Publications

The purpose of this convergent mixed methods interprofessional education (IPE) pilot project was to help health profession students gain valuable insight about the experiences of people living with mental illness, to help them have a better understanding of person-centered care and have greater knowledge about the importance of interprofessional collaboration. A developmental workgroup which consisted of mental health consumers, four interdisciplinary students, and our team developed and implemented a virtual Mental Health World Café IPE event. Twelve other students attended the World Café event. A paired sample t-test was used to examine group differences between pre- and post-test scores for the Interprofessional Socialization and Valuing Scale and the Texas AHEC Survey measures among the four student leaders and the 12 student participants of the virtual Mental Health World Cafe. We conducted individual interviews with the four student leaders and collected reflective journals from the 12 students who attended the World Café event. We examined to what extent the statistically significant quantitative results supported the qualitative results separately for the student leaders and for the student participants of the virtual World Café. We also examined how both the quantitative and qualitative findings aligned with the key components of the Patient-Centered Care in Interprofessional Collaborative Practice Model. While the project allowed the students to reflect upon how they may apply the principles of person-centered care and interprofessional collaboration, the impact of the consumers on the student’s experiences was profound and resulted in widespread engagement of the students who attended the event.

Recto, P., Lesser, J., Paleo, J., Gray, A.H., Zapata Jr., J., A., Zavala Idar, A., Castilla, M., & Gandara, M. (Accepted). Teaching person-centered care and interprofessional collaboration through a virtual mental health world café: A mixed methods IPE pilot project. Issues in Mental Health Nursing.

Lesser, J., Castilla, M., Castillo, C., Escareno, J., Flores, M., Gandara, E., Hernandez, L., Morales, V., Recto, P., Vela, V., Zapata Jr., J., Zavala-Idar, A. (in-press). Developing a COVID-19 health equity workgroup with CHWs: Answering a call to action. Issues in Mental Health Nursing.

To examine how the COVID-19 Project ECHO program may have influenced the mental health of community health workers (CHWs) from South Texas. The program was designed around case-based learning and mentorship to provide support to CHWs and help them gain expertise to provide services to their communities. An explanatory sequential mixed methods pilot study. Fifteen CHWs who were enrolled in the program participated in this study. The Center for Epidemiological Studies-Depression (CES-D) and the Perceived Stress Scale (PSS) were used to measure the differences pre- and post-intervention. Qualitative description was used to explore the experiences of the participating CHWs. The PSS post-test mean (12.53) showed a statistically significant decrease from the pretest mean (17.01) (t (14 = 2.456, p = .028). The CHWs explained that the death of loved ones, feelings of isolation, and work-related concerns influenced their mental health. CHWs expressed that the program provided them with emotional support and resources for their clients. The impact of the COVID-19 pandemic on disadvantaged and medically underserved areas will be long-lasting; therefore, the need is greater than ever for CHWs to receive mental health support and be able to connect communities with vital resources.

Recto, P., Lesser, J., Zapata, J., Jr, Gandara, E., Idar, A. Z., & Castilla, M. (2023). Supporting community health workers during the COVID-19 pandemic: A mixed methods pilot study. Public health nursing (Boston, Mass.), 40(1), 63–72. https://doi.org/10.1111/phn.13144

Substance use disorders (SUDs), like opioid use disorder (OUD) have had a significant impact on communities across the U.S. In 2018, an estimated two million people were reported to have an opioid use disorder in the U.S. (CDC, n.d.). Within the State of Texas, opioid-involved overdose deaths totaled 1402 in 2019, with Latinos making up 25% of opioid overdose-related deaths (Kaiser Family Foundation, n.d.; National Institute on Drug Abuse, n.d.). Within the literature, several sociocultural factors have been associated with limited access to services for opioid misuse within the Latino community. Language barriers are often one of the largest issues related to prevention, treatment, and recovery strategies for Latinos regarding the opioid crisis; demonstrating the need for more bilingual providers and program materials available in participants' native language (SAMHSA, 2020). Within the literature, Community Health Workers (CHWs) have been shown to be effective across multiple settings and health issues. In order to tackle OUD in South Texas, the ST-AHEC team decided to adopt an existing OUD program for CHWs, the CHW-OUD Project ECHO Program developed by UNM.In order to translate our English CHW-OUD ECHO program into Spanish, a Spanish-language CHW-OUD workgroup was created that was made up predominantly of CHWs. This workgroup used a participatory approach to translate our existing English CHW-OUD Project ECHO curriculum into Spanish. This Spanish language CHW-OUD ECHO program that was developed is important as it targets many of the socio-cultural barriers noted in the literature that influence access to opioid services for Latinos. In addition, it meets the community-informed strategies that SAMHSA has stated are needed to address opioid misuse in Latino communities.

Gandara, E., Recto, P., Zapata, J., Jr, Moreno-Vasquez, A., Idar, A. Z., Castilla, M., Hernández, L., Flores, M., Escareño, J., Castillo, C., Morales, V., Medellin, H., Vega, B., Hoffman, B., González, M., & Lesser, J. (2023). Reducing opioid use disorder health inequities within Latino communities in South Texas. Public health nursing (Boston, Mass.), 40(1), 163–166. https://doi.org/10.1111/phn.13124

This scoping review will identify, characterize, and classify co-curricular interprofessional education activities and practices. According to the World Health Organization, interprofessional education occurs when students from two or more professions learn about, from, and with one another to enable effective collaboration and improve health outcomes. As such, interprofessional education is imperative to health professions education. Globally, competency frameworks and guidelines have urged educators to reach consensus about interprofessional education terminology and to integrate this form of education into formal curricula. Voluntary interprofessional education that takes place outside formal curricula (ie, co-curricular) is frequently used to overcome well-documented barriers (eg, discordant academic calendars). We will explore the global literature to identify, characterize, and classify published examples of co-curricular interprofessional education activities. This review will consider voluntary interprofessional education involving students from at least two different health professions. These education activities will take place outside the formal curriculum and will not result in transcript designation. The search strategy will aim to locate primary studies from peer-reviewed journals indexed in MEDLINE, CINAHL, Scopus, ERIC, and Academic Search Complete. The results will be limited to English-language publications from 2009 until the present. Two independent reviewers will screen titles and abstracts, and potentially relevant papers will be assessed in detail. Data will be extracted using a tool developed by the reviewers. Descriptive statistics will be used to characterize the data, which will be presented in diagrammatic, tabular, or other relevant formats.

Lesser, J., Farokhi, M. R., Lacy, J., Chapa, I., Garcia, S., Geelhoed, M., Johnson, L., Stone, M., Worabo, H., & Zorek, J. A. (2022). Defining and classifying co-curricular interprofessional education in the health professions: a scoping review protocol. JBI evidence synthesis, 20(7), 1842–1851. https://doi.org/10.11124/JBIES-21-00206

Our belief is that health profession students can best learn about the principles of person-centered mental health care from the experiences of people living with serious mental illness. Person-centered care, also referred to as patient-centered care, is an approach that emphasizes and respects the values, beliefs, and hopes of individuals (Epstein et al., 2010). Mead and Bower (2000) identified five dimensions of patient-centeredness to include viewing health holistically, sharing power and responsibility and engaging the person as an active participant in their care, knowing the patient as a person beyond their health condition, building a therapeutic alliance where the quality of relationship is regarded as having value, and understanding how the personal qualities of a provider may influence care. Previously published literature has shown the positive influence of teaching recovery and person-centered care by people living with serious mental illness to health profession students (Byrne et al., 2013; Horgan et al., 2021). Byrne et al. (2013) found that teaching mental health recovery from the lived experience perspective helped nursing students gain a better understanding of what it means to live with mental illness, and the importance of providing holistic, person-centered care. Additionally, they learned that people living with serious mental illness are able to live fruitful, productive lives and that recovery from mental illness was possible. Being taught by a person with lived experiences during their education and training teaches students to see individuals as a person beyond their illness, and the importance of collaborating with them about their own care (Byrne et al., 2013; Horgan et al., 2021).

Recto, P., Lesser, J., Paleo, J., Gray, A. H., Zapata, J., Jr, Idar, A. Z., Castilla, M., & Moreno-Vasquez, A. (2022). The Co-Development and Implementation of a Mental Health World Cafe. Issues in mental health nursing, 1–5. Advance online publication. https://doi.org/10.1080/01612840.2022.2085453

Community health workers (CHWs) are frontline public health workers who are trusted members of the community they serve (Centers for Disease Control and Prevention, n.d.). CHWs often serve as connectors between social services, healthcare, and the community in order to help increase access to services to members in the community (Centers for Disease Control and Prevention, n.d.). Moreover, CHWs play an important role in improving the quality and cultural competence of how services are delivered (Centers for Disease Control and Prevention, n.d.). This is because CHWs often share ethnicity, language, socioeconomic status, and life experiences with the individuals that they serve in their communities (National Heart, Lung, and Blood Institute, 2014). Moreover, CHWs often reside in the community they serve and are to able take information with them where it is needed most (National Heart, Lung, and Blood Institute, 2014). In addition, CHWs are noted as agents of change in helping to reduce health disparities within underserved communities (National Heart, Lung, and Blood Institute, 2014).

Gandara, E., Recto, P., Zapata, J., Jr, Moreno-Vasquez, A., Zavala Idar, A., Castilla, M., Hernández, L., Flores, M., Escareño, J., Castillo, C., Morales, V., Medellin, H., Vega, B., Hoffman, B., González, M., & Lesser, J. (2022). Using CBPR Principles with CHWs to Translate an English to Spanish Language CHW COVID-19 & Health Inequities Project ECHO within South Texas. Issues in mental health nursing, 1–5. Advance online publication. https://doi.org/10.1080/01612840.2022.2029103

To date, Texas has had over 4 million cases of infections and more than 74,000 deaths from the novel coronavirus disease (COVID-19) (Texas Department of State Health Services, 2021). The COVID-19 pandemic has exposed frontline healthcare workers to unprecedented situations thereby causing them to experience psychological distress and burnout (Gupta & Sahoo, 2020). The ever-increasing number of confirmed and suspected cases, overwhelming workload, understaffed personnel, risk of exposure to the infection, as well as feelings of isolation due to social distancing measures are contributing to high rates of depression, anxiety, post-traumatic stress, and insomnia to frontline healthcare workers (Gupta & Sahoo, 2020; Pappa et al., 2020). Much of the research and the literature we found about the mental health of frontline healthcare workers during the COVID-19 pandemic were focused on nurses, physicians, and first responders. Research involving other frontline healthcare workers such as CHWs is largely absent. Although a growing body of literature exists, the need to better understand the mental health consequences of the COVID-19 pandemic as a whole on frontline healthcare workers, including CHWs, is indicated. Doing so could result in the development of effective programs that can deliver mental health support to all frontline healthcare workers, including CHWs.

Recto, P., Zapata, J., Jr, Gandara, E., Moreno-Vasquez, A., Zavala Idar, A., Castilla, M., Hernandez, L., Flores, M., Escareno, J., Castillo, C., Morales, V., & Lesser, J. (2022). The Vital Role of CHWs During the COVID-19 Pandemic within the South Texas Communities. Issues in mental health nursing, 1–4. Advance online publication. https://doi.org/10.1080/01612840.2022.2027695

The purpose of this study is to describe the perceptions of community health workers (CHWs), post opioid use disorder training, including the impact of the intervening COVID-19 pandemic, on service delivery and communication. Semi-structured interviews with 10 CHWs were conducted. Categories from the interviews focused on the loss of connections with their clients and how the COVID-19 pandemic caused the CHWs to experience significant interruptions in both their professional and personal lives. The COVID-19 pandemic caused dramatic changes in how CHWs operate within the communities they serve and limited the interpersonal relationships that are vital to their profession.

Zapata, J., Jr, Lesser, J., Recto, P., Moreno-Vasquez, A., & Idar, A. Z. (2022). Perceptions of Community Health Workers during Two Concurrent National Health Crises: Opioid Use Disorder and COVID-19. Issues in mental health nursing, 43(6), 498–506.

The COVID-19 pandemic has brought with it many changes: social distancing, wearing a mask, shelter in place orders, virtual learning, but one of the most striking was changes to employment. Employees from all sectors experienced a paradigm shift in their work lives from outright losing their jobs, to a reduction in hours, to working from home. In addition, was the introduction of a new term into common parlance “essential workers.” The Centers for Disease Control and Prevention (CDC) defines essential workers as “Workers who are essential to maintain critical infrastructure and continue critical services and functions (CDC, 2021).” Essential workers included healthcare workers and first responders who were on the frontline, but also include occupations that have been previously undervalued like sanitation engineers, grocery store employees, construction workers, and home health aides (CDC, 2021).

Moreno-Vasquez, A., Ovalle, B., Castilla, M., Recto, P., Gandara, E., Zapata, J., Jr, Zavala Idar, A., & Lesser, J. (2022). Essential to the Fabric of Their Community: COVID-19 and Female Domestic Workers Living on the Westside of San Antonio. Issues in mental health nursing, 43(4), 382–385.