"Following the Breath:" A Trauma-Informed Intervention for Educator Wellness in Rural Montana.

Given the prevalence of mental health issues for both educators and adolescents in rural Montana, this project is designed to help mitigate the impact of stressors by providing coping strategies linked to improvements in overall mental health outcomes for teachers, which may ultimately lead to improved co-regulation of students and classroom climate. The immediate goal of this pilot study was to measure physical and mental health outcomes of educators resulting from a remotely-delivered trauma-informed yoga intervention. Findings suggest improvements in participants' depression and anxiety levels, trauma symptoms, sleep quality, and non-significant changes in heart rate variability and cortisol levels.

Mitigating Rural Adolescent Trauma: Remote Delivery of a Trauma-Informed Yoga Intervention During COVID-19.

Given the prevalence of childhood trauma in rural Montana, this project is intended to help mitigate stressors that may contribute to poor behavioral and mental health in high school-aged children, which may be exacerbated by the collective trauma of the COVID-19 pandemic. The immediate goal was to measure physical and mental health outcomes in adolescents resulting from a remotely delivered trauma-informed yoga intervention designed to foster positive youth development. Our study builds on the successes from an initial feasibility pilot study one year prior in order to evaluate a more robust intervention comparing experimental and control group outcomes. Students at a small, rural high school in Montana volunteered to participate in a 6-week, twice-weekly trauma-informed yoga intervention in their physical education class. Validated survey measures, including the PHQ-A, GAD-7, and ACE-Q instruments, were utilized to measure mental health outcomes pre- vs. post-intervention. Salivary cortisol levels were also measured pre-, mid-, and post-intervention. Statistically significant declines in cortisol levels and improvements in sleep duration were noted when comparing experimental vs. control groups. Noteworthy declines in depression and anxiety levels were also seen when comparing the treatment to control groups. Descriptive differences between the control and experimental groups illustrate the mental health benefits of reduced anxiety and depressive symptoms in rural adolescents resulting from a remotely delivered trauma-informed yoga intervention. Our study holds the potential for a long-term public health impact in reducing adolescent rates of anxiety and depression while mitigating trauma in geographically isolated settings. Trial Registration: ClinicalTrials.gov identifier: NCT04664855.

Trauma-Informed Yoga: Investigating an Intervention for Mitigating Adverse Childhood Experiences in Rural Contexts.

In a state ravaged by suicide and a mental health crisis, this study sought to mitigate impacts of adverse childhood experiences (ACEs) and depressive and anxiety symptomology in high school students in a rural Montana community. Through a seven-week, twice weekly intervention of trauma-informed yoga, participants experienced statistically significant reductions in anxiety (GAD-7) and increases in Strengths and Difficulties (SDQ-11) overall scores and some subscales; noteworthy improvements were also present in depressive symptomatology (PHQ-A), salivary cortisol levels, and sleep duration. Importantly, participant qualitative feedback indicated significant benefits in focus, relaxation, and overall well-being. Further research is needed to imply generalizability and should include a larger, more diverse sample as well as utilization of control groups and an examination of academic and behavioral impacts at the school level.

Stressors and barriers to using mental health services among diverse groups of first-generation immigrants to the United States.

This study examined stressors and barriers to using mental health services among first-generation immigrants in San Jose, California. Focus groups for 30 immigrants from Cambodia, Eastern Europe, Iran, Iraq, Africa, and Vietnam were audio-recorded, translated and transcribed. Two researchers coded the data and identified themes pertaining to mental health stressors and barriers. Six primary stressors were identified: economic, discrimination, acculturation due to language differences, enculturation, parenting differences, and finding suitable employment. Primary barriers included: stigma, lack of a perceived norm in country of origin for using mental health services, competing cultural practices, lack of information, language barriers, and cost. A conceptual model is presented that may be used to inform the design and implementation of mental health services for this population.

Building an Effective Medico-Legal Intervention Model in post-Earthquake Haiti / Construcción de un modelo de intervención médico-legal efectivo tras el terremoto en Haití

The earthquake that struck Haiti on January 12, 2010 left the country and its people devastated, with overwhelming losses, death, homelessness and increased violence and safety concerns. This study proposes an effective intervention model for facilitating humanitarian parole for survivors of the earthquake. A medico-legal team of psychiatrists and human rights and immigration evaluated traumatized individuals and families in Port-au-Prince in March 2010. With support from local NGOs, the legal team screened and prioritized the most severe cases, and the medical team assessed individuals with acute medical and psychiatric concerns. 124 cases were screened for humanitarian parole. Psychological, psychiatric and medical assessments were completed in 48 families (68 individuals) to identify orphans and vulnerable children, survivors of past violence who faced a risk of re-traumatization, and those at high-risk of psychological trauma. All cases needed shelter, clean water and food. Mental health impairment beyond loss and grief were identified in 89.7% of cases. Our findings suggest that a multi-disciplinary, community-based model is effective in identifying individuals and families that meet the conceptual criteria for Humanitarian Parole. The model is also effective in identifying the psychosocial and medical needs of survivors and assisting them in receiving essential health services

El terremoto que azotó Haití el 12 de Enero de 2010 dejó devastados al país y a su gente, con abrumadoras preocupaciones en torno a la pérdida, la muerte, el aumento de la violencia y la seguridad. Este estudio propone un modelo de intervención efectivo para proporcionar refugio humanitario en EE.UU. a los supervivientes del terremoto. Un equipo médico-legal de psiquiatras, personal de inmigración, y de derechos humanos, evaluó a los individuos traumatizados y a sus familias en Puerto Príncipe en Marzo de 2010. con el apoyo de ONGs locales, el equipo legal valoró y priorizó los casos más graves, y el equipo médico evaluó a los individuos con problemas médicos y psiquiátricos. Se seleccionaron 124 casos para proporcionarles refugio humanitario en EE.UU. Se completaron las valoraciones psicológica, psiquiátrica y médica en 48 familias (68 individuos), con el fin de identificar niños huérfanos y vulnerables, supervivientes de violencia pasada con riesgo de nueva traumatización, y persona de alto riesgo de trauma psicológico. Todos los casos necesitaban albergue, agua limpia y comida. Se identificó desajuste mental más allá del propio de la pérdida y el duelo en un 89,7% de los casos. Nuestros hallazgos sugieren que un modelo multidisciplinar, basado en la comunidad, es efectivo para identificar las necesidades psicológicas y médicas de los supervivientes y asistirles para recibir servicios sanitarios esenciales

Healthcare access and burden of care for patients with Lyme disease: a large United States survey.

OBJECTIVE: To evaluate the challenges faced by Lyme disease patients in obtaining adequate healthcare. METHODS: A web-based survey conducted over nine months was analyzed for the study. The survey focused on medical status, access to healthcare, and burden of illness. For inclusion in the study, survey respondents had to reside in the United States, be more than 10 years old, and have clinically diagnosed Lyme disease with chronic symptoms and positive laboratory testing. RESULTS: Responses from 2424 patients were included in the study. Half of the respondents reported seeing at least seven physicians before the diagnosis of Lyme disease was made. Nearly half had Lyme disease for more than 10 years and traveled over 50 miles to obtain treatment. Most respondents experienced symptoms lasting six months or more despite receiving at least 21 days of antibiotic treatment. A quarter of respondents had been on public support or received disability benefits due to Lyme disease symptoms, and over half had visited an emergency room at least once as a result of these symptoms. CONCLUSIONS: Lyme disease patients frequently endure extensive delays in obtaining an initial diagnosis, have poor access to healthcare and suffer a severe burden of illness.