Public Health and Community Medicine

Permanent URI for this collectionhttps://digital.lib.washington.edu/handle/1773/19593

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    Working Within a Broken System; Caseworker Perspectives on Homelessness in King County
    (2022-07-14) Rait, Yaniv; Spigner, Clarence
    Objectives. Homelessness caseworkers are in demand in cities experiencing high numbers of visibly unhoused people. We aimed to understand the roles, working conditions and views of caseworkers who coach and assist unhoused individuals in the Seattle metro area. Methods. We conducted 16 semi-structured interviews with caseworkers who were supporting unhoused individuals in the Seattle metro area of Washington State between January 2022 and March 2022. Using an inductive approach, we used Atlas.ti to analyze transcripts and elicit themes. Results. Caseworker participants described high levels of job satisfaction with the content of their work, but many frustrations with their working conditions, resources available to offer clients, and very low levels of compensation. Assisting clients in navigating the complicated web of social services in public and private agencies requires in depth knowledge of a fractured system, and relationships with individuals across organizations. Within their own organizations, caseworkers described short-staffing, feeling underpaid in relation to the physical risk and mental toll of their work, and a lack of a comprehensive resource guide. The resources they can offer clients are limited by a lack of suitable, affordable housing options and high barriers to attaining housing for clients. Caseworkers noted Seattle’s policy of relentless and destructive encampment sweeps as regressive and cruel. Though participants overwhelmingly believed Seattle had a better range of social services for supporting unhoused individuals than many other areas of the United States, Seattle-based caseworkers also acknowledged the services available may attract an influx of unhoused individuals, especially from the suburban areas of the county, burdening the thinly spread service providers. Conclusions. Little is known about the growing number of homelessness-facing caseworkers across America’s cities; these workers offer insights into the systems in which they work. To better support unhoused clients, caseworkers need better support from their employing organizations to decrease burnout and increase retention. Additionally, they need better options for homelessness relief from policymakers, shelter providers and other stakeholders. Despite their weaknesses, social service systems in King County are probably stronger than many other places experiencing high levels of homelessness, and may offer a model for other municipalities.
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    Evaluation of the Amigas Latinas Motivando el Alma (ALMA) Mental Health Intervention
    (2022-07-14) Morales Miranda, Monserrat; Ornelas, India; Rao, Deepa
    Objective: The Latina immigrant population is at increased risk for higher levels of depression, anxiety, and stress than other racial/ethnic groups (8,9). However, few studies have implemented and evaluated interventions to improve the mental health disparities among Latina immigrants. Method: In this exploratory study, we randomly selected a sample of 30 participants to invite them to complete qualitative semi-structured interviews. Both intervention and control group participants were interviewed to assess participant satisfaction and acceptability with the ALMA intervention. Results: Findings suggest that Latina immigrant women from both in-person and online interventions found the program supportive and helpful in maintaining their mental health. Participants learned techniques and exercises to help them manage stress, depression, and anxiety and incorporate these into their daily lives. They also learned to connect with themselves and prioritize their mental health needs. Some differences noted by women receiving the intervention online were their ability to connect with other women in the program, and external distractions at home caused them not fully to engage during the online sessions. Conclusion: This study illustrates the potential usefulness and feasibility of a mindfulness intervention to improve mental wellbeing among Latina immigrants and other vulnerable populations that experience barriers to accessing mental health care. Future studies should assess the impact of mindfulness-based interventions on Latina immigrants during the COVID-19 pandemic.
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    Traditional Chinese Medicine Use for Health-Related Quality of Life, a Secondary Analysis of the INCLD Health Data
    (2022-07-14) Sodders, Mark D; Kessler, Larry
    Background: Traditional Chinese Medicine (TCM) commonly employs acupuncture and herbal medicine, both of which are growing in popularity in the United States. These treatments are commonly used in overall health maintenance to promote health and for disease prevention. However, there is a lack of information on how TCM affects Health-Related Quality of Life (HRQoL). Objectives: The objectives of this study are to evaluate the association of TCM and self-reported HRQoL measures, and to explore the association of TCM and both medication use and medical comorbidities. Methods: Data collected and analyzed were from the International Cohort on Lifestyle Determinants of Health (INCLD Health) study and identified a prospective cohort of students reporting the concurrent use of acupuncture and Chinese herbal medicine. Generalized Estimating Equations with a working independence correlation structure were used for cross-sectional analyses for baseline and six-month follow-up observations. The HRQoL outcomes included the PROMIS®-29 profile, the Perceived Stress Scale, and the Personal Wellbeing Index, modified. The covariate-adjusted estimates were reported for HRQoL measures, and odds ratios were reported for the associations of TCM use and medication and comorbidities. Results: Of the 173 observations at baseline, 48 were classified as using TCM. Of the 90 observations at the six-month follow-up, 31 were classified as using TCM. PROMIS®-29 instrument scores indicated values congruent with the average United States adult population at both baseline and follow-up for both groups, with only slightly higher scores for fatigue and anxiety. At baseline, TCM use was associated with lower Perceived Stress, and higher perceptions of mental, spiritual, personal, social, and overall wellness. At follow-up, TCM use was associated with lower Perceived Stress, and higher perceptions of physical and overall wellness. These differences at baseline and follow-up were considered statistically significant, but were not considered clinically meaningful. Medication use and the presence of comorbidities were not associated with TCM. Conclusions: TCM use over six months was not associated with further improvements in HRQoL. Comorbidities and medication use did not appear to affect an individual’s decision to use TCM. The small sample size and a healthy cohort limit the ability to detect meaningful changes in HRQoL from the use of TCM. With more individuals using TCM for health maintenance, future research should focus on HRQoL outcomes.