Publications

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. Within the State of Texas, opioid-involved overdose deaths totaled 1402 in 2019, with Latinos making up 25% of opioid overdose-related deaths. 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. 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. (2022). Reducing opioid use disorder health inequities within Latino communities in South Texas. Public health nursing, 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. 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) 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.

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, 44(4), 338-342. 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. 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. Moreover, CHWs play an important role in improving the quality and cultural competence of how services are delivered. This is because CHWs often share ethnicity, language, socioeconomic status, and life experiences with the individuals that they serve in their communities. Moreover, CHWs often reside in the community they serve and are to able take information with them where it is needed most. In addition, CHWs are noted as agents of change in helping to reduce health disparities within underserved communities.

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, 44(3), 218-222. 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). The COVID-19 pandemic has exposed frontline healthcare workers to unprecedented situations thereby causing them to experience psychological distress and burnout. 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. 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, 43(9), 878-881. 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. https://doi.org/10.1080/01612840.2021.2011508

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.” 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.

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. https://doi.org/10.1080/01612840.2021.1975979

The novel coronavirus disease (COVID-19) pandemic that has swept our country has led to significant community-wide disruptions in all sectors of public and private life. In the weeks and months following the pandemic, many communities faced inadequate access to essential supplies such as food and diapers, reduced access to health care, and a widening digital divide. To date, Texas has had over 2.9 million cases of infections and 52,000 deaths from COVID-19. The devastations of the pandemic in Texas have intensified the longstanding structural drivers of health inequities such as adverse working conditions, growing economic disparities, and limited resources and access to essential goods and healthcare services.

Recto, P., Lesser, J., Zapata, J., Jr, Moreno-Vasquez, A., Gandara, E., Zavala Idar, A., & Castilla, M. (2022). The Development and Implementation of a COVID-19 Project ECHO: A Program for Community Health Workers Serving Populations from Rural and Medically Underserved Areas in South Texas. Issues in mental health nursing, 43(2), 184-188. https://doi.org/10.1080/01612840.2021.1954449

As part of a new directive, the Human Resources Services Administration (HRSA) mandated Area Health Education Center (AHEC) Programs across the nation to implement an interprofessional education (IPE) program for health professional students, with the goal of fostering collaborative practice among health profession students and motivating students to work in medically underserved areas post-graduation. The South Texas AHEC Program collaboratively developed and implemented a co-curricular IPE initiative, the AHEC Scholars Program, including didactic and practicum components, focused on the needs of communities in our area. A pre-post quasi-experimental design was used to evaluate the student outcomes related to IPEC Competencies and knowledge and preparation for the practice of core topic areas mandated by HRSA. Student outcomes showed statistically significant improvement in all measures. In order to obtain more detailed accounts of students' practicum experiences, students were asked to complete reflective journals after each practicum. The AHEC Scholars Program provides students with opportunities to work with underserved populations and enables students to explore the benefits of team-based care. This article summarizes the collaborative process of the development and implementation of the AHEC Scholars Program; secondly, it details student outcomes from a 3-month pilot study.

Moreno-Vasquez, A., Gandara, E., Idar, A. Z., Recto, P., Zapata, J., Jr, & Lesser, J. (2021). Developing and Implementing a Co-curricular IPE Program: AHEC Scholars Program. Public health nursing, 38(6), 1080-1087. https://doi.org/10.1111/phn.12947

The purpose of this secondary analysis of qualitative data was to understand the multifactorial influences that impact the health and health behaviors of Hispanic adolescent fathers DESIGN & METHODS: Qualitative description was the method used for this secondary analysis. The theoretical domains of the Vulnerable Populations Conceptual Framework were used to guide this study. The semi-structured interviews of 17 participants were analyzed using qualitative content analysis. Participants were Hispanic adolescent fathers, between the ages of 16 and 23 years, who were attending a fatherhood program. Most participants came from socioeconomically disadvantaged backgrounds and unstable families. Additionally, their exposure to widespread neighborhood and domestic violence resulted in gang involvement and illegal activities. The cumulative impact of adverse childhood events resulted in substance use and psychological distress. However, becoming a father was transformative, motivating adolescents to stop engaging in destructive, unhealthy behaviors. Adolescent fathers' well-being is an important component of perinatal health because it affects family functioning and health outcomes in their children. The perinatal period presents a "golden" opportunity to promote health and should be leveraged by nurses to allow adolescent fathers to become involved during the perinatal period. A family-centered approach is critical in addressing the complex needs of this population. An assessment of their psychosocial environment, including childhood trauma, is necessary to help nurses identify at-risk fathers. Additionally, trauma informed care is a valuable tool that nurses can utilize to foster trust in Hispanic adolescent fathers.

Recto, P., & Lesser, J. (2021). Adolescent Fathers’ Perceptions and Experiences of Fatherhood: A Qualitative Exploration with Hispanic Adolescent Fathers. Journal of pediatric nursing, 58, 82-87. https://doi.org/10.1016/j.pedn.2020.12.010