Centering culture in the treatment of opioid use disorder with American Indian and Alaska Native Communities: Contributions from a National Collaborative Board

American Indian/Alaska Native (AI/AN) communities are disproportionally impacted by the opioid overdose epidemic. There remains a dearth of research evaluating methods for effectively implementing treatments for opioid use disorder (OUD) within these communities. We describe proceedings from a 2-day Collaborative Board (CB) meeting tasked with developing an implementation intervention for AI/AN clinical programs to improve the delivery of medications to treat OUD (MOUD). The CB was comprised of Elders, cultural leaders, providers, individuals with lived experience with OUD, and researchers from over 25 communities, organizations, and academic institutions. Conversations were audio-recorded, transcribed, and coded by two academic researchers with interpretation oversight provided by the CB. These proceedings provided a foundation for ongoing CB work and a frame for developing the program-level implementation intervention using a strength-based and holistic model of OUD recovery and wellbeing. Topics of discussion posed to the CB included engagement and recovery strategies, integration of extended family traditions, and addressing stigma and building trust with providers and clients. Integration of traditional healing practices, ceremonies, and other cultural practices was recommended. The importance of centering AI/AN culture and involving family were highlighted as priorities for the intervention.     

Treatment preference and acceptability: Epistemology and locus of control

Abstract

Treatment preference and acceptability were investigated in 397 female university students. Three audiovisual vignettes depicting a client and therapist discussing a body image disturbance problem were presented to subjects. Predictions were that subjects would prefer one of three therapy approaches—behavioral, cognitive—rational, or cognitive—constructivist—as a function of personal epistemology and locus of control. Overall, subjects rated the constructivist therapy approach more favorably than either the cognitive—rational or behavioral approach. Similarly, subjects evaluated the constructivist therapist more positively than either the rational or behavioral therapist. After degree of subject identification with the target problem was controlled, results indicated that matching subjects who had an external locus of control orientation to a behavioral or cognitive-rational therapist resulted in more favorable assessments of that therapist. Matching subjects who had an internal locus of control orientation to a constructivist therapist resulted in more positive assessments of that therapist. Implications for matching in clinical practice are discussed.     

Integrative problem-centered metaframeworks therapy I: core concepts and hypothesizing

Over the last 20 years psychotherapy and family therapy have been inundated with a plethora of empirically validated treatments for particular disorders. That trend will increase. Psychotherapists will increasingly be exhorted and ultimately required to integrate empirical data and multicultural competence into their practice. Additionally, individual psychotherapy's default dominance of psychotherapeutic discourse needs to integrate and come to theoretical and clinical terms with the implications of the growing body of research demonstrating the validity and value of a multisystemic perspective. This article (and its companion article) presents a comprehensive, integrative, multisystemic, and empirically informed psychotherapeutic perspective to help therapists and psychotherapy trainers successfully address these challenges-Integrative Problem Centered Metaframeworks (IPCM) Therapy. This first article presents and illustrates IPCM's theoretical foundation, core concepts, and "case formulating" components. It delineates a Blueprint for the practice and teaching of 21st century psychotherapists who can meld science and art into best practice.     

Knowledge about the deleterious effects of smoking and its relationship to smoking cessation among pregnant adolescents

Smoking cessation among pregnant adolescents remains a complex and unresolved issue. The purpose of this study was to examine adolescents' knowledge of the detrimental effects of smoking on pregnant women and fetuses and its relationship to efforts to quit smoking. The sample consisted of 71 pregnant adolescents, and a three-group randomized intervention design-Teen FreshStart (TFS), Teen FreshStart with buddy (TFSB), and usual care control (UCC)-was used. Instruments included a demographic questionnaire, a smoking history questionnaire, and an 11-item scale measuring knowledge of the effects of smoking during pregnancy. For the entire sample, knowledge scores increased significantly (p = .000) from T1 (preintervention) to T2 (postintervention), and the adolescents who quit smoking had significantly higher knowledge at T2 (p = .028) and greater increases (T1 to T2) in their knowledge (p = .019) than did those who did not quit. Together, the TFS and TFSB groups had significantly higher knowledge at T2 (p = .017) and a significantly greater increase in knowledge from T1 to T2 (p = .005) than did the UCC group. This also held true when the TFS and TFSB groups were examined individually. Each had significantly higher knowledge at T2 (TFS, p = .029; TFSB, p = .008) and a significantly greater increase in knowledge from T1 to T2 (TFS, p = .007; TFSB, p = .009) than did the UCC group. Furthermore, despite the small sample sizes, within-group comparisons showed (a) no significant differences between quitters and nonquitters in the UCC group, (b) significantly higher knowledge at T2 (p = .052) and a trend indicating greater increases in knowledge from T1 to T2 (p = .092) for the quitters compared with the nonquitters in the TFS group, and (c) a trend for adolescents in the TFSB group who quit smoking to have greater increases in knowledge compared with those who did not quit (p = .158). These results indicate the need for continued inquiry into the relationship between pregnant teenagers' health knowledge and decisions to stop smoking.     

Clinical versus mechanical prediction: a meta-analysis

The process of making judgments and decisions requires a method for combining data. To compare the accuracy of clinical and mechanical (formal, statistical) data-combination techniques, we performed a meta-analysis on studies of human health and behavior. On average, mechanical-prediction techniques were about 10% more accurate than clinical predictions. Depending on the specific analysis, mechanical prediction substantially outperformed clinical prediction in 33%-47% of studies examined. Although clinical predictions were often as accurate as mechanical predictions, in only a few studies (6%-16%) were they substantially more accurate. Superiority for mechanical-prediction techniques was consistent, regardless of the judgment task, type of judges, judges' amounts of experience, or the types of data being combined. Clinical predictions performed relatively less well when predictors included clinical interview data. These data indicate that mechanical predictions of human behaviors are equal or superior to clinical prediction methods for a wide range of circumstances.