forums (n = 233) to obtain the perspectives of rural African Americans on mental health problems in their community. Inductive qualitative analysis found three common themes: rural African Americans (1) understood stresses of poverty and racism were directly related to mental health, (2) were concerned about widespread mental illness stigma, and (3) thought community members could not identify mental health problems requiring treatment. Deductive analyses identified only minor differences in content between the two approaches. This single case study suggests that researchers could consider using deliberative democracy forums rather than focus groups with marginalized populations, particularly when seeking to mobilize communities to create community-initiated interventions.

To what extent do community members' personal health beliefs and experiences impact what they consider to be important for their community-at-large?

BACKGROUND: Health assessments are used to prioritize community-level health concerns, but the role of individuals' health concerns and experiences is unknown. We sought to understand to what extent community health assessments reflect health concerns of the community-at-large versus a representation of the participants sampled. METHODS: We conducted a health assessment survey in 30 rural African American churches (n = 412). Multivariable logistic regression produced odds ratios examining associations between personal health concern (this health concern is important to me), personal health experience (I have been diagnosed with this health issue) and community health priorities (this health concern is important to the community) for 20 health issues. RESULTS: Respondents reported significant associations for 19/20 health conditions between personal health concern and the ranking of that concern as a community priority (all P < 0.05). Inconsistent associations were seen between personal health experience of a specific health condition and the ranking of that condition as a community priority. CONCLUSIONS: Personal health concerns reported by individuals in a study sample may impact prioritization of community health initiatives. Further research should examine how personal health concerns are formed.

Influence of schizophrenia diagnosis on providers' practice decisions.

OBJECTIVE: Persons with schizophrenia often receive suboptimal physical health care, but the reasons are poorly understood. Vignettes have been used to examine how a patient's race, gender, or physical health influences a provider's practice; in this study, we used vignettes to examine the effect of a mental health diagnosis (schizophrenia) on providers' clinical expectations and decision making regarding physical health care. METHOD: A cross-sectional survey was administered from August 2011 to April 2012 to 275 primary care and mental health providers in 5 US Department of Veterans Affairs medical centers. Vignettes described identical scenarios for patients with and without schizophrenia. The survey assessed providers' clinical expectations of patients (adherence, competence, ability to read and understand health education materials) and practice behaviors (referrals to weight reduction, pain management, and sleep study). RESULTS: Clinicians expected persons with schizophrenia would be less adherent to treatment (P = .04), less able to read and understand educational materials (P = .03), and less capable of managing their health and personal affairs (P < .01). Providers were less likely to refer a patient with schizophrenia to a weight-reduction program (P = .03). Other types of referral decisions (for pain management and sleep study) were not influenced by a schizophrenia diagnosis. CONCLUSIONS: For both mental health and primary care providers, a history of schizophrenia was found to negatively affect provider expectations of patients' adherence to treatment, ability to understand educational materials, and capacity to manage their treatment and financial affairs as well as some treatment decisions, such as referral to a weight-reduction program.

Women's Perceptions of Provider Empathy in the Context of Healthcare Disparities.

An issue in addressing racial healthcare disparities is the need to reduce, often unconscious, provider bias. Provider empathy can overcome such bias. Patient perceptions of provider empathy were explored to identify which provider behaviors patients perceived as conveying empathy and how perceived provider empathy influenced patient-provider interactions. In this qualitative study utilizing in-depth interviews and medical records, interviewers conducted in-depth interviews with 23 patients from three clinics. Patients reported that the following influenced perceptions of provider empathy: Taking time, patient engagement, valuing the patient, clear communication, and the healthcare system. Subtle racial differences existed. This information contributes to research on empathy and patient-provider interaction and provides preliminary evidence for racial differences.

Building partnerships with rural Arkansas faith communities to promote veterans' mental health: lessons learned.

BACKGROUND: The Mental Health-Clergy Partnership Program established partnerships between institutional (Department of Veterans' Affairs [VA] chaplains, mental health providers) and community (local clergy, parishioners) groups to develop programs to assist rural veterans with mental health needs. OBJECTIVES: Describe the development, challenges, and lessons learned from the Mental Health-Clergy Partnership Program in three Arkansas towns between 2009 and 2012. METHODS: Researchers identified three rural Arkansas sites, established local advisory boards, and obtained quantitative ratings of the extent to which partnerships were participatory. RESULTS: Partnerships seemed to become more participatory over time. Each site developed distinctive programs with variation in fidelity to original program goals. Challenges included developing trust and maintaining racial diversity in local program leadership. CONCLUSIONS: Academics can partner with local faith communities to create unique programs that benefit the mental health of returning veterans. Research is needed to determine the effectiveness of community based programs, especially relative to typical "top-down" outreach approaches.

A rural African American faith community's solutions to depression disparities.

OBJECTIVE: The aim of this study was to explore how a rural African American faith community would address depression within their congregations and the community as a whole. DESIGN AND SAMPLE: A qualitative, interpretive descriptive methodology was used. The sample included 24 participants representing pastors, parishioners interested in health, and African American men who had experienced symptoms of depression in a community in the Arkansas Delta. MEASURES: The primary data sources for this qualitative research study were focus groups. RESULTS: Participants identified three key players in the rural African American faith community who can combat depression: the Church, the Pastor/Clergy, and the Layperson. The roles of each were identified and recommendations for each to address depression disparities in rural African Americans. CONCLUSIONS: The recommendations can be used to develop faith-based interventions for depression targeting the African American faith community.

Mental health stigma and primary health care decisions.

People with serious mental illness have higher rates of mortality and morbidity due to physical illness. In part, this occurs because primary care and other health providers sometimes make decisions contrary to typical care standards. This might occur because providers endorse mental illness stigma, which seems inversely related to prior personal experience with mental illness and mental health care. In this study, 166 health care providers (42.2% primary care, 57.8% mental health practice) from the Veteran׳s Affairs (VA) medical system completed measures of stigma characteristics, expected adherence, and subsequent health decisions (referral to a specialist and refill pain prescription) about a male patient with schizophrenia who was seeking help for low back pain due to arthritis. Research participants reported comfort with previous mental health interventions. Path analyses showed participants who endorsed stigmatizing characteristics of the patient were more likely to believe he would not adhere to treatment and hence, less likely to refer to a specialist or refill his prescription. Endorsement of stigmatizing characteristics was inversely related to comfort with one׳s previous mental health care. Implications of these findings will inform a program meant to enhance VA provider attitudes about people with mental illness, as well as their health decisions.

The pew versus the couch: relationship between mental health and faith communities and lessons learned from a VA/clergy partnership project.

The history of the relationship between religion and mental health is one of commonality, conflict, controversy, and distrust. An awareness of this complex relationship is essential to clinicians and clergy seeking to holistically meet the needs of people in our clinics, our churches, and our communities. Understanding this relationship may be particularly important in rural communities. This paper briefly discusses the history of this relationship and important areas of disagreement and contention. The paper moves beyond theory to present some current practical tensions identified in a brief case study of VA/Clergy partnerships in rural Arkansas. The paper concludes with a framework of three models for understanding how most faith communities perceive mental health and suggests opportunities to overcome the tensions between "the pew" and "the couch."