Community Health for Asian Americans

Reminiscence Therapy has documented success in alleviating depression and improving life satisfaction among elders, yet less is known about its ethnic specific efficacy. We report on the County of Santa Clara Behavioral Health Services Department’s Innovation Project of combining storytelling (simple reminiscence) with three innovative elements: including family members in the process; conducting community events to showcase artwork and life-story books to family and community attendees; and utilizing ethnically and linguistically matched community workers. 73 Hispanic and 92 Vietnamese clients completed the 12-week intervention with pre and post-test assessments. Clients were mostly female (62%), foreign-born, mean age 75 years, 27% lived alone, and the majority had limited English proficiency. Paired t-test analyses indicated clinically significant change scores in depression (5+ points on PHQ-9) for 32% of clients and smaller improvement in depression scores (1 – 4 points) for 54%. A few clients experienced no change or worse PHQ-9 scores at post-test. Statistically significant improvements were observed in scales measuring loneliness (Hughes, 2004), and life satisfaction (Pavot/Diener, 1993). 43% had a family member participate in the intervention. Yet, 62% reported improved relationships with family/friends through improved communication and shared understanding of the client’s life story. 50% of clients participated in a community event and reported improved connection with their community through listening to others’ life experiences and sharing their own. Client perceptions of culturally matched workers were uniformly positive but many indicated they could work with someone from a different cultural background. Successes and challenges to implementation will be discussed.

BackgroundData are limited on effective methods for recruiting persons, especially from ethnically diverse populations, into population-based studies. The goal of this study was to evaluate the variation among and representativeness of controls identified using multiple methods for a population-based case–control study of breast cancer among Asian Americans, Native Hawaiians and Pacific Islanders (AANHPIs) in the San Francisco Bay Area.MethodsWe used a unique combination of targeted recruitment strategies, including address-based sampling, community-based methods, and internet-based and media-based approaches for recruiting controls, frequency matched on age and ethnicity to a population-based sample of cases. To characterise the participating controls, we compared the distribution of sociodemographic characteristics and cancer risk factors between recruitment sources using χ2 tests. To ensure that the controls we recruited were representative of the underlying at-risk population, we compared characteristics of the controls, by ethnicity and in aggregate, to data from the California Health Interview Survey (CHIS), and adjusted the relative mix of recruitment strategies throughout the study as needed to achieve representativeness.ResultsAs expected, controls (n=483) recruited by any single method were not representative. However, when aggregated across methods, controls were largely representative of the underlying source population, as characterised by CHIS, with regard to the characteristics under study, including nativity, education, marital status and body mass index.ConclusionsA multimode approach using targeted recruitment strategies is an effective and feasible alternative to using a single recruitment method in identifying a representative, diverse control sample for population-based studies.

Introduction: The integration of primary care and behavioral health consists of unique multifactorial challenges and successes, which will be discussed using the example of the Integrated Behavioral Health (IBH) Clinic at Asian Americans for Community Involvement (AACI) in San Jose, California. AACI is a community-based organization that focuses on the health and wellness of predominantly Asian American and non-Asian ethnic populations. Historically, stigma towards psychological services, along with other factors, prevented Asian Americans from seeking help. Despite cultural challenges, integrated care for patients at AACI enabled patients to receive patient-centered and holistic treatment. Practice change implementation and timeline: The IBH program was launched in June 2012. Changes included the use of shared electronic health records across health professionals, and implementation of integrated care (2012-present) includes four phases: preparation, preimplementation, implementation post-implementation/optimization. The PHQ-2 was implemented during medical visits and administered on an annual basis to screen and detect depression in patients. When mood symptoms are suspected, patients are referred to the IBH team, where they receive services including treatment from the evidenced-based, culturally adapted IMPACT model and other effective interventions. The PHQ-9 and GAD-7 measures are administered weekly during psychotherapy appointments to track their depression and anxiety respectively. The referral/“warm handoff” process from physicians to psychologists facilitates the treatment and helps to reduce stigma for patients. Interdisciplinary staff discusses pertinent clinic updates through daily morning huddles as well as regular provider meetings. The IBH team consults with the physicians and consulting psychiatrist on a frequent basis, along with conducting patient maintenance calls, home visits, and community outreach. Highlights: The integrated program has shown effectiveness in behavioral health treatment and patient engagement. Over 83% of our patients who completed short-term therapy reduced their depressive symptoms by at least half (average 70% reduction). Over 71% of patients achieved 50% or more reduction in anxiety symptoms (average 62% reduction). Patients reported 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 1 International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-117070 – http://www.ijic.org/ improvements in at least two areas of functioning after treatment. These results are significantly better than that of a similar treatment offered at a non-integrated mental health setting at AACI. Also, 80% of the referred patients from primary care accepted treatment compared to 50% acceptance rate in a similar IBH program in the community serving a primarily Latino population. The no show rate is also less than 15% compared to an average of 30% no show rate among community mental health centers. In addition, our joint medical-behavioral health group visits reflected a higher degree of clinical collaboration. Group topics included self-management of patients’ chronic health conditions. Groups are co-led by Psychologists and a Physician, and guest speakers (e.g. dietician, patient navigator). The integration of patient navigators at AACI has been a positive asset to help patients navigate the complicated U.S. healthcare system. Conclusions: True integration and collaboration often comes with challenges that take a few years to overcome. AACI has shown significant progression in advocating for and implementing integrated healthcare services. In summary, besides clear methodologies of implementation, a smooth integration requires organizational support at all levels and consideration of cultural factors, since “culture eats strategy for breakfast”. Discussion: The purpose and effectiveness of integrated care has been increasingly researched and documented to support the triple aim of America’s healthcare reform – improving population health, enhancing the consumer experience of care, and reducing the per capita cost of care. Well-established models of integration such as IMPACT make it transferable and adaptable to clinics in different settings. AACI has adapted the IMPACT model to better fit the primarily Asian American population and achieved satisfactory results. Financial sustainability may be challenging due to enabling services provided in integrated care that is not billable until the new payment model is established in 2016. Lessons Learned and Future Directions: Human side of change Primary care physicians and mental health providers come from different work subcultures and therefore integration requires training and adaptation for both parties. Data: In order to get buy-in from both the medical and mental health side, ability to show the mindbody connection through collection of both biomarkers and mental health outcomes will be helpful. Systems: Electronic health records need to include more user-friendly behavioral health measures for easier reporting of relevant outcomes; and billing practices need to re-examined to catch up with clinical practices, such as allowing reimbursement for “same day visits” for medical and behavioral health services. Integrated care can be extended to include substance abuse screening and early intervention It is AACI’s plan to advance to being a truly integrated health provider—an effective “one-stop shop”, patient-centered Health Home.

Southeast Asian Americans are highly at risk for tobacco use. Youth-led, environmentally focused tobacco prevention programs have been identified as highly effective in engaging youth in tobacco research and prevention, but may be challenging for the most at-risk youths. We report on lessons learned in a pilot tobacco prevention program with Southeast Asian youth in Northern California. We reviewed meeting notes, participatory research products, and a transcribed focus group with tobacco prevention project participants. Challenges to the youths' participation related to structural issues (limited time, scheduling conflicts, financial difficulties, aging out of programs) and personal issues (school and work pressure, family stressors). Coordinating with ongoing program activities and the county coalition enabled some supports as well as challenges. Key supports for youth were youth leaders, social and financial rewards, and the ability to interpret tobacco prevention information in culturally and age-relevant media.

This study examined stressors and barriers to using mental health services among first-generation immigrants in San Jose, California. Focus groups for 30 immigrants from Cambodia, Eastern Europe, Iran, Iraq, Africa, and Vietnam were audio-recorded, translated and transcribed. Two researchers coded the data and identified themes pertaining to mental health stressors and barriers. Six primary stressors were identified: economic, discrimination, acculturation due to language differences, enculturation, parenting differences, and finding suitable employment. Primary barriers included: stigma, lack of a perceived norm in country of origin for using mental health services, competing cultural practices, lack of information, language barriers, and cost. A conceptual model is presented that may be used to inform the design and implementation of mental health services for this population.