Barriers to Mental Health Treatment in Patients Referred by Primary Care

Problem: Limited access to mental health treatment is one of many potential barriers to treating mental illness in the United States. Where resources are readily available, reportedly high no-show rates for established mental health appointments suggests further investigation is necessary to identify frequent barriers within that population. This was a quality improvement project to identify common themes in patient-reported barriers to care. Methods: A 4-question phone survey was offered to individuals that did not appear at their mental health appointment. Data was analyzed to identify the most commonly reported barriers to mental health treatment. Additional data collected includes reported history of mental health treatment, and perception of referral explanation by primary care. Results: 133 individuals met inclusion criteria, with 23 choosing to participate in the study. Transportation was the most frequently reported barrier (n=9), followed by the individual’s perception of a poor experience with their PCP at the time of referral (n=6). Other reported barriers included: medical/mental health issues that prevented them from leaving the home, attitudinal reasoning, inability to take off work, forgetting about/being unaware of an appointment, financial problems, an unexpected event, and family obligations. Implications for Practice: Despite high participation among individuals that were contacted, an excessive number of answered calls indicates that future studies may gain more valuable data if patients were contacted through other means. With transportation and poor perception of primary care as the most frequently reported barriers, organizations should strive to educate patients on available resources and continually work to improve communication between the patient and the provider

Assessing the Relationship between SafeCare Fidelity and Competence Measures

As more evidence-based programs are implemented in community settings, there is a strong need to ensure those models are implemented with integrity. Implementation of programs should be evaluated for fidelity, the degree of adherence to treatment protocols, and competence, the level of skill in implementation (Schoenwald et al., 2011). The purpose of this study was to review audio recordings of SafeCare home visiting sessions to discover the relationship between the measures of fidelity and competence. Six coders were assigned 209 SafeCare home visiting audiotapes to be coded for fidelity and competence. A sample of audios were double coded to evaluate fidelity and competence scores for inter-rater reliability. Fidelity and competence items were classified into process and content categories, forming the six main variables of process fidelity, content fidelity, total fidelity, process competence, content competence, and total competence. Total fidelity correlated with total competence at a level of .615, with process fidelity and process competence correlating at a much lower level than content items. The total correlation level can be interpreted as that fidelity and competence are strongly related measures, but are not identical constructs. The goal for SafeCare coders would be to continue refining competence definitions and attempting to remove the subjective nature from the competence coding process. With these two efforts, competence reliability should increase to an acceptable level. Given the main fidelity and competence correlation level, it is advisable for SafeCare coders to continue to code both fidelity and competence to avoid missing valuable components of the session. Additional research may be needed once the competence scale becomes better established

A Syndemic Perspective on Anti-Asian Racism and Asian American Mental Health During the COVID-19 Pandemic

Asian Americans have been negatively impacted by the COVID-19 pandemic, experiencing COVID-related anti-Asian racism as well as exacerbated pandemic-related stressors, such as increased negative mental health symptoms and economic challenges, due to existing structural inequities. Asian Americans are a diverse group made up of various ethnic and cultural groups with differential impacts from the pandemic. Examining differences within Asian Americans is therefore important to further understand the impacts of health inequities, economic challenges, and racism. Using a large, national dataset, I conducted three studies that examine Asian Americans’ experiences of anti-Asian racism, negative mental health symptoms, and economic challenges within the context of the COVID-19 pandemic. Study one examined Asian Americans’ prevalence rates of psychological distress and unmet mental health needs by sociodemographic subgroups. In study two, I examined rates of discrimination and awareness of anti-Asian COVID-related racism by sociodemographic subgroups as well as the impacts these two forms of racism have on psychological distress and physical health decline. Finally, in study three, I examined latent profiles of a proposed COVID-19 anti-Asian racism syndemic, describing how experiences of anti-Asian racism, mental and physical health, and economic challenges overlap and differ for Asian American subgroups. Asian Americans’ wellbeing is an important public health concern that needs to be addressed systemically. By examining subgroup differences in mental health and related disparities (i.e., anti-Asian racism and economic inequities), these three studies delineate specific Asian American subgroups who are most vulnerable and in need of services and policy change

Hope and Focus on Future as Protective Health Factors? A Moderation Analysis with Race and Income

Health promotion and prevention are important goals in public health (Dubois, 2017). Hope and consideration of future consequences are two suggested protective factors that promote healthy behaviors, such as healthy eating and physical activity (Joireman et al., 2012; Joireman & King, 2016; Kwon et al., 2015; Scioli et al., 2011; Valle et al., 2006). These behaviors are important preventive measures and promote optimum physical and mental health (Aboderin et al., 2001; Elisaf, 2001; Hu et al., 2001; Key, Allen, Spencer, & Travis, 2002; WHO, 2018). However, physical and mental health disorders disproportionally impact oppressed and marginalized communities (Adler & Rehkopf, 2008; Davey-Smith, 1997; Oyserman, Smith, & Elmore, 2014; Williams & Jackson, 2005). At the same time, research examining hope and consideration of future consequences rarely examines the differential impact of these constructs for different communities (Johnson, Blum, & Cheng, 2014; Kwon et al., 2015). This study assessed how participants’ levels of hope, future orientation, and present orientation promote healthy eating and physical activity in the contexts of income and race. Specifically, results showed that hope predicted physical activity but not healthy eating; consideration of future consequences predicted both healthy eating and physical activity; and consideration of immediate consequences predicted less healthy eating but did not predict physical activity. Furthermore, income moderated the relationship between consideration of future consequences and healthy eating. Race did not show any significant moderation effects. Interventions that emphasize hope, considering future consequences, and considering immediate consequences may have some effect on individuals’ physical activity and healthy eating behaviors. However, these results will likely be limited without additional intervention components. Indeed, the efforts of any intervention should be aimed towards higher-order change, which is necessary for affecting individuals’ and communities’ opportunities and likelihood of increasing health-promoting behaviors

Enhancing laser sideband cooling in one-dimensional optical lattices via the dipole interaction

We study resolved sideband laser cooling of a one-dimensional optical lattice with one atom per site, and in particular the effect of the dipole interaction between radiating atoms. For simplicity, we consider the case where only a single cooling laser is applied. We derive a master equation, and solve it in the limit of a deep lattice and weak laser driving. We find that the dipole interaction significantly changes the final temperature of the particles, increasing it for some phonon wavevectors and decreasing it for others. The total phonon energy over all modes is typically higher than in the non-interacting case, but can be made lower by the right choice of parameters

How not to grow an ORCID program

In 2017 the University of Massachusetts Medical School became a member of ORCID (Open Researcher and Contributor ID) through a regional library consortium. Over the course of the year, the library made efforts to establish ORCID implementations with the institution’s faculty profile system. However, progress was insufficient by the end of the year to warrant membership renewal. In this lightning talk, we will discuss our efforts to get ORCID off the ground and the positive lessons we learned in the process

Negotiating excess treatment costs in a clinical research trial: the good, the bad and the innovative

Barriers to recovering the excess treatment costs associated with health research from local organisations in the United Kingdom can increase research costs, delay completion of high- quality studies and risk disenfranchising health trusts and patients from participation. The authors demonstrate how the process for recovering excess treatment costs at a local National Health Service (NHS) trust level in a multicentre study was inconsistent and resulted in excess effort and cost to the research budget. An innovative example of how an organisation acting as a broker between commissioners and researchers facilitated a more timely excess treatment cost agreement is highlighted