"It Was Broken Here Before": Present day impact of historical trauma in telemental health services in a rural and remote Aleutian Islands Community.

Telemental health technology is a feasible tool for providing behavioral healthcare in rural areas. However, there is scant literature about implementing this technology within Indigenous populations. The Aleutian Pribilof Islands Association is an urban-based Tribal Health Organization in Alaska tasked with providing behavioral health services to remote Unangax̂ communities. To expand telemental health services, a formative program evaluation was conducted to examine the acceptability of and barriers to implementing telemental health. Using a qualitative approach, five individuals with lived experience in the same community were interviewed using a semi-structured format. Data were analyzed using critical thematic analysis and situated within the context of historical trauma. Five themes were constructed that showed broken trust as the primary barrier to services, despite the substantial obstacles related to communications infrastructure. When situated within the context of historical trauma, the results show how colonization spurred and has maintained broken trust. The clinical, research, and policy implications resulting from this study point to the need for decolonization and integration of culture in behavioral health services. These findings can be informative for organizations and providers seeking to implement telemental health in Indigenous communities.

Preventing Sexual Violence: A Behavioral Problem Without a Behaviorally Informed Solution.

What solutions can we find in the research literature for preventing sexual violence, and what psychological theories have guided these efforts? We gather all primary prevention efforts to reduce sexual violence from 1985 to 2018 and provide a bird's-eye view of the literature. We first review predominant theoretical approaches to sexual-violence perpetration prevention by highlighting three interventions that exemplify the zeitgeist of primary prevention efforts at various points during this time period. We find a throughline in primary prevention interventions: They aim to change attitudes, beliefs, and knowledge (i.e., ideas) to reduce sexual-violence perpetration and victimization. Our meta-analysis of these studies tests the efficacy of this approach directly and finds that although many interventions are successful at changing ideas, behavior change does not follow. There is little to no relationship between changing attitudes, beliefs, and knowledge and reducing victimization or perpetration. We also observe trends over time, including a shift from targeting a reduction in perpetration to targeting an increase in bystander intervention. We conclude by highlighting promising new strategies for measuring victimization and perpetration and calling for interventions that are informed by theories of behavior change and that center sexually violent behavior as the key outcome of interest.

Integrated multidisciplinary treatment teams; a mental health model for outpatient settings in the military.

OBJECTIVE: To evaluate critically whether treatment models existed in the literature to treat a soldier with multiple psychiatric and other comorbidities and propose a mental health model consisting of an integrated multidisciplinary treatment team for use in military outpatient settings. METHOD: A case example was described to demonstrate the complexity of presentation including depression, anxiety, insomnia, post-traumatic stress disorder, chronic pain, substance abuse, relationship problems, and suicide attempts. Literature search was conducted for the period 2004-2009. Articles that referred to collaborative/integrated care were examined in detail. RESULTS: Seven articles described collaborative care. Of these, five described collaboration with only primary care and 2 with other specialties including pain, substance abuse, and vocational rehabilitation services. Most articles gave a broader description of the collaborative model. Some postulated a theoretical framework. One described collaborative care in detail but was coordinated by only one professional. None described integration of providers involved in the patient's care. The process of implementation was not sufficiently described. CONCLUSION: Because of limitations in the published literature, a mental health model consisting of a multidisciplinary integrated treatment team is proposed to treat the soldiers in the military outpatient setting.