Eliminating disparities in youth substance use among Native Hawaiian, Micronesian, and sex and gender minorities: A qualitative needs assessment from interviews with public service leaders.

Youth substance use (SU) has been linked to adverse mental health outcomes. For those youth involved in public sector systems of care, reports of SU are consistently high compared to general populations. These public sector services systems of care include mental health, juvenile justice, child welfare, homeless intervention services, as well as SU service systems. In addition, minority and marginalized youth tend to report disproportionately high SU. As an example, in Hawai'i, youth who are Native Hawaiian (NH), Micronesian, or who identify as sexual or gender minorities not only report elevated rates of SU, but are overrepresented in public sectors. In order to reduce youth SU health disparities, access to and quality of the system of care for youth must improve. To inform systems change, this needs assessment study used qualitative methods to engage professionals in Hawai'i working within public sectors that may intersect with youth SU service system of care. Professionals identified several themes which have implications for practice, policy, and research: colonialism and inclusivity at the macro level, the need for policies at the exo level, meso level changes regarding family and community, and stigma and discrimination at the micro level. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The impact of maternal depression on child mental health treatment and models for integrating care: a systematic review.

Maternal depression negatively impacts child mental health and is a well-known risk factor for child psychopathology. However, maternal depression treatment and child mental health treatment are rarely integrated. The purpose of this review was to assess the impact of maternal depression on child mental health treatment, including (1) how treatment of maternal depression affects child mental health outcomes, (2) the impact of maternal depression on children receiving mental health care, and (3) emerging models that address maternal depression in primary-care pediatrics and child mental health settings. A systematic literature review was conducted using PubMed and PsycInfo. Initial search yielded 224 records, and after exclusion, 29 papers were reviewed. Effective treatment of maternal depression is associated with a significant decrease in child psychiatric symptoms. Maternal depression negatively affects child mental health treatment in that there is a high rate of untreated mental illness among mothers of psychiatrically ill children, and maternal depression impedes effective child mental health treatment. Current models to address maternal depression in child settings include screening in pediatric primary care, psychotherapy for depressed mothers of psychiatrically ill children, and emerging models that integrate maternal and child mental health treatment. Effective treatment of maternal depression significantly improves child mental health and should be better integrated into child treatment. Opportunities to improve care include more robust screening for parental mental illness, supports to refer parents to psychiatric care, and on-site services for parents. Such interventions hold promise, but require significant support from a multidisciplinary team.

Implementation of an Adapted Collaborative Care Model.

Kosrae is an island state in the Federated States of Micronesia, a low- to middle-income country. Kosrae Community Health Center, an independent nonprofit organization, partnered with the Department of Psychiatry at the University of Hawai'i to integrate behavioral health services by using the collaborative care model (CoCM). The partnership encountered logistic and cultural challenges, but regular communication, case reviews, and training sessions enabled successful CoCM implementation. This success indicates that CoCM can be adapted in a remote island nation with finite resources. Findings indicate that planning for a longer implementation period may be required for international collaborations with limited previous experience in behavioral health.

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.

Hope, help, and healing: Culturally embedded approaches to suicide prevention, intervention and postvention services with native Hawaiian youth.

Suicide rates have reached their highest documented levels in the United States with the greatest increases among indigenous youth, including Native Hawaiians. Culturally informed, effective prevention and treatment services are needed now more than ever for Native communities to heal and flourish. Multicomponent prevention and service strategies rooted in indigenous values and approaches show the most promise. Native Hawaiian communities are united around a common goal of suicide prevention, intervention and postvention, linking cultural meanings to improve understanding and guide local efforts. This paper highlights important cultural values to consider when developing and implementing suicide prevention, intervention and postvention. Strategies build upon the strengths of Native Hawaiian youth and their respective communities. Native Hawaiian sayings anchor each level and serve to organize a set of culturally informed and culturally embedded programs and approaches along the continuum of prevention, intervention and postvention. Application of indigenization to suicide prevention enhances connections to people and place, inspiring hope among Native Hawaiian youth, their families and their communities. (PsycINFO Database Record

Monitoring the multi-faceted problem of youth violence: the Asian/Pacific Islander Youth Violence Prevention Center's surveillance system.

Youth violence (YV) is a complex public health issue that spans geographic, ethnic, and socioeconomic lines. The Asian/Pacific Islander Youth Violence Prevention Center conducts qualitative and quantitative research on YV in Hawai'i. A critical element in YV prevention involves measuring YV and its risk-protective factors to determine the scope of the problem and to monitor changes across time. Under the Asian/Pacific Islander Youth Violence Prevention Center's (APIYVPC's) surveillance umbrella, a variety of methodologies are utilized. The major forms of active surveillance are a School-Wide Survey for youth, and a Safe Community Household Survey for adults. A variety of secondary data sources are accessed, such as the Centers for Disease Control and Prevention (Youth Risk Behavior Surveillance System), the Hawai'i State Department of the Attorney General, the Hawai'i State Department of Education, and the Hawai'i State Department of Health. State data are especially important for the Center, because most of these sources disaggregate ethnicity data for Asian Americans/Pacific Islanders. This paper details the surveillance methodologies utilized by the APIYVPC to monitor YV in one specific community and in Hawai'i, in comparison to the rest of the State and nation. Empirical results demonstrate the utility of each methodology and how they complement one another. Individually, each data source lends valuable information to the field of YV prevention; however, collectively, the APIYVPC's surveillance methods help to paint a more complete picture regarding violence rates and the relationship between YV and its risk-protective factors, particularly for minority communities.

Risk and Protective Factors of Micronesian Youth in Hawai'i: An Exploratory Study.

This exploratory, qualitative study examined the risk and protective factors of Micronesian middle and high school students in Hawai'i. Forty one Micronesian youth participated in 9 focus groups that explored their experiences within their schools, families, and communities. The findings describe youths' experiences of ecological stress beginning with their migration to Hawai'i, and the potential outcomes of this stress (e.g., fighting, gangs, and drug use). Cultural buffers, such as traditional practices and culturally specific prevention programs, were described as aspects that prevented adverse outcomes. Implications for prevention practice are discussed.