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Health Centers Provide Necessary Integrated Care to Hawaii’s Underserved

Posted: August 20, 2018

Imagine having nowhere to sleep tonight. Every shelter in your neighborhood is full, and you have nowhere else to turn. You’re left on the street, wondering where you’ll get your next meal, your next hot shower or even prescription refill to manage your blood pressure.

Sadly, this is reality for the more than 7,000 homeless individuals living in Hawaii, which has the highest per capita rate of homelessness in the United States. Many are living with chronic conditions and mental health issues that need regular attention, but because of a lack of stable housing or access to transportation, they lack access to regular primary and preventive care.

To address these health needs, many of Hawaii’s homeless population depend on community health centers for comprehensive, affordable care. These centers specialize in treating underserved populations such as the homeless, offering integrated services all “under one roof.”

In fact, community health centers serve more than 150,000 Hawaii residents, offering medical, dental and mental health services in one convenient location.

This approach has led to better health outcomes.

According to the National Association of Community Health Centers, community health center patients have fewer low birth weight babies and higher rates of diabetes and blood pressure control compared with the national average.

And patients are satisfied.

The Commonwealth Fund found 73 percent of patients using community health centers as their regular source of care thought their care was high quality.

As a result of these efforts, community health centers save an estimated $24 billion per year by reducing unnecessary hospitalizations or emergency room visits. And the results are even more impressive when you examine the Medicaid system — the public health insurance program for low-income Americans.

According to NACHC, community health centers care for 1 in 6 Medicaid members, and in Hawaii, 56 percent of health center patients have Medicaid. Studies show health center patients with Medicaid have lower use of costly hospital and emergency department-related services compared with patients at other providers, saving the U.S. Medicaid program approximately $6 billion annually.

That’s why ‘Ohana Health Plan, which provides managed care services to nearly 50,000 Medicaid and Medicare Advantage members in Hawaii, proudly partners with more than 30 community health centers throughout the state that offer primary and behavioral health care services in addition to dental care, diabetes management, prenatal care, tobacco cessation and much more.

Read more on HawaiiTribune-Herald.com



How Police Killings Affect Black Mental Health

Posted: August 16, 2018

“#IfIDieInPoliceCustody Know that the color of my skin was the only crime committed,” a woman tweeted in 2015, three days after Sandra Bland was found dead in her Texas jail cell.

“Nothing will happen to the Police in the Freddie Gray case... ” a man tweeted three days after the death of a 25-year-old Baltimore man whose fatal spinal injury while in police custody in 2015 triggered protests throughout the nation.

These sentiments — perception of a systemic unfairness and a loss of faith in institutions — are common among black people in the days and months following police killings of unarmed African Americans, according to a study published last month in the medical journal the Lancet.

The report analyzed data collected between 2013 and 2016 from 103,710 black adults, finding the incidents to be detrimental to the psyche, adding 1.7 days of poor mental health annually per person. The study also analyzed white Americans’ self-reported mentality after all police killings (of  white and black people), determining that “mental health impacts were not observed.”

Atheendar Venkataramani, a co-author of the study, told The Washington Post that these findings did not mean white people had no emotional reaction to killings. But their responses, he said, haven’t “crossed the line from being upsetting to something that can create or cause disease.”

The paper said the decline in black mental health was seen in all black Americans, regardless of whether there was a relationship with the victim, and can manifest itself in a variety of ways, including “reactions of anger, activation of prior traumas and communal bereavement.”

“Structural racism experienced vicariously can be very consequential for [black] mental health,” said Venkataramani, who is a professor at the University of Pennsylvania’s Perelman School of Medicine. “We are not telling people in the black American community something they do not already know.”

University of Texas at Austin professor Christen Smith told The Post in an email that society has “treated police violence like an acute crisis that only impacts those violated and/or killed and to some extent their immediate kin. This study pushes us to think more broadly about the impact of police violence however,” she wrote.

“Police violence poses a mental health threat to the black community writ large, which means that our social responsibility is much greater than we previously thought.”

Read more on WashingtonPost.com.



2018 Health Disparities Research Institute Scholars

Posted: August 15, 2018

The National Institute on Minority Health and Health Disparities (NIMHD) held its annual Health Disparities Research Institute (HDRI) from July 23–27, 2018 in Bethesda, Maryland. As with previous years, the selection process was very competitive with nearly 300 applications received from early stage investigators. Fifty scholars from 24 U.S. states, the District of Columbia, and one U.S. territory were accepted to the Institute. Selected scholars shared one common attribute—a strong commitment and desire to build a research career focused on minority health and health disparities research.

During the weeklong Institute, leading scientists in minority health and health disparities research held interactive sessions that highlighted the current state of research. Lectures and lively scientific discussions focused on how to advance the field. Scholars were exposed to a wide array of research topics that spanned from how health disparities occur to how they can be effectively eliminated. Topics covered included the embodiment of social factors, big data, systems science, and the use of artificial intelligence, as well as promising and innovative intervention approaches to reduce health disparities. One theme clearly resonated with HDRI scholars—health disparities research is becoming inherently more transdisciplinary and requires a team science approach that harnesses the expertise of scientists from different fields.

Learn more about the Health Disparities Research Institute and the Scholars from NIMHD.Blogs.gov.



What We Know About the Connection Between Climate Change and Suicide Rates

Posted: August 14, 2018

The above-average temperatures that result from climate change are worrying for many reasons—and, according to a study published this week in Nature Climate Change, an increase in suicide rates is among them.

The study, which used data from the United States and Mexico across multiple decades, found that suicide rates rose when monthly average temperatures increased by one degree Celsius. The rate went up by 9.7 percent in U.S. counties, and 2.1 percent in Mexican municipalities. Using these rates, the study's authors project that climate change, on its current course, could lead to between 9,000 and 40,000 additional suicides by 2050. That rate change, they note, is "comparable to the estimated impact of economic recessions, suicide prevention programmes or gun restriction laws."

The study is not the first to point out a link between suicide rates and natural disasters—the latter of which are growing more frequent and severe due to climate change. Take post-Hurricane Katrina New Orleans as an example: In the first 10 months after the 2005 hurricane, New Orleanians committed suicide at close to three times the previous rate.

Puerto Rico has also seen higher suicide rates since Hurricane Maria. Though no comprehensive study has yet been conducted, one report shows suicides increased by 29 percent in 2017 (the year Maria hit) compared to 2016. NBC News reports that more than 5,000 people experiencing suicidal ideation called a government crisis line in Puerto Rico between September of 2017 and January of 2018.

Stress and trauma following natural disasters are factors in the increased suicide rates that follow those events. When it comes to higher temperatures, according to the new study, the heat may have neurological effects, in turn affecting overall mental health.

Climate change also has profound economic consequences—for example, food insecurity—which can in turn further affect individuals' mental health. The American Psychological Association notes that long-term climate change affects "agriculture, infrastructure and livability, which in turn affect occupations and quality of life and can force people to migrate."

Suicide is the tenth leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. It's impossible to say how much climate change has affected or will affect that rate, but the authors of the new study note that the "large magnitude" of their results "adds further impetus to better understand why temperature affects suicide and to implement policies to mitigate future temperature rise."

A 2017 report from the American Psychological Association offers several recommendations for helping individuals "prepare for and recover from climate change-related mental trauma." These include cultivating coping skills, maintaining meaningful practices and healthy habits, and connecting with family and community.

Read more from Pacific Standard.



Written Exposure Therapy: A Shorter but Effective Treatment for PTSD

Posted: August 13, 2018

First-line treatments for post-traumatic stress disorder (PTSD) often require many treatment sessions and delivery by extensively trained therapists. Now, research supported by the National Institute of Mental Health (NIMH) has shown that a shorter therapy may be just as effective as lengthier first-line treatments. The study appeared in the March 2018 issue of JAMA Psychiatry

First-line treatments for PTSD consist of psychotherapies that focus on exposure and/or cognitive restructuring. One such therapy is cognitive processing therapy (CPT), which is widely acknowledged as an effective treatment for PTSD. Patients being treated with CPT take part in 12 weekly therapy sessions that are delivered by a highly-trained practitioner. During these sessions, patients learn to recognize and challenge dysfunctional thoughts about their traumatic event, themselves, others, and the world. In addition, patients are given homework to complete between sessions.

“While of proven efficacy, structured therapies, such as CPT, require extensive training of therapists, a relatively long series of treatments, and, as a further burden on patients, homework exercises between treatment sessions,” said Matthew Rudorfer, M.D., program chief of adult interventions in the NIMH Division of Services and Intervention Research. “A more streamlined intervention that requires less specialized therapist training and fewer sessions while maintaining therapeutic effectiveness would, therefore, be appealing for treatment of PTSD in the community.”

In this study, the researchers examined whether another trauma-focused therapy—called written exposure therapy (WET)—may provide practitioners and patients with an equally effective, but shorter, treatment option. WET consists of five treatment sessions during which patients write about their specific traumatic event. Patients follow scripted instructions directing them to focus on the details of the event and on the thoughts and feelings that occurred during the event. WET requires less specialized practitioner training and no homework assignments between therapy sessions. While WET has been shown to be effective in treating PTSD, it had not yet been tested against more commonly used first-line treatments for PTSD, such as CPT.

To compare the efficacy of WET with CPT, the researchers randomly assigned participants with PTSD to either WET or CPT. Participants were assessed for PTSD symptom severity at baseline and at 6-, 12-, 24-, and 36-weeks after the first treatment session.  WET was found to be as effective as CPT at all time points. In addition, individuals assigned to WET were less likely to drop out before completion of the treatment (6.3 percent) than participants in the CPT group (39.7 percent). Participants in both treatment groups reported high levels of satisfaction with the treatment they received.

“The findings of the study suggest that PTSD can be treated with fewer sessions than previously thought and with less burden on the patient and the therapist,” said lead study author Denise Sloan, Ph.D., an associate director at the National Center for PTSD in the VA Boston Healthcare System and professor of psychiatry at Boston University School of Medicine. “Moreover, the brief treatment was well-tolerated—demonstrated by the small number of patients that dropped out. We look forward to better understanding for whom written exposure therapy works best.”

Dr. Rudorfer added that while more research is needed to identify who might require standard, more intensive therapy, the availability of the new WET intervention “offers additional options for personalizing treatment to meet the needs of the individual.”

Read more on NIMH.NIH.gov. Click here to access the study.



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