Michelle Silva

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

Exploring New Frontiers: Recovery-Oriented Peer Support Programming in a Psychiatric ED

Enhancing the diversity of roles for paid peer-support specialists is a topic of increasing interest throughout the country. Peer specialist positions promote a renewed sense of hope for the possibility of recovery, while also offering unique and valuable competitive employment options for mental health consumers. As we strive toward local and national recovery-oriented systems of care, we must continue to explore practical program applications and their associated benefits and challenges. The authors describe the development and implementation of a recovery-oriented peer support team within the psychiatric service of an emergency department (psychiatric ED) located at an academic medical center in a northeastern state.

Negative Weight-Based Attitudes in Treatment-Seeking Obese Monolingual Hispanic Patients with and without Binge Eating Disorder

OBJECTIVE The aims of this study were to compare weight-based attitudes in obese Latino adults with and without binge eating disorder (BED) and to examine whether these attitudes are related to indices of eating disorder psychopathology and psychological functioning. METHOD Participants were a consecutive series of 79 monolingual Spanish-speaking-only obese Latinos (65 female, 14 male) participating in a randomized placebo-controlled trial performed at a Hispanic community mental health center. Participants were categorized as meeting the criteria for BED (n = 40) or obese non-binge-eating controls (n = 39) based on diagnostic and semistructured interviews administered by fully bilingual research clinicians trained specifically for this study. RESULTS Analyses revealed that negative attitudes toward obesity did not differ significantly between the BED and non-binge-eating groups nor were they correlated with the intensity of eating disorder psychopathology (eg, levels of weight and shape concerns). Overall, the levels of negative attitudes toward obesity in this Latino/Latina group are similar to those reported previously for samples of English-speaking primarily white obese persons. DISCUSSION These findings suggest that it may be obesity per se-rather than eating disorder psychopathology or body image-that heightens vulnerability to negative weight-based attitudes.

The Connecticut Latino Behavioral Health System: A culturally informed community-academic collaboration.

The Connecticut Latino Behavioral Health System (LBHS) represents a culturally informed community-academic collaboration that includes agencies focused on mental health, addictions, behavioral health within community health centers, and social rehabilitation; the Yale University Department of Psychiatry; and the Connecticut Department of Mental Health and Addiction Services. The core mission of the LBHS is to expand and enhance the provision of recovery-oriented, and culturally and linguistically appropriate, services to the monolingual Spanish-speaking community in parts of South Central Connecticut. This article outlines the rationale and need for such a collaboration to meet the needs of an underrepresented and underserved ethnic minority group. The process by which these entities came together to develop and successfully implement systemic strategies is described in the context of 2 overarching priorities: (a) workforce development, and (b) access to services. The authors also highlight lessons learned that have informed the decision-making process since the inception of the LBHS, and future directions to ensure that it is prepared to meet changing consumer needs and systemic priorities. (PsycINFO Database Record

Culturally Adapted, Web-Based Cognitive Behavioral Therapy for Spanish-Speaking Individuals With Substance Use Disorders: A Randomized Clinical Trial

Objectives To evaluate whether adding Web-based cognitive behavioral treatment (CBT) to standard outpatient psychiatric or addiction treatment improved substance use outcomes. Methods We conducted a randomized clinical trial in New Haven, Connecticut, between 2014 and 2017 comparing 8 weeks of standard outpatient treatment to the same treatment with access to a culturally adapted version of Web-based CBT with a 6-month follow-up. Participants were 92 treatment-seeking individuals with Spanish as their primary language and current substance use disorder, with few other restrictions. Results Treatment completion and data availability were high (98% of the randomized sample). For the primary outcome (change in frequency of primary substance used), there was a significant effect of treatment condition by time (t 1, 718 = −2.64; 95% confidence interval = −0.61, 0.09; P = .01), indicating significantly greater reductions for those assigned to Web CBT, which were durable through the 6-month follow-up. The knowledge test indicated significantly greater increases for those assigned to Web CBT. Conclusions Adding a culturally adapted version of Web-based CBT to standard treatment improved substance use outcomes. Public Health Implications This approach has high potential to address health disparities by providing an easily accessible, inexpensive form of evidence-based treatment to a range of Latinos with substance use disorders.