Jacob C. Warren

Rural mental health and psychological treatment: a review for practitioners

Practitioners in rural areas face particular challenges in providing psychological services, ranging from disparate rates of mental disorders to unique circumstances in treating special populations. In this article, we discuss the burden of mental disorders in rural areas, current trends in integration of mental health care and primary care, and unique concerns practitioners face in treating two special populations in rural areas (children and families, and older adults and their caregivers). Implications for practice are also discussed.

Development of an easy to use tool to assess HIV treatment readiness in adolescent clinical care settings

Abstract Optimal management of HIV disease requires high levels of lifelong adherence once a patient initiates highly active antiretroviral therapy (HAART). Because suboptimal adherence to HAART is associated with adverse consequences, many providers are hesitant to prescribe HAART for patients whom they perceive as not being ready to initiate treatment. Accurately predicting HIV treatment readiness is challenging. Despite the importance of this construct, few reliable and valid instruments to assess HIV treatment readiness have been developed; none of these have been validated with adolescents and young adults, who comprise an increasing proportion of new HIV cases diagnosed. As a first step to achieve this goal, we developed the HIV Treatment-Readiness Measure (HTRM) for administration by way of audio computer-assisted self-interview (ACASI) and conducted a study to examine its internal consistency, test–retest reliability, acceptability, and preliminary factor structure. We recruited 201 adolescents and young adults living with HIV from 15 adolescent medicine clinics that were part of the Adolescent Trials Network for HIV Interventions. Youth completed the initial assessment and two weeks later the retest assessment. The refined HTRM had high internal consistency (α = 0.84). Test–retest reliability using both sum scores and mean scores were high. The HTRM was also highly acceptable and feasible to use in routine clinical practice. In exploratory factor analysis we found that a five-factor solution was the best fit; each of the subscales (Disclosure, Psychosocial Issues, Connection with Care, HIV Medication Beliefs, and Alcohol and Drugs) had good to acceptable alphas and eigenvalues greater than 2.0. Our findings support conducting a future study to examine the tools predictive validity.

A quantitative comparison of the health-care disclosure experiences of rural and nonrural lesbians.

Concealment of sexual orientation from health-care providers and/or delay of care due to fears of discrimination or maltreatment in the health-care setting can be major risk factors for the health and well-being of lesbians. Given the added vulnerabilities that rural lesbians may face as they interact with the traditional health-care system, the purpose of the current study was to investigate the relation of sexual minority status and rural background to lesbians’ health-care disclosure-related attitudes or beliefs, behaviors, and experiences. A national, diverse sample of 746 lesbians from rural (38.3%) and nonrural (61.7%) backgrounds participated in the current online study. Participants completed a series of demographic questions and the Multidimensional Disclosure to Health Care Providers Scale. A multivariate analysis of covariance was used to investigate rural versus nonrural differences across 5 disclosure indices. Post hoc analyses of covariance were then conducted for each subscale to explore the specific direction of the rural versus nonrural differences. After race or ethnicity and education were controlled for, the results revealed that rural lesbians endorsed fewer attitudes and beliefs that facilitated disclosure to a health-care provider, experienced fewer health-care opportunities in which disclosure could be initiated, reported less communication of their sexual orientation to providers, and reported previously experiencing greater negative reactions to their disclosure by providers when compared to their nonrural counterparts. Rural lesbians appear to face multiple risks related to health-care disclosure. It is important for rural health-care providers to examine their own biases and beliefs and seek out cultural competency training and consultation related to providing affirming care to lesbians in order to facilitate positive disclosure and overall health-care experiences.