Continuing Education Training Focused on the Development of Behavioral Telehealth Competencies in Behavioral Healthcare Providers

Introduction: Telehealth allows behavioral health care and specialty services to be extended to rural residents. Telehealth is an important resource for the Alaskan healthcare system, which is tasked with providing services to culturally diverse populations living in remote areas. Training competent providers to deliver telehealth services is vital for the implementation of successful telehealth programs. Yet, the literature is lacking in the area of provider behavioral telehealth competency training. Methods: This study assessed the impact of a Behavioral Telehealth Ethical Competencies Training program on 16 behavioral health providers\u27 development of behavioral telehealth competency. A total of 14 competencies were developed, which required participants to understand the roles and responsibilities of a behavioral telehealth coordinator working at the distal site as well as the roles and responsibilities of the therapist. Video vignettes evaluating the 14 competencies, self-reported competence surveys and follow-up surveys of progress on telehealth goals were utilized to assess effects of the training. Results: Results indicated participants\u27 behavioral telehealth competencies increased following training. Participants reported positive perceptions regarding their competency, and achieved progress on the majority of behavioral telehealth goals set during the training. Conclusions: This study provides a baseline for developing a best practice model for behavioral telehealth service delivery by identifying specific provider competencies for administering effective behavioral telehealth services. A unique continuing education training model, led by content experts including university professors and Alaska Native Elders, incorporating behavioral telehealth, rural ethics, cultural competency and vicarious trauma training is described. Lastly, this study details the use of an innovative video vignette assessment instrument for evaluating the effectiveness of continuing education training

Value of Community Partnership for Understanding Stress and Coping in Rural Yup’ik Communities: The CANHR Study

Stress and trauma can compromise physical and mental health. Rural Alaska Native communities have voiced concern about stressful and traumatic events and their effects on health. The goal of the Yup’ik Experiences of Stress and Coping Project is to develop an in-depth understanding of experiences of stress and ways of coping in Yup’ik communities. The long-range goal is to use project findings to develop and implement a community-informed and culturally grounded intervention to reduce stress and promote physical and mental health in rural Alaska Native communities. This paper introduces a long-standing partnership between the Yukon-Kuskokwim Regional Health Corporation, rural communities it serves, and the Center for Alaska Native Health Research at the University of Alaska Fairbanks. Within the context of the Stress and Coping project, we then discuss the value and challenges of taking a CBPR approach to advance science and address a priority community concern, and share strategies to respond to challenges. Focus groups were conducted to culturally adapt an existing structured interview and daily diary protocol to better fit Yup’ik ways of knowing. As modified, these interviews increased understanding of stress and coping particular to two Yup’ik communities. Challenges included the geographical nature of Yup’ik communities, communication barriers, competing priorities, and confidentiality issues. Community participation was central in the development of the study protocol, helped ensure that the research was culturally appropriate and relevant to the community, and facilitated access to participant knowledge and rich data to inform intervention development

Disseminating Research in Rural Yup’ik Communities: Challenges and Ethical Considerations in Moving from Discovery to Intervention Development in the Translational Pathway

The native people of Alaska have experienced historical trauma and on-going rapid, often externally imposed changes in culture and lifestyle patterns. As a consequence, these populations shoulder a disproportionately high burden of psychological stress. Yup\u27ik communities in the Yukon Kuskokwim Delta region in Southwest Alaska have experienced epidemics and forced acculturation, contributing to behavioural health issues, including substance abuse and suicide. Cultural loss in Yup\u27ik communities has resulted in generational gaps that disrupt the transmission of cultural traditions and values important for well-being. Despite these intrusions, Yup\u27ik communities have retained cultural traditions which act as protective factors against the development of physical and psychological illness. These cultural protective factors can be harnessed to collaboratively develop culturally grounded interventions that reduce stress and build connections across generations, helping communities move towards wellness on their own terms

Photometry of the Didymos System across the DART Impact Apparition

On 2022 September 26, the Double Asteroid Redirection Test (DART) spacecraft impacted Dimorphos, the satellite of binary near-Earth asteroid (65803) Didymos. This demonstrated the efficacy of a kinetic impactor for planetary defense by changing the orbital period of Dimorphos by 33 minutes. Measuring the period change relied heavily on a coordinated campaign of lightcurve photometry designed to detect mutual events (occultations and eclipses) as a direct probe of the satellite’s orbital period. A total of 28 telescopes contributed 224 individual lightcurves during the impact apparition from 2022 July to 2023 February. We focus here on decomposable lightcurves, i.e., those from which mutual events could be extracted. We describe our process of lightcurve decomposition and use that to release the full data set for future analysis. We leverage these data to place constraints on the postimpact evolution of ejecta. The measured depths of mutual events relative to models showed that the ejecta became optically thin within the first ∼1 day after impact and then faded with a decay time of about 25 days. The bulk magnitude of the system showed that ejecta no longer contributed measurable brightness enhancement after about 20 days postimpact. This bulk photometric behavior was not well represented by an HG photometric model. An HG 1 G 2 model did fit the data well across a wide range of phase angles. Lastly, we note the presence of an ejecta tail through at least 2023 March. Its persistence implied ongoing escape of ejecta from the system many months after DART impact

Indigenous Knowledge: Revitalizing Everlasting Relationships between Alaska Natives and Sled Dogs to Promote Holistic Wellbeing

Introduction: Indigenous peoples have documented their culture’s history in oral stories, revealing lessons about holistic relationships fostering perseverance. Despite vast differences in time, relationships and stories are equally important today. Athabascans retain their values, life skills, and wellness through cultural practices. Creating opportunities for youths to learn through reciprocal relationships increases wellness in Indigenous communities, highlighting the significance of community-developed programs that connect youths to their place and culture. Method: Athabascan youths in rural Alaska get hands-on experience and Elder mentorship working with sled dogs in the Frank Attla Youth and Sled Dog Care-Mushing Program (FAYSDP). Through a community-based participatory research partnership with the community of Huslia and Jimmy Huntington School, we examined how FAYSDP affects youths, and how relationships within culture and land promote wellbeing. Fifteen middle and high-school youths shared their perspectives on how FAYSDP impacts them and their community using photovoice and digital storytelling. Nineteen adults contributed their perspectives in focus groups. We used emerging themes (inductive) and Athabascan cultural values and elements of social capital (deductive approaches) to analyze the qualitative data. Results: Findings illustrate how FAYSDP promotes wellbeing by empowering youths to apply what they learn to generate their own knowledge, while centering communities around culturally significant practices such as dog mushing. It connects youths to their home and their cultural values, using dogs as the driving force to bridge generations and foster youth wellness. Discussion: We discuss implications for community-based programs that engage Elders as teachers and the land as their classroom to promote youth holistic wellness

Disseminating research in rural Yup’ik communities: challenges and ethical considerations in moving from discovery to intervention development

Background. The native people of Alaska have experienced historical trauma and rapid changes in culture and lifestyle patterns. As a consequence, these populations shoulder a disproportionately high burden of psychological stress. The Yup’ik Experiences of Stress and Coping project originated from rural Yup’ik communities’ concerns about stress and its effects on health. It aimed to understand the stressful experiences that affect Yup’ik communities, to identify coping strategies used to deal with these stressors and to inform culturally responsive interventions. Objectives. Here, we examine the process of moving from research (gaining understanding) to disseminating project findings to translation into intervention priorities. We highlight the importance of community participation and discuss challenges encountered, strategies to address these challenges and ethical considerations for responsible intervention research with indigenous communities that reflect their unique historical and current socio-cultural realities. Design. Community-wide presentations and discussions of research findings on stress and coping were followed by smaller Community Planning Group meetings. During these meetings, community members contextualized project findings and discussed implications for interventions. This process placed priority on community expertise in interpreting findings and translating results and community priorities into grant applications focused on intervention development and evaluation. Results. Challenges included translation between English and Yup’ik, funding limitations and uncertainties, and the long timelines involved in moving from formative research to intervention in the face of urgent and evolving community needs. The lack of congruence between institutional and community worldviews in the intervention research enterprise highlights the need for “principled cultural sensitivity”. Conclusions. Cultural sensitivity requires sharing results that have practical value, communicating openly, planning for sustainability and incorporating indigenous knowledge and expertise through a community-guided process. Our research findings will inform continued work within our partnership as we co-develop culturally based strategies for multilevel community interventions to address stress

Modeling suggests that microliter volumes of contaminated blood caused an outbreak of hepatitis C during computerized tomography.

Background & aimsAcute hepatitis C (AHC) is not frequently identified because patients are usually asymptomatic, although may be recognized after iatrogenic exposures such as needle stick injuries, medical injection, and acupuncture. We describe an outbreak of AHC among 12 patients who received IV saline flush from a single multi-dose vial after intravenous contrast administration for a computerized tomography (CT) scan. The last patient to receive IV contrast with saline flush from a multi-dose vial at the clinic on the previous day was known to have chronic HCV genotype 1b (termed potential source, PS). Here we sought to confirm (via genetic analysis) the source of infection and to predict the minimal contaminating level of IV saline flush needed to transmit infectious virus to all patients.MethodsIn order to confirm the source of infection, we sequenced the HCV E1E2 region in 7 CT patients, in PS, and in 2 control samples from unrelated patients also infected with HCV genotype 1b. A transmission probabilistic model was developed to predict the contamination volume of blood that would have been sufficient to transmit infectious virus to all patients.ResultsViral sequencing showed close clustering of the cases with the PS. The transmission probabilistic model predicted that contamination of the multi-dose saline vial with 0.6-8.7 microliters of blood would have been sufficient to transmit infectious virus to all patients.ConclusionAnalysis of this unique cohort provides a new understanding of HCV transmission with respect to contaminating volumes and viral titers