Undocumented PTSD among African American clients with serious mental illness in a statewide mental health system.

OBJECTIVES: African Americans are at increased risk for trauma exposure and the development of posttraumatic stress disorder (PTSD) relative to other racial groups. Among African Americans with Serious Mental Illness (SMI), PTSD is frequently underdiagnosed and untreated. The primary objective of this study was to investigate trauma exposure, PTSD symptom severity, and the rate of undocumented PTSD in medical records among African Americans diagnosed with SMI. METHODS: Screening for trauma exposure and PTSD symptoms was implemented among 404 clients receiving community mental health services. Participants endorsed at least 1 traumatic event, had a score of at least 45 on the DSM-IV PTSD Checklist indicating probable PTSD, and had a chart diagnosis of an Axis I disorder. RESULTS: Around 18.3% of participants had PTSD diagnosed in their medical chart. A diagnosis of schizophrenia/schizoaffective disorder was inversely related to the detection of PTSD in the chart. Client age and gender did not adversely affect the detection of PTSD, and detection rates remained low overall. Childhood sexual abuse was the most commonly endorsed index trauma, followed closely by sudden death of a loved one (including violent death). Participants typically experienced an average of 8 types of traumatic events in their lifetime. Cumulative total trauma exposure significantly predicted PTSD severity. Clients with mood disorders reported more severe PTSD. CONCLUSION: Findings highlight the low detection rate of PTSD and related symptoms in African American clients with SMI. There is a need for early intervention, grief counseling, culturally sensitive trauma screening, and culturally informed treatment options for this population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Family Systems Cultural and Resilience Dimensions to Consider in Nutrition Interventions: Exploring Preschoolers' Eating and Physical Activity Routines During COVID-19.

OBJECTIVE: To describe the weight-related family functioning of racial minority families with low income using family systems theory as an interpretive framework. DESIGN: Primarily a qualitative study with interviews plus; descriptive demographics, anthropometrics, a family functioning measure, and food insecurity screening. SETTING: Telephone interviews with families of preschool-aged children in an urban setting. PARTICIPANTS: Primary caregivers of preschool-aged children. PHENOMENON OF INTEREST: Cultural impacts on family systems. ANALYSIS: Interviews were audio-recorded, transcribed verbatim, and loaded into NVivo 12 for thematic analysis. Descriptive statistics. RESULTS: The 23 participants were mothers and 2 maternal grandmothers. Seventy-four percent were African American, most children were normal weight (n = 15, 65%), mean family function scores were high, and more than half the families were at risk for food insecurity (n = 13, 56%). Acculturation and intergenerational eating-related cultural dimensions were discerned as the overarching themes influencing family cohesion. Family cohesion appeared to have helped the families adapt to the impact of coronavirus disease 2019. CONCLUSIONS AND IMPLICATIONS: Cultural dimensions such as acculturation and intergenerational influences appeared to be associated with social cohesion and family functioning around weight-related behaviors for these families. These findings add cultural and family resilience dimensions to family systems theory in nutrition interventions.

Comparison of Teaching Strategies for Cultural Humility in Physical Therapy.

UNLABELLED: Cultural competence and cultural humility are ongoing processes that healthcare professionals should continually strive for in order to provide effective and comprehensive plans of care for patients. METHODS: This 2-year, longitudinal, educational pilot study describes the levels of competency in second-year entry-level physical therapy students and compares the outcomes of three teaching strategies for cultural competence and cultural humility. All students received a standard 2-hour lecture; study volunteers were randomly assigned to one of two enriched educational groups, involving a standardized patient or a paper case enrichment. RESULTS: Students shifted from initial levels of "culturally incompetent" and/or "culturally aware" to "culturally competent" as measured by the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised. This shift was maintained after 1.5 yrs following the exposure. Because the enriched educational groups were underpowered, preliminary quantitative data are inconclusive, but qualitative feedback from students is strongly positive. DISCUSSION: A minimal dose of a structured 2-hr lecture with a skilled instructor, who creates a safe environment for cultural learning, produced positive shifts toward greater cultural competence. Five processes emerged for teaching cultural humility that may assist in designing comprehensive educational experiences on this topic. A framework for organizing course content is presented.