Asian American communities have important and unmet mental health needs, but there is comparatively little research data on process and outcomes that can guide evidence-based approaches to mental health care. This paper describes our experience of building research programs in a community-based health care facility, some of the challenges we faced, and barriers that were overcome. We have learned that a) mental health services research can be carried out in a community health center with minimal intrusion on usual patient flow; b) the effort must be shared between the health center and the community; c) barriers to participation in mental health research programs are multifactorial ranging from conceptual, cultural, and attitudinal biases to practical concerns inherent in the ethnic minority population; and d) resistance can be overcome by working with participants' cultural and social needs and using their explanatory belief models when developing and pursuing studies.

Objective: Addiction or Substance Use Disorder (SUD) is a growing public health problem which affects the person, the whole family and society. The primary care physician is often the first point of contact in health care and can play a significant role in early detection and intervention. It is well established that early intervention is associated with better outcome, however in their formal medical training; primary care physicians receive no formal training on drug addiction management. In this pilot study we developed an innovative tele-mentoring model for drug addiction management and looked at feasibility as well acceptability among remote primary care physicians (PCPs). Methods: The tele-mentoring model consists of both synchronous and asynchronous components. The synchronous component (which includes the National Institute of Mental Health And Neuro Sciences (NIMHANS) academic centre Hub and remote district level primary care Spoke), is implemented by use of low-cost multipoint videoconference based tele-ECHO clinics. During the tele-ECHO clinics, held fortnightly, the remote PCPs used internet enabled smartphones to connect as well as present the patient case summaries to the multidisciplinary expert team of NIMHANS HUB. The asynchronous component consists of mobile based ubiquitous e-learning integrated to a course completion certificate. We evaluated this innovative tele-mentoring Programme on participant engagement, learning, competence and satisfaction. A pre-post design and e-learning assignments were used to measure the outcomes. Results: Of the proposed 21 tele-ECHO clinics, 11 were held till the end of August 2017. All the primary care physicians were able to virtually join at least one drug tele-ECHO clinic. Out of 38 participants, two participated in all the tele-ECHO clinics and 47.36% (n=18) attended more than six (>60% of total) tele-ECHO clinics. 76.31% (n=29) of the PCPs presented 41 patient case summaries. Among 38 PCPs, a cumulative of 89.47% has completed three E-Learning assignments. Majority of participants (80%) used smartphone with 4G connections to join the tele-ECHO clinics. There was a significant increase in the score on knowledge gained over the time duration of 1 month (3.00±0.86, p < 0.001) and 3 months (3.16±0.90, p < 0.001) assessments compared to the baseline (1.77±1.02). 32.25% (n=10) reported improved confidence level in managing a case of SUD on 10 point scale. Discussion: It has been feasible to connect an academic hub i.e. NIMHANS to the PCPs of 36 remote districts of Bihar and conduct multipoint videoconference based tele-ECHO clinics. The results indicate high-participant retention. The learners are comfortable in adapting new technology based learning as evidenced by higher rate of e-learning assignment completion. These findings suggest this new innovative learning model using technology can be an important way for effective training to address addiction management.

This case report describes the application of Taoist cognitive therapy (TCT) to a 32-year old Chinese (Fujianese) American immigrant woman with generalized anxiety disorder (GAD). TCT is a manualized adaptation of an indigenous psychotherapy developed in China (Zhang & Young, 1998; Zhang et al., 2002). Mrs. Liu received 16 sessions of TCT administered in Mandarin by a Chinese American social worker in conjunction with psychopharmacologic treatment. Sources of data included case notes, transcripts of session recordings, client thought records, and a battery of standardized measures. Mrs. Liu presented with significant guilt regarding her perceived failures to fulfill her filial obligations postmigration, which resulted in constant worry about family members’ health, reassurance-seeking, and controlling behavior. Her anxiety and worry were conceptualized as the result of rigid attachments to beliefs, goals, and desires that are not reflective of the natural order of the universe (Tao). Mrs. Liu was guided in reevaluating stressful situations from the perspective of 8 Taoist principles that promote collective benefit, noncompetition, moderation, acceptance, humility, flexibility, wuwei (nonaction), and harmony with the laws of nature. Clinically significant reductions in anxiety, worry, and experiential avoidance were observed after 16 sessions. However, results were attenuated by the 4-month follow-up due to acute stress surrounding her husband’s deportation proceedings. This case highlights how immigration-related stressors, including transnational family separation and cultural values, can shape the experience and expression of GAD. Further, the positive treatment response provides some evidence of the acceptability and applicability of TCT to Chinese immigrants with GAD.