Cultural adaptations to augment health and mental health services: a systematic review.

BACKGROUND: Membership in diverse racial, ethnic, and cultural groups is often associated with inequitable health and mental health outcomes for diverse populations. Yet, little is known about how cultural adaptations of standard services affect health and mental health outcomes for service recipients. This systematic review identified extant themes in the research regarding cultural adaptations across a broad range of health and mental health services and synthesized the most rigorous experimental research available to isolate and evaluate potential efficacy gains of cultural adaptations to service delivery. METHODS: MEDLINE, PsycINFO, CINAHL, EMBASE, and grey literature sources were searched for English-language studies published between January 1955 and January 2015. Cultural adaptations to any aspect of a service delivery were considered. Outcomes of interest included changes in service provider behavior or changes in the behavioral, medical, or self-reported experience of recipients. RESULTS: Thirty-one studies met the inclusion criteria. The most frequently tested adaptation occurred in preventive services and consisted of modifying the content of materials or services delivered. None of the included studies focused on making changes in the provider's behavior. Many different populations were studied but most research was concerned with the experiences and outcomes of African Americans. Seventeen of the 31 retained studies observed at least one significant effect in favor of a culturally adapted service. However there were also findings that favored the control group or showed no difference. Researchers did not find consistent evidence supporting implementation of any specific type of adaptation nor increased efficacy with any particular cultural group. CONCLUSIONS: Conceptual frameworks to classify cultural adaptations and their resultant health/mental health outcomes were developed and applied in a variety of ways. This review synthesizes the most rigorous research in the field and identifies implications for policy, practice, and research, including individualization, cost considerations, and patient or client satisfaction, among others.

Glycogen synthase kinase 3 is a potential drug target for African trypanosomiasis therapy.

Development of a safe, effective, and inexpensive therapy for African trypanosomiasis is an urgent priority. In this study, we evaluated the validity of Trypanosoma brucei glycogen synthase kinase 3 (GSK-3) as a potential drug target. Interference with the RNA of either of two GSK-3 homologues in bloodstream-form T. brucei parasites led to growth arrest and altered parasite morphology, demonstrating their requirement for cell survival. Since the growth arrest after RNA interference appeared to be more profound for T. brucei GSK-3 "short" (Tb10.161.3140) than for T. brucei GSK-3 "long" (Tb927.7.2420), we focused on T. brucei GSK-3 short for further studies. T. brucei GSK-3 short with an N-terminal maltose-binding protein fusion was cloned, expressed, and purified in a functional form. The potency of a GSK-3-focused inhibitor library against the recombinant enzyme of T. brucei GSK-3 short, as well as bloodstream-form parasites, was evaluated with the aim of determining if compounds that inhibit enzyme activity could also block the parasites' growth and proliferation. Among the compounds active against the cell, there was an excellent correlation between activity inhibiting the T. brucei GSK-3 short enzyme and the inhibition of T. brucei growth. Thus, there is reasonable genetic and chemical validation of GSK-3 short as a drug target for T. brucei. Finally, selective inhibition may be required for therapy targeting the GSK-3 enzyme, and a molecular model of the T. brucei GSK-3 short enzyme suggests that compounds that selectively inhibit T. brucei GSK-3 short over the human GSK-3 enzymes can be found.

Child protection and justice systems processing of serious child abuse and neglect cases.

OBJECTIVE: The aim of this study was to examine the trajectory of cases through four systems: child protection, law enforcement, the dependency courts, and the criminal courts. METHOD: This study focused on a county selected from a 41-county telephone survey conducted for the National Incidence Study of Child Abuse and Neglect (NIS-3). For this analysis prospective samples were drawn from law enforcement (n=225) and the county child protection (CPS) agency (n=225) and followed through in-depth case tracking across all agencies and through both the dependency and criminal court systems. RESULTS: The percentage of CPS cases opened in dependency court was similar to prior studies (29%), but the acceptance and prosecution rates were much higher--92% of the cases referred from CPS, including many cases of physical abuse. Compared to referrals from CPS to law enforcement (93%), few cases were referred from law enforcement to CPS (17%). Anecdotally, case referral patterns appeared to be influenced by communication patterns and mutual positive regard, regardless of the collaborative protocols in place. One of the most instructive findings was the degree of difficulty in tracking cases across organizations and the types of obstacles that impeded success. Disorganization was not an issue, rather internal structures set up to facilitate intra-organizational processing were the same structures that actually impeded cross-organizational case finding. CONCLUSIONS: It is not sufficient to rely on the existence of multi-disciplinary teams or Child Advocacy Centers to ensure collaboration. More attention to daily tasks and activities as well as the nature and quality of communication is warranted. On the technical side, use of common case identifiers on cases that are cross-referred is strongly recommended. Future studies should broaden the scope of inquiry to include the consequences of all case trajectories, rather than solely focusing on the justice system.

Effectiveness of Culturally Appropriate Adaptations to Juvenile Justice Services.

Despite efforts to increase cultural competence of services within juvenile justice systems, disproportional minority contact (DMC) persists throughout Canada and the United States. Commonly cited approaches to decreasing DMC include large-scale systemic changes as well as enhancement of the cultural relevance and responsiveness of services delivered. Cultural adaptations to service delivery focus on prevention, decision-making, and treatment services to reduce initial contact, minimize unnecessary restraint, and reduce recidivism. Though locating rigorous testing of these approaches compared to standard interventions is difficult, this paper identifies and reports on such research. The Cochrane guidelines for systematic literature reviews and meta-analyses served as a foundation for study methodology. Databases such as Legal Periodicals and Books were searched through June 2015. Three studies were sufficiently rigorous to identify the effect of the cultural adaptations, and three studies that are making potentially important contributions to the field were also reviewed.

Caffeine: implications of recent research for clinical practice.

Caffeine is a central nervous system stimulant that has come under increasing scrutiny due to its effects on the health and mental health of those who consume it. This article summarizes the physiological effects of caffeine, reviews recent research on behavioral and mood changes associated with consumption, and discusses clinical implications for the mental health professional. Data on caffeine consumption and principal sources of caffeine are outlined.

Investigation laws and practices in child protective services.

This study was triggered by the experience of one state agency when a state audit found that its investigation response and completion rates of child abuse and neglect reports did not reach 100%. At compliance rates of 99.6% and 97.58%, respectively, the auditors and news media reported a lack of compliance by the state child welfare agency. This article reviews the approaches legislatures and agencies have used to address and resolve problems of ensuring agency responsiveness without setting standards and expectations that are impossible to meet.

Illinois's child welfare research agenda: an approach to building consensus for practice-based research.

This article presents a consensus-building initiative to develop a statewide research agenda that responds to the needs of Illinois's child welfare community. Researchers conducted this process through a university-community partnership to engage those interested in child welfare services. The process and findings resulted in a living document that will guide child welfare research throughout the state. Findings of the inquiry suggest that the development of best practice models may be one of the most important contributions research can make to practice.