Manuel Paris

Culture and Clinical Practice: Recommendations for Working With Puerto Ricans and Other Latinas(os) in the United States

Much has been written concerning ethno– cultural constructs and their application to the behavioral health treatment of Latinas(os). Perhaps because of the inherent complexity of attempting to describe ethno– cultural beliefs and treatment implications while avoiding stereotyping and overgeneralizing, writings in this area often begin with brief descriptions of select cultural values. Often what follow are treatment implications and recommendations, embedded in a broader theoretical discussion. This article builds upon this work by placing cultural concepts in ecological perspective and offering practice recommendations that follow from specific cultural beliefs. Although not exhaustive, these recommendations are intended to offer concrete approaches to care that are consistent with a contextual understanding of individuals of Hispanic heritage, particularly of individuals of Puerto Rican ethnicity living in an urban setting.

Burnout in the Mental Health Workforce: A Review

There are enormous concerns regarding the recruitment, retention, training, and performance of the behavioral health workforce. Paramount among these concerns is turnover, which causes disruption in continuity of care, diminishes access to care while a position remains vacant, and poses financial hardship on the provider organization through costs related to recruitment, orientation, and training of a new hire. There is frequent mention of burnout within the literature and among behavioral health managers as a potential cause of turnover. However, there is no recent or comprehensive review of burnout that examines the evidence surrounding its validity, utility, and potential relationship to turnover. The purpose of this paper is to provide such a review by examining the construct of burnout, methodological and measurement issues, its prevalence in the mental health workforce, correlates of burnout, and interventions to decrease it. The implications for provider organizations and recommendations for future research are identified.

A multisite randomized effectiveness trial of motivational enhancement therapy for Spanish-speaking substance users.

Hispanic individuals are underrepresented in clinical and research populations and are often excluded from clinical trials in the United States. Hence, there are few data on the effectiveness of most empirically validated therapies for Hispanic substance users. The authors conducted a multisite randomized trial comparing the effectiveness of 3 individual sessions of motivational enhancement therapy with that of 3 individual sessions of counseling as usual on treatment retention and frequency of substance use; all assessment and treatment sessions were conducted in Spanish among 405 individuals seeking treatment for any type of current substance use. Treatment exposure was good, with 66% of participants completing all 3 protocol sessions. Although both interventions resulted in reductions in substance use during the 4-week therapy phase, there were no significant Treatment Condition x Time interactions nor Site x Treatment Condition interactions. Results suggest that the individual treatments delivered in Spanish were both attractive to and effective with this heterogeneous group of Hispanic adults, but the differential effectiveness of motivational enhancement therapy may be limited to those whose primary substance use problem is alcohol and may be fairly modest in magnitude.

Mental Health And Addiction Workforce Development: Federal Leadership Is Needed To Address The Growing Crisis

The mental health and addiction workforce has long been plagued by shortages, high turnover, a lack of diversity, and concerns about its effectiveness. This article presents a framework to guide workforce policy and practice, emphasizing the need to train other health care providers as well as individuals in recovery to address behavioral health needs; strengthen recruitment, retention, and training of specialist behavioral health providers; and improve the financial and technical assistance infrastructure to better support and sustain the workforce. The pressing challenge is to scale up existing plans and strategies and to implement them in ways that have a meaningful impact on the size and effectiveness of the workforce. The aging and increasing diversity of the US population, combined with the expanded access to services that will be created by health reform, make it imperative to take immediate action.

Engaging Latinos through the integration of cultural values and motivational interviewing principles.

A rapidly growing Latino population challenges the U.S. mental health system. Despite a high service need, significant disparities in access to care have resulted in patterns of low utilization and frequent dropout. Furthermore, natural ambivalence as individuals access a traditionally underutilized

Workforce Competencies in Behavioral Health: An Overview

Competency-based training approaches are being used more in healthcare to guide curriculum content and ensure accountability and outcomes in the educational process. This article provides an overview of the state of competency development in the field of behavioral health. Specifically, it identifies the groups and organizations that have conducted and supported this work, summarizes their progress in defining and assessing competencies, and discusses both the obstacles and future directions for such initiatives. A major purpose of this article is to provide a compendium of current competency efforts so that these might inform and enhance ongoing competency development in the varied behavioral health disciplines and specialties. These varied resources may also be useful in identifying the core competencies that are common to the multiple disciplines and specialties.

REPORT OF RECOMMENDATIONS: THE ANNAPOLIS COALITION CONFERENCE ON BEHAVIORAL HEALTH WORK FORCE COMPETENCIES

In May 2004, the Annapolis Coalition on Behavioral Health Workforce Education convened a national meeting on the identification and assessment of competencies. The Conference on Behavioral Health Workforce Competencies brought leading consumer and family advocates together with other experts on competencies from diverse disciplines and specialties in the fields of both mental health care and substance use disorders treatment. Aided by experts on competency development in business and medicine, conference participants have generated 10 consensus recommendations to guide the future development of workforce competencies in behavioral health. This article outlines those recommendations. A collaborative effort to identify a set of core or common competencies is envisioned as a key strategy for advancing behavioral health education, training, and other workforce development initiatives.

The prevalence and structure of obsessive-compulsive personality disorder in Hispanic psychiatric outpatients

This study sought to confirm a multi-factor model of Obsessive-compulsive personality disorder (OCPD) in a Hispanic outpatient sample and to explore associations of the OCPD factors with aggression, depression, and suicidal thoughts. One hundred and thirty monolingual, Spanish-speaking participants were recruited from a community mental health center and were assessed by bilingual doctoral-level clinicians. OCPD was highly prevalent (26%) in this sample. Multi-factor models of OCPD were tested and the two factors - perfectionism and interpersonal rigidity - provided the best model fit. Interpersonal rigidity was associated with aggression and anger while perfectionism was associated with depression and suicidal thoughts.

Cultural Influences on Causal Beliefs About Depression Among Latino Immigrants

Purpose: This study describes causal beliefs about depression among Dominican, Colombian, and Ecuadorian immigrants. The authors describe participants’ narratives about how particular supernatural or religious beliefs may contribute to or alleviate depression. Method: Latino primary care patients (n = 177) were interviewed with the Beliefs About Causes of Depression Scale, a list of 35 items rated from not at all important to extremely important. Participants had the option of expanding on responses using an informal conversational approach. Underlying themes of these explanatory comments were derived from narrative and content analysis. Results: Major themes that emerged were Psychosocial and Religious and Supernatural causal beliefs. A third theme emerged that represented the integration of these categories in the context of the immigrant experience. Discussion and Conclusions: This article adds to the understanding of cross-cultural beliefs about depression. Psychosocial stressors related to the immigrant experience and adverse life events were highly endorsed, but the meaning of these stressors was construed in terms of religious and cultural values. To provide culturally appropriate services, nurses should be aware of and discuss the patient’s belief systems, illness interpretations, and expectations of treatment.

Correlates of religious, supernatural and psychosocial causal beliefs about depression among Latino immigrants in primary care

The purpose of this cross-sectional study was to explore causal attributions about depression and to identify psychosocial factors associated with these beliefs among Latino immigrants. We interviewed 177 primary care patients with instruments to assess causal beliefs, depressive and somatic symptoms, ethnic identity and stigma. An exploratory factor analysis of the Causal Beliefs scale yielded three factors, “Balance,” “Psychosocial” and “Malevolent Spirituality/Transgressions” that were used as dependent variables in multivariate analyses. Depressive symptoms, age, country of origin and religiosity were significantly associated with particular factors of causal beliefs. Those with higher education were most likely to endorse psychosocial causal beliefs. Stigma pertained to causal beliefs related to “malevolent forces” and “personal transgressions.” In conclusion, psychosocial and religious explanations of illness were strongly endorsed by these Latino immigrants, indicating a dual system of Western-medicine and traditional beliefs. These results suggest culturally-specific interventions for improving health knowledge and communication with patients about depression.