Creating a Culture of Mental Health in Filipino Immigrant Communities through Community Partnerships

One out of five children in the United States has a mental, emotional, or behavioral health diagnosis. Behavioral health issues cost America $247 billion per year and those with mental health disorders have poorer health and shorter lives. Evidence-based parenting interventions provided in childhood have proven to be effective in helping parents to prevent disruptive, oppositional and defiant behaviors, anxiety and depressive symptoms, tobacco, alcohol, and drug misuse, aggression, delinquency, and violence. Yet, few parents participate in such programs, especially hard-to-reach, underserved minority and immigrant populations. The Robert Wood Johnson Foundation has identified a culture of health action framework that mobilizes individuals, communities, and organizations in order to examine ways to improve systems of prevention, invest in building the evidence base for such systems, and provide evidence-based information to decision makers. The overarching goal of this effort was to create a culture of mental health among Filipinos, a large, yet understudied immigrant community that is affected by alarming mental health disparities, including high rates of adolescent suicide ideation and attempts. Our impact project focused on increasing the reach of the Incredible Years® because maximizing the participation of high-risk, hard-to-engage populations may be one of the most important ways to increase the population-level impact of evidence-based parenting programs. If the approach succeeded with Filipinos, comparable strategies could be used to effectively reach other underserved populations in the U.S., many of whom are reluctant to seek behavioral health services. In this chapter we discuss 1) the state of the literature on the topic of Filipino adolescent mental health disparities; 2) our wicked problem and the impact project aimed at ameliorating this issue; 3) how our team formed and implemented our impact project; 4) outcomes and results of our efforts; 5) challenges we faced and how they were overcome; 6) the leadership and health equity skills that were most helpful in addressing our problem; and 7) a toolkit that could assist other communities addressing youth mental health and prevention of suicide and depression.

The Role of Demographic Research in Promoting Refugee Resettlement and Integration in the United States

This introduction to this special issue of the Journal on Migration and Human Security discusses the background and focus of two meetings precursory to this collection, considers refugee resettlement and integration in the United States within the broader framework of the literature on migrant integration, and reflects on the role that population research can play in promoting successful and healthy refugee resettlement in the United States. Other contributions to the special issue are based on five of the presentations at a scientific workshop held in May 2019 in Washington, DC, entitled, “Forced Migration Research: From Theory to Practice in Promoting Migrant Well-Being.” A sixth article evolved from a virtual stakeholder meeting held as a follow-up activity in December 2020, entitled, “Refugee Resettlement in the United States: The Role of Migration Research in Promoting Migrant Well-being in a Post-Pandemic Era.” Both the workshop and the virtual meeting were hosted by the Committee on Population of the US National Academies of Sciences, Engineering, and Medicine, with dedicated support from the Robert Wood Johnson Foundation and the Andrew W. Mellon Foundation.

The Role of Migration Research in Promoting Refugee Well-Being in a Post-Pandemic Era

This paper summarizes the presentations and discussions of a virtual stakeholder meeting on Refugee Resettlement in the United States which built on the foundation of the May 2019 workshop represented in this special issue. With support from the Robert Wood Johnson Foundation and the Andrew W. Mellon Foundation and hosted by the Committee on Population (CPOP) of the US National Academies of Sciences, Engineering, and Medicine on Dec 1–2, 2020, 1 the meeting convened migration researchers, representatives of US voluntary resettlement agencies, and other practitioners to consider the role of migration research in informing programs serving refugees and migrants during the COVID-19 pandemic, continuing an emphasis on bringing global learning to those on the ground working with refugees. The goal of CPOP's work in this area has always been to build bridges between communities of research and practice and to create a dialogue for a shared agenda. We present the goals and framework for the 2020 meeting, followed by a summary of each of the four sessions and themes that emerged from these discussions. The paper ends by considering effective ways of amplifying the role of research in refugee policy and programs of refugee resettlement in the United States and how demographers and population researchers might contribute to this goal.

TMAP

The Texas Medication Algorithm Project (TMAP), which featured atypical antipsychotics, was considered more of a commercial scam than science. TMAP had its beginning in 1995, when it was granted $1.7 million by the Robert Wood Johnson Foundation and various officials and academics in Texas to develop a model mental health treatment program for incorporation into public mental health and prison systems. The Foundation was related to the Johnson & Johnson company, and what they funded was a “guidelines” project for schizophrenia. The TMAP subverted scientific integrity; it appeared to be a purely scientific venture when it was actually a marketing venture for Risperdal. The guidelines produced by TMAP became the basis for the TMAP algorithms, giving a market edge to the J&J products in Texas.

A County-Level Analysis of Socioeconomic and Clinical Predictors of COVID-19 Incidence and Case-Fatality Rates in Georgia, March–September 2020

Objectives The global COVID-19 pandemic has affected various populations differently. We investigated the relationship between socioeconomic determinants of health obtained from the Robert Wood Johnson Foundation County Health Rankings and COVID-19 incidence and mortality at the county level in Georgia. Methods We analyzed data on COVID-19 incidence and case-fatality rates (CFRs) from the Georgia Department of Public Health from March 1 through August 31, 2020. We used repeated measures generalized linear mixed models to determine differences over time in Georgia counties among quartile health rankings of health outcomes, health behaviors, clinical care, social and economic factors, and physical environment. Results COVID-19 incidence per 100 000 population increased across all quartile county groups for all health rankings (range, 23.1-51.6 in May to 688.4-1062.0 in August). COVID-19 CFRs per 100 000 population peaked in April and May (range, 3312-6835) for all health rankings, declined in June and July (range, 827-5202), and increased again in August (range, 1877-3310). Peak CFRs occurred later in counties with low health rankings for health behavior and clinical care and in counties with high health rankings for social and economic factors and physical environment. All interactions between the health ranking quartile variables and month were significant ( P < .001). County-level Gini indices were associated with significantly higher rates of COVID-19 incidence ( P < .001) but not CFRs. Conclusions From March through August 2020, COVID-19 incidence rose in Georgia’s counties independent of health rankings categorization. Differences in time to peak CFRs differed at the county level based upon key health rankings. Public health interventions should incorporate unique strategies to improve COVID-19–related patient outcomes in these environments.

Online Grocery Shopping Patterns and Barriers Among Families Eligible for SNAP: A Mixed-Methods Study

Objectives The USDA is partnering with retailers to authorize online EBT card use to increase grocery store access and promote healthy eating. We examined online grocery shopping behaviors among households with children (&lt; age 8), including SNAP recipients and SNAP-eligible non-recipients (income &lt; 130% of federal poverty level). Methods Mixed-methods data were collected between Nov 2020-Jan 2021. A survey (n = 300; Qualtrics) assessed attitudes, social norms, barriers, perceived behavior control (4-point Likert scale, validated), and frequency of food purchases online and in-store. Descriptive statistics (mean and %) were analyzed using Stata. Using random sampling, respondents participated in in-depth interviews (n = 10) and focus group discussions (n = 50, 5 groups). All interviews were transcribed and analyzed using MAXQDA. Results Participants were predominantly female (88%), 20–39 years old (42%), 30% Non-Hispanic Black, 78% received SNAP. Among online shoppers (58%), 48% had paid with an EBT card, most perceived spending same amount (31%) or less (42%) online than in-store, and 69% reported more impulse purchases in-store than online. Delivery was the preferred method to receive groceries (65%), but fees were a barrier (52%). Most participants purchased less frequently fresh fruits (52%), vegetables (57%), meat and seafood (57%) online than in-store (Gamma p-value for all &lt; 0.001). Trusting food selection and returns were reasons for not buying fresh produce and meats online: “We did try ordering produce and meats and stuff like that, and most of it was rotten and I ended up having to go back to get my money back anyway”. Saving time and convenience were facilitators: “[It appeals to me] because the kids, the corona, taking kids to the store, walking up and down the aisles, I forget stuff when in the store… if I'm in the house, I know what I need, I can just click and order”. Conclusions Families with children receiving SNAP are using online grocery services. Despite the potential to address inequities in food access, fees, and food selection concerns may lead families to purchase less fresh produce online than in-store. Successful scale-up of the USDA program must ensure that the EBT online program supports healthier purchasing and eating practices among SNAP-eligible families. Funding Sources Healthy Eating Research from the Robert Wood Johnson Foundation.

Community voice in cross-sector alignment: concepts and strategies from a scoping review of the health collaboration literature

Background Health care access is an important driver of population health, and factors beyond health care also drive health outcomes. Recognizing the importance of the social determinants of health (SDOH), different actors in the health care, public health, and social service sectors are increasingly collaborating to improve health outcomes in communities. To support such collaboration, the Robert Wood Johnson Foundation developed a cross-sector alignment theory of change. According to the cross-sector alignment theory of change, community voice is critical for helping collaboratives address community health needs. Yet research on health collaboratives offers mixed guidance on how community voice should be understood and which community voice strategies are most effective. Methods This study addresses a gap in the literature with a systematic scoping review of research on health-oriented cross-sector collaboration and community voice. By scanning key academic journals, searching three academic databases, and obtaining documents from across our professional networks, we identified 36 documents that address community voice in health collaboratives. Results The review reveals several conceptions of community voice and a range of community voice strategies. We find that community voice strategies fall on a spectrum between two broad types of approaches: active and passive. These vary not only in the level of power shared between communities and collaborators, but also in the level of involvement required from the community, and this in turn has important implications for community collaboration strategies. We also find that while most strategies are discussed in the context of short-term collaboration, many also lend themselves to adoption in the context of sustainable collaboration and, ultimately, cross-sector alignment. Conclusion This review provides a characterization and conceptualization of community voice in health-oriented collaborations that provides a new theoretical basis for future research. Passive and active community voice strategies can be studied in more detail for their expected impact on health outcomes and disparities. Increased attention to active community voice and the resources it requires can help practitioners achieve improved health outcomes and researchers understand the pathways to health improvement through collaboration.

Longitudinal Use of the Consolidated Framework for Implementation Research to Evaluate the Creation of a Rural Center of Excellence in Transgender Health

Background: Transgender people face numerous barriers to accessing care, particularly in rural settings. Transportation, travel time, a lack of providers offering transgender care, and discrimination all contribute to these barriers. The Gender Wellness Center was established in New York State, USA, to fill a gap in rural transgender care and was subsequently awarded a Robert Wood Johnson Foundation grant to establish a Center of Excellence. This study examined the implementation of the Center of Excellence, a complex intervention, to assess barriers and facilitators to implementation over 18 months. Methods: The Consolidated Framework for Implementation Research (CFIR) was used to develop baseline and follow-up surveys. These were distributed to members of the core implementation team at the Gender Wellness Center at the midpoint and conclusion of the Robert Wood Johnson Foundation grant. Responses were largely open-ended and analyzed qualitatively. Results: Results are presented in terms of CFIR domains and constructs, as well as the relative outlook (positive or negative) of implementation. Overall, there were improvements over time, with more encouraging feedback and examples of success at follow-up. Though true, organizational culture and individual beliefs about the provision of transgender care challenged implementation of the Center of Excellence throughout the project. Conclusions: This study highlights the importance of organizational culture on implementation efforts, as well as the need for complex, multifaceted interventions to overcome such challenges in order to improve care for marginalized populations.

Community Voice in Cross-Sector Alignment: Concepts and Strategies from a Scoping Review of the Health Collaboration Literature

BackgroundHealth care access is an important driver of population health, and factors beyond health care also drive health outcomes. Recognizing the importance of the social determinants of health (SDOH), different actors in the health care, public health, and social service sectors are increasingly collaborating to improve health outcomes in communities. To support such collaboration, the Robert Wood Johnson Foundation recently developed the cross-sector alignment theory of change. According to the cross-sector alignment theory of change, community voice is critical for helping collaboratives address community health needs. Yet research on health collaboratives offers little guidance on how community voice should be understood, or which community voice strategies are most effective.MethodsThis study addresses a gap in the literature with a systematic scoping review of research on health-oriented collaboration and community voice. By scanning key academic journals, searching three academic databases, and obtaining documents from across our professional networks, we identified 36 documents that address community voice in health collaboratives. The review reveals several concepts of community voice and a range of community voice strategies.ResultsWe find that community voice strategies fall into two broad approaches: active and passive. These vary in the level of engagement required from the community and in the level of power shared between communities and collaborators, and this in turn has implications for community health outcomes. We also find that while most strategies are discussed in the context of short-term collaboration, many also lend themselves to adoption in the context of sustainable collaboration and, ultimately, cross-sector alignment.ConclusionThis review provides a characterization and conceptualization of community voice in health-oriented collaborations that provides a new theoretical basis for future research. Passive and active community voice strategies can be studied in more detail for their expected impact on health outcomes and disparities. The increased attention to active community voice can help practitioners achieve improved health outcomes and researchers understand the pathways to health improvement through collaboration.