Suchergebnisse

In 2005, New Mexico created a single health plan to administer all publicly-funded behavioral health services. Our mixed-method study combined surveys, document review, and ethnography to examine this reform's influence on culturally competent services (CCS). Participants were executives, providers, and support staff of behavioral healthcare agencies. Key variables included language access services and organizational supports, i.e., training, self-assessments of CCS, and maintenance of client-level data. Survey and document review suggested minimal effects on statewide capacity for CCS during the first three years of the reform. Ethnographic research helped explain these findings: (1) state government, the managed behavioral health plan and agencies failed to champion CCS; and (2) increased administrative requirements minimized time and financial resources for CCS. There was also insufficient appreciation among providers for CCS. Although agencies made progress in addressing language assistance services, availability and quality remained limited.

In 2005, the State of New Mexico undertook a sweeping transformation of all publicly funded behavioral health services. The reform was intended to enhance the cultural responsiveness and appropriateness of these services. To examine achievement of this objective, we conducted a qualitative study of the involvement of Native Americans in reform efforts and the subsequent impacts of reform on services for Native Americans. We found that the reform was relatively unsuccessful at creating mechanisms for genuine community input or improving behavioral health care for this population. These shortcomings were related to limited understandings of administrators concerning how tribal governments and health care systems operate, and the structural limitations of a managed care system that does not allow flexibility for culturally appropriate utilization review, screening, or treatment. However, interaction between the State and tribes increased, and we conclude that aspects of the reform could be strengthened to achieve more meaningful involvement and service improvements.

With forcible displacement at unprecedented levels and only expected to increase as conflict, economic inequities, and climate change escalate, it is critical to understand the ways in which social networks of migrants are disrupted and reconstituted in new contexts. This requires critical examination and expansion of existing social network conceptualization, measurement, and theory that considers transnational movement and experiences to ensure cultural and contextual validity. As part of a community-engaged intervention study designed to promote the well-being of recently resettled refugees by addressing social determinants of mental health, the social networks of refugees were measured over time. This paper describes the conceptualization, operationalization, data collection, and data analysis of refugees' social networks; challenges and lessons learned; and implications for transdisciplinary social network theory and methodologies. Tracing the development of quantitative and qualitative instruments and participatory processes of iteratively refining them throughout implementation with four cohorts of refugees (2013–2017; N = 290) resettling in a medium-sized city in the Southwestern United States, we offer innovative ways of viewing social networks that expand conceptualization, improve measurement, and extend theory. Our findings address known challenges to social network data collection (e.g., instrument bias, participant recall bias, and interviewer capacity) and suggest how social networks data collection can be strengthened through approaches that include (1) community members as collaborative researchers, (2) transdisciplinary theoretical and methodological perspectives, and (3) team-based practices that share leadership, learning experiences, and responsibility for data analysis, interpretation, and dissemination.

Immigration is at the forefront of national, state, and local policy struggles in the United States, and Latinx/@ immigrants have experienced increased deportations, detention, and individual threats. A mobilities perspective allows analysis to extend our view of migration beyond frameworks confined to pre- and postmigration, examining trajectories of social inclusion and exclusion that are influenced by multiple factors in the receiving country. The Immigrant Well-being Project, a community-based participatory research project involving university faculty, students, staff, and representatives from 4 community-based organizations (CBOs), was initiated in New Mexico in 2017 to better understand and promote Latinx/@ immigrant mental health and integration by creating change at multiple levels. We began these efforts by conducting an in-depth study of the mental health needs, stressors, current socioeconomic, legal, and political context, and local solutions as experienced by 24 Latinx/@ immigrants and their mixed status families. Five trajectories of immigrant integration emerged: continuous exclusion, simultaneous exclusion and inclusion, continuous inclusion, movement from exclusion to inclusion, and movement from inclusion to exclusion. These diverse mobilities were shaped by participants' social locations, agency, and experiences with CBOs, which played critical roles in creating, maintaining, and/or transforming immigrants' trajectories. However, CBOs could not completely buffer immigrants from the current hostile climate and related stressors that resulted in experiences of exclusion or movement from inclusion to exclusion. These findings add to understandings of immigrant mental health, complex ongoing mobility, and mechanisms of resilience and resistance within the United States and have important implications for policy and practice.