Referrals to Community and State Agencies to Address Social Determinants of Health for Improving Mental Health, Functioning, and Quality of Care Outcomes for Diverse Adults.

Objectives. To examine whether referral for social determinants of health (SDH) needs decreases psychological distress and posttraumatic stress disorder (PTSD) symptoms and improves level of functioning and quality of care among diverse adults. Methods. Data are from control participants (n = 503 adults) in a randomized controlled trial testing a mental health intervention in North Carolina and Massachusetts. We fitted multilevel mixed-effects models to repeated assessments (baseline, 3, 6, and 12 months) collected between September 2019 and January 2023. Results. After referral to services for trouble paying utility bills, participants reported lower PTSD symptoms. Participants reported better quality of care when receiving referrals to mental health care. After adjusting for income and employment status, we found that participants who were referred more often also had lower PTSD symptoms and better levels of functioning. Conclusions. Referrals for certain SDH needs might decrease PTSD symptoms and improve self-reported quality of care and functioning. However, referrals alone, without ensuring receipt of services, might be insufficient to affect other mental health outcomes. Research is needed on training and providing care managers time for offering interpersonal support, securing services, and understanding agencies' contexts for addressing high SDH needs. (Am J Public Health. 2024;114(S3):S278-S288. https://doi.org/10.2105/AJPH.2023.307442).

Racial/Ethnic Disparities in Substance Use Treatment in Medicaid Managed Care in New York City: The Role of Plan and Geography.

OBJECTIVE: The aim was to assess the magnitude of health care disparities in treatment for substance use disorder (SUD) and the role of health plan membership and place of residence in observed disparities in Medicaid Managed Care (MMC) plans in New York City (NYC). DATA SOURCE: Medicaid claims and managed care plan enrollment files for 2015-2017 in NYC. RESEARCH DESIGN: We studied Medicaid enrollees with a SUD diagnosis during their first 6 months of enrollment in a managed care plan in 2015-2017. A series of linear regression models quantified service disparities across race/ethnicity for 5 outcome indicators: treatment engagement, receipt of psychosocial treatment, follow-up after withdrawal, rapid readmission, and treatment continuation. We assessed the degree to which plan membership and place of residence contributed to observed disparities. RESULTS: We found disparities in access to treatment but the magnitude of the disparities in most cases was small. Plan membership and geography of residence explained little of the observed disparities. One exception is geography of residence among Asian Americans, which appears to mediate disparities for 2 of our 5 outcome measures. CONCLUSIONS: Reallocating enrollees among MMC plans in NYC or evolving trends in group place of residence are unlikely to reduce disparities in treatment for SUD. System-wide reforms are needed to mitigate disparities.

How Ethnic Minority Context Alters the Risk for Developing Mental Health Disorders and Psychological Distress for Latinx Young Adults.

Policy Points In low-income communities in the South Bronx and Puerto Rico, Puerto Rican youth are exposed to many of the same risk and protective factors for developing depression, anxiety, or psychological distress; yet it is unclear how the ethnic minority context of the South Bronx and ethnic majority context of Puerto Rico influence risk. Results from our quasi-experimental, longitudinal study demonstrate the importance of addressing social factors (parent-child relationships, youth peer relationships) for youth living in the majority context, and neighborhood and cultural factors (residential mobility, perceived discrimination, perceived social position in the neighborhood) for youth living in the minority context. Our findings support the need for tailoring programs specific to the needs of youth who reside in an ethnic majority or a minority context, since some of the risk factors might operate differently depending on context. Housing and neighborhood environment policies that address discrimination and eliminate structural inequities for ethnic minority groups may protect against the harm of minoritization on young people's mental health. CONTEXT: Puerto Rican youth growing up in low-income communities in the South Bronx and Puerto Rico are exposed to many of the same risk factors for major depressive disorder, generalized anxiety disorder, and psychological distress. One potentially powerful factor differs: Puerto Ricans have been socially marginalized as an ethnic minority group in the South Bronx, but are the ethnic majority of the population in Puerto Rico. A growing body of literature demonstrates the influence of neighborhood, cultural, and social factors and parental psychopathology in the development of mental health problems. An important unanswered question is whether these risk and protective factors have the same impact for youth raised as members of an ethnic majority versus minority group. METHODS: Using a population-based cohort study, with four waves of assessment from early childhood into young adulthood, we investigated whether ethnic minority context alters risk and protective factors for depression, anxiety, and psychological distress. Our longitudinal data set includes 2,491 young children at baseline (82.8% retained at wave 4). Using a quasi-experimental design, we examine how ethnic minority context can alter the development of mental health disorders as Latinx children transition to late adolescence and young adulthood. FINDINGS: Some risk and protective factors operated differently across minority and majority contexts. Higher discrimination and social position were more powerful risk and protective factors, respectively, in the minority context, whereas positive peer relationships mattered more in the majority context. Children of mothers with depression were significantly more likely to develop anxiety in late adolescence and young adulthood in the majority context (60.0%) compared to the minority context (4.5%). CONCLUSIONS: Preventing depression and anxiety disorders in Latinx young adults may require targeting different childhood factors depending on whether they reside within the ethnic majority or minority context. People in the ethnic minority context may benefit more from policies aimed at reducing discrimination and improving economic opportunity, while people in the majority context may benefit more from opportunities for strengthening family and peer relationships.

Effectiveness of a Disability Preventive Intervention for Minority and Immigrant Elders: The Positive Minds-Strong Bodies Randomized Clinical Trial.

OBJECTIVE: To test the acceptability and effectiveness of a disability prevention intervention, Positive Minds-Strong Bodies (PMSB), offered by paraprofessionals to mostly immigrant elders in four languages. DESIGN: Randomized trial of 307 participants, equally randomized into intervention or enhanced usual care. SETTING: Community-based organizations in Massachusetts, New York, Florida, and Puerto Rico serving minority elders. Data collected at baseline, 2, 6, and 12 months, between May 2015 and March 2019. PARTICIPANTS: English-, Spanish-, Mandarin-, or Cantonese-speaking adults, age 60+, not seeking disability prevention services, but eligible per elevated mood symptoms and minor to moderate physical dysfunction. INTERVENTIONS: Ten individual sessions of cognitive behavioral therapy (PM) concurrently offered with 36 group sessions of strengthening exercise training (SB) over 6 months compared to enhanced usual care. MEASUREMENTS: Acceptability defined as satisfaction and attendance to >50% of sessions. Effectiveness determined by changes in mood symptoms (HSCL-25 and GAD-7), functional performance (SPPB), self-reported disability (LLFDI), and disability days (WHODAS 2.0). RESULTS: Around 77.6% of intervention participants attended over half of PM Sessions; 53.4% attended over half of SB sessions. Intent-to-treat analyses at 6 months showed significant intervention effects: improved functioning per SPPB and LLFDI, and lowered mood symptoms per HSCL-25. Intent-to-treat analyses at 12 months showed that effects remained significant for LLFDI and HSCL-25, and disability days (per WHODAS 2.0) significantly decreased 6-month after the intervention. CONCLUSIONS: PMSB offered by paraprofessionals in community-based organizations demonstrates good acceptability and seems to improve functioning, with a compliance-benefit effect showing compliance as an important determinant of the intervention response.

High HIV/STI Test Acceptance Through a Behavioral Health Encounter in Latino Immigrants with Substance Use and Mental Health Problems.

Latino immigrants with substance use and mental health problems are at risk for undiagnosed HIV and sexually transmitted infections (STIs). Participants in a randomized control trial were recruited in Boston, USA and Madrid and Barcelona, Spain. Eligibility criteria were Latino self-identification, age 18-70, elevated substance use and mental health symptoms, and not currently in substance or mental health care. A multinomial logistic regression examined predictors of HIV/STI testing decline and lost to follow-up (LTFU) prior to testing compared with acceptance. Of 341 participants, 74% accepted testing, 4% declined, and 22% were LTFU. The odds of LTFU were higher in those with high concern for HIV and those whose main partner had done HIV testing. Age ≥ 35 years, females, higher education, and higher report of discrimination lowered the odds of LTFU. Delivery of HIV/STI testing through community agencies and outreach could overcome barriers to HIV/STI diagnosis in this population of Latinos.Clinical Trial Number: NCT02038855.

Trauma, immigration, and sexual health among Latina women: Implications for maternal-child well-being and reproductive justice.

Latina immigrant women are vulnerable to traumatic stress and sexual health disparities. Without autonomy over their reproductive health and related decision-making, reproductive justice is elusive. We analyzed behavioral health data from 175 Latina immigrant participants (M age = 35; range = 18-64) of the International Latino Research Partnership (ILRP) study. We used descriptive and inferential statistics to compare immigrant mothers of minor children to those without, regarding their psychological and reproductive health, and correlates of past exposure to sexual trauma. Over one third (38%) of ILRP participants had minor children, and 58% had citizenship in their host country. The rate for sexual assault was 30 and 61%, respectively, for physical assault; these rates were similarly high for women with and without minor children. Women who reported sexual assault scored significantly higher for depression, posttraumatic stress disorder, and substance-abuse screens. Odds of experiencing sexual assault was highest for women who experienced physical assault (odds ratio = 10.74), and for those from the Northern Triangle (odds ratio = 8.41). Subgroups of Latina migrant mothers are vulnerable to traumatic stress and related sexual and mental health risks. Given these findings, we frame the implications in a reproductive justice framework and consider consequences for caregiver-child well-being.

Trasfondo: Las mujeres latinas inmigrantes son vulnerables al estrés traumático y a las disparidades de salud sexual. Sin autonomía sobre su salud reproductiva y las decisiones que se deben tomar al respecto, la justicia reproductiva es difícil de alcanzar. Métodos: Analizamos información sobre las actitudes con respecto a la salud de parte de 175 inmigrantes latinas participantes (edad promedio 35; entre 18 y 64) del estudio de Investigación Conjunta Internacional de Asuntos Latinos (ILRP). Usamos estadísticas descriptivas y deductivas para comparar las madres inmigrantes de niños menores con aquellas sin ellos, sin tomar en cuenta su salud sicológica y reproductiva, y correlacionar el haber estado expuestas a trauma sexual en el pasado. Resultados: Más de un tercio (38%) de las participantes del grupo de ILRP tenían niños menores, y 58% tenían ciudadanía en el país donde residían. El promedio en cuanto a la agresión sexual fue de 30% y 61% en el caso de agresión física; estos promedios fueron similarmente altos tanto para mujeres con niños pequeños como mujeres sin niños pequeños. Las mujeres que reportaron agresión sexual tuvieron puntajes significativamente más altos en el caso de depresión, trastorno por estrés postraumático (PTSD) y exámenes de detección de abuso de sustancias. Las posibilidades de experimentar agresión sexual fue lo más alto para mujeres que experimentaron agresión física (OR = 10.74), y para aquellas del Triángulo del Norte (OR = 8.41). Conclusiones: Los subgrupos de madres latinas inmigrantes son vulnerables al estrés traumático y los relacionados riesgos de salud sexual y mental. Dados estos resultados, colocamos las implicaciones dentro de un marco de trabajo de justicia reproductiva y consideramos las consecuencias para el bienestar de quien le presta cuidados al niño.

Contexte Les femmes immigrées latinas sont vulnérables au stress traumatique et aux disparités de santé sexuelle. Sans autonomie quant à leur santé reproductive et les décisions qui y sont liées, leur justice reproductive est insaisissable. Méthodes Nous avons analysé des données de santé comportementale de 175 participantes immigrées (moyenne d'âge 35 ans; éventail de 18 à 64 ans) de l'étude du partenariat de recherche international International Latino Research Partnership (ILRP). Nous avons utilisé des statistiques descriptives et déductives pour comparer les mères immigrées d'enfants mineurs à celles sans enfants, pour ce qui concerne leur santé psychologique et reproductive, ainsi que les corrélats d'exposition à un trauma sexuel dans le passé. Résultats Plus d'un tiers (38%) des participantes ILRP avaient des enfants mineurs et 58% détenaient la citoyenneté dans leur pays d'accueil. Le taux de violences sexuelles était de 30% et de 61% pour les aggressions physiques. Ces taux étaient aussi élevés chez les femmes avec ou sans enfants mineurs. Les femmes ayant déclaré des violences sexuelles ont fait état de scores bien plus élevés pour la dépression, le TSPT et la toxicomanie. Les probabilités de faire face à des violences sexuelles étaient les plus élevées chez les femmes ayant vécu une aggression physique (OR = 10,74), et pour celles du Triangle du Nord de l'Amérique centrale (OR = 8,41). Conclusions Des sous-groupes de mères migrantes latinas sont vulnérables au stress traumatique et à des risques de santé mentale qui y sont liés. Au vu de ces résultats, nous encadrons les implications dans une structure de justice de reproduction et considérons les conséquences pour le bien-être mère-enfant.

Resilience of racial and ethnic minority older adults during the COVID-19 pandemic: The role of a prior disability prevention intervention.

Older adults from racially and ethnically diverse backgrounds and with preexisting mental illness have been disproportionately vulnerable to severe illness, disability, and death due to the adverse impacts of the COVID-19 pandemic. This study used a sample of older adults (60 +; N = 307) from a randomized clinical trial (Positive Minds-Strong Bodies [PMSB]) conducted between May 25, 2015, and March 5, 2019. Participants were recontacted to assess symptoms of anxiety, depression, general distress, and physical functioning during the COVID-19 pandemic between March 2, 2021, and July 18, 2022 (62.7% recontacting rate excluding ineligible participants; N = 165). We estimated an analysis of covariance model to evaluate whether or not prior differences between the PMSB intervention and enhanced usual care (EUC) groups continued to be observed at the COVID-19 follow-up. Results showed that, compared to EUC, participants who received the PMSB intervention reported fewer depression symptoms (Geriatric Depression Scale-15 scores) and greater physical functioning (Late-Life Functioning and Disability Instrument scores) at the COVID-19 follow-up. No significant differences were observed between the PMSB intervention and EUC groups on anxiety symptoms (Generalized Anxiety Disorder-7 scores) during the pandemic. Last, findings suggested that the lower depression symptoms and greater physical functioning observed after treatment completion were sustained, though not further improved, over time. These findings provide evidence that the PMSB intervention is a powerful intervention to promote resilience and prevent disability associated with major life stressors, such as the COVID-19 pandemic. Future research is needed to examine the underlying mechanisms of psychosocial and exercise training interventions that lead to lasting resilience. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Learning Assessment to Increase Diversity in Academic Health Sciences.

Importance: Strategies and innovations to advance racial and ethnic equity in recruitment, promotion, and retention at academic health science institutions are needed. Objective: This learning assessment aims to isolate evidence-based strategies to advance racial equity in the academic health sciences, which have implications for policy and institution-level interventions. Evidence Review: This learning assessment used a mixed-methods approach, including a quantitative survey, qualitative in-depth interviews, and a scoping literature review. Survey respondents were recruited from outreach lists that included researchers working with racial and ethnic minoritized populations. In-depth interviews were conducted among 60 university administrators, faculty/staff, scholars, students, and individuals affiliated with governmental, nongovernmental, and identity-based professional associations. A search of the literature in PsycINFO, MEDLINE, ERIC, Education Source, Academic Search Ultimate, and CINAHL was conducted for the scoping review. The scoping review included 366 primary articles of studies evaluating strategies to advance racial and ethnic equity at academic health science institutions. Findings: The survey yielded analyzable results from 328 individuals, including faculty, students, administrators, or staff, and individuals not currently employed at or enrolled full time at a university or college. The interviews included 60 participants with a mean (SD) age of 49.3 (16.5) years, and 39 (65%) were female. The scoping review included 366 primary research articles that met inclusion criteria for analysis. Data were analyzed individually across the survey, interviews, and scoping review, and findings were triangulated. While each of the 3 assessments yielded unique findings, 13 common themes emerged across all project components. Results revealed strategies implemented and evaluated successfully, as well as challenges and barriers to advancing equity in the academic health sciences. Conclusions and Relevance: In this study, 13 meaningful strategies emerged across the survey, in-depth interviews, and scoping review. Through triangulation of findings, recommendations of actionable steps were made.

Uncovering Barriers to Engagement in Substance Use Disorder Care for Medicaid Enrollees.

OBJECTIVE: The authors aimed to uncover factors that affect engagement in substance use disorder treatment among Medicaid beneficiaries in New York State. METHODS: The authors conducted 40 semistructured interviews with clients, plan administrators, health care providers, and policy leaders directly involved with substance use care in New York State. Data were analyzed with thematic analysis. RESULTS: Main themes resulting from analysis of the 40 interviews showed that most stakeholders agreed that a need exists to better integrate psychosocial services into behavioral health care systems; that systemic stigma, stigma from providers, and lack of cultural responsiveness in the substance use care system hinder engagement in and provision of high-quality care; and that rural health care networks with coordinated models benefit clients' engagement in care. CONCLUSIONS: Stakeholders involved in care for substance use disorder perceived a lack of integration of resources to meet clients' social needs, the presence of stigma, and low levels of cultural and linguistic capacity as key factors contributing to low engagement in and low quality of care for substance use disorder. Future interventions should address social needs within the therapeutic regimen and modify curricula in clinical training to reduce stigma and increase cultural competence.

Role of social determinants in anxiety and depression symptoms during COVID-19: A longitudinal study of adults in North Carolina and Massachusetts.

Trajectory studies of the COVID-19 pandemic have described patterns of symptoms over time. Yet, few have examined whether social determinants of health predict the progression of depression and anxiety symptoms during COVID-19 or identified which social determinants worsen symptom trajectories. Using a racially, ethnically, and linguistically diverse sample of adults participating in a randomized clinical trial with pre-existing moderate to severe depression and/or anxiety symptoms, we compare symptom patterns before and during COVID-19; characterize symptom trajectories over a 20-week follow-up period; and evaluate whether social determinants are associated with within- and between- person differences in symptom trajectories. Data were collected before and during COVID-19 in Massachusetts and North Carolina. On average, depression and anxiety symptoms did not seem to worsen during the pandemic compared to pre-pandemic. During COVID-19, anxiety scores at follow-up were higher for participants with baseline food insecurity (vs no food insecurity). Depression scores at follow-up were higher for participants with food insecurity and for those with utilities insecurity (vs no insecurity). Participants with child or family care responsibilities at baseline had depression symptoms decreasing at a slower rate than those without these responsibilities. We discuss the important implications of these findings.

Key stakeholder perspectives on the use of research about supported employment for racially and ethnically diverse patients with mental illness in the United States.

OBJECTIVE: To explore how stakeholders responded to research evidence regarding supported employment (e.g., vocational rehabilitation), and ways evidence could be incorporated into policy and action. DATA SOURCES: Qualitative data were collected from three stakeholder groups-people with lived experience of mental health challenges, community health advocates, and state health policy makers. STUDY DESIGN: This study consisted of two sequential steps. First, three focus groups were conducted after presenting stakeholder groups (inclusive of 22 participants) with simulation data showing that improvement in employment status had a stronger impact on mental health than improvement in education or income for racially/ethnically diverse groups. Second, with guidance from focus group findings, researchers conducted additional in-depth interviews (n = 19) to gain a deeper understanding of the opportunities and challenges related to incorporating these findings into policy and practice. DATA COLLECTION/EXTRACTION METHODS: Focus groups and in-depth interviews were conducted, audio recorded, transcribed, and analyzed using a thematic analysis approach. PRINCIPAL FINDINGS: People with lived experience described the positive effect of employment in their own life while highlighting the need to increase workplace accommodations and social supports for those with mental health challenges. Across stakeholder groups, participants emphasized the need for linguistic and cultural competence to promote equity in delivery of supported employment programs. Stakeholders also underscored that centralizing existing resources and using evidence-based approaches are crucial for successful implementation. CONCLUSION: Implementing effective supported employment programs should focus on meeting the specific needs of target individuals, as many of those needs are not considered in current employment-related programming. Collecting information from diverse users of research demonstrates what other aspects of supported employment are required for the likelihood of successful uptake. Implementation and dissemination efforts need to fortify collaborations and knowledge transfer between stakeholders to optimize supported employment and mental health resources.

Performance Metrics of Substance Use Disorder Care Among Medicaid Enrollees in New York, New York.

Importance: There is limited evaluation of the performance of Medicaid managed care (MMC) private plans in covering substance use disorder (SUD) treatment. Objective: To compare the performance of MMC plans across 19 indicators of access, quality, and outcomes of SUD treatment. Design Setting and Participants: This cross-sectional study used administrative claims and mandatory assignment to plans of up to 159 016 adult Medicaid recipients residing in 1 of the 5 counties (boroughs) of New York, New York, from January 2009 to December 2017 to identify differences in SUD treatment access, patterns, and outcomes among different types of MMC plans. Data from the latest years were received from the New York State Department of Health in October 2019, and analysis began soon thereafter. Approximately 17% did not make an active choice of plan, and a subset of these (approximately 4%) can be regarded as randomly assigned. Exposures: Plan assignment. Main Outcomes and Measures: Percentage of the enrollees achieving performance measures across 19 indicators of access, process, and outcomes of SUD treatment. Results: Medicaid claims data from 159 016 adults (mean [SD] age, 35.9 [12.7] years; 74 261 women [46.7%]; 8746 [5.5%] Asian, 73 783 [46.4%] Black, and 40 549 [25.5%] White individuals) who were auto assigned to an MMC plan were analyzed. Consistent with national patterns, all plans achieved less than 50% (range, 0%-62.1%) on most performance measures. Across all plans, there were low levels of treatment engagement for alcohol (range, 0%-0.4%) and tobacco treatment (range, 0.8%-7.2%), except for engagement for opioid disorder treatment (range, 41.5%-61.4%). For access measures, 4 of the 9 plans performed significantly higher than the mean on recognition of an SUD diagnosis, any service use for the first time, and tobacco use screening. Of the process measures, total monthly expenditures on SUD treatment was the only measure for which plans differed significantly from the mean. Outcome measures differed little across plans. Conclusions and Relevance: The results of this cross-sectional study suggest the need for progress in engaging patients in SUD treatment and improvement in the low performance of SUD care and limited variation in MMC plans in New York, New York. Improvement in the overall performance of SUD treatment in Medicaid potentially depends on general program improvements, not moving recipients among plans.

Development of a computerized adaptive substance use disorder scale for screening and measurement: the CAT-SUD.

BACKGROUND AND AIMS: The focus of this paper is on the improvement of substance use disorder (SUD) screening and measurement. Using a multi-dimensional item response theory model, the bifactor model, we provide a psychometric harmonization between SUD, depression, anxiety, trauma, social isolation, functional impairment and risk-taking behavior symptom domains, providing a more balanced view of SUD. The aims are to (1) develop the item-bank, (2) calibrate the item-bank using a bifactor model that includes a primary dimension and symptom-specific subdomains, (3) administer using computerized adaptive testing (CAT) and (4) validate the CAT-SUD in Spanish and English in the United States and Spain. DESIGN: Item bank construction, item calibration phase, CAT-SUD validation phase. SETTING: Primary care, community clinics, emergency departments and patient-to-patient referrals in Spain (Barcelona and Madrid) and the United States (Boston and Los Angeles). PARTICIPANTS/CASES: Calibration phase: the CAT-SUD was developed via simulation from complete item responses in 513 participants. Validation phase: 297 participants received the Composite International Diagnostic Interview (CIDI) and the CAT-SUD. MEASUREMENTS: A total of 252 items from five subdomains: (1) SUD, (2) psychological disorders, (3) risky behavior, (4) functional impairment and (5) social support. CAT-SUD scale scores and CIDI SUD diagnosis. FINDINGS: Calibration: the bifactor model provided excellent fit to the multi-dimensional item bank; 168 items had high loadings (> 0.4 with the majority > 0.6) on the primary SUD dimension. Using an average of 11 items (four to 26), which represents a 94% reduction in respondent burden (average administration time of approximately 2 minutes), we found a correlation of 0.91 with the 168-item scale (precision of 5 points on a 100-point scale). VALIDATION: strong agreement was found between the primary CAT-SUD dimension estimate and the results of a structured clinical interview. There was a 20-fold increase in the likelihood of a CIDI SUD diagnosis across the range of the CAT-SUD (AUC = 0.85). CONCLUSIONS: We have developed a new approach for the screening and measurement of SUD and related severity based on multi-dimensional item response theory. The bifactor model harmonized information from mental health, trauma, social support and traditional SUD items to provide a more complete characterization of SUD. The CAT-SUD is highly predictive of a current SUD diagnosis based on a structured clinical interview, and may be predictive of the development of SUD in the future.

Barriers and strategies for implementing community-based interventions with minority elders: positive minds-strong bodies.

BACKGROUND: By 2040, one out of three older adults in the USA are expected to belong to a racial/ethnic minority group. This population has an increased risk of mental and physical disability with significant barriers to access care. Community-based organizations (CBOs) often provide programming to serve minority and immigrant elders. Limited resources and other barriers such as lack of trained staff make it difficult to implement evidence-based interventions (EBIs) in CBOs for long-term adoption. Yet little is known about what factors can facilitate adoption of EBIs in CBOs serving minority elders. METHODS: Positive-Minds-Strong Bodies (PM-SB), an evidence-based intervention offered in four languages, aims to reduce mental and physical disability for minority and immigrant elders through the efforts of community health workers and exercise trainers. The intervention consists of cognitive behavior therapy and exercise training sessions delivered over 6 months. During a recent clinical trial of this intervention, we elicited feedback from CBO staff to determine how best to facilitate the implementation and long-term sustainability of PM-SB within their agencies. We surveyed 30 CBO staff members, held four focus groups, and conducted 20 in-depth interviews to examine staff perspectives and to reveal factors or changes needed to facilitate long-term adoption in prospective CBOs. RESULTS: Participants reported that staff motivation and implementation could be improved through the following changes: increasing patient compensation for treatment sessions, decreasing levels of organizational accountability, and reducing staff demands embedded in the intervention. Although most staff perceived that PM-SB improved their agency's ability to address the health and well-being of elders, capacity-building strategies such as a "train-the-trainer" initiative were identified as priorities to address staff turnover for sustainability. Adapting the intervention to get financial reimbursement also emerged as vital. CONCLUSIONS: Augmenting financial incentives, streamlining procedures, and simplifying staff accountability were suggested strategies for facilitating the transition from a disability prevention clinical trial in minority and immigrant elders to a scalable implementation in routine services at CBOs. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02317432.

Predictors of Research Assessment Completion in a Latino Sample with Dual Disorders.

Latinos are underrepresented in clinical trials, where they encounter challenges in participation and a lack of effective recruitment and retention strategies. For Latino migrants with mental health and substance use problems, these challenges are even greater. Analyzing results from a multicenter randomized clinical trial for Latino migrants with mental health and substance use problems in Boston, Massachusetts, USA as well as Madrid and Barcelona, Spain, we describe six retention strategies used to facilitate participant engagement in follow-up assessments, and report the sociodemographic, clinical, and educational factors associated with research assessment completion. Among 341 randomized participants, 77% completed the 12-month follow-up and 75% completed at least 3 of the 4 follow-up assessments. Having a high school diploma, being recruited at community centers versus other sites, and having a less severe mental health condition were significantly associated with completing more follow-up interviews. Rigorous and customized methods reflecting participant's individual context can bolster research assessment completion for diverse Latino populations with behavioral health concerns.

Mentoring future researchers: Advice and considerations.

Despite efforts to increase the diversity of academia, minority scholars continue to face significant barriers (e.g., higher financial burden, lack of institutional support for research interests, social isolation) that undermine their representation in the field and overall professional success. Researchers have suggested increased mentorship as a means of mitigating these challenges. In 2015, with the support of the Robert Wood Johnson Foundation, a panel of senior investigators met via WebEx to discuss strategies to improve the mentorship of underrepresented scholars. The topics covered by this panel included factors that optimize or challenge mentorship based on personal experience, what is special about mentorship in the context of race/ethnicity, relational dynamics, work-life balance, discrimination, and how to address challenges to the mentoring relationship. The current article provides an overview of the convening and synthesizes the lessons learned by panelists' first-hand experiences of mentoring trainees and junior faculty of color. Authors conclude with recommendations and a description of the social and institutional implications of bolstering the professional support of minority scholars. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

HIV Testing in Clinical and Community Settings for an International Sample of Latino Immigrants and Nonimmigrants.

Latino/as in the U.S. and Spain make up a disproportionate percentage of cases of HIV infection, and often are diagnosed later than their non-Latino/a counterparts. Understanding the factors that affect HIV testing in different contexts is critical to best promote HIV testing, which is considered essential to both prevention and early treatment. This study explored differences in HIV testing rates among Latino/a participants in an international study designed to examine behavioral health screening for Latino/a populations. We collected data on testing rates and results from 407 Latino/as - both first generation immigrants and those of Latino/a descent - in the U.S. (Boston) and Spain (Madrid and Barcelona), through interviews conducted in community clinics and agencies. Using multivariate logit models, we evaluated predictors of screening and positive testing, adjusting for sex, age, and clinic type. HIV testing rates were highest in Boston, followed by Barcelona and Madrid (82%, 69%, and 59%, respectively, p < .0001). In multivariate regression models, Barcelona and Madrid patients were significantly less likely to have received testing than Boston patients. Significant positive predictors of HIV testing were: education level higher than high school, HIV concerns, infrequent condom use, other risk behaviors, reports of discrimination, and higher benzodiazepine consumption. Significant differences in HIV testing found in this study help to illuminate best practices for engaging patients in testing across sites.

Los latino/as representan, tanto en Estados Unidos como en España, un porcentaje desproporcionado de los casos de infección por el VIH y, a menudo son diagnosticados más tarde que sus homólogos no latino/as. Conocer los factores que influyen en la realización de la prueba del VIH en diferentes contextos resulta fundamental para la promoción de dicha prueba, lo que se considera esencial tanto para la prevención como para el tratamiento precoz. Este estudio internacional explora las diferencias en las tasas de realización de la prueba de VIH entre participantes latino/as y que fue diseñada para examinar el estado de salud mental de los imigrantes latino/as. Para ello, se han recopilado datos sobre las pruebas del VIH y sus resultados en 407 latino/as - tanto inmigrantes como de ascendencia latina-en los Estados Unidos (Boston) y España (Madrid y Barcelona). La información fue recogida en entrevistas realizadas en clínicas y agencias comunitarias. Se evaluaron los factores que predicen hacerse la prueba de VIH y de tener resultados positivos en la misma, ajustando por género, edad y el sitio de reclutamiento del paciente, y empleando para ello un modelo de regresión logística multivariado. La tasa más alta de realización de la prueba de VIH fue la de la población de Boston, seguida por Barcelona y Madrid (82%, 69%, y 59%, respectivamente, p<.0001). Según los modelos de regresión multivariada, la probabilidad de que los pacientes de Barcelona y Madrid se hicieran la prueba fue significativamente menor que la de Boston. Entre los predictores positivos para realizarse la prueba estaban un grado de escolarización superior a la secundaria, el grado de preocupación por el VIH, el uso infrecuente del condón, el informar experiencias de discriminación y el uso elevado de benzodiacepinas. Las diferencias significativas entre las tasas de realización de la prueba del VIH entre las tres ciudades sugieren la necesidad de gestionar mejores prácticas para atraer a los pacientes hacia la realización temprana de la prueba.

The effect of minority status and social context on the development of depression and anxiety: a longitudinal study of Puerto Rican descent youth.

Few longitudinal studies have explored to date whether minority status in disadvantaged neighborhoods conveys risk for negative mental health outcomes, and the mechanisms possibly leading to such risk. We investigated how minority status influences four developmental mental health outcomes in an ethnically homogeneous sample of Puerto Rican youth. We tested models of risk for major depressive disorder (MDD) and generalized anxiety disorder (GAD), depressive and anxiety symptoms (DAS), and psychological distress, as Puerto Rican youth (aged 5-13 years) transitioned to early adulthood (15-29 years) in two sites, one where they grew up as a majority (the island of Puerto Rico), and another where they were part of a minority group (South Bronx, New York). At baseline, a stratified sample of 2,491 Puerto Rican youth participated from the two sites. After baseline assessment (Wave 1), each youth participant and one caregiver were assessed annually for two years, for a total of three time points (Waves 1-3). From April 2013 to August 2017, participants were contacted for a Wave 4 interview, and a total of 2,004 young people aged 15 to 29 years participated in the assessment (response rate adjusted for eligibility = 82.8%). Using a quasi-experimental design, we assessed impacts of minority status on MDD, GAD, DAS and psychological distress. Via mediation analyses, we explored potential mechanisms underlying the observed relationships. Data from 1,863 Puerto Rican youth (after exclusion of those with MDD or GAD during Waves 1-3) indicated links between minority status and higher rates of lifetime and past-year GAD, DAS and past 30-day psychological distress at Wave 4, and a marginal trend for MDD, even after adjustments. Childhood social support and peer relationships partially explained the differences, as did intercultural conflict, neighborhood discrimination, and unfair treatment in young adulthood. The experience of growing up as a minority, as defined by context, seemingly elevates psychiatric risks, with differences in social relationships and increased social stress as mediators of this relationship. Our findings suggest that interventions at the neighborhood context rather than at the individual level might be important levers to reduce risks for the development of mood disorders in minority youth.

Evaluation of the Integrated Intervention for Dual Problems and Early Action Among Latino Immigrants With Co-occurring Mental Health and Substance Misuse Symptoms: A Randomized Clinical Trial.

Importance: Immigrants are at an increased risk for co-occurring mental health and substance misuse symptoms; however, effective treatments are lacking. Objective: To evaluate the effectiveness of the Integrated Intervention for Dual Problems and Early Action (IIDEA) program compared with enhanced usual care. Design, Setting, and Participants: This effectiveness randomized clinical trial was conducted from September 2, 2014, to February 2, 2017, in 17 clinics or emergency departments and 24 community sites in Boston, Massachusetts, as well as in Madrid and Barcelona, Spain. Equal randomization (1:1) in 2-person blocks was used, assigning participants to either the IIDEA treatment group (n = 172) or the enhanced usual care control group (n = 169). Intent-to-treat analyses assessed effectiveness, and post hoc analyses examined whether results varied by symptom severity or treatment dose. Eligible participants were between 18 and 70 years of age, self-identified as Latino, screened positive for co-occurring symptoms, and were not receiving specialty behavioral health services. Interventions: Participants were randomized to a 10-session IIDEA treatment or to enhanced usual care. Main Outcomes and Measures: Primary outcomes were changes in alcohol and drug misuse and results of a urine test for drug metabolites but not for alcohol misuse. Secondary outcomes were symptoms of depression, generalized anxiety, posttraumatic stress disorder, and overall mental health. Results: In total, 341 participants were randomized to either the IIDEA treatment group (n = 172; 94 [54.7%] female, mean [SD] age, 33.5 [11.6] years) or the enhanced usual care control group (n = 169; 80 [47.3%] female, mean [SD] age, 34.3 [11.8] years). No statistically significant effects of IIDEA were found for primary drug and alcohol outcomes (ASI Lite-drug score: ß = -0.02 [SE, 0.69; P = .88; Cohen d, 0.00; 95% CI, -0.17 to 0.17]; ASI Lite-alcohol score: ß = -0.01 [SE, 1.19; P = .66; Cohen d, 0.00; 95% CI, -0.12 to 0.12]; urine drug test result: ß = -0.36 [SE, 0.43; P = .50; OR, 0.70; 95% CI, 0.30-1.61]), but statistically significant effects were observed for secondary mental health outcomes. The IIDEA treatment was effective in reducing depressive symptoms per the Public Health Questionnaire-9 score (ß = -1.14; SE, 0.47; P = .02; Cohen d, 0.20 [95% CI, 0.04-0.36]), posttraumatic stress disorder symptoms per the Posttraumatic Stress Disorder Checklist-5 score (ß = -3.23; SE, 1.59; P = .04; Cohen d, 0.25 [95% CI, 0.01-0.37]), and overall mental health symptoms per the Hopkins Symptom Checklist-20 (ß = -0.20; SE, 0.07; P = .01; Cohen d, 0.25 [95% CI, 0.08-0.42]) and composite mental health (ß = -3.70; SE, 1.75; P = .04; Cohen d, 0.19 [95% CI, 0.01-0.36]) scores at the 6-month follow-up. Exploratory analyses suggested that 6-month treatment effects occurred for patients whose drug misuse was moderate to severe at the baseline assessment. Among patients with moderate to severe substance misuse, IIDEA substantially reduced substance use per the urine test results (odds ratio, 0.25 [95% CI, 0.09-0.67]; P = .01). Treatment dose showed small to large effect sizes by outcome. Conclusions and Relevance: The IIDEA treatment did not change drug misuse but did improve secondary mental health and substance misuse outcomes for a heterogeneous population with moderate to severe symptoms; this finding provides a path for treating Latino immigrants with co-occurring mental health and substance misuse symptoms. Trial Registration: ClinicalTrials.gov Identifier: NCT02038855.

Successful validation of the CAT-MH Scales in a sample of Latin American migrants in the United States and Spain.

We examined cultural differences in the item characteristic functions of self-reported of symptoms of depression, anxiety, and mania-hypomania in a Latino population taking Computerized Adaptive Tests for Mental Health (CAT-MH) in Spanish versus a non-Latino sample taking the tests in English. We studied differential item functioning (DIF) of the most common adaptively administered symptom items out of a bank of 1,008 items between Latino (n = 1276) and non-Latino (n = 798) subjects. For depression, we identified 4 items with DIF that were good discriminators for non-Latinos but poor discriminators for Latinos. These items were related to cheerfulness, life satisfaction, concentration, and fatigue. The correlation between the original calibration and a Latino-only new calibration after eliminating these items was r = .990. For anxiety, no items with DIF were identified. The correlation between the original and new calibrations was r = .993. For mania-hypomania, we identified 4 items with differential item functioning that were good discriminators for non-Latinos but poor discriminators for Latinos. These items were related to risk-taking, self-assurance, and sexual activity. The correlation between the original and new calibration was r = .962. Once the identified items were removed, the correlation between the original calibration and a Latino-only calibration was r = .96 or greater. These findings reveal that the CAT-MH can be reliably used to measure depression, anxiety, and mania in Latinos taking these tests in Spanish. (PsycINFO Database Record (c) 2018 APA, all rights reserved).