Deborah Goebert | University of Hawaii at Manoa (original) (raw)

Papers by Deborah Goebert

Journal of Addictions Nursing, Apr 1, 2023

Background Screening, Brief Intervention, and Referral to Treatment (SBIRT) has been established ... more Background Screening, Brief Intervention, and Referral to Treatment (SBIRT) has been established as an effective screening tool for providing interventions for patients with risky substance use. Objectives The objectives of this project were to train and coach staff nurses in the use of SBIRT, offer SBIRT to all admissions of a brief psychiatric inpatient unit, and decrease readmission rates. Design Using the Iowa Model for Implementing Evidence-Based Practices, SBIRT was implemented on the unit. Data were collected on the frequency of patients offered SBIRT and readmission rates. Results Fifty-nine percent of all admissions were offered SBIRT. The average readmission rates decreased by 18.3% for the first 2 months of implementation and by 67.5% for Days 16–31 postdischarge. Conclusions SBIRT is an effective tool for nurses on psychiatric units to address substance use and to decrease readmission rates.

General Hospital Psychiatry, Nov 1, 2019

A business plan for multidisciplinary consultation liaison team: Return on investment Mental heal... more A business plan for multidisciplinary consultation liaison team: Return on investment Mental health competency on medical units is a national issue [1]. Providers often lack knowledge and comfort when caring for patients with mental illness. This is reflected in recent findings at The Queen's Medical Center (QMC), a 530 bed tertiary care center in Honolulu, Hawaii. QMC is the only Level 1 trauma center with comprehensive psychiatric services and the largest private, non-profit, hospital in the state. It serves a disproportionately higher percentage of the significantly mentally ill population of Hawaii. Staff were asked, "How competent do you feel working with patients with mental health needs?" in a 2015 survey of which 54% of respondents stated low to neutral competency. The Multidisciplinary Consultation Liaison Team (MCLT) was used to educate staff, manage patients, reduce workplace violence, and improve patient outcomes. MCLT was additionally tasked with reducing the use of enhanced observation by addressing behaviors. As the team did not bill for service, cost savings through reduction of enhanced observation was a primary outcome measure to demonstrate value added by the team. Composition of the MCLT was sought from key stakeholders including administration, psychiatry, medical services, nurse managers, security, and risk management. The final team comprised of five advanced practice registered nurses (APRNs) and two Creative Arts Therapists. The APRNs possessed certifications in mental health, geriatrics, and family practice, and the therapists were certified in music and art therapy. All members of the team were masters prepared or higher and had extensive psychiatric experience. Salaries were paid for by departmental funds. At QMC, the use of enhanced observation followed national trends [2-4]. Stated reasons for enhanced observation (sitter) orders over a 12-month period (Jul 2014-Jun 2015) identified: 29% of sitters were ordered for fall risk, risk of injury from falls (osteoporosis, anticoagulants, etc.), and/or impulsively getting out of bed; 20% pulling at lines, drains, or other medical equipment; 18% impulsive behavior; 15% agitation or combativeness; 10% behaviors associated with dementia (wandering, intrusiveness, etc.); 9% behaviors associated with delirium, (combinations of some or all previously listed behaviors); with the remainder averaging 3% or less for elopement, self-harm, traumatic brain injury, or substance withdrawal. From May 2014-April 2015 sitters became a significant burden diverting 58,328 staffed hours and costing a total of US$1,241,518. After a review of existing literature [5-10], MCLT focused on changing hospital policy and procedure requiring administrative approval at the unit manager and director level, and creating an algorithm identifying alternative solutions to sitters prior to requesting a sitter

Mental health needs of minorities receive minimal attention, resulting in inadequate provision of... more Mental health needs of minorities receive minimal attention, resulting in inadequate provision of culturally appropriate mental health care in racial and ethnic minority communities. Advancing our understanding of cultural issues is essential for reducing disparities. Culture is embedded in many social components, including identity, gender ideologies, generational experience, racial discrimination, and socioeconomic status. Through ongoing efforts to improve our understanding of the ways culture influences mental illness, health, and wellbeing, we enhance our ability to reduce stigma, optimize screening, enhance formulation, and design more effective interventions for all groups. Using case vignettes, this chapter illustrates key cultural considerations for psychosomatic practitioners to provide quality care and reduce mental health disparities in children and adolescents.

Medicine and Science in Sports and Exercise, May 1, 1997

PubMed, Feb 1, 2010

A diversified, outpatient experience is an important part of psychiatric training, yet challengin... more A diversified, outpatient experience is an important part of psychiatric training, yet challenging to attain. We describe a multiple, subspecialty psychiatry clinic model for 3rd year psychiatry residents. Evaluation findings based on its initial implementation indicated improved resident supervision, better therapeutic alliance and an overall increase in satisfaction. This model facilitates resident exposure to diverse patients and treatment modalities as well as faculty development of expertise. It also promotes academic training excellence.

Journal of Substance Use, Dec 12, 2013

Abstract Objectives: This preliminary study examined methamphetamine (MA) use behaviors and motiv... more Abstract Objectives: This preliminary study examined methamphetamine (MA) use behaviors and motivators for MA use among 46 ethnically diverse participants from an university-affiliated community hospital and narcotics anonymous groups in Hawaii. Method: Data were collected among 46 participants using an anonymous survey. Results: Results showed that both women and men use MA primarily to get high and to get more energy. Women were more likely than men to use MA to cope with negative feelings and for increased energy. Men were more likely than women to use MA for sexual reasons and due to peer pressure. Conclusion: These results suggest that some women may be self-medicating with MA. Studying these behaviors may guide in developing future prevention and treatment strategies.

Evaluation and Program Planning, Feb 1, 2018

To provide one model for evaluating academic research centers, given their vital role in addressi... more To provide one model for evaluating academic research centers, given their vital role in addressing public health issues. Methods: A theoretical framework is described for a comprehensive evaluation plan for research centers. This framework is applied to one specific center by describing the center's Logic Model and Evaluation Plan, including a sample of the center's activities. Results: Formative and summative evaluation information is summarized. In addition, a summary of outcomes is provided: improved practice and policy; reduction of risk factors and increase in protective factors; reduction of interpersonal youth violence in the community; and national prototype for prevention of interpersonal youth violence. Conclusions: Research centers are important mechanisms to advance science and improve people's quality of life. Because of their more infrastructure-intensive and comprehensive approach, they also require substantial resources for success, and thus, also require careful accountability. It is therefore important to comprehensively evaluate these centers. As provided herein, a more systematic and structured approach utilizing logic models, an evaluation plan, and successful processes can provide research centers with a functionally useful method in their evaluation.

International Journal of Psychiatry in Medicine, Dec 1, 2008

Objective: To provide a descriptive characterization of the CL Psychiatry service at a major medi... more Objective: To provide a descriptive characterization of the CL Psychiatry service at a major medical center in Honolulu, Hawaii. We hypothesized differing demographic trends than seen nationally and internationally, an increasing prevalence of elderly and substance abusing patients, and increasing consultation requests related to these issues. Methods: Retrospective data was gathered from 180 randomly selected patient records, identified as having a request for inpatient psychiatric consultation on the medicalsurgical floors during identical 3-month periods in 2000 and 2005. Descriptive statistics were calculated. Chi-square and ANOVA were used to compare differences across time. Results: There were no significant differences by age, reason for referral, or diagnoses between the 2 years. Patients age 65 years and older accounted for only 16.6% of the consults. Caucasians accounted for 45.6% of consultations despite low prevalence rates in the 425

PubMed, Sep 1, 1999

This review attempts to emphasize the urgency in addressing issues of violence against women in H... more This review attempts to emphasize the urgency in addressing issues of violence against women in Hawaii. It demonstrates that violence against women is a significant, challenging, and often overwhelming and overlooked public health problem. While attention to this problem has dramatically increased, more needs to be done to end violence against women and improve the well-being of women and our society as a whole.

Addictive Disorders & Their Treatment, Mar 1, 2008

Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Addictive Disorde... more Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Addictive Disorders & Their Treatment. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but ...

Springer eBooks, Mar 8, 2012

Violence is pervasive in our society among all racial and ethnic groups. Asian Americans are no e... more Violence is pervasive in our society among all racial and ethnic groups. Asian Americans are no exception. Hate crimes, youth violence, intimate partner violence, and suicide are the most prevalent. Improving our understanding of risk and protective factors leads to preventive and treatment interventions, thereby enhancing wellbeing and ensuring safety across all ages.

PubMed, Oct 1, 2001

Background: Although studies have been published regarding airline in-flight medical emergencies,... more Background: Although studies have been published regarding airline in-flight medical emergencies, there is a lack of any specific studies about in-flight psychiatric emergencies. This study seeks to ascertain the incidence of in-flight psychiatric emergencies, their associated factors, and outcomes. Methods: All in-flight calls for physician consultation to MedAire, a leading medical resource for airlines, during 1997 were reviewed for psychiatric symptomatology. Results: Of 1375 consultations, 3.5% were characterized as psychiatric, with a large majority (90%) of these cases presenting primarily as acute anxiety. Most of the psychiatric cases (69%) required arrangements for the passenger to be evaluated on arrival, and three cases required emergency flight diversion and landing. Conclusions: This study suggests that an anxiolytic agent with a rapid onset may be indicated for the on-board medical kit.

Journal of Substance Abuse, Dec 1, 2001

Purpose: This study examines the validity of selected items from the Substance Abuse Subtle Scree... more Purpose: This study examines the validity of selected items from the Substance Abuse Subtle Screening Inventory-Adolescent (SASSI-A) version in predicting Diagnostic Interview Schedule for Children (DISC version 2.3) Substance abuse and dependency (SA/D) for Native Hawaiian (i.e., indigenous people of the Hawaiian Islands) and non-Hawaiian adolescents (youth without any Native Hawaiian indigenous ancestry). Methods: 542 students were randomly selected from the larger sample to participate in the DISC administration. Demographic information, SASSI-A scores, and DISC diagnoses were obtained for each student. Univariate and multiple logistic regressions were performed in the prediction of DISC SA/D. Results: SASSI-A Factor 1, consisting of three items measuring substance use, was found to have the best utility, accounting for 18.1% of the variance, in predicting DISC SA/D. Implications: These results support selected SASSI-A items in screening for SA/D for Native Hawaiian and non-Hawaiian adolescents in Hawai`i as compared to other community-based screening instruments for other populations.

PubMed, 2011

Objective: Generalized anxiety disorder (GAD) is common, chronic, and debilitating. Treatment wit... more Objective: Generalized anxiety disorder (GAD) is common, chronic, and debilitating. Treatment with benzodiazepines and newer antidepressants is often inadequate. This article reviews the effectiveness of alternative and augmenting medications, such as older antidepressants, antipsychotics, anticonvulsants, and β-blockers. Data sources: A search using MEDLINE (1980 to week 4 of May 2010) with the key words generalized anxiety disorder or GAD and therapeutics or treatment was conducted. Articles included adult patients with a GAD diagnosis that established chronicity of illness. These included a small number of studies that used DSM-III criteria but added a chronicity of symptoms and included all studies that used DSM-III-R and DSM-IV criteria. Articles that did not include medications or that exclusively focused on newer antidepressants (selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, bupropion, and mirtazapine), buspirone, benzodiazepines, or herbal or investigational medications were excluded. Review articles and non-English-language articles were also excluded. Results: Thirty-six studies were reviewed. All of the references were then analyzed, and key portions were extracted. Many studies were open trials. Double-blind, placebo-controlled studies with imipramine, risperidone, olanzapine, hydroxyzine, ondansetron, tiagabine, valproate, and pregabalin had been conducted. Imipramine, hydroxyzine, valproate, and pregabalin were the most effective, although risperidone, olanzapine, ziprasidone, and aripiprazole may also reduce symptoms. Conclusions: Several medication strategies can be considered as promising alternatives or augmenting to antidepressant or benzodiazepine therapy in GAD.

Cambridge University Press eBooks, Oct 5, 2014

Journal of clinical and translational science, Apr 1, 2023

showed no effect. Urinary lactulose/mannitol ratio decreased in 1 of the 4 studies, and urinary l... more showed no effect. Urinary lactulose/mannitol ratio decreased in 1 of the 4 studies, and urinary lactulose percent decreased in 2 studies. DISCUSSION/SIGNIFICANCE: Probiotic supplementation may be remediating an obesity-induced increase in intestinal permeability as evidenced from the effect on serum LPS and mixed sugar solution assays. However, additional studies are needed to further clarify which strain of probiotic bacteria is most effective and the optimal intervention length in subjects with obesity.

PubMed, May 1, 2020

Mental health continues to be a significant concern both globally and locally in Hawai'i, with ne... more Mental health continues to be a significant concern both globally and locally in Hawai'i, with nearly half of all mental illness beginning in childhood or adolescence. A shortage of mental health providers has led to less than a third of patients receiving appropriate and timely care. Primary care providers are often the first-line responders to untreated mental health conditions, but they are often underprepared to address these conditions. To help provide guidance to primary care providers and other first-line responders, a child and adolescent mental health resource manual was developed, that is tailored to Hawai'i. This manual was presented at several pediatric didactic sessions and general conferences to describe its evolution, utility, to elicit feedback, as well as for an initial distribution. While feedback was overall positive, future manual development and strategic updates will be made to insure its suitability and timeliness, while continuing circulation efforts to primary care providers will ultimately benefit a greater proportion of children in need.

Teaching and Learning in Medicine, Jul 3, 2015

The field of medical education is represented by a fairly wide variety of models for utilizing jo... more The field of medical education is represented by a fairly wide variety of models for utilizing journal clubs as an effective teaching tool, each with varying levels of empirical support. Our own prior attempts at developing and implementing an effective journal club required improvements. Our intervention consisted of an innovative, effective journal club model that has more well-defined elements that are readily adaptable for other residency programs. The collective strategies were based on the previous literature and our own experiences. Our intervention was implemented in a department of psychiatry within a university-based medical school. Study participants came from a psychiatry department&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s residency programs (N = 36) during academic year 2011-2012 with senior residents having the option to attend journal club. Using a multifaceted approach, measures included attendance, presession quizzes, postsession evaluations, and a final postcourse evaluation of 11 dimensions (e.g., goals, objectives). Thirty-one (86%) trainees attended journal club-a substantial increase from previous years. The presession-quiz median was 4.4 total correct out of 6 questions (range = 3.3-5.3), indicating that the articles were generally read before the session. The postsession-evaluation median was 4.6 (1-5 scale, 5 the highest; range = 4.1-4.8), indicating sessions were well received. The final postcourse-evaluation overall mean was 3.9 (1-5 scale, 5 the highest; subscale M range = 3.4-4.5). Qualitative and quantitative analyses of the postcourse evaluation indicated the following positive aspects: educational objectives generally met, overall structured format, quality of discussions, individuals involved (e.g., course directors, trainees, faculty facilitators), and availability of food. Areas of possible improvement included time management within the sessions, more contemporary and clinically relevant articles, consistency in faculty moderators, and evaluation process. Engagement in learning appeared to have been dramatically increased through five strategies: (a) meaningful incentives; (b) assigned, engaged consistently prepared faculty; (c) meaningful evaluation; (d) prejournal club preparations that helped residents assimilate critical appraisal with time-and-task-management skills; and (e) a planning group that developed and improved curricula and instruction to meet the objectives of the course. Overall, effective, and successful journal clubs require systematic planning, implementation, modification, and refinement.

International Journal of Social Psychiatry, Sep 1, 2005

Background: Research on the prevalence and correlates of adolescent misconduct, arrests, and juve... more Background: Research on the prevalence and correlates of adolescent misconduct, arrests, and juvenile delinquency has been greatly neglected for the ethnically diverse adolescent groups in Hawai‘i (i.e. Asian Americans, Pacific Islanders). Aims: The aims of the present study are three-fold: (1) to determine whether there are differential rates of adolescent misconduct based on ethnicity, gender, and socioeconomic (SES) factors; (2) on an exploratory basis, to ascertain the demographic, social-cultural, psychological-psychiatric, and school-related correlates of misconduct, with some focus on cultural identification; and (3) to derive a parsimonious model of the correlates for an ethnically diverse group of adolescents by disentangling cultural identification from other variables including ethnicity. Methods: Data were analyzed from the Native Hawaiian Mental Health Research Development Program, consisting of 2,732 Asian/Pacific Islander youths. Misconduct was operationally defined as ‘was arrested or got in serious trouble with the law' within the past six months via adolescent self-report. Of added importance were the inclusion of a valid measure of Hawaiian cultural identification and actual school data. Results: Significantly higher rates were obtained for Native Hawaiians, males, and adolescents whose main wage earners' educational attainment was at the high school level or less. Absences may be a more important marker for females than males in the prediction of arrests and serious trouble with the law. The most parsimonious model of self-reported arrests/serious trouble with the law consisted of four variables in the following order of importance: substance use, actual grade-point average, aggressive symptoms, and gender. Conclusion: This is one of the first major studies to examine the prevalence and risk-protective factors of misconduct for adolescents of Asian/Pacific Islander ancestry, and the first to include a valid measure of cultural identification and actual school data. The findings indicated that gender-specific prevention and intervention programs are needed. However, the issues are also complex whereby the use of substances, school performance, and aggression must be taken into account in deriving successful programs. The lack of sustained association between culturally based factors (e.g., ethnicity, Hawaiian cultural identifi-cation) and misconduct in the final parsimonious model suggested that the culturally based variables are not direct causes of misconduct, but rather correlates of misconduct that are over-shadowed by more substantive factors, such as substance use and academic performance, the latter being variables that must be addressed for youths across the United States. The present results reaffirmed the common correlates of misconduct across different ethnic groups. Further research is needed in the causal relationships among these important associations with misconduct.

Assessment, Mar 1, 2000

Anxiety disorders are said to be universal across all cultures and recent reviews have found rela... more Anxiety disorders are said to be universal across all cultures and recent reviews have found relatively high prevalence rates across different countries. However, the experience and interpretation of anxiety are strongly influenced by cultural factors. Demonstrating crosscultural equivalence of measures of anxiety is essential to assure that comparisons between cultures will result in meaningful interpretations. Despite the State-Trait Anxiety Inventory being the most researched of anxiety measures from a cross-cultural basis, there is a lack of empirical studies on the psychometric properties of the STAI with adolescent Asian/Pacific Islanders. The present study examined the STAI using a large sample of ethnically diverse high school students in Hawaii. In general, a four-factor model (State-Anxiety Absent, State-Anxiety Present, Trait-Anxiety Absent, and Trait-Anxiety Present) provided the best fit based on a series of confirmatory factor analyses. Indicators of internal consistency supported the reliability of the factors and subscales, and the inter-factor correlations reflected positively on the concurrent validity of the different STAI factor and subscale measures. This study suggested cautious use and interpretation of one particular item (Trait Item 14 = "I try to avoid facing a crisis or difficulty"), and cautious application of the STAI to Filipino adolescents (particularly Filipino males). Domains for further research are discussed.