Cultural Humility in Working with Diverse Clients and Trainees

Ana Maria Melendez Guevara, Ph.D., Kamryn Morris, Ph.D., & Kimberly Osborne, Ph.D.

April 17, 2023

Cultural Humility in Working with Diverse Clients

In clinical and academic settings alike, appreciation is growing for the importance of sensitivity to clients' and trainees' varying cultural backgrounds. Moreover, the realities of living with prejudice, discrimination, and inequity have become increasingly prominent in the national conversation, and these issues come up in therapeutic and educational settings. Those engaging in these conversations often come from different backgrounds, but explicit training in how to approach such conversations is rare. While one option is to aspire to competence in specific cultural contexts represented among one's clients or students, this "cultural competence" approach has drawbacks. This talk will review an alternative approach - cultural humility - that honors each individual's intersecting identities and experience.

Talk Highlights

• Conversations about culture and identity are important, and help improve rapport and quality of care, especially between those in positions of authority and clients/mentees.
• Cultural humility is an approach to actively engaging another’s identity and cultural perspective with open-minded inquiry. Unlike cultural competency, cultural humility emphasizes intersectionality of identity and within-group diversity of experience.
• The cultural humility approach encourages reflecting on and bridging status differences between providers/instructors and clients/students; and emphasizes lifelong learning, acceptance of making mistakes and learning, rather than achieving static competence.
• Recommendations: create safe space for conversations about culture; engage with these conversations by asking questions, listening openly; self-reflect on own background and privilege; advocate for diversity and equity, in and beyond the workplace.

Watch the full talk here.

Psychedelic-Assisted Therapy for Mental Health and Substance Use Disorders

Candace Lewis, Ph.D.

April 3, 2023

Dr. Lewis's research focuses on the impact of early life social experiences on epigenetic regulation of gene systems involved in mental health; the relationships between peripheral epigenetics and brain structure, function, microbiome composition and behavior; and the potential of psychedelic-assisted therapy to reduce symptoms through psychological healing and epigenetic alterations. In this brownbag talk, Dr. Lewis will discuss the state of the science on this latter innovative and promising, yet controversial treatment approach. Please join us for a stimulating presentation covering the history, modern, and potential future landscapes of psychedelic-assisted therapy. 

  Watch the full talk here.

COMMUNITY DISCUSSION: The Opioid Settlement Fund and Extraordinary Science

Moderated by SATRN Director Michelle "Lani" Shiota, Ph.D.

March 20, 2023

Planning is underway for deployment of funds from the national opioid settlement - $548 million in Arizona over the next 18 years - to alleviate harm associated with substance use disorder. Funds will be disbursed through public health organizations at the city, county and state levels; SATRN and its affiliates are already engaged with needs assessment and related efforts by Maricopa County and the City of Phoenix. The long-term commitment of these resources, and the potential for strategic, coordinated action among agencies, creates an extraordinary opportunity for intervention.  It also creates an opportunity for extraordinary science, with a comparably strategic, coordinated, large-scale approach. Please join this initial conversation on strategy for learning as much as possible about what works (and what doesn't) in the years ahead; a conversation to continue at the SATRN retreat on May 5. Light lunch will be provided. 

Addiction Treatment through Telehealth: Stigma, Evidence, and Best Practice

Matt Meier, Ph.D.

February 27, 2023

In response to the COVID-19 pandemic, there was exponential growth in the use of telehealth services for mental health and substance use disorder treatment. In an effort to avoid reducing access to desperately needed services, many providers implemented telehealth programs with limited training or preparation. This talk reviews recent evidence on the effectiveness of telehealth treatment, as well as implications for practitioners.  

Talk Highlights

• Benefits of telehealth treatment include increased access for those in rural and underserved geographic areas, convenience for clients, avoiding stigma associated with receiving treatment. Limitations may include access to and comfort level surrounding the necessary technology, and possible lack of privacy.
• Although more providers strongly prefer in-person sessions, overall evidence suggests telehealth services are as effective as in-person services, both in terms of client perception of rapport and treatment outcomes. 
• Feelings of discomfort and skepticism are natural for clinicians new to telehealth care. Dr. Meier recommends clinicians address personal concerns surrounding telehealth and addiction, and participate in training to develop telehealth-specific competencies

Watch the full talk here.

The Science of Emotion Regulation: Implications for Prevention, Treatment, Policy

Michelle "Lani" Shiota, Ph.D.

February 13, 2023

Life stress is a well-established risk factor, both for the development of substance use disorder and for relapse. Strong emotion regulation skills may help people manage substance use in healthier ways; calls are growing for training/curricula appropriate for SUD-related prevention and treatment, as well as for the general population. This talk summarizes the current state of the scientific literature on emotion regulation, and suggests concrete implications for practice as well as crucial directions for future research.

Talk Highlights

• Stress and distress led to increased craving, impaired impulse control and delay of gratification, self-medication, and difficulties with self-regulation.
• While healthy emotion regulation can help break this link, there is no “one size fits all” emotion regulation strategy appropriate for all contexts. 
• Emotion regulation coaching should promote flexibility: ability to identify and deploy the strategy/ies most likely to be beneficial in a given situation. 
• A strong “toolkit” likely includes strategic situation selection; problem solving; savoring pleasant experiences; reappraisal facilitating a positive mindset; and activities that directly reduce physiological arousal.

Watch the full talk here.

Nothing much changed: Patient experience of federal flexibilities for methadone and buprenorphine during COVID, Arizona 2022

Beth Meyerson Ph.D. & Danielle Russell, M.S.

November 14, 2022

In March 2020, federal regulators allowed flexibilities to facilitate access to methadone and buprenorphine while decreasing risk of COVID exposure. This presentation shares findings from statewide interviews with people on methadone and buprenorphine during COVID in Arizona. The study, MOUD (Medication for Opioid Use Disorder) Access Policy Impact (MAPI), examined the impact of these recommended policy changes.

Talk Highlights

• Federally-recommended flexibilities included telehealth options and increased multi-day dosing accommodations.
• Study findings indicate that few Arizonans on methadone/buprenorphine actually experienced these benefits.
• Providers were able to conduct telehealth appointments remotely, but patients were typically still required to be in the clinic.
• The majority of methadone patients with high COVID risk were still required to go to the clinic daily for doses, rather than being offered multi-day dosing.
• Practical implications: COVID-era flexibilities should be required (as distinct from recommended) on an ongoing basis; more patient advocacy frameworks for clinic and state policy adoption are needed.

Read more about their research here. Watch the full talk and discussion here. 

The Yavapai Reentry Project: Providing Support, Restoration and Hope

Merilee Fowler & Clarissa Nelson

October 31, 2022

Justice-involved individuals face significant risk related to substance use disorder upon release from incarceration and reentry into society. The Yavapai County Reentry Project (YRP) was formed in 2012 to provide support to individuals returning home to Yavapai County from prison. This grassroot effort had no set funding, but relied on volunteers wanting to make a difference in their community.

Talk Highlights

• In Arizona the rate of individuals returning into custody within three years of release is 40%.
• Challenges individuals face after release include securing employment, housing, health care, and lack of emotional and behavioral support. The YRP matches participants with a personal community coach who provides support and resources to overcome these barriers.
• The YRP has trained six additional counties in developing their own reentry programs; and continue to support government and community organizations.

Watch Merilee & Clarissa's talk here. 

Measurement-Based Care: Behavioral Health Providers' Use and Attitudes

Marisa Domino, Ph.D.

October 17, 2022

Despite robust evidence for efficacy of measurement-based care (MBC) in behavioral health care, studies suggest limited adoption of MBC in practice. This talk presents results from a survey of behavioral health care providers on utilization of MBC, beliefs about MBC, and barriers to its adoption. 

Talk Highlights

• In Measurement Based Care (MBC) providers collect data from individual patients to track their progress and plan treatment. While common practice in physical health care, MBC is less common in behavioral health.  
• Fewer than half of behavioral health care providers reported using MBC with at least half of their patients; perceived low clinical utility of MBC was strongly associated with lower MBC use.
• Behavioral health providers who offer specialized care, were more recently trained, and/or practice in rural areas were more likely to report using MBC in their practice.  
• Possible barriers to using MBC include administrative burden, lack of training opportunities, and lack of knowledge about the benefits of implementing MBC.

    

Medication-Assisted Smoking Cessation Treatment: Recent Research on Cytisine

Scott Leischow Ph.D

October 3, 2022

Smoking remains a leading cause of preventable disease and mortality. The most effective treatment currently available is combination of the medication varenicline with behavioral support. However, the most popular brand of varenicline (Chantix) has been pulled from the market due to concerns about ingredients. Cytisine is a closely related, naturally occurring substance and a promising alternative medication.

Talk Highlights

• Cytisine is a naturally occurring substance with a chemical structure similar to varenicline, and has been shown to be as effective as varenicline in helping smokers quit with minimal side effects.
• Cytisine may be a more affordable option, as varenicline is very expensive for those without health insurance.
• Although cytisine is approved and available in multiple countries, additional research is needed in the US before it can be submitted to the FDA for approval as a medication for smoking cessation. That research is underway.

  

  

Environmental Contaminants in Cannabis: Hidden Health Hazards to Recreational Users and Medical Patients

Maxwell Leung Ph.D

September 19, 2022

Dr. Maxwell Leung is an Assistant Professor at the Pharmacology and Toxicology program at ASU West Campus. His research focuses on the potential environmental contaminants which can be found in cannabis, including pesticides and microbes. Each poses potential health risks – alone and/or in interaction with cannabis – with effects being studied in labs today.

Talk Highlights

• Because cannabis is illegal under federal law, there are no national-level regulations. Due to different contaminant restrictions across states, a batch of cannabis could pass health regulations in one state but not another.
• For those who use cannabis as part of treatment for a variety of illnesses, particularly those who are immune-compromised, the lack of information and regulation around contaminants is a serious concern.
• Further research and information is needed to inform effective health and safety regulations for cannabis. Click here to read more about Maxwell's research.

  

Harm Reduction Saves Lives

Haley Coles

April 11, 2022

Harm reduction is the radical principle of accepting that drug use exists in our society. Sonoran Prevention Works is a nonprofit organization focused on harm reduction, whose mission is to build a safe and healthy Arizona for people who use drugs. Sonoran Prevention Works advocates for individual and systemic change in how communities approach people who use drugs, and issues surrounding drug use disorders.

Talk Highlights

• Originally Phoenix Harm Reduction Organization, Sonoran Prevention Works began practicing and advocating for harm reduction in 2010.
• Sonoran Prevention Works is the largest Naloxone distributor in the country, and has helped pass 3 laws in Arizona.
• The program works to reduce stigma around drug use and substance use disorders through education initiatives on the history of drug use, developing harm reduction projects, supporting community based participatory research were people with lived experiences in drug use and drug use disorder are heard, and continued work with policy makers to create policies and laws that support harm reduction efforts.

Access a recording of the talk here.

     

Young adult opioid misuse indicates a general tendency toward substance use and is strongly predicted by general substance use risk

Sabrina Oesterle, Ph.D. & Danielle Pandika, Ph.D.

March 14, 2022

This study uses recent data from the Community Youth Development Study and structural equation modeling to demonstrate that young adult opioid misuse mostly reflects a general tendency to use substances.

Talk Highlights

• Risk pathways to opioid misuse are mostly shared with those for other commonly used substances (i.e. alcohol, tobacco, and marijuana).
• Practical implication:  expanded implementation of existing substance use prevention programs may be an effective strategy for combating the opioid crisis in young adult populations.

Access the presentation slides here: 

SATRN_Brownbag_Oesterle&Pandika.pdf 1.49 MB

    

     

      

Early treatment predictors of Medication Assisted Treatment outcomes for Opioid Use Disorder

Will Corbin, Ph.D.

February 21, 2022

Funded by a SATRN Glen J. Swette Seed Grant, this project in partnership with Community Medical Services (CMS) examines early treatment predictors of Medication Assisted Treatment (MAT) outcomes for individuals with Opioid Use Disorder - specifically consistency of early dosing and size of initial dose. Dr. Corbin discusses ways researchers can establish positive collaborative relationships with community partners, summarizes the study methods and preliminary findings, and discusses next steps for their team and research.

Talk Highlights

• Study hypotheses were that more consistent dosing and larger initial dose would be associated with better MAT outcomes, and that clinics with blocked dosing (i.e., same set time window for dosing each day) would have better outcomes than those without blocked dosing.
• Preliminary findings at the individual level were consistent with hypotheses. At the clinic level, however, patients with blocked dosing had worse retention and dose stability than patients without.
• Practical implication: Blocked dosing may create an unintended treatment barrier.

Access a recording of the talk here.

    

The Probation Journey

Shanda Breed

January 24, 2022

Changing lives starts with changing as individuals and as a system. Probation partners want to be part of the solution, rather than the recidivism revolving doors. Shanda Breed, a program Manager for the Adult Probation Services Division at the Arizona Supreme Court, discusses the reality of probation in Arizona, how the government is reexamining their processes to better support the needs of formerly incarcerated individuals, as well as how communities can help.

Talk Highlights

• The Arizona Supreme Court is examining if their rules and regulations for recently incarcerated individuals are realistic. 
• To help build empathy and understanding within the community, the courts have created a simulation training to walk participants through what it is like to be released from prison, encountering the steps and barriers they would have to navigate in order to successfully reenter their community.
• Greater understanding of the challenges formerly incarcerated individuals face, both within the legal system and in their personal lives, is important to create a better probation system for Arizona.

Access a recording of the talk here.

    

         

  

“They say it’s fentanyl, but they honestly look like Perc 30s:” Lay experiences with the increasing street availability of counterfeit pills containing non-pharmaceutical fentanyl 

Raminta Daniulaityte, P.hD.

November 15, 2021  

Worsening of the overdose crisis in the U.S. has been linked to continuing proliferation of non-pharmaceutical fentanyl, fentanyl analogs, and other novel synthetic opioids (NSO). The new wave of NSO spread in the U.S. is fueled by increased presence of counterfeit pain pills that contain fentanyl and other NSOs. This qualitative study aims to detail and contextualize attitudes and experiences with counterfeit pain pill use among people who use illicit opioids (PWUO) in Arizona.

Talk Highlights

• Researchers conducted interviews with 22 individuals in Arizona who have used illicit opioids in the past 30 days, and/or participated in treatment for opioid use disorder in the past 12 months. 
• Interviews give insight into the increased access and availability of fentanyl in Arizona and the perceived risks and ideas of illicit opioid use.
• Study findings highlighted ideas for harm reduction and important targets of policy change, particularly increased access to fentanyl testing strips.

Access the presentation slides here: 

SATRN Brown Bag_Daniulaityte_11.15.21.pdf 5.01 MB

    

       

Can E-cigarettes Help Smokers Quit:  Exploring the Science, Policy and Future Research Directions

Scott Leischow, Ph.D.

September 9, 2021

Helping smokers quit remains one of the top public health challenges, as few smokers who try to quit on any one occasion are successful. The most effective treatment is behavioral support combined with either varenicline or two types of nicotine replacement used together. In this talk, Dr. Leischow discusses the controversial use of e-cigarettes as a tool for smoking cessation.

Talk Highlights

• Since e-cigarettes have been on the market, many smokers have used them to make quit attempts. However, e-cigarettes have not been formally tested and approved by the FDA for that purpose.
• Multiple studies have explored the, but the definitive studies have not been completed. Preliminary findings from several studies suggest e-cigarettes may faciliate smoking cessation for up to 6 months. 
• More research is required for researchers to feel comfortable recommending e-cigarettes as part of a quit attempt, and to provide smokers with the information needed to make an informed choice when they decide to quit smoking.

Access the presentation slides here: 

SATRN Brown Bag_Leischow_9.20.21_0.pdf 5.16 MB