Pilot of a screening, brief intervention and referral to treatment process for symptoms of trauma among primary care patients.

Background: For populations with high rates of trauma exposure yet low behavioural health service use, identifying and addressing trauma in the primary care setting could improve health outcomes, reduce disability and increase the efficiency of health system resources.

Objective: To assess the acceptability and feasibility of a screening, brief intervention and referral to treatment (SBIRT) process for trauma and symptoms of posttraumatic stress disorder (PTSD) among American Indian and Alaska Native people. We also examine the short-term effects on service utilization and the screening accuracy of the Primary Care Posttraumatic Stress Disorder Screen.

An Internet-Based Therapeutic Tool for American Indian/Alaska Native Adults With Posttraumatic Stress Disorder: User Testing and Developmental Feasibility Study.

Background: Posttraumatic stress disorder (PTSD) is a major public health concern among American Indian and Alaska Native populations. Primary care clinics are often the first point of contact for American Indian and Alaska Natives seeking health care and are feasible locations for trauma-focused interventions.

Objective: Web-based therapeutic interventions have the potential to reduce PTSD symptoms by offering psychoeducation and symptom self-management tools.

Attitudes Towards Evidence-Based Practice in Substance Use Treatment Programs Serving American Indian Native Communities.

The objective of this paper was to compare attitudes towards evidence-based practice (EBP) of substance use disorder treatment (SUDT) center employees' serving American Indian and Alaskan Native (AIAN) populations to those serving non-AIAN populations. Survey data on the openness and divergence subscales of the Evidence-Based Practice Attitude Scale (EBPAS) were collected and analyzed. Independent samples T tests were performed to compare the two samples.

Disseminating Information on Trauma Screening, Brief Intervention, and Referral to Treatment in a Tribal Health Setting: A Case Study.

Exposure to trauma is consistently associated with co-occurrence of behavioral health disorders. Primary care settings are opportune places to screen for traumatic experiences and symptoms, as they are often the initial point of care for behavioral health concerns by the Alaska Native and American Indian (AN/AI) population. In this case study, we examine results dissemination activities at the SCF Research Department-hosted 2016 Alaska Native Health Research Forum (Forum) of a pilot study of a trauma-focused screening, brief intervention, and referral to treatment (T-SBIRT) process for AN/AI adults in primary care.

National Overview of Medication-Assisted Treatment for American Indians and Alaska Natives With Substance Use Disorders.

Objective: American Indians and Alaska Natives (AI/ANs) experience higher rates of substance use disorders and less access to high-quality care compared with other racial-ethnic groups. The objective of this study was to better understand the use of medication-assisted treatment (MAT) of substance use disorders for AI/ANs and barriers to broader implementation.

Methods: Representatives of 192 substance abuse treatment programs completed a survey about their use of MAT.

Correlates of Motivational Interviewing Use Among Substance Use Treatment Programs Serving American Indians/Alaska Natives.

Motivational interviewing (MI) offers a treatment modality that can help meet the treatment needs of American Indians/Alaska Natives (AI/ANs) with substance use disorders. This report presents results from a national survey of 192 AI/AN substance abuse treatment programs with regard to their use of MI and factors related to its implementation, including program characteristics, workforce issues, clinician perceptions of MI, and how clinicians learned about MI. Sixty-six percent of programs reported having implemented the use of MI in their programs.

A National Study of American Indian and Alaska Native Substance Abuse Treatment: Provider and Program Characteristics.

American Indians and Alaska Natives (AIANs) experience major disparities in accessing quality care for mental health and substance use disorders. There are long-standing concerns about access to and quality of care for AIANs in rural and urban areas including the influence of staff and organizational factors, and attitudes toward evidence-based treatment for addiction. We conducted the first national survey of programs serving AIAN communities and examined workforce and programmatic differences between clinics located in urban/suburban (n=50) and rural (n=142) communities.

Development of a Screening and Brief Intervention Process for Symptoms of Psychological Trauma Among Primary Care Patients of Two American Indian and Alaska Native Health Systems.

American Indian and Alaska Native (AI/AN) people experience high rates of acute, chronic, and intergenerational trauma. Traumatic experiences often increase the risk of both medical and behavioral health problems making primary care settings opportune places to screen for trauma exposure or symptomology. The objective of this study was to determine considerations and recommendations provided by patients, health care providers, health care administrators, and tribal leaders in the development of an adult trauma screening, brief intervention, and referral for treatment process to pilot at two large AI/AN primary care systems.

Use of evidence-based treatments in substance abuse treatment programs serving American Indian and Alaska Native communities.

Background: Research and health surveillance activities continue to document the substantial disparities in the impacts of substance abuse on the health of American Indian and Alaska Native (AI/AN) people. While Evidence-Based Treatments (EBTs) hold substantial promise for improving treatment for AI/ANs with substance use problems (as they do for non-AI/ANs), anecdotal reports suggest that their use is limited. In this study, we examine the awareness of, attitudes toward, and use of EBTs in substance abuse treatment programs serving AI/AN communities.

How do providers serving American Indians and Alaska Natives with substance abuse problems define evidence-based treatment?

Rates of substance abuse remain high in American Indian and Alaska Native (AI/AN) populations. While there are many evidence-based treatments (EBTs) for substance use problems, no studies exist describing how directors of treatment programs serving AI/ANs perceive and use EBTs. Twenty-one key informant interviews with program administrators and 10 focus groups with clinicians were conducted at 18 treatment programs for AI/ANs with substance use problems.

A framework for conducting a national study of substance abuse treatment programs serving American Indian and Alaska native communities.

Background: Because of their broad geographic distribution, diverse ownership and operation, and funding instability, it is a challenge to develop a framework for studying substance abuse treatment programs serving American Indian and Alaska Native communities at a national level. This is further complicated by the historic reluctance of American Indian and Alaska Native communities to participate in research.

Objectives And Methods: We developed a framework for studying these substance abuse treatment programs (n ≈ 293) at a national level as part of a study of attitudes toward, and use of, evidence-based treatments among substance abuse treatment programs serving AI/AN communities with the goal of assuring participation of a broad array of programs and the communities that they serve.

Walking on: celebrating the journeys of Native American adolescents with substance use problems on the winding road to healing.

High rates of substance use and related problems have been long recognized as critical health issues for Native American adolescents. Unfortunately, no manualized interventions address the specific needs of Native American adolescents in a culturally appropriate manner. In 2006, the Cherokee Nation partnered with the University of Colorado to employ a community-based participatory research process to develop an intervention for Native American adolescents with substance use problems.

Problems with non-adherence to antipsychotic medication in Samoan New Zealanders: a literature review.

This paper explores what is known about adherence to antipsychotic medications in general and the possible reasons for non-adherence in Samoan New Zealanders. Samoan New Zealanders are either Samoan-born immigrants or their descendents born in New Zealand. Clinicians recognize a high prevalence of non-adherence among Samoan New Zealanders.

Malignant Narcissism: from fairy tales to harsh reality.

Introduction: Malignant Narcissism has been recognized as a serious condition but it has been largely ignored in psychiatric literature and research. In order to bring this subject to the attention of mental health professionals, this paper presents a contemporary synthesis of the biopsychosocial dynamics and recommendations for treatment of Malignant Narcissism.

Methods: We reviewed the literature on Malignant Narcissism which was sparse.

The existential way to recovery.

This paper explores the essential features of recovery and the need for an existential approach in psychiatry. The biopsychosocial model often fails to sufficiently validate the existential suffering of patients. We review the major principles of recovery and the philosophical and psychiatric principles of existentialism.

Early intervention in first episode psychosis: hope for a better future.

In the last two decades the clinical and research focus in psychotic disorders has shifted to first episode psychosis, early detection of the prodromal phase of psychosis and an effective integrated treatment model known as "Early Intervention". The first five years of psychosis that is described as a "critical period" is the most important time for recognition and treatment. Services for Early Intervention should be easily accessible, non-threatening and non-stigmatising.

An investigation of the field trip model as a method for teaching breastfeeding to pediatric residents.

Pediatricians in training are underexposed to breastfeeding issues and as a result are not fully prepared to promote breastfeeding and support the breastfeeding mother. This study is a pre-post evaluation of the effectiveness of a pilot breastfeeding curriculum. Using the "field trip model," pediatric residents participated in 4 half-day teaching sessions at community sites, including a visit to a La Leche League home meeting, a Kaiser lactation consultant clinic, hospital-based lactation rounds, and a children's hospital-based referral clinic.

Linking nursing home working conditions to organizational performance.

Exploring selected working conditions and performance in nursing homes suggests that high and low performers can be determined based on both quantitative and qualitative findings.

An Internet-based patient-provider communication system: randomized controlled trial.

Background: Internet-based interactive websites for patient communication (patient portals) may improve communication between patients and their clinics and physicians.

Objective: The aim of the study was to assess the impact of a patient portal on patients' satisfaction with access to their clinic and clinical care. Another aim was to analyze the content and volume of email messages and telephone calls from patients to their clinic.

Nursing home culture: a critical component in sustained improvement.

In the third in a series of articles exploring working conditions and quality improvement in nursing homes, 31 nursing homes were surveyed using an adaptation of the Competing Values Framework (CVF) Organizational Assessment. The CVF provides information about the organizational culture through describing dominant perceived values, distribution of values across organizational characteristics, and orientation of values toward flexibility. Staff reported a dominant group culture, reflecting a family and team orientation within their settings.

Utilization and costs for children who have special health care needs and are enrolled in a hospital-based comprehensive primary care clinic.

Objective: When deciding how much hospital resources should be allocated to comprehensive primary care clinics for children with multisystem disorders, it is important to consider all of the non-primary care revenue streams associated with these children as well as the effects of a comprehensive primary care program on access and quality. The objectives of this study were, first, to determine costs as well as the payments associated with hospital ambulatory and inpatient services for children with multisystem disorders followed by a comprehensive primary care clinic; and, second, to determine the effect of enrollment in a hospital-based comprehensive primary care clinic on ambulatory and inpatient utilization patterns and expenditures for children with multisystem disorders.

Methods: The study population for the payment analysis consisted of 1012 children of all ages who were seen in the Special Primary Care Clinic (SPCC) in 2001.

Expectations of patients and physicians regarding patient-accessible medical records.

Background: Middle class populations have supported shared medical records, including Internet-accessible medical records. The attitudes of lower income populations, and of physicians, are less clear.

Objectives: The objective of this study was to compare the attitudes toward shared outpatient medical records among (1) socioeconomically disadvantaged patients in community health centers, (2) insured patients in primary care offices, and (3) a broad range of physicians in outpatient practice.

Assessing nursing homes' capacity to create and sustain improvement.

Nursing home leadership and staff in 32 nursing homes were surveyed using an adaptation of Shortell's Organization and Management Survey. An earlier psychometric assessment of Shortell's communication and leadership scales raised concerns about the reliability of these scales in the nursing home setting. Exploratory factor analysis was performed to determine if another scale structure should be considered.

Challenges in operationalizing the DSM-IV clinical significance criterion.

Background: An explicit clinical significance (CS) criterion was added to many DSM-IV diagnoses in an attempt to more closely approximate the clinical diagnostic process and reduce the proportion of false positives in epidemiological studies. The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) offered a unique opportunity to examine the success of this effort.

Objective: To determine the impact of distress, impairment, and help-seeking reported in a lay structured interview on concordance with a clinical reappraisal.