Michael Fukuda

Telemental Health Training, Team Building, and Workforce Development in Cultural Context: The Hawaii Experience

OBJECTIVE The goal of the University of Hawaii (UH) child and adolescent psychiatry telemental health (TMH) program is to train child and adolescent psychiatry fellows to provide behavioral health services for the children of Hawaii and the Pacific Islands in the cultural context of their rural communities using interactive videoteleconferencing (IVTC). The training experience balances learning objectives with community service. Learning objectives include: Understanding mental health disparities in rural communities, leveraging community resources in ongoing treatment, providing culturally effective care, and improving health care access and delivery through TMH service research and evaluation. METHODS We describe the UH experience. Several UH faculty are experienced with IVTC technology. They are triple-board trained, are recognized for their research in program evaluation and mental health disparities, and are committed to serving Hawaiis rural communities. We demonstrate the role of TMH in linking children and their families living in rural communities with multiple mental health treatment providers. The service-learning curriculum and a unique collaboration with Mayo Clinic provide the opportunity to examine the role of TMH in global service, and training, education, and research. RESULTS TMH provides direct services to patients and consultation on Hawaii Island and Maui County. The collaboration with the Mayo Clinic brings further consultation in complex diagnostics, pharmacogenomics, and cross-cultural psychiatry. A curriculum provides trainees experience with IVTC with the goal of potential recruitment to underserved rural communities. The TMH program at UH is unique in its team building and workforce development by joining multiple entities through IVTC and translating expertise from the Mayo Clinic to rural communities, and strengthening collaboration with local child and adolescent psychiatrists, and primary care and other mental health providers. CONCLUSIONS The UH psychiatry program is a model program to develop an expert mental health workforce in cultural context for children living in rural communities.

Sociodemographic Characterization of ECT Utilization in Hawaii

Objectives Minimal research has been done on sociodemographic differences in utilization of electroconvulsive therapy (ECT) for refractory depression, especially among Asian Americans and Pacific Islanders. Methods This study examined sociodemographic and diagnostic variables using retrospective data from Hawaii, an island state with predominantly Asian Americans and Pacific Islanders. Retrospective data were obtained from an inpatient and outpatient database of ECT patients from 2008 to 2010 at a tertiary care community hospital on O’ahu, Hawaii. Results There was a significant increase in overall ECT utilization from 2008 to 2009, with utilization remaining stable from 2009 to 2010. European Americans (41%) and Japanese Americans (29%) have relatively higher rates of receiving ECT, and Filipino Americans and Native Hawaiians have relatively lower rates in comparison with their population demographics. Japanese Americans received significantly more ECT procedures than European Americans. Conclusions Electroconvulsive therapy is underutilized by certain sociodemographic groups that may benefit most from the treatment. There are significant differences in ECT usage based on ethnicity. Such differences may be related to help-seeking behavior, economic differences, and/or attitudes regarding mental illness. Further research is needed to elucidate the reasons for differences in utilization.

Health Care 101 and Systems-Based Practice

In 2010, the delivery of health care in America was dramatically and extensively changed by the Patient Protection and Affordable Health Care Act (ACA; H.R. 3590) and the Health Care and Education Reconciliation Act (H.R. 4872). Both laws set forth insurance market reforms with the goals of achieving the triple aim: improving the individual patient care in terms of satisfaction and quality, improving the health of the population, and reducing and controlling the cost of care. This chapter will provide a broad overview of the ACA and its impact on the patient, health-care workforce, and health-care provider systems.