Transcript Rauch - Emory Global Mental Health

ANTHROPOLOGY IN APPLIED
CLINICAL MENTAL HEALTH RESEARCH
Sheila A.M. Rauch, Ph.D.
Clinical Director
Emory Healthcare Veterans Program
Emory University School of Medicine
Atlanta VAMC
The views expressed in this presentation are solely those of the
author and do not reflect an endorsement by or the official
policy of the Department of Defense, the Department of
Veterans Affairs, or the U. S. Government.
The authors have no conflicts of interest to disclose.
MY CAREER
• Experimental paradigms for sexual perpetration and
victimization
• Behavioral health intervention
• Program evaluation on small and large scales
• Treatment development, dissemination, and
implementation
• Policy development
• Biomarkers and risk in the development and treatment
of disorders
• Clinical trials for outcomes and translational treatment
outcomes research
ANTHROPOLOGY IN
MENTAL HEALTH RESEARCH
• Underutilized currently but growing within health
services
• Qualitative methods of assessment
• Study of systems and culture
• Implementation science
• Can provide methods to study:
• Social context
• Historical perspective
• Influence of culture/s
• Some limited examples from my experience where we
consulted with people in anthropology as well as one
example where we did not but I see lots of potential
QUALITATIVE METHODS
• Focus groups
• Methodology to examine themes and pull out
consistencies across less structured interview styles
• Look for themes within groups
• Veteran focus groups examining access and satisfaction
with care
• Look for themes across groups
• Are the themes similar or different across genders,
ethnicities, etc?
• Look for direction for next steps
• Can the themes inform treatment modifications or provide
insight into creation of quantitative methods that can be
applied to a larger population
VISN 4 MIRECC
• Behavioral Health Laboratory- Lead by Dr. Katz and
Dr.Oslin
• New process being implemented to improve access to
MH care in VA
• Designed based on focus groups with veterans
• Across veteran demographics they wanted to access
options for MH care in PC
• Wanted immediate access to MH resources without referral
• Quantitative satisfaction and other measures developed
based on these focus groups as well
• Looking at scheduling data for access
• Asking veterans about their satisfaction with quality, speed
of scheduling, and access to specific MH resources
DISCONTINUATION OF
BENZODIAZEPINES IN OLDER
VETERANS
• Focus Groups examined
• Beliefs about benzodiazepines
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Long-term effects
Tolerance
Risk of falls an injury
Efficacy
Willingness and when they would consider reduction or
discontinuation
• Able to determine that
• beliefs about benzodiazepines were often inaccurate and
problematic
• Few people wanted to discontinue even when they know
the associated risks in older adults
IMPACT OF PROGRAM
DESIGN
• Focus group analysis informed:
• Intervention design
• Focusing on provision after risk events (such as falls or
reduced cognitive function) when people most amenable
• Integration of MI to increase motivation for reduction when
needed
• Measure design included outcomes of concern and value
to the veterans that may not have been apparent
• Sleep even for those not taking the medication for that
purpose
• Social function
TRIPLE DISASTER, JAPAN
• On Friday, March 11, 2011, an earthquake with a magnitude
of 9.0 on the Richter scale occurred about 40 miles off the
coast of Sendai, Japan. Officially known as the Great East
Japan Earthquake, the disturbance caused a tsunami of
waves up to 120 feet high traveling as far as 6 miles inland.
The earthquake is the largest to have ever occurred in Japan
and is the fourth largest in the world since recording began in
1900 (US Geological Survey, 2011). The Tsunami caused
failures at the nuclear power plant leading to contamination.
The disasters were associated with over 24,000 deaths or
missing people and over 5,000 injuries (Japanese National
Police Agency, 2011); additionally, between 400,000
and 170,000 individuals have lost or were evacuated from
their homes within the month following (Japanese Fire and
Disaster Management Agency, 2011).
COMMUNITY REQUEST
FOR HELP
• Team of Psychologists went to Mito and Tokyo to work
with community activists and mental health
professionals to respond to the needs of the Japanese
people.
• Expertise is in trauma response, recovery, and
treatment of PTSD and related issues.
• Expertise is NOT Japanese language, Japanese culture,
and Japanese mental health systems.
PREPARATION
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Preparatory calls with our Japanese colleagues
Research on Mental Health System in Japan
Resources available
Translating materials
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Slides
Videos
Measures
Group discussions
• Working with Japanese culture
• Set up problem solving tasks and small groups to share
results
WHY CONSIDER
ANTHROPOLOGY?
• CONTEXT
• Cultural context
• Historical context
• Systems context
• Assist with effective implementation
• What are the ways that this culture disseminates
knowledge naturally? Can we utilize some of those
existing systems?
• What are the absolute low likelihood methods for this
system? What should we avoid?
• What are the most salient issues for this population and
how can we address them in interventions and
assessment?
SUMMARY
• Not extensive experience with anthropology but see its
value across MH research
• Anthropology can provide:
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New perspectives
Context
Establish themes
Improve intervention and assessment
Much more