Edwina S. Uehara

Effects of combining disparate groups in the analysis of ethnic differences: Variations among asian american mental health service consumers in level of community functioning

The Asian American population comprises historically, socially, and culturally diverse ethnic groups. Given this diversity, investigators caution that combining disparate ethnic groups together may lead to erroneous conclusions. Whether by choice or necessity, however, mental health studies still typically consider Asian Americans as a single ethnic category rather than as separate ethnic groups. Few investigations have addressed the consequences of this practice. This paper examines the implications of conceptualizing Asian Americans as an ethnic category versus ethnic groups, in an investigation of the community functioning status of clients in publicly funded mental health programs in King County, Washington. When treated as a single ethnic category in a multivariate linear regression model, Asian Americans are found to have a lower level of functioning difficulty than their white counterparts. However, when treated as separate ethnic groups (e.g., Vietnamese, Japanese), only one of five Asian ethnic groups has a significantly lower level of difficulty. In a separate analysis of the Asian American subsample, groups are found to differ significantly from one another with respect to functional status. Several factors, including refugee status, account for this difference.

Posttraumatic Distress, Alcohol Disorders, and Recurrent Trauma Across Level 1 Trauma Centers

BACKGROUND Injured survivors of individual and mass trauma receive their initial evaluation in acute care. Few investigations have comprehensively screened for posttraumatic stress disorder (PTSD) symptoms and related comorbidities across sites. METHODS This investigation included 269 randomly selected injury survivors hospitalized at two level 1 trauma centers. All patients were screened for PTSD, depressive, and peritraumatic dissociative symptoms during their surgical inpatient admission. Prior traumatic life events and alcohol abuse/dependence also were assessed. RESULTS In this study, 58% of the patients demonstrated high levels of immediate posttraumatic distress or alcohol abuse/dependence. Regression analyses identified greater prior trauma, female gender, nonwhite ethnicity, and site as significant independent predictors for high levels of posttraumatic distress. CONCLUSIONS High levels of posttraumatic distress, recurrent trauma, and alcohol abuse/dependence were present in more than half of acute care inpatients. Early mental health screening and intervention procedures that target both PTSD and alcohol use should be developed for acute care settings.

Understanding the dynamics of illness and help-seeking: event-structure analysis and a Cambodian–American narrative of “Spirit Invasion”

Event structure analysis (ESA) and its computer analog, ETHNO, represent a class of relatively new methodological approaches that make it possible to capture the complexity of help-seeking interactions. Using narrative data from a study of Cambodian-American help-seeking interactions within a circumscribed illness episode, this paper demonstrates the feasibility of using ESA/ETHNO to illuminate how event sequence, operant illness beliefs, structural conditions, and human agency interpenetrate and shape the occurrence and timing of pivotal actions and the denouement of a help-seeking episode.

Ethnic/Racial diversity and posttraumatic distress in the acute care medical setting.

Recent commentary has advocated for epidemiological investigation as a foundational science for understanding disparities in the delivery of mental health care and for the development of early trauma–focused interventions. Few acute care investigations have examined the diversity of ethnic/racial heritages or compared variations in early posttraumatic distress in representative samples of injured trauma survivors. Hospitalized injury survivors at two United States level I trauma centers were randomly approached in order to document linguistic and ethnic/racial diversity. Approximately 12% of patients approached were non–English speaking with 16 languages represented. English speaking, inpatients were screened for posttraumatic stress disorder, peritraumatic dissociative, and depressive symptoms. For 269 English speaking study participants, ethnic/racial group status was clearly categorized into one group for 72%, two groups for 25%, and three groups for 3% of participants. Regression analyses that adjusted for relevant clinical and demographic characteristics revealed that relative to whites, patients from American Indian, African American, Hispanic, and Asian heritages demonstrated significant elevations in one or more posttraumatic symptom clusters. A remarkable diversity of heritages was identified, and posttraumatic distress was elevated in ethnic/racial minority patients. Policy–relevant clinical investigations that combine evidence–based treatments, bilingual/bicultural care–management strategies, and support for trauma center organizational capacity building may be required in order to enhance the quality of mental health care for diverse injured trauma survivors.

African American Youth Encounters With Violence: Results From the Community Mental Health Council Violence Screening Project

Tragically, encountering violence appears almost commonplace among African American youths. Nationally, homicide is the leading cause of death for African Americans between the ages of 15 and 24 years (Federal Bureau of Investigation, 1988) and the violent crime victimization rate of African American youths is 20% to 30% higher than that of their White counterparts (Jamison & Flanagan, 1989). Youth encounters with violence are not restricted to perpetration or direct victimization. Data from Detroit (Batchelor & Wicks, 1985) and Los Angeles (Pynoos & Eth, 1985a) suggest that persons 18 years old or younger may be eyewitnesses to between 10% and 20% of homicide incidents reported to police in those cities. Witnessing violence, especially when perpetrated against familiar persons, is increasingly characterized as an indirect form of victimization, associated not only with increased aggres-

Grand Challenges for Social Work

This invited article introduces the concept of grand challenges—ambitious yet achievable goals for society that mobilize the profession, capture the public’s imagination, and require innovation and breakthroughs in science and practice to achieve (Kalil, 2012). We call for broad and deep participation of social work scientists and practitioners in the Grand Challenges for Social Work initiative, which will be coordinated by the American Academy of Social Work and Social Welfare.

'Eloquent Chaos' in the Oral Discourse of Killing Fields Survivors: An Exploration of Atrocity and Narrativization

If “narrative” implies a form of discourse in which sequencedevents are meaningfully connected, an “anti-narrative” is achaotic discourse form “of time without sequence, telling withoutmediation, and speaking about oneself without being fully able toreflect on oneself” (Frank 1995: 98). This paper examinesnarratives and anti-narratives in the oral discourses ofsurvivors of the Cambodian killing fields. Through an extendedanalysis of two cases, we demonstrate the internal logic and “eloquence” of anti-narratives – i.e., the ways in whichanti-narrative patterns vividly express and reveal a survivorscomplex and continuing experience of atrocity.

Teaching Notes: Partnership for Integrated Community-Based Learning: A Social Work Community-Campus Collaboration

In this article, the authors describe the Partnership for Integrated Community-Based Learning as an example of “engaged” social work education that integrates social works teaching, research, and service missions and promotes public-spirited, culturally competent leadership, and community–capacity building. The article includes a description of the community and program contexts of that partnership, the core components of the partnership model, collaborator views on the projects benefits, and key challenges in institutionalizing its long-term mission of strengthening community–campus partnerships.

Intersection of Stress, Social Disadvantage, and Life Course Processes: Reframing Trauma and Mental Health.

This paper describes the intersection of converging lines of research on the social structural, psychosocial, and physiological factors involved in the production of stress and implications for the field of mental health. Of particular interest are the stress sensitization consequences stemming from exposure to adversity over the life course. Contemporary stress sensitization theory provides important clinical utility in articulating mechanisms through which these multiple levels exert influence on mental health. Stress sensitization models (a) extend understanding of neurobiological and functional contexts within which extreme stressors operate and (b) make clear how these can influence psychologically traumatic outcomes. The value of interventions that are sensitive to current contexts as well as life course profiles of cumulative stress are illustrated through recent treatment innovations.

Developing local service standards for managed mental health services

Managed care schemes for community mental health services are becoming common. Capitated funding models designed to control costs may create incentives to withhold care. The authors describe a method for creating local standards for minimally appropriate levels of service. The use of such standards can lead to a dialogue with funders and managed care administrators over what constitutes a suitable service package.