Evidence-based medicine calls for the use of current best evidence (together with individual clinical expertise). Guidelines aim to distil such evidence, yet clinical practice often fails to follow guidelines, for multiple reasons that are still not well understood. One under-researched aspect of the gap between guidelines and practice is psychology. My literature review found that the application of psychology to implementation research has been limited, and such research is not well integrated into wider implementation research. In this study, I sought to a) systematically apply psychological theory to understand the different psychological processes in the stages of adoption described in the diffusion of innovations model; b) collect and analyse data to explore and test this new, psychologically-enhanced model of guideline adoption; and c) improve and extend my model in the light of my empirical data. Having populated my proposed framework with potentially relevant psychological theories based on my literature review, I undertook a first assessment of the validity and added value of this proposed theoretical framework through a case study of the implementation of guidance on universal offering of HIV testing in hospitals serving populations meeting the criteria for high HIV prevalence in the catchment population, interviewing 20 healthcare professionals across two sites. My findings broadly supported my proposed theoretical approach, and illustrated relevant psychological theories for different stages of adoption. My findings support two provisional conclusions. First, that there is potential to improve the effectiveness of efforts to implement guidelines by augmenting the widely-used innovation adoption model with specific psychological theories. Second, that policymakers would do well to shift from viewing the health system as a complicated entity that policy can control and direct is misconceived; I recommend shifting to a perspective of the health system as a complex system, and rethinking the role of policy from that perspective.

A community coalition is a formal alliance of organisations, groups and agencies that have come together for a common goal. Collaborative partnerships between the health professionals and the communities they serve have received attention as a strategy for achieving health gain and are spreading globally. This partnership approach has a potential for a synergistic maximization of impact and has been advocated as a means to increase citizen participation and ownership among under-privileged groups. Despite the popular appeal and theoretical promise of this approach, the precise domains that need to be fostered by the stakeholders to implement this complex model remain unclear. The aim of this study was to investigate and compare the characteristics and perceptions of the CPs' stakeholders as regards the structural characteristics and operational parameters of the partnerships, as well as the correlates of effectiveness and impact for each participant group. Of particular interest was to identify the characteristics which enable partnerships to fulfill their organizational tasks and goals, regardless of the scope or complexity of purpose. The five CPs were located across South Africa and aimed at Health Professions Education reforms. Quantitative data was collected from 668 coalition members and qualitative data from 46 strategic participants. The partnerships' documents were also scrutinized and ample participant observations were undertaken. The data was then pooled and the comparison groups were constructed: the professionals, comprising of staff from the academic institutions and the health service providers, the community members and the full-time paid employees of the partnerships, the core staff. The analyses of the partner's opinions and views as well as the predictors of accomplishment of diverse stakeholders hold lessons for managers concerned with health coalitions. Generally, training and development seem to be the main thrust of the partnerships' missions. The observation is that clarity of roles, procedures and responsibilities is imperative. Clarity requires transparency to each others agendas. Although there was an under-representation of the youth, there seemed to exist a mixture of various levels of satisfaction in the partnerships, with the community members in need for more sense of ownership. The findings also point to that consultation in decision making seem to be lacking with unilateral decision making taking place. This might lead to power struggles and hidden agendas between the partners that could hamper the advancement of the partnerships. Explanation of why stakeholders are satisfied or committed or what explains their views on effectiveness and activity levels of their partnerships may inform efforts in other settings. With diverse partners, it is important to be somewhat cautious in the consideration of the stakeholders engaged in these collaborative efforts. Partners working together need not be considered homogenous entities. The groups come from different backgrounds, organizations and cultures. The attitude to be created in collaborative interventions is one of a clear understanding that embraces the different origins and aspirations of the stakeholders and recognises the mutual roles, responsibilities, resources and limits. Only by paying due attention to their individual values and weaving it into a common vision can the partnership process be taken forward.

Submitted by Suellen Rodrigues (suellen_rodrigues18@yahoo.com.br) on 2017-09-28T18:38:45Z No. of bitstreams: 1 Versão final..pdf: 2027194 bytes, checksum: b1abe06e18e019c92d79b3c3bd5fb7b1 (MD5) / Approved for entry into archive by Monique Sasaki (sayumi_sasaki@hotmail.com) on 2017-09-29T17:28:50Z (GMT) No. of bitstreams: 1 rodrigues_ss_me_arafcl.pdf: 2027194 bytes, checksum: b1abe06e18e019c92d79b3c3bd5fb7b1 (MD5) / Made available in DSpace on 2017-09-29T17:28:50Z (GMT). No. of bitstreams: 1 rodrigues_ss_me_arafcl.pdf: 2027194 bytes, checksum: b1abe06e18e019c92d79b3c3bd5fb7b1 (MD5) Previous issue date: 2017-08-17 / A formação do professor é fundamental para assegurar um trabalho sistemático, contínuo e formal de educação sexual na escola, assim como, nos distintos ambientes de saúde. Há a necessidade de formação inicial e continuada deste profissional, considerando que os cursos de graduação geralmente não apresentam em seus currículos temas relacionados a gênero, sexualidade e, diversidade sexual. Aliado a isso, é imprescindível se ter professores aptos e que possam ser sensibilizados à necessidade de se discutir temas relacionados à sexualidade humana levando em consideração a necessidade de serem abordados no contexto escolar. O mesmo pode ser dito acerca dos profissionais da saúde. A formação acerca deste tema é incipiente diante das demandas que apresentam de abordar este assunto. Diante disso, a presente pesquisa teve por o objetivo geral averiguar as demandas dos profissionais da educação e saúde relativas à sexualidade e educação sexual, para a partir disso e neste contexto, elaborar e implementar propostas interventivas em sexualidade e educação sexual direcionado aos mesmos, acompanhando-os e assessorando-os no desenvolvimento de projetos de educação sexual. A abordagem metodológica utilizada na presente pesquisa é qualitativa, mediado pela pesquisa-ação. A pesquisa foi realizada no município de Abaetetuba-PA. E os participantes da pesquisa foram profissionais da educação (pedagogos e professor de matemática) e da saúde (psicóloga). Quanto aos instrumentos de pesquisa para a coleta de dados foi utilizado um questionário com perguntas abertas. A partir dos dados deste instrumento foram implementadas propostas interventivas para assessorar os profissionais nas efetivações de ações em sexualidade. Em linhas gerais, a elaboração de propostas interventivas visou dar legitimidade para uma formação articulada, fornecendo oficinas sobre as seguintes temáticas (história da sexualidade, diferença sexualidade e sexo, relação de gênero, gravidez na adolescência, prevenção as IST-HIV-AIDS, diversidade sexual, direitos sexuais e reprodutivos e violência sexual), assim como, sensibilizando ante à necessidade de implementação destas propostas. Contudo, por meio da implementação das propostas interventivas direcionadas aos profissionais de educação e saúde, foi notório verificar as contribuições que a formação propiciou nas concepções destes e, principalmente, no manejo para abordar o tema na prática profissional. Desse modo, percebemos que por meio dos resultados obtidos os profissionais da educação e saúde do citado município necessitam de formação e informação para desenvolver trabalhos interventivo de sexualidade, o que salienta a urgência do acréscimo de cursos contínuos para a efetivação das ações em ambas áreas. / The aim of this paper was to enhance the proper preparation concerning to teachers specialization in matters of systematical, continuous and formal-standardized sexual education, which has to be assured preparing teachers to deal with this topics in schools, as well as in all health institutions. It is extremely necessary to emphasize the urge of this initial and continuous preparation of this professional, considering that undergraduation courses at the university generally do not contemplate these issues on its course curriculum, those themes are related to gender, sexuality and sexual diversity. Still attached to this idea, it is also demanding from teachers to be prepared and cope with this sexual education themes adequately, taking into consideration the compromise of approaching those issues accordingly. Providing the same know how and preparation as the health professionals receive on their specialized courses giving thus, the important implementation and reinforcement due to the necessity to convey this sexual matters approach. To this view, the present research had its general objective to assure the demands of education and health professionals regarding to sexuality and sex education, to start from this point and in this especific context to elaborate and implement interventional proposals on sexuality and sexual education advising them on the development of sex education projects. The methodological approach, on this research was qualitative, verified via action research. The research was applied in the city of Abaetetuba-PA. And the research participants were education professionals (pedagogy professionals), (mathematics teachers) and in the health area (psychologists). In terms of tools applied, in order to, collect data, it has been used a survey-questionnaire. Based on the data collected, there were implemented inventive proposals to assist those professionals on effective actions related to sexuality issues. In general terms, the concept of elaborating an inventive proposal intended to assure authenticity in articulated preparation, providing workshops on the following themes (history of sexuality, sexuality and sex difference, gender relations, teenage pregnancy, STI-HIV-AIDS prevention, sexual diversity, sexual and reproductive rights, and sexual violence), as well as, the awareness of the massive needs on implementing these proposals. Nevertheless, through implementing those inventive proposals directed to these professionals of education and health fields respectively, there has been noticed the necessity of verifying the contributions that this preparation provided on this professionals’ conceptions, especially on how the theme has been approached in real life scenarios. In this way, we realize that through the results obtained, the education and health professionals who participated of the research need an appropriate training and information about the issue discussed in order to develop interventional sexuality educational effective work, which highlights the urgency of adding continuous courses for the implementation of actions in both areas.

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / Nas Ãltimas dÃcadas, a AtenÃÃo BÃsica à SaÃde (ABS) tornou-se um tema especialmente relevante, resultando na reformulaÃÃo do Sistema Nacional de SaÃde. Assim, a rede bÃsica no Brasil tornou-se um espaÃo de prÃtica potencial e necessÃria, na qual os vÃrios cursos de formaÃÃo de profissionais de saÃde deverÃo inserir seus estudantes. Neste contexto, o programa interministerial PET-SaÃde (Programa de EducaÃÃo pelo Trabalho para SaÃde) tem contribuÃdo para a integraÃÃo universidade-serviÃo. O preceptor à a figura inserida no PET-SaÃde que surge no cenÃrio de prÃtica, como o profissional de saÃde-educador que oferece ao aluno ambiente que lhe permita construir e descontruir conhecimentos e experimentar vivÃncias prÃticas de um atendimento humanizado. O presente estudo buscou analisar a preceptoria do PET-SaÃde na EstratÃgia SaÃde da FamÃlia nos MunicÃpios de Fortaleza, Pacatuba e MaracanaÃ, tendo como pÃblico-alvo 82 preceptores da EstratÃgia de SaÃde da FamÃlia (ESF) do MunicÃpio de Fortaleza, 12 de Maracanaà e 06 de Pacatuba. Em relaÃÃo aos alunos bolsistas, foi pesquisada uma amostra de 113 alunos de Fortaleza, 24 de Maracanaà e 12 de Pacatuba. Trata-se de um estudo quantitativo, descritivo, observacional e transversal. A coleta de dados foi realizada atravÃs de um questionÃrio semiestruturado direcionado aos alunos e preceptores. As informaÃÃes foram analisadas no programa estatÃstico SPSS versÃo 17.0. A pesquisa foi aprovada pelo Comità de Ãtica em Pesquisa, com o parecer n 751292. Buscou-se identificar e correlacionar as percepÃÃes dos preceptores e alunos sobre as competÃncias exigidas na preceptoria, as principais dificuldades para o seu exercÃcio e quais resultados prÃticos foram alcanÃados com a realizaÃÃo da preceptoria em relaÃÃo preceptor/serviÃo. A pesquisa mostrou que 54,43% dos preceptores realizaram curso de pÃs-graduaÃÃo apÃs inÃcio da preceptoria e 65,82% afirmaram que a preceptoria influenciou na escolha desse curso. Os resultados apontaram as seguintes dificuldades na preceptoria: despreparo pedagÃgico dos preceptores, infraestrutura deficiente e pouca valorizaÃÃo da preceptoria pelo serviÃo. Com os resultados alcanÃados, pode-se concluir que o exercÃcio da preceptoria do PET-SaÃde à uma experiÃncia que apresenta possibilidades de crescimento para o profissional e desafios em relaÃÃo ao melhor preparo dos preceptores e serviÃos que devem ser superados com uma maior interaÃÃo entre gestores, preceptores, profissionais do serviÃo, instituiÃÃes de ensino e comunidade. / In recent decades, the Primary Health Care (ABS) has become a particularly important issue, resulting in the reformulation of different national health systems. The basic field has become a potential and necessary practice space, in which the various health professionals training courses shall insert its students. In this context, the inter-ministerial program PET-Health (Education Program for Working for Health) greatly contributes to the university-service integration. The Preceptor is the figure inserted into the Pet-health that arises in practical scenario, such as health educator professional who provides the student environments that allow them to build and deconstruct knowledge and experiment practical experiences of humanized care. This study investigated the PET-health preceptorship in Family Health Strategy in the municipalities of Fortaleza, Pacatuba and MaracanaÃ, having as target 82 preceptors professionals of the Family Health Strategy (FHS) in the city of Fortaleza, 12 from Maracanaà and 06 from Pacatuba. Regarding the scholarship students will be surveyed a sample of 113 students from Fortaleza, 24 students and 12 students from Maracanaà and Pacatuba. It is a quantitative and qualitative, descriptive, observational and cross-sectional study. Data collection wasconducted through semi-structured questionnaire directed to students and preceptors. The study was approved by the Research Ethics Committee opinion n 751 292. It sought to identify and correlate perceptions of competence required on preceptorship according to the preceptors and students, the main difficulties for exercise and what practical results preceptorship in Strategy Family Health brought to preceptors, students and service. Research has shown that 54.43% of the preceptors made a graduate course after the initiation of preceptorship and 65.82% said preceptorship influenced in the choice of course. The results showed the following difficulties in preceptorship: the pedagogical unpreparedness of preceptors, poor infrastructure and little appreciation of preceptorship by the service. With the results it can be concluded that the exercise of PET-health preceptorship is an experience that offers growth possibilities for professional and challenges relative to better preparation of preceptors and services that must be overcome with greater interaction among managers, preceptors, service professionals, educational institutions and community.

Magister Artium - MA / Background: Healthcare workers are the human face of health systems, serving to connect knowledge and service delivery to improve patient care. The development of core competencies in the education of health professionals is fundamental for health improvement. Interprofessional collaboration amongst healthcare workers has been linked to improved patient outcomes as no single professional can address all healthcare issues. Aim: The aim of this research was to determine how UWC undergraduate physiotherapy students were being prepared for collaborative work as part of their professional development. Educational experiences of the third- and final-year physiotherapy cohort, physiotherapy educators’ perspectives on the development of competency for collaboration and a review of physiotherapy module outlines were explored. Research Method: A descriptive qualitative research design utilizing focus groups, semi-structured interviews and document analysis was employed. A pedagogical framework was used for instrument development and data analysis. The pedagogical framework was adapted from the CanMEDS physician competency framework, the core competency framework by the Medical and Dental Board of the Health Professions Council of South Africa and the Essential Competency Profile for physiotherapists in Canada. Research was conducted at the Department of Physiotherapy at the University of the Western Cape. Purposive sampling was undertaken with the sample population having consisted of six third- and six final-year physiotherapy students for the focus group discussions and seven lecturers formed the sample for the semi-structured interviews as well as sixteen physiotherapy module outlines. Data was collected and focus group discussion and interviews were transcribed verbatim. An inductive content analysis of the transcribed data was conducted and compared to the Pedagogical framework. Content analyses of module outlines were conducted drawing on Biggs work on constructive alignment and compared to the Pedagogical framework. Ethical clearance was received from the Senate Research Committee of the University of the Western Cape. Results: Participants showed a keen knowledge on the importance of collaboration in the teaching and clinical environment. It had relevance for personal development and learning as well as for interprofessional collaboration. Interprofessional education and group work were thought to be instrumental in collaborative learning but a lack of congruency of learning activities could be a barrier to learning. The clinical environment was highlighted as beneficial to developing collaboration through interprofessional observation and interaction but high patient loads and a lack of understanding of the roles and responsibilities of all healthcare professionals were identified as barriers. To a lesser degree, communication, conflict management and confidence were identifiable skills physiotherapy students should have to be effective collaborators. Conclusion: Students are well-positioned to participate within interprofessional team but have inadequately developed collaborative competencies. These include interprofessional role understanding and skills in conflict management, confidence and communication. Constructive alignment of curriculum by aligning learning outcomes and learning activities to develop collaboration including interprofessional learning activities would better prepare students for interprofessional collaboration.

Thesis advisor: Janet E. Helms / Historically, psychological theory and mental health researchers have viewed sex work as inherently harmful to sex workers and capable of producing negative mental and physical health effects (Sprankle et al., 2018). Moreover, research focused on clinicians’ expectations for sex workers in therapy has not specifically examined clinicians’ attitudes toward sex workers or sex work as separate concepts (Benoit et al., 2015; Koken, 2011; Ma et al., 2017). In addition, mental health professionals may not view sex work as legitimate work because of the virtual lack of evidence-based theoretical frameworks for guiding therapy for sex workers, and, therefore, may use prostitution stigma as a substitute for theory (Krumrei-Mancuso, 2017; Williamson & Cluse-Tolar, 2002). The present study investigated the extent to which mental health professionals’ expectations of sex work and sex workers were related to prostitution stigma and their perceptions of sex workers’ overall mental health and evaluations of sex work as decent work. In particular, the study investigated the extent to which mental health professionals stigmatized the work of sex workers. Mental health professionals (N = 201) read a clinical vignette and completed an online survey containing a demographic information sheet, the Attitudes Toward Prostitutes and Prostitution Scale (Levin & Peled, 2011); (c) the Decent Work Scale (Duffy et al., 2017), (d) the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1986), and (e) the PTSD-8 (Hansen et al., 2010). Results from multivariate multiple regression analyses supported that when mental health professionals held higher levels of stigma towards sex work and sex workers, they may diagnose the client with higher levels of PTSD symptoms. Further, the results supported that endorsement of a feminist orientation moderated the relationship between sex work stigma and diagnosis clients’ PTSD avoidance symptoms. The discussion included methodological limitations and implications for research and practice. / Thesis (PhD) — Boston College, 2020. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.

Intimate partner violence (IPV), including physical, psychological, and sexual violence towards a partner, is a human rights violation that is associated with the development of a multitude of short- and long-term physical and mental health problems (WHO, 2013). IPV survivors are at greater risk of developing mood, anxiety, and trauma- and stressor-related disorders (García-Moreno et al., 2005). Public health guidelines recommend screening for IPV in mental health settings (WHO, 2013). However, most mental health practitioners do not routinely assess for IPV in their practice (Howard et al., 2010). Lack of training in how to assess for and respond to IPV has been identified as an important barrier for IPV assessment in mental health settings (Trevillion et al., 2016). IPV-related training has been linked to positive outcomes for clinicians, including higher ratings of perceived knowledge and confidence in addressing IPV (Forsdike et al., 2019). Yet, studies suggest that approximately one quarter to one half of mental health professionals have never received IPV-related training (Murray et al., 2016; Nyame et al., 2013). To address this gap, the WHO advanced a series of evidence-based training recommendations (WHO, 2013). At present, there is a dearth of research exploring the degree to which global mental health providers’ experiences of training resemble WHO guidelines. Furthermore, few studies have investigated factors that contribute to clinicians’ likelihood of participating in IPV-related training, and reasons for obtaining training are not well understood. There has also been no previous research into the relationship between mental health professionals’ experiences of training and their accuracy in correctly identifying IPV. The present thesis, consisting of two studies, sought to assess global mental health providers’ IPV-related training experiences, including factors that influence the probability of participating in training and the relationship between training and diagnostic accuracy. In study 1, mental health professionals’ IPV-related training experiences were surveyed, and factors that may contribute to the likelihood of participating in training were explored (e.g., IPV prevalence, norms, and legislation, and professional experience with IPV). The relationship between IPV-related training and knowledge and experience of relationship problems was also examined; 321 specialized mental health professionals (psychologists and psychiatrists) from 24 countries participated in an online survey. Participants responded to a series of questions regarding the content, duration, and frequency of their IPV-related training based on WHO recommendations, and rated their level of knowledge and experience with relationship problems. Descriptive analyses showed that nearly half of participants (46.9%) had never received IPV-related training. Approximately half of those who received training (49.4%) indicated that their training followed WHO recommendations. Logistic regressions revealed that participants who were from countries with relatively better implemented laws addressing IPV and participants who encountered IPV more often in clinical practice were more likely to have received training. Furthermore, participants who received training were more likely than those without training to report higher knowledge and experience of relationship problems. Findings highlight global challenges with regards to IPV-related training. They suggest that clinicians’ likelihood of participating in training is related to their clinical contact with IPV and the institutional context in which they practice. Study 2 investigated the relationship between IPV-related training and clinicians’ diagnostic accuracy in the context of relationship problems, using the same sample as study 1. Chi-square analyses evaluated relationships between IPV-related training and clinicians’ performance while assessing for clinically significant relationship problems (RPM) in case-controlled vignettes across two study conditions: RPM present (i.e., when the task was to correctly identify RPM) and RPM absent (i.e., when the task was to correctly identify that there was no RPM; normative relationship problems were presented). Results showed that participants who received IPV-related training were more likely to perform better than those without training in the RPM present condition, but not in the RPM absent condition. In the RPM present condition, participants were more likely to respond correctly when their training was more recent and more closely resembled WHO recommendations for training. In the RPM absent condition, a similar percentage of participants with training (60-78%) and without training (45-76%) misclassified normative relationship problems as clinically significant RPM. Overall, findings suggest that IPV-related training is related to improved diagnostic accuracy in the context of relationship problems. WHO recommendations for training are supported.

My thesis examines the interprofessional collaboration between school-based educators and health professionals (HPs). Four research questions guided the study: 1) What is the current state of literature on interprofessional collaborations between school-based educators and HPs? 2) Based on the existing literature, how are school-based educators and HPs collaborating interprofessionally? 3) Based on the existing literature, what are the outcome(s) or impact(s) of interprofessional collaborations between school-based educators and HPs? and 4) Based on the current state of the literature, what areas are important to consider for future research on interprofessional collaborations between school-based educators and HPs? It is important for both school-based educators and HPs alike to consider answers to these questions as it can refine and strengthen their current and future practices in an effort to ultimately create a successful working and learning environment for themselves and for their students and patients. Systematic searches of four databases yielded 46 articles for inclusion, data extraction, and analysis. Through a thematic analysis of the literature, I found the following two overarching themes that govern the implementation of interprofessional collaboration: 1) time and 2) funding. In addition to these themes, I extracted two major themes and one minor theme from the literature that can guide current and future interprofessional collaborative practices. These themes included 1) pre-service training whereby a) everyone is involved, b) there is a mutual understanding between and of educators and HPs, c) both educators and HPs feel valued in their positions for their work, d) there is less sophisticated profession-specific jargon which can in turn open further dialogue between both teams of professionals, and e) a journal or frequent log can be kept to track the successes and challenges of and suggestions for the collaborative efforts as well as of student satisfaction; and 2) in-service training whereby a) educators and HPs are able to maintain consistency in their roles and responsibilities as well as for students educationally, and b) provide continued support for all. I discuss methods of how this interprofessional collaboration could be implemented, noting a) proximity (i.e., how closely, in what ways, and how frequently educators and HPs work together) and b) frequent meetings as essential to successful interprofessional collaboration. Finally, a minor theme emerged from the literature with suggestions for current and ongoing implementation of interprofessional collaboration which suggested a) increased and stronger liaison in schools and b) frequent meetings to establish and build upon a foundation that will foster further interprofessional collaboration. This review of the available literature on this topic, especially of the literature empirical in nature, worked to map key concepts, evidence, and main sources of information as well as synthesize a myriad of information (Arksey and O’Malley, 2005), fill a visible gap in the area of interprofessional collaboration among school-based educators and HPs specifically, and provide avenues for further study and practical application.

No description available.

There are extensive amounts of psychological research that highlight the needs and experiences of racial ethnic minority populations in general and more specifically minority sexual identities and genders, also referred to as non-heteronormative populations (Alexeyeff & Besnier, 2014). However, there continues to be a lack of representation in the research of Polynesians and an even greater lack of representation of non-heteronormative Polynesians and their experiences (Allen et al., 2011). Māhū, a population of native Hawaiians who identify as non-heteronormative or third gender, are almost completely absent from scholarly work. This study examines the experience of self-identified māhū and how mental health professionals can support them. Qualitative interviews of six Native Hawaiians who identify as māhū were completed. Hermeneutic principles guided the interpretation and analysis of the interviews. Analysis of the interviews produced three main themes comprising seven subthemes. Primary themes included (a) the definition of māhū has changed over time and can be dependent on personal views through a cultural lens (b) the Hawaiian culture provides safety and protection for those who identify as māhū and (c) māhū have suggestions regarding the ways in which mental health practitioners (both Hawaiian and non-Hawaiian) can serve this population.