Training senior peer counselors to provide telephone support for newly diagnosed breast cancer survivors.

Volunteers require carefully designed and evaluable training before providing support to newly diagnosed older breast cancer survivors (BCS) after surgery. A training module and 20-h course incorporating discussion, role plays, dyads, and written material were created to supplement core training of senior peer counselors, who provided a telephone support intervention in a randomized controlled trial. Twelve volunteers began the training, ten completed the course, and six of the ten subsequently provided telephone support to 107 BCS. Specialized supplemental training, along with ongoing supervision, effectively prepared volunteers to provide support via telephone to BCS, augmenting professional support.

Provider and consumer perspectives of community mental health services: Implications for consumer-driven care.

Public mental health services in the community are broad and continue to expand to address the multiple issues faced by those with serious mental illnesses. However, few studies examine and contrast how helpful consumers and providers find the spectrum of services. The present study examines the services at community mental health service clinics (CMHCs) from the perspectives of providers and consumers. There were 351 consumers and 147 providers from 15 CMHCs who rated and ranked the helpfulness of 24 types of common services. All of the agencies were participating in a Practice-Based Research Network (PBRN). Social support was the highest rated service by both types of respondents, and the creation of a welcoming environment was the highest ranked service by both. There were also areas of disagreement. Consumers identified traditional mental health services (individual therapy and medication services) as being most helpful to them whereas providers selected longer-term services that promote self-reliance (e.g., securing housing, and promoting self-sufficiency) as the most helpful. Understanding how consumers and providers perceive the range of CMHC services provided in usual care is important to develop new targets for intervention. A welcoming milieu and providing social support appear important to both, but significant differences exist between these groups regarding other aspects of services. This holds implications for the design and implementation of consumer-driven services. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Creating a Culture of Health for Perinatal Women with Mental Illness: A Community-Engaged Policy and Research Initiative.

BACKGROUND: Maternal mental health disorders (MMHDs) affect 35% to 40% of low-income, minority, perinatal women and negatively impact these women, their newborns, families, and communities. However, MMHDs are overlooked or stigmatized by medical systems, families, and women themselves. OBJECTIVES: We sought to answer the following research questions: 1) What lessons can we learn about maternal mental health in our local neighborhoods by creating and engaging with a community advisory board (CAB)? 2) What policy recommendations can we formulate with the CAB to address MMHDs among a low-income Latino population? METHODS: We conducted a qualitative research study guided by a community-based participatory research (CBPR) approach. We built on long-term relationships as well as newly identified organizations to develop a CAB of community service providers. We also drew from the perspective of two focus groups of women in the community who had experienced a MMHD. We engaged in an 18-month, iterative process focused on mutual sharing to learn about community perspectives on maternal mental health care barriers and solutions. Researchers and the CAB then created a community policy brief. RESULTS: We developed a CAB and facilitated two focus groups. Together we gleaned a stronger understanding of the importance of education, culture, the patient-provider relationship, and community-based resources. We built on these findings to create specific policy recommendations. CONCLUSIONS: Engaging the CAB and facilitating focus groups informed our understanding of MMHDs from a community perspective, grounding our results and policy in culturally sensitive ways. We developed partnerships between researchers and community providers that can continue to reduce barriers and create solutions to maternal mental health care in our community.

The Community Mentorship Program: Providing Community-Engagement Opportunities for Early-Stage Clinical and Translational Scientists to Facilitate Research Translation.

PROBLEM: A goal of the Southern California Clinical and Translational Science Institute (SC-CTSI) at the University of Southern California and Children's Hospital Los Angeles is to train early-stage clinical and translational scientists (CTSs) to conduct research that improves the health of diverse communities. This goal aligns well with the Institute of Medicine's recommendations emphasizing community engagement in biomedical research that facilitates research translation. The Community Mentorship Program (CMP), created to complement community-engaged research didactics, matches CTSs with community mentors who help them identify and complete community-engaged experiences that inform their research. APPROACH: The CMP was piloted in 2013-2015 by the SC-CTSI Workforce Development and Community Engagement cores. The CMP team matched three CTSs (assistant professors pursuing mentored career development awards) with mentors at community-based organizations (CBOs) aligned with their research interests. Each mentor-mentee pair signed a memorandum of understanding. The CMP team checked in regularly, monitoring progress and addressing challenges in CTSs' completion of their community-engaged experience. OUTCOMES: Each pair completed at least one community-engaged activity informing the CTS's research. In exit interviews, the CTSs and CBO mentors expressed satisfaction with the program and stated that they would continue to work together. The CTSs reported that the program provided opportunities to develop networks outside academia, build trust within the community, and receive feedback and learn from individuals in communities affected by their research. NEXT STEPS: The CMP will be expanded to include all eligible early-career CTSs and promoted for use in similar settings outside the SC-CTSI.

Integrating behavioral healthcare for individuals with serious mental illness: A randomized controlled trial of a peer health navigator intervention.

OBJECTIVE: Individuals with serious mental illness also have high rates of comorbid physical health issues. To address those issues, this population needs interventions that improve self-management of health and healthcare. METHODS: In order to improve the health and healthcare of individuals with serious mental illnesses, 151 consumers with serious mental illness were randomized to receive either usual mental healthcare plus the Bridge intervention (n=76) or usual mental healthcare while on a 6month waitlist (n=75). The waitlist group received the intervention after the waitlist period. RESULTS: Change score comparisons (difference of differences) of the treatment vs the waitlist groups revealed that the treated group showed significantly greater improvement in access and use of primary care health services, higher quality of the consumer-physician relationship, decreased preference for emergency, urgent care, or avoiding health services and increased preference for primary care clinics, improved detection of chronic health conditions, reductions in pain, and increased confidence in consumer self-management of healthcare. CONCLUSIONS: Peer providers using a manualized intervention can be an important part of the efforts to address the general medical care of individuals with serious mental illnesses.

The Recovery-Oriented Care Collaborative: A Practice-Based Research Network to Improve Care for People With Serious Mental Illnesses.

Practice-based research networks (PBRNs) create continuous collaborations among academic researchers and practitioners. Most PBRNs have operated in primary care, and less than 5% of federally registered PBRNs include mental health practitioners. In 2012 the first PBRN in the nation focused on individuals with serious mental illnesses-the Recovery-Oriented Care Collaborative-was established in Los Angeles. This column describes the development of this innovative PBRN through four phases: building an infrastructure, developing a research study, executing the study, and consolidating the PBRN. Key lessons learned are also described, such as the importance of actively engaging direct service providers and clients.

Senior peer counseling by telephone for psychosocial support after breast cancer surgery: effects at six months.

PURPOSE/OBJECTIVES: To evaluate the efficacy of senior peer counseling by telephone for supplemental psychosocial support of older women after breast cancer surgery. DESIGN: Experimental, randomized block, longitudinal. SETTING: A community-based senior service agency and a community hospital-based breast surgical oncology practice in an urban area of California. SAMPLE: 142 women newly diagnosed and scheduled for surgery for stage 0-III breast cancer (X age = 61.8, range = 50-94). METHODS: Participants were stratified by age and randomized to receive telephone calls from a peer counselor (a) once per week for five weeks beginning within 72 hours postsurgery, (b) once weekly for five weeks beginning six weeks postsurgery, and (c) by request. Assessments were conducted before surgery, postintervention, and six months after surgery. Questionnaires included the Hospital Anxiety and Depression Scale, the Interpersonal Relationship Inventory, and the Brief COPE. MAIN RESEARCH VARIABLES: Anxious mood, social support, and coping by seeking instrumental support. FINDINGS: At six months, significant main effects of age were noted for social support, fear of recurrence, and resource use. Significant independent effects of age and intervention were noted for coping by seeking instrumental support. After controlling for age, a significant interaction effect of intervention and time was observed for coping by seeking instrumental support. CONCLUSIONS: Peer counseling may affect instrumental support seeking and appears to be differentially received by age group. Additional study is needed to better understand who benefits most and how from peer counseling. IMPLICATIONS FOR NURSING: Trained senior peer counselor volunteers, supervised by a skilled clinical team, may be a useful adjunct in addressing psychosocial needs of women after breast cancer surgery.

Mindful movement program for older breast cancer survivors: a pilot study.

BACKGROUND: Older breast cancer survivors (BCSs) are at risk for late and long-term treatment effects on quality of life (QOL), including lower physical functioning and fear of recurrence. Two promising approaches to address this include dance/movement therapy and mindfulness. OBJECTIVE: The purpose of this 2-group randomized controlled pilot feasibility study was to test short-term effects of a 12-week Mindful Movement Program (MMP) intervention combining mindfulness with self-directed movement on QOL and mindfulness in female BCSs 50 years or older and at 12 months or more following treatment. METHODS: Consented participants were randomized to an experimental group (EG) (12 weekly MMP sessions) or a control group (no sessions). All completed questionnaires 3 times. The EG participants kept home practice diaries. Analysis was conducted after intervention for immediate effects on outcome variables and 6 weeks later for maintenance of effects. RESULTS: Participants (n = 49) ranged in age from 50 to 90 years (average, 65.6 years) and were at 9.8 years since diagnosis (range, 1-32 years), and the majority were white, unpartnered, and retired. After intervention, EG participants showed improved QOL via decreased fear of recurrence and increased mindfulness attitude. At 6 weeks, initial effects were retained. CONCLUSIONS: The MMP appears to benefit older BCSs by reducing fear of recurrence and improving mindfulness attitude. Although these findings are promising, a larger study is needed to determine more specifically what short- and long-term effects are possible. IMPLICATIONS FOR PRACTICE: The combination of self-directed movement and mindfulness, as tested here, may be a valuable tool for promoting health and well-being in older long-term survivors of breast cancer.

Participant perceptions of a mindful movement program for older women with breast cancer: focus group results.

BACKGROUND: Little attention has been directed to the longer-term survivorship phase for older breast cancer survivors (BCSs) who often continue to struggle with late and long-term adverse effects of treatment including lower physical functioning, fear of recurrence, stress and anxiety, neuropathies, and pain. Creative and accessible strategies are needed that offer support to this population of cancer survivors. OBJECTIVE: The purpose of this study was to examine participant perceptions of the effects of a Mindful Movement Program intervention on quality of life and mindfulness through focus groups. This was part of a pilot feasibility study testing the intervention with older women at more than 1 year after treatment for breast cancer. METHODS: Eight to 9 weeks after completion of 12 weekly, 2-hour mindful movement sessions, focus groups were held with 3 experimental group cohorts of participants who had attended on average 10.4 classes. Focus group interviews were recorded, transcribed verbatim, and analyzed using qualitative techniques for recurrent themes. RESULTS: Four themes emerged from the direct quotes of the participants: freedom, rediscovering, body sense in moving, and in the moment. Participants also contributed opinions about program delivery. CONCLUSIONS: Participants described how the Mindful Movement Program experience affected their lives. Their feedback indicated that the intervention yielded positive results and was feasible for a variety of older BCSs. IMPLICATIONS FOR PRACTICE: Research with a wider group of participants is needed. Preliminary indications are that mindful movement may offer an acceptable strategy for increasing activity and decreasing stress among older BCSs.

Outreach to multiethnic, multicultural, and multilingual women for breast cancer and cervical cancer education and screening: a model using professional and volunteer staffing.

Reaching low-income women from diverse ethnic and cultural communities for the purpose of breast and cervical cancer education and screening is a challenge. This article describes an approach used by Center for Healthy Aging in Santa Monica, California, to implement three projects aimed at Hispanic and African American women to encourage early intervention behaviors. Hispanic and African American volunteers and professional staff work together to establish trusting relationships, join forces with community leaders and develop collaborative approaches to achieve the goal of screening about 1,000 underserved women annually and providing education for an additional 5,000 women. Incorporated in the article are lessons learned about working with this population, the communities in which they live and the use of volunteers for these and other projects.