Assessing Access to Trauma-Informed Outpatient Mental Health Services for Adolescents: A Mystery Shopper Study.

OBJECTIVE: The authors aimed to examine how access to trauma-informed mental health services in safety-net health centers varies by insurance type and race-ethnicity of the care seeker. METHODS: In this mystery shopper study, three women (White, Latina, and Black voice actresses) called community mental health centers (CMHCs) and federally qualified health centers (FQHCs) (N=229) in Cook County, Illinois, posing as mothers requesting a mental health appointment for their traumatized adolescent child. Each health center was called twice-once in the spring and once in the summer of 2021-with alternating insurance types reported (Medicaid or private insurance). Ability to schedule an appointment, barriers to access, wait times, and availability of trauma-specific treatment were assessed. RESULTS: Callers could schedule an appointment in only 17% (N=78 of 451) of contacts. Reasons for appointment denial varied by organization type: the primary reasons for denial were capacity constraints (67%) at CMHCs and administrative requirements to switch to in-network primary care providers (62%) at FQHCs. Insurance and organization type did not predict successful appointment scheduling. Non-White callers were significantly less likely (incidence rate ratio=1.18) to be offered an appointment than the White caller (p=0.019). The average wait time was 12 days; CMHCs had significantly shorter wait times than FQHCs (p=0.019). Only 38% of schedulers reported that their health center offered trauma-informed therapy. CONCLUSIONS: Fewer than one in five contacts resulted in a mental health appointment, and an apparent bias against non-White callers raises concern that racial discrimination may occur during scheduling. For equitable access to care, antidiscrimination policies should be implemented.

Barriers and facilitators of physical activity among Latina immigrant and Mexican mothers living in the US and Mexico: A qualitative study.

Latina immigrant women are among the least physically active when compared with women in other racial/ethnic groups in the US. Similarly, Mexican mothers in Mexico have low rates of physical activity. Motherhood and immigration experiences are recognized barriers to engage in physical activity among Latina immigrant mothers. Less is known about the factors that promote and limit physical activity engagement among Mexican mothers in Mexico, and how their experiences compare with their immigrant counterparts. This transnational qualitative study aimed to investigate the barriers and facilitators of physical activity of 25 Latina mothers in Mexico and the US. Low-income Mexican mothers of kindergarten aged children and Latino mothers of similar aged children were recruited in San Luis Potosí, Mexico and central Illinois, US. Semi-structured interviews were administered by two bilingual and bicultural researchers in participants language of preference. Interviews were transcribed verbatim and analyzed using a thematic network approach and multi-stage coding analysis guided by the Socio-Ecological Model framework. We found that at the macro-level: 1) familial obligations, and 2) cold weather after migrating; at the mezzo-level: 1) changes in walking patterns, and 2) social cohesion (e.g., lack of an invitation to engage in activities); and at the micro-level: 1) individual perceptions, particularly unattainable perceptions of physical activity and 2) shift exhaustion were perceived as barriers and occasionally facilitators of physical activity by mothers in both countries. Context-specific interventions are needed to increase women's physical activity levels in the US and Mexico.

'It is in our hands-Why wait until you are sick?': Perceptions about diabetes prevention of Latina mothers in Mexico and the United States.

AIMS: This study aimed to understand the perceptions driving type 2 diabetes mellitus prevention and management behaviours of Mexican and Latina mothers in Mexico and the United States. METHODS: Low-income Mexican mothers in San Luis Potosí, Mexico and Latina mothers in Illinois, United States, were recruited by the Holistic Obesity Prevention Study (HOPS). Verbatim transcripts of the semistructured interviews conducted in Spanish (n = 24) and English (n = 1) were analysed using the Health Belief Model (HBM) framework. RESULTS: Of the 25 participants, 22 (88%) indicated 'knowing someone with diabetes'-specifically a father (n = 8), mother (n = 6) or grandparent (n = 7). Using the HBM, themes showed that mothers perceived: that Type 2 diabetes can happen to anyone, are attributable to genetic predisposition and may be driven by strong emotions (perceived susceptibility). Type 2 diabetes introduces severe comorbidities and emotional difficulties for people and their families (perceived severity). Adopting a healthier diet, exercising and staying in good spirits were recognized as benefits of Type 2 diabetes prevention (perceived benefits). The costs of food, challenges of exercising, dieting, modifying habits and time limitations were recognized as perceived costs. Cues to action included doctors' recommendations (external) and fear (internal). Mothers acknowledged they could live a healthy life by controlling their weight, exercising, adhering to treatments/medications and having the determination to carry-on (self-efficacy). CONCLUSIONS: Mothers sought to prevent Type 2 diabetes and live healthy lives, particularly, after receiving a diagnosis of gestational diabetes or when learning about their children's risks for Type 2 diabetes but perceived significant barriers to Type 2 diabetes prevention.

Context Matters: A Qualitative Study About the Perinatal Experiences of Latina Immigrant Women.

Although immigrants' health is better compared to their native-born counterparts, their wellbeing starts to deteriorate as they spend more time in the United States. To date, few qualitative studies investigate how migration can influence the perinatal period. This study qualitatively assesses Latina immigrant mothers' perinatal experiences. Thirty Latina women were recruited in 2015 to participate in interviews, all of which were conducted in Spanish. The data were analyzed using thematic analysis. Latina mothers' experiences during the perinatal period were impacted by the cultural expectations that may or may not depend on the context where they are located. Context-independent themes included: (1) Cravings and (2) Body dissatisfaction. Context-dependent themes included: (1) Breastfeeding and (2) Loss of extended social ties. In order to reduce health disparities in the perinatal period among Latina immigrant mothers and their children, it is necessary to provide interventions that promote healthy behaviors and increase social capital and peer support.

Mental health disparities in Latinx immigrant communities residing in the United States during COVID-19: Implications for policy and practice.

Objectives: Studies have demonstrated that Latinx populations face significant health disparities in access to mental health care. The objective of this study was to describe the impact of the COVID-19 pandemic on the mental health needs of Latinx families, from the perspectives of direct service providers working with Latinx communities. Methods: Twenty-one semi-structured interviews were conducted virtually with direct service providers to the Latinx community from August to October 2020. Interviews were transcribed verbatim and analyzed using thematic analysis. Results: Two-thirds of providers were female, with a median age of 33 years, and provided direct services to Latinx clients and had extensive experience working with immigrant families, particularly in Massachusetts. Key themes identified describing the impact of COVID-19 on the mental health needs of Latinx families included: (1) exacerbation of mental health symptoms, (2) financial stressors, (3) preoccupation regarding transnational lives, (4) secondary needs becoming more salient, and (5) immigration status as a main driver of inequality. Conclusions: Our findings highlight the importance of focusing on the mental health needs of Latinx immigrants and ensuring their access to mental health services. Telehealth seems to be a potential tool that promotes mental health access among Latinx clients. Future research needs to continue investigating the role of telehealth in decreasing mental health access disparities.

Effectiveness of Mental Health Literacy and Stigma Interventions for Latino/a Adults in the United States: A Systematic Review.

Latinos/as in the United States (U.S.), face persistent mental health care disparities, even after adjusting for education, health insurance, and socioeconomic factors. While there has been increased attention on mental health stigma and mental health literacy, no systematic literature review currently exists of interventions developed to reduce mental health stigma and improve mental health literacy in the Latino/a community. This review aimed to (1) examine the methodological rigor of these intervention studies, (2) describe the mental health literacy and stigma interventions developed for Latinos/as in the U.S., and (3) summarize the outcomes of these studies focusing on mental health literacy and stigma outcomes. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to inform our systematic literature review. The methodological rigor of each study was assessed using an adapted version of the Methodological Quality Rating Scale. Seven articles met the inclusion criteria for this review. The majority of studies were small pilot studies with small samples and short follow-up periods of less than a month. These interventions showed promising results for improving knowledge of mental disorders and mixed results for reducing stigma towards people with mental illness and mental health treatments. As the Latino/a population continues to grow, future research should continue investigating and developing more intensive and prolonged mental health stigma interventions that use multiple media platforms (e.g., radio, television, website, print, and social media) to help reduce mental health care disparities in this population.