Valentine’s Day can make many people feel left out. Teens and young adults are particularly susceptible to harmful relationship beliefs and peer pressure. They take in messages like, “If you love me, you will . . . .” Fill in the blank with any conditional requirement. This raises a red flag. Young people are learning about the many con games and romantic masks that create toxic relationships. Your patients may sense that their relationship is imbalanced in terms of commitment. If relationships are a problem for your patients or clients, consider the way OPTIONS can help them make better choices. Inform patients and clients that they can always rewind a relationship, take a time-out from a relationship, or start over completely!
Recent findings from the University of Northern Colorado indicate that 18% of the sample of participants aged 14 – 24 years of age (N=109) have low satisfaction with their decision to have sex. In addition, 69% do not use risk reduction strategies correctly.
This Valentine’s Day make a commitment to helping young people learn how to establish authentic intimate relationships. Ask your patients questions such as, “Is sex everything you thought it would be?” “Have you ever thought about taking a time-out from sex in order to recalibrate your decisions about intimate relationships?” One client’s decision to take a time-out from sex exemplifies the challenges young adults may experience with intimate relationships:
I realized that I had nothing to show for the numerous sexual encounters that I had had. And I began to hate the fact that I had so frivolously given away the most intimate and sacred parts of myself. Instead of finding acceptance and love I found loneliness and a broken heart and I realized that in actuality I didn’t feel any more beautiful and I didn’t feel any more valuable. Instead, I felt misunderstood, insignificant and empty. – Female, Age 21
Timeouts, rewinds, and relationship do-overs create intentionality, reducing ambiguity and increases the use of risk reduction strategies in future relationships. School and community-based relationship education support knowledge and skills that help young people pursue healthy relationships. Clinicians, educators and parents have crucial roles in helping teens and young adults think differently about their sexual choices. The digital app cliexa-OPTIONS fosters effective and brief clinical interventions between providers and patients.
In addition, a recent meta-analysis found relationship education improves communication skills and reduces unhealthy relationship beliefs. School-based relationship education such as the evidence-based Healthy Futures program supports relationship skills for middle school students. Young people deserve the best relationships. This Valentine’s Day help teens and young adults take advantage of new approaches.
For more information on cliexa-OPTIONS research, contact Dr. William Merchant at the University of Northern Colorado: William.Merchant@unco.edu.
Collateral Damage: Reversing the Trends of Pandemic-Triggered Mental Illness
By Lisa Rue, PhD., cliexa Senior Advisor Adolescent Behavioral Health
Findings from a 2021 study of cliexa’s holistic screening (cliexa-OPTIONS) for adolescents and young adults confirms early suspicions regarding mental health issues among adolescents and young adults. The collateral damage resulting from lockdowns during the Covid-19 national response has been devastating, with young people struggling to cope with a range of issues, including how to manage negative feelings of depression, along with anxiety and thoughts of suicide.
Independent research presented this month by Dr. William Merchant from the Department of Applied Statistics and Research Methods (ASRM) and Dr. Stephen Wright from the Department of Applied Psychology and Counselor Education (APCE) at the University of Northern Colorado found dramatic increases in the frequency of patients and clients (ages 14-24 years) dealing with a mental health challenge. The percentages are outlined in Figure 1.
Figure 1. Percentages of UNC Students Exhibiting Various Mental Health Issues (N=202)
Parents and clinicians are facing difficulties in supporting these adolescents and young people. The continuum of mental health and wellness fluctuates regularly, increasing or decreasing depending on individual resiliency and support. While little can be done about individual genetic predisposition to depression or anxiety, certain measures can support young people by building resiliency or protective factors when increased risk is identified. Parents and clinicians can encourage resiliency and protective factors by asking a few targeted questions, such as:
Do you have a trusted adult, friend or family member that you can chat with? If not, can we think of someone together? Sometimes just being able to talk to someone about how you are feeling helps us cope.
Tell me some good things about yourself? What are some areas that you know you do well in that you can continue to develop? Let’s make a plan to spend more time building your skills and confidence in these areas.
Do you think people are respecting you? How do you think you can get people to respect your position and listen to your concerns? Sharing your concerns without getting angry will help communicate your concerns and validate
What makes you happy? What can you do to spend more time on things that make you happy?
What are some of your goals in the next 6 months? Two years? What are some steps you can take to meet those goals?
How has the pandemic affected your behavior and actions toward others? What can we control with respect to how we treat others during this difficult time?
A new resource available now, is the Dibble Institute’s new website for teens called Me and My Emotions (MeandMyEmotions.org), is a timely resource. Young people will find a wealth of information that they can use on their own to build resiliency, mindfulness skills, and improve mental wellness.
If mental health struggles sound familiar, remind your loved ones that they are not alone, and that life will eventually get back to normal. During this temporary struggle, it’s important to avoid using alcohol and other drugs to cope. Instead, focus on increasing your protective factors to decrease risks and create balance.
For more information about this study and its benefits, click here.
Dr. Dhaliwal, who recently joined cliexa’s executive management team will be leading strategic growth at cliexa. Dr. Dhaliwal, is a physician entrepreneur, has been serving as CEO of Momentum Healthcare Staffing, board member of two VC funds and other healthcare startups. Dr. Dhaliwal also served as the Associate Medical Director of Prognos Health. With his innovative approach and passion in healthcare technology, Dr. Dhaliwal as a practicing physician is highly optimistic about putting a dent on today’s healthcare challenges by partnering with cliexa.
“As a physician and executive, I am excited to be a member of cliexa family. cliexa is truly an innovative solution to not only increase clinical efficiency but also to improve reimbursement within institutions. It will be a great journey to work with cliexa staff and advisors to grow this one stop shop solution, providing a complete platform for patient journey.” said Dr. Dhaliwal.
cliexa since the inception in late 2016, expanded its solutions offering, intelligent patient triage and onboarding, integrated EMR solutions, quality and compliance add-ons and remote patient monitoring. In June 2021, cliexa and American College of Cardiology announced the launch of cliexa-PULSE, device and EMR agnostic patient engagement and remote patient monitoring platform that leverages patient-centered data with multiple co-morbidities. cliexa uses patented clinical data processing algorithms (USPTO Patent# 10628555: evidence-based data collection, processing and indexing algorithms) and now leveraging American College of Cardiology’s proprietary risk algorithms for cardiovascular conditions.
“With Dr. Dhaliwal’s leadership in growth strategy, combined with Dr. Kowalcyzk’s clinical and business guidance, cliexa will be taking a big step in onboarding new customers and expanding its footprint with current health system contracts” said Mehmet Kazgan, Founder and CEO of cliexa.
University of Colorado College of Nursing Partners with cliexa to Launch a Mobile Application with Evidence-based Infographics
HIV disproportionately affects Latinos who experience higher prevalence, faster disease progression, more HIV-related deaths, and a marked delay in diagnosis and treatment than their white counterparts. This is a concern in geographic regions across the United States (US) as Latinos comprise the largest minority group in the US. Similar HIV-related health disparities exist in developing countries, such as the Dominican Republic (DR), where those with low socioeconomic status experience higher disease burdens and worse outcomes than those with higher socioeconomic status. These health disparities are exacerbated when affected individuals have low health literacy and are unable to understand the information needed for self-management, as inability to self-manage leads to less use of healthcare services and worse understanding of illness, health behaviors, and health outcomes. Therefore, to improve health outcomes and reduce health disparities among Latino persons living with HIV (PLWH), clinicians must provide the health information needed for effective self-management to diverse Latino PLWH in a meaningful way.
In response to these concerns, Dr. Samantha Stonbraker, Assistant Professor at the University of Colorado College of Nursing, rigorously and iteratively developed the Info Viz for Health intervention to assist clinicians to provide this health information to PLWH through several NIH-funded studies. She first identified a need for this intervention (T32 NR013454).1-3 Then, she worked with an expert visualization team at Columbia University in New York and with health care providers and PLWH at a clinic in the Dominican Republic to develop a set of culturally relevant and evidence-based infographics to assist clinical communication (T32 NR007969).4, 5 She has since assessed the feasibility of using the Info Viz for Health intervention to improve clinical communication with, and outcomes of, PLWH in the DR.6, 7 She also adapted infographics to the cultural and clinical context of Latino PLWH living in New York (NY), who are mainly of Dominican origin/descent and also assessed their feasibility and acceptability at a clinic specializing in HIV care in Northern Manhattan (K99 NR017829).
Two critical next steps in this work were:
- To adapt Info Viz for Health for relevance to heterogeneous Latino populations across the US by adapting them to Latinos of Mexican origin/descent as these individuals form the largest Latino group in the US and their inclusion is necessary to enhance generalizability and enable future scalability of the intervention. To do this, Dr. Stonbraker conducted a series of in-depth interviews with PLWH attending a clinic that specializes in HIV care in Denver, CO, and adapted the infographics accordingly.
- To integrate the Info Viz for Health infographics into a mobile platform to enable ease of use and scalability. Dr. Stonbraker teamed up with cliexa, an innovative company that develops and creates digital health solutions. Together, they incorporated the Info Viz for Health into a mobile app that is now accessible on the App Stores both in Apple and Google in English and Spanish languages.
Currently, Dr. Stonbraker is conducting a multi-site randomized controlled trial (RCT) to evaluate the efficacy of using the Info Viz for Health app to improve clinical communication and treatment outcomes of Latino PLWH at clinical sites in CO and the DR. Seven providers at the two different clinical sites are using the Info Viz for Health app as a communication aid while they provide information to study participants.
The research aims of this project are to:
Aim 1 Assess the efficacy of the intervention as compared to standard care in improving treatment outcomes (CD4 count, viral load, self-efficacy to manage HIV, among others) of PLWH and determine how resultant effects vary over time (baseline to 9-months) and between sites.
Aim 2 Evaluate the feasibility, acceptability, and usability of the app among interdisciplinary and multi-cultural providers using the app.
Aim 3 Identify implementation factors of integrating the mobile app into electronic health records (HER) through in-depth interviews and leverage findings to ensure the app effectively interfaces with EHRs in the US and DR.
- Health care providers at all sites where infographics have been used have requested additional infographics be incorporated into the app so that they can address additional topics with their patients. Dr. Stonbraker will conduct a needs assessment to identify the pertinent topics to include next and will create rigorously designed and culturally appropriate infographics in response to identified needs.
- The Info Viz for Health app is provider-facing and would benefit from integration with EHRs. Therefore, the next step in app development is to integrate it with Fast Healthcare Interoperability Resources (FHIR)®, which is the standard for connecting mobile apps and electronic health records (EHR). This permits scalability, as the resultant app enables clinicians to easily access evidence-based infographics from diverse settings globally.
The final product will be an app that interfaces with EHRs in resourced and under-resourced areas globally, has been rigorously tested amongst diverse Latino PLWH in distinct geographic settings in multiple languages, and includes evidence-based infographics to facilitate the clinical communication that helps patients improve their self-management and obtain better health.
- Stonbraker S, Smaldone A, Luft H, et al. Associations between health literacy, HIV-related knowledge, and information behavior among persons living with HIV in the Dominican Republic. Public Health Nurs. 2017;35(3):166-175. doi:10.1111/phn.12382
- Stonbraker S, Befus M, Lerebours Nadal L, Halpern M, Larson E. Factors associated with health information seeking, processing, and use among HIV positive adults in the Dominican Republic. AIDS Behav. 2016;21(6):1588–1600. doi:10.1007/s10461-016-1569-5
- Stonbraker S, Larson E. Health-information needs of HIV-positive adults in Latin America and the Caribbean: an integrative review of the literature. AIDS Care. 2016;28(10):1223-1229. doi:10.1080/09540121.2016.1173645
- Stonbraker S, Halpern M, Bakken S, Schnall R. Special Section on Visual Analytics in Healthcare: Developing infographics to facilitate HIV-related patient-provider communication in a limited-resource setting. Appl Clin Inform. 2019;10:597-609. doi:10.1055/s-0039-1694001
- Stonbraker S, Richards SD, Halpern M, Bakken S, Schnall R. Priority topics for health education to support HIV self-management in limited-resource settings. J Nurs Scholarsh. 2019;51(2):168-177. doi:10.1111/jnu.12448
- Stonbraker S, Flynn G, George M, et al. Feasibility and acceptability of using information visualizations to improve HIV-related communication in a limited-resource setting: A short report. AIDS Care. In Press;doi:10.1080/09540121.2021.1883517
- Stonbraker S, Liu J, Sanabria G, et al. Clinician Use of HIV-Related Infographics During Clinic Visits in the Dominican Republic is Associated with Lower Viral Load and Other Improvements in Health Outcomes. AIDS Behav. In Press:1-13. doi:10.1007/s10461-021-03331-8