BackgroundThe study was conducted to explore challenges faced by trained informal health providers referring individuals with suspected mental disorders for treatment, and potential opportunities to counter these challenges.MethodsThe study used a qualitative focus group approach. It involved community health workers, traditional and faith healers from Makueni County in Kenya. Ten Focus Group Discussions were conducted in the local language, recorded and transcribed verbatim and translated. Using a thematic analysis approach, data were entered into NVivo 7 for analysis and coding.ResultsResults demonstrate that during the initial intake phase, challenges included patients’ mistrust of informal health providers and cultural misunderstanding and stigma related to mental illness. Between initial intake and treatment, challenges related to resource barriers, resistance to treatment and limitations of the referral system. Treatment infrastructure issues were reported during the treatment phase. Various suggestions for solving these challenges were made at each phase.ConclusionsThese findings illustrate the commitment of informal health providers who have limited training to a task-sharing model under difficult situations to increase patients’ access to mental health services and quality care. With the identified opportunities, the expansion of this type of research has promising implications for rural communities.
Family stressors predict negative psychological outcomes for immigrant adolescents, yet little is known about how such stressors interact to predict school outcomes. The purpose of this study was to explore the interactive role of family stressors on school outcomes for newcomer adolescent immigrants. Using a convergent parallel mixed-methods design, we used quantitative methods to explore interactions between family separation, acculturative family conflict, and family life events to predict 2 school outcomes, academic achievement (via grade point average [GPA]), and externalizing problems (student- and teacher-reported). The sample included 189 newcomer immigrant public high school students from 34 countries of origin. Quantitative measures included the Multicultural Events Scale for Adolescents, Family Conflicts Scale, and the Achenbach System of Empirically Based Assessment (ASEBA). Qualitative data were collected through a semi-structured interview. Quantitative results found that more family life events were associated with lower GPA, but this association was weaker for participants who had been separated from their parents. More family conflict was associated with more externalizing symptoms (both youth- and teacher-reported). However, the association between family conflict and teacher-reported externalizing symptoms was found only among participants reporting a greater than average number of life events. Qualitative results show that separation from extended family networks was among the most stressful of experiences, and demonstrate the highly complex nature of each family stressor domain. At a time when immigration is rapidly changing our school system, a better understanding of early risk factors for new immigrants can help teachers, administrators, and mental health practitioners to identify students with greatest need to foster behavioral, academic, and emotional well-being. (PsycINFO Database Record
Training professional psychologists in a time of increasingly complex diversity-related issues requires innovative approaches to teaching cultural competency and cultural humility at the doctoral level. However, there is currently little empirical evidence to support effective teaching techniques in cultural competency training. To address this pedagogical need, the authors implemented and tested the utility of a 2-stage, developmental approach to using cultural formulation (CF) assignments. Students in a doctoral-level course on cultural competency were given a CF assignment at the course midpoint and a second assignment at the end of the academic term. Students were given extensive feedback after CF1, with the goal of providing direction for improvement of their cultural considerations in CF2. Using a thematic content analysis approach, each set of CF assignments were coded into themes demonstrating core competencies for cultural competence and cultural humility, and tallied to assess improvement in levels of competency across the 2 assignments. Results demonstrated several emergent themes: perspective taking, acknowledging intersections of identity, cultural self-awareness, scientific mindedness, and unsupported cultural statements. Related tallies reflect an overall improvement between the 2 assignments. This article therefore provides support for the use of 2-stage CF assignments as a tool for developing and measuring dimensions of cultural competence and cultural humility. Limitations and implications of the findings for clinical training are discussed.
This study examined stigma (both the perception that mental illness is stigmatized and stigma concerns about entering treatment) and other treatment concerns along with subsequent treatment engagement within three months in a sample of 42 black adults referred to public-sector outpatient treatment. Contrary to expectation, perceived stigma of mental illness was unrelated to treatment engagement; however having stigma or other concerns about treatment was associated with increased odds of engagement. Findings indicate the importance of examining stigma as a multi-dimensional construct and raise questions about the utility of addressing stigma as a way of promoting service use in black adults. More work is clearly needed to understand the complex relationship between stigma and help-seeking in black populations and other underserved groups.
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