Training to reduce behavioral health disparities: How do we optimally prepare family medicine residents for practice in rural communities?

Family physicians are a critical part of the healthcare system in rural areas, but little is known about the training they need to more effectively address behavioral health disparities. Practicing family physicians in Montana were surveyed about the behavioral health needs of their patients, the behavioral resources at their disposal, their prioritization of a number of behavioral skills and interventions in the training of family physicians, factors that limit their own use of behavioral skills, and the extent of their behavioral science training. Respondents across the state reported high rates of mental/emotional health issues and high need for health behavior change in their patients. Surprisingly, although rural family physicians reported access to significantly fewer behavioral health resources, they did not rate any of the behavioral skills as higher training priorities than their urban counterparts and they were more likely to identify limitations (lack of patient interest, lack of confidence or competence, and inadequate knowledge or training) on their own use of such skills in practice. Family physicians, both rural and urban, whose residency programs had a higher emphasis on behavioral science felt better prepared to use behavioral skills in practice. Consequently, rural training programs are encouraged to emphasize behavioral science training for their family medicine residents, particularly training that focuses on mental health stigma reduction, emphasizes time savings and practicality, covers more severe psychiatric presentations, promotes cultural sensitivity to rural values of autonomy and self-sufficiency, and teaches skills to advocate for individual and community health with regard to behavioral health disparities.

Do specialized services exist for LGBT individuals seeking treatment for substance misuse? A study of available treatment programs.

Substance abuse research has demonstrated that client sexual orientation influences treatment outcomes. Consequently, many substance user treatment programs offer services for lesbian, gay, bisexual, and transgender (LGBT) individuals. In a recent search of SAMHSA treatment listings, 11.8% (N=911) of substance user treatment programs (including residential, outpatient, and partial hospitalization) in the United States and Puerto Rico indicated that they offer specialized services for LGBT clients. However, a telephone survey we conducted in 2003-2004 revealed that 70.8% of these "LGBT" programs were no different from services offered to the general population, and only 7.4% could identify a service specifically tailored to the needs of LGBT clients. Implications for LGBT individuals seeking services are discussed, the study's limitations are noted, and future research directions are identified.

Sexual abuse in lesbian and bisexual young women: associations with emotional/behavioral difficulties, feelings about sexuality, and the "coming out" process.

SUMMARY We examined associations between childhood sexual abuse (CSA) and emotional/behavioral difficulties, feelings about one's sexuality, and the "coming out" process in a sample of 227 lesbian and bisexual women, ages 18-23, recruited for an online questionnaire study. Participants with a CSA history ("experiencers") reported significantly more emotional/behavioral difficulties than their nonexperiencer counterparts, suggesting that CSA may be an important contributor to some problems and behaviors currently linked in the literature to sexual orientation. Lesbian and bisexual experiencers varied widely as to whether and how they felt a CSA history affected their feelings about their sexuality or their "coming out" process. We discuss the implications of these findings for counseling, research, and theorizing involving lesbian and bisexual young women.