Bio


Christiane Brems, PhD, ABPP, RYT-500, C-IAYT, received her PhD in Clinical Psychology from Oklahoma State University in 1987. Dr. Brems is licensed as a psychologist in several US states and board-certified as a clinical psychologist by the American Board of Professional Psychology (ABPP). She is a registered yoga teacher (E-RYT500) and certified C-IAYT yoga therapist. She is also certified in Interactive Guided Imagery.

She began her career in academia at the University of Oklahoma Health Sciences Center. She then served on faculty at the University of Alaska Anchorage for 23 years, where she held a variety of leadership positions, including as (Co-Founding) Director of the Center for Behavioral Health Research and Services, (Co-Founding) Director of the PhD Program in Clinical-Community Psychology, and Interim Vice Provost for Research and Dean of the Graduate School. Most recently, she served for nearly six years as Dean and Professor of the School of Graduate Psychology (SGP) at Pacific University Oregon.

Dr. Brems has worked for decades as an applied researcher and clinical practitioner with particular interests in health promotion, rural healthcare delivery, and all things yoga. Her work has been funded by grants and contracts from the National Institutes of Health, the Centers for Dis. Control and Prevention, the Substance Abuse and Mental Health Service Administration, and local and State of Alaska funding sources. She has shared her work extensively in over 120 peer-reviewed journal articles, 100s of technical reports, and several books, including the Comprehensive Guide to Child Psychotherapy (now in its 4th edition), Dealing with Challenges in Psychotherapy and Counseling, Basic Skills in Counseling and Psychotherapy, and others. Dr. Brems is committed to excellence in and integration of clinical services, teaching, consultation, and research.

Dr. Brems has integrated yoga, mindfulness, complementary interventions, and self-care strategies in her work as a consultant, author, dean, teacher, researcher, mentor, supervisor, colleague, and service provider. She values these practices as crucial aspects of day-to-day professional and personal life and seeks to enhance access to them for all who can benefit.

Academic Appointments


  • Clinical Professor, Psychiatry and Behavioral Sciences

Administrative Appointments


  • Clinical Professor and Director of YogaX, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University (2019 - Present)
  • Dean, School of Graduate Psychology, Pacific University, Hillsboro, Oregon (2012 - 2017)
  • PhD Program Director for Accreditation, University of Alaska Anchorage and University of Alaska Fairbanks (2011 - 2012)
  • Interim Vice Provost of Research and Graduate Studies and Dean of the Graduate School, University of Alaska Anchorage, Anchorage, Alaska. (2011 - 2011)
  • UAA Program Director (Founding Co-Director), PhD Program in Clinical-Community Psychology; U Alaska Anchorage and U Alaska Fairbanks (2004 - 2012)
  • Research Center Director (Founding Co-Director), Center for Behavioral Health Research and Services, Anchorage, Alaska (1999 - 2012)

Honors & Awards


  • School of Graduate Psychology Faculty Award for Valuable Contributions, Pacific University Oregon (2017)
  • School of Graduate Psychology PsyD Program Faculty Award, Pacific University (2016)
  • University of Alaska Anchorage Chancellor’s Award for Outstanding Faculty, University of Alaska Anchorage (2007)
  • Achievement of a Lifetime Award, Alaska Psychological Association (2006)
  • Woman of Achievement Award, Anchorage YWCA/BP (1999)
  • University of Alaska Anchorage Chancellor’s Award for Excellence in Research and Creative Activity, University of Alaska Anchorage (1998)
  • Contributions to the Profession of Psychology Award, Alaska Psychological Association (1994)
  • Madigan (Professor of the Year) Award, Department of Psychology at the University of Alaska Anchorage (1990)

Boards, Advisory Committees, Professional Organizations


  • Member of the Steering Committee, Academy of Integrative Health and Medicine Fellowship Program (2015 - 2017)
  • Deans and Directors Council, College of Health Professions at Pacific University (2013 - 2017)
  • Member of the Board of Directors, Oregon Collaborative for Integrative Medicine (2012 - 2017)
  • Chancellor-appointed Member of the Biomedical Research Planning Group, University of Alaska Anchorage and University of Alaska Fairbanks (2010 - 2011)
  • Biomedical Research Steering Committee, University of Alaska Anchorage (2008 - 2010)
  • Council of Graduate Directors, University of Alaska Anchorage (2007 - 2011)
  • Member of the CAS Dean’s Scientific Advisory Council, University of Alaska Anchorage (2007 - 2010)
  • Member of the Council of Research Directors, University of Alaska Anchorage (2006 - 2008)
  • Co-Chair for the Healing from the Center Conference Planning Committee, University of Alaska Anchorage (2006 - 2007)
  • University Liaison for the Western Psychological Association, University of Alaska Anchorage (1998 - 2008)
  • President, Alaska Psychological Association, Anchorage, AK (1996 - 1998)
  • Senior Research Associate, Alaska Psychiatric Institute, Anchorage, AK (1994 - 2007)
  • Executive Director, Alaska Psychological Association, Anchorage, AK (1994 - 1996)
  • Committee Member and Co-Chair, Continuing Education Committee for the State of Alaska of the Alaska Psychological Association (1992 - 1999)

Professional Education


  • ABPP, American Board of Professional Psychology, Clinical Psychology (1998)
  • C-IAYT, International Association of Yoga Therapists, Yoga Therapy (2016)
  • E-RYT-200, Yoga Alliance, Yoga Teacher (2010)
  • MS, Oklahoma State University, Psychology with Mental Health Specialty (1984)
  • PhD, Oklahoma State University, Clinical Psychology (1998)

All Publications


  • Bridging Body and Mind: Case Series of a 10-Week Trauma-Informed Yoga Protocol for Veterans. International journal of yoga therapy Justice, L., Brems, C. 2019

    Abstract

    This case series explored the feasibility and preliminary efficacy of therapeutic yoga as a complementary form of treatment for combat-related trauma. The series recruited for and implemented a 10-week Trauma-Informed Yoga protocol for veterans in an interprofessional community health treatment setting. Participants were enrolled in a series of 90-minute therapeutic yoga classes adapted to be trauma-informed. Feasibility was measured by recruitment, retention, and level of participation in the study. Preliminary efficacy was explored via the Posttraumatic Stress Disorder Checklist, Scale of Body Connection, PROMIS-29, P ROMIS Alcohol Use, PROMIS Substance Use, Difficulties in Emotional Regulation Scale, and Self-Compassion Scale-Short Form. All measures were administered at baseline, week 5, week 10, and at a 5-week follow-up. A qualitative Feasibility Questionnaire was administered weekly and at the 5-week follow-up to assess barriers and motivators for home practice and to collect feedback about session content. Recruitment challenges resulted in only seven interested individuals. Four participants (three males, one female) were successfully enrolled in the study after seven phone screenings and five in-person interviews. The four enrolled clients had a 100% follow-up retention rate, reported no adverse events, and on average participated in 85% of classes. Clinically significant enhancements were observed on trauma- and body connection-related scales for three participants from baseline to follow-up. Qualitative data revealed that motivators to practice include in-session philosophical discussions based on psychological themes; breathwork; mindfulness; and physical, social, work/academic, and mental health impact. Barriers included motivation, time, and location. Important themes emerged related to cultural considerations for veterans. Although this 10-week trauma-informed protocol faced challenges to recruitment, retention and participation were high. Efficacy measures yielded promising results for reducing reducing trauma-related symptoms.

    View details for DOI 10.17761/D-17-2019-00029

    View details for PubMedID 30958711

  • Mindfulness-based Wellness and Resilience intervention among interdisciplinary primary care teams: a mixed-methods feasibility and acceptability trial PRIMARY HEALTH CARE RESEARCH AND DEVELOPMENT Colgan, D., Christopher, M., Bowen, S., Brems, C., Hunsinger, M., Tucker, B., Dapolonia, E. 2019; 20
  • Comprehensive guide to child psychotherapy and counseling Brems, C., Rasmussen, C. Waveland. 2019
  • Empowering a Community from the Inside Out: Evaluation of a Yoga Teacher Training Program for Adults in Custody. International journal of yoga therapy Freeman, H., Brems, C., Michael, P., Marsh, S. 2018

    Abstract

    The current study evaluated a yoga teacher training program to understand the effect of bringing yoga psychology (as an integrated eight-limbed system) to adults in custody (AIC), who were trained to become yoga teachers who will in turn teach other AICs. The study used quantitative and qualitative measures to assess the yoga teacher training program's impact on individuals, their relationships, and the overall prison environment. The study included assessments and interviews with 12 AICs and nine yoga teacher volunteers, as well as key informant interviews with two correctional officers and five administrators who work within or directly with the Department of Corrections on the implementation of the program. Quantitative results revealed significant enhancements and sustainability in all key outcome variables (self-compassion, mindfulness, perceived stress, understanding of yoga philosophy, and teaching skills) from pretest to program completion and from completion to 3-month follow-up. Additionally, AIC yoga teachers became more similar on all outcome measures to the volunteer teachers from pretest to program completion and from completion to follow-up. Qualitative methods (used for 31 key informant and focus group interviews) revealed themes that illuminated positive effects on the prison community regarding participants' personal experiences, attitudes and values, behaviors, relationships, yoga philosophy in prison, culture, and future directions. Implications and recommendations are provided to support sustaining the current program and to help with the creation of new programs to infuse yoga philosophy into corrections departments.

    View details for DOI 10.17761/2019-00015

    View details for PubMedID 30430916

  • Bridging Body and Mind: Considerations for Trauma-Informed Yoga. International journal of yoga therapy Justice, L., Brems, C., Ehlers, K. 2018; 28 (1): 39–50

    Abstract

    Individuals who suffer from trauma-related symptoms are a unique population that could benefit from the mind-body practice of yoga-or have their symptoms reactivated by it, depending on the type of yoga. Trauma-informed yoga (TIY), that is, yoga adapted to the unique needs of individuals working to overcome trauma, may ameliorate symptoms by creating a safe, tailored practice for students to learn how to respond, rather than react, to symptoms and circumstances. Yoga not thus adapted, on the other hand, may increase reactivity and activate symptoms such as hyperarousal or dissociation. This article reports on expert input about adapting yoga for individuals with trauma, with special considerations for military populations. Eleven experts, recruited based on literature review and referrals, were interviewed in person or via telephone and asked seven questions about trauma-informed yoga. Verbatim transcripts were subjected to open-coding thematic analysis and a priori themes. Findings revealed that TIY needs to emphasize beneficial practices (e.g., diaphragmatic breath and restorative postures), consider contraindications (e.g., avoiding sequences that overly engage the sympathetic nervous system), adapt to limitations and challenges for teaching in unconventional settings (e.g., prisons, VA hospitals), and provide specialized training and preparation (e.g., specialized TIY certifications, self-care of instructors/therapists, adaptions for student needs). TIY for veterans must additionally consider gender- and culture-related barriers, differing relationships to pain and injury, and medication as a barrier to practice.

    View details for DOI 10.17761/2018-00017R2

    View details for PubMedID 29419338

  • Involving incarcerated individuals in the research process: Perspectives of key stakeholders ACTION RESEARCH Johnson, M. E., Brems, C., Mills, M. E., Eldridge, G. D. 2018; 16 (1): 43–64
  • Yoga in Print Media: Missing the Heart of the Practice. International journal of yoga Freeman, H., Vladagina, N., Razmjou, E., Brems, C. 2017; 10 (3): 160–66

    Abstract

    Background: Popular media typically portray yoga as an exercise or posture practice despite the reality that yoga comprised eight practices (called limbs) including ethical behavior, conscious lifestyle choices, postures, breathing, introspection, concentration, meditation, and wholeness.Aim: This study assessed the comprehensiveness of yoga practice as represented in articles in the popular yoga magazine, Yoga Journal. It explored the degree to which articles referenced each of the eight limbs of yoga and other contents (e.g., fitness, spirituality).Materials and Methods: Six coders were trained to reliably and independently review 702 articles in 33 Yoga Journal issues published between 2007 and 2014, coding for the limbs of yoga and other contents.Results: Breathing and postures were most frequently referenced, which were covered in 48.7% and 40.1% of articles. Internal practices were covered in 36.5% of articles with introspection being the most and concentration the least commonly referred to internal practices. Ethical and lifestyle practices were least frequently covered (5.2% and 6.8%). Since 2007, coverage of postures steadily increased, whereas contents related to the other limbs steadily decreased. The most frequent other contents related to fitness (31.7%), spirituality (20.8), and relationships (18.7%) coverage of these did not change across time.Conclusions: Representation of yoga in articles contained in the most popular yoga magazine is heavily biased in favor of physical practices. Recommendations are offered about how to shift media representation of yoga to make the heart of the practice more accessible to individuals who could experience health benefits but currently feel excluded from the practice.

    View details for DOI 10.4103/ijoy.IJOY_1_17

    View details for PubMedID 29422747

  • Popular media images of yoga: Limiting perceived access to a beneficial practice Media Psychology Review Razmjou, E., Freeman, H., Vladagina, N., Freitas, J., Brems, C. 2017; 11 (2)
  • Elements of yogic practice: Perceptions of students in healthcare programs. International journal of yoga Brems, C., Colgan, D., Freeman, H., Freitas, J., Justice, L., Shean, M., Sulenes, K. 2016; 9 (2): 121–29

    Abstract

    BACKGROUND: The practice of yoga has a long history as an integrated lifestyle science. Those who have practiced yoga in its full form (including all eight traditional aspects) find that it touches almost every aspect of their inter- and intra-personal lives. Despite this rich history, the West has adopted limited aspects of yoga practice. When understood narrowly as a physical fitness practice, healthful benefits of yoga may be lost, possibly promoting body-consciousness and injury instead.AIM: To understand whether students in healthcare programs view yoga from a physical fitness versus holistic perspective, we explored perceptions of what constitute yoga's essential practices.METHODS: We assessed endorsement of the eight limbs of yoga via the acceptability of yoga survey. The sample (n = 498) was recruited from programs in 10 healthcare professions at a Northwestern university. Participants were categorized as nonyogis, contemplators, yogis, and superyogis.RESULTS: Across all groups, findings confirmed a narrow definition of yoga as portrayed in popular media and gym-based yoga classes. Breathing and posture practices were the most commonly endorsed practices, even among the sample's most seasoned yoga practitioners. Ethical practices and daily commitments of introspection, disciplined practice, or living with purity were least commonly associated with yoga despite their foundational nature in yoga philosophy. Concentration and meditation practices were only moderately endorsed as essential practices. Super-yogis endorsed a wider variety of limbs than nonyogis, contemplators, and yogis.CONCLUSIONS: We offer a rationale for these findings along with recommendations that may help augment the definition of yoga and hence maximize its benefits.

    View details for DOI 10.4103/0973-6131.183710

    View details for PubMedID 27512319

  • Mental Health Research in Correctional Settings: Perceptions of Risk and Vulnerabilities ETHICS & BEHAVIOR Johnson, M. E., Kondo, K. K., Brems, C., Ironside, E. F., Eldridge, G. D. 2016; 26 (3): 238–51

    Abstract

    With over half of individuals incarcerated having serious mental health concerns, correctional settings offer excellent opportunities for epidemiological, prevention, and intervention research. However, due to unique ethical and structural challenges, these settings create risks and vulnerabilities for participants not typically encountered in research populations. We surveyed 1,224 researchers, IRB members, and IRB prisoner representatives to assess their perceptions of risks associated with mental health research conducted in correctional settings. Highest-ranked risks were related to privacy, stigma, and confidentiality; lowest-ranked risks were related to prisoners' loss of privileges or becoming targets of violence due to having participated in research. Cognitive impairment, mental illness, lack of autonomy, and limited access to services emerged as the greatest sources of vulnerability; being male, being female, being over age of 60, being a minority, and being pregnant were the lowest-ranked sources of vulnerability. Researchers with corrections experience perceived lower risks and vulnerabilities than all other groups, raising the question whether these researchers accurately appraise risk and vulnerability based on experience, or if their lower risk and vulnerability perceptions reflect potential bias due to their vested interests. By identifying areas of particular risk and vulnerability, this study provides important information for researchers and research reviewers alike.

    View details for DOI 10.1080/10508422.2015.1011327

    View details for Web of Science ID 000372838200004

    View details for PubMedID 27092025

    View details for PubMedCentralID PMC4833090

  • Exploring strategies to enhance self-efficacy about starting a yoga practice Annals of Yoga and Physical Therapy Justice, L., Brems, C., Jacova, C. 2016; 1 (2): 1-7
  • Key Stakeholders' Perceptions of Motivators for Research Participation Among Individuals Who Are Incarcerated JOURNAL OF EMPIRICAL RESEARCH ON HUMAN RESEARCH ETHICS Hanson, B. L., Faulkner, S. A., Brems, C., Corey, S. L., Eldridge, G. D., Johnson, M. E. 2015; 10 (4): 360–67

    Abstract

    Understanding motivations of research participants is crucial for developing ethical research protocols, especially for research with vulnerable populations. Through interviews with 92 institutional review board members, prison administrators, research ethicists, and researchers, we explored key stakeholders' perceptions of what motivates incarcerated individuals to participate in research. Primary motivators identified were a desire to contribute to society, gaining knowledge and health care, acquiring incentives, and obtaining social support. The potential for undue influence or coercion were also identified as motivators. These results highlight the need for careful analysis of what motivates incarcerated individuals to participate in research as part of developing or reviewing ethically permissible and responsible research protocols. Future research should expand this line of inquiry to directly include perspectives of incarcerated individuals.

    View details for DOI 10.1177/1556264615597500

    View details for Web of Science ID 000361485600002

    View details for PubMedID 26283681

    View details for PubMedCentralID PMC4575263

  • HIV/AIDS Research in Correctional Settings: A Difficult Task Made Even Harder? JOURNAL OF CORRECTIONAL HEALTH CARE Johnson, M. E., Kondo, K. K., Brems, C., Eldridge, G. D. 2015; 21 (2): 101–11

    Abstract

    Housing a large number of individuals living with or at risk for HIV/AIDS, correctional settings have considerable potential for epidemiological, prevention, and treatment research. However, federal regulations and institutional challenges have limited the extent and types of such research with prisoners. This study examines the degree to which HIV/AIDS correctional researchers report greater challenges than do their noncorrectional counterparts. Results indicate that correctional researchers reported significantly more frequent challenges than those in noncorrectional settings, even after controlling for experience, with the dominant difference related to challenges due to the research setting. These findings add empirical data and support previous research in the field; however, additional research should include correctional staff and incarcerated individuals, and explore whether these differences extend to other research topics.

    View details for DOI 10.1177/1078345815572347

    View details for Web of Science ID 000356427900002

    View details for PubMedID 25788606

    View details for PubMedCentralID PMC4476641

  • Knowledge of Federal Regulations for Mental Health Research Involving Prisoners. AJOB empirical bioethics Johnson, M. E., Brems, C., Bergman, A. L., Mills, M. E., Eldridge, G. D. 2015; 6 (4): 12–18

    Abstract

    BACKGROUND: Given their vulnerability to coercion and exploitation, prisoners who participate in research are protected by Office for Human Research Protections (OHRP) regulations designed to ensure their safety and wellbeing. Knowledge of these regulations is essential for researchers who conduct and institutional review boards (IRBs) that oversee mental health research in correctional settings.METHODS: We explored depth of knowledge of OHRP regulations by surveying a nationwide sample of: (1) mental health researchers who have conducted research in correctional settings; (2) mental health researchers who have conducted research in non-correctional settings; (3) IRB members who have overseen mental health research in correctional settings; (4) IRB members who have overseen mental health research in in non-correctional settings; and (5) IRB prisoner representatives. Participants responded to a 10-item knowledge questionnaire based on OHRP regulations.RESULTS: 1,256 participants provided usable data (44.9% response rate). Results revealed limited knowledge of OHRP regulations, with a mean across groups of 44.1% correct answers. IRB Prisoner representatives, IRB members, and researchers with correctional experience demonstrated the highest levels of knowledge; however, even these participants were able to correctly answer only approximately 50% of the items.CONCLUSIONS: Although awareness that prisoners are a protected population and that different regulatory procedures apply to research with them is likely to be universal among researchers and IRB members, our findings reveal limited mastery of the specific OHRP regulations that are essential knowledge for researchers who conduct and IRB members who oversee mental health research in correctional settings. Given well-documented health and healthcare disparities, prisoners could potentially benefit greatly from mental health research; increasing knowledge of the OHRP regulations among researchers and IRB members is a crucial step toward meeting this important public health goal.

    View details for PubMedID 26495325

  • Improving access to yoga: Barriers and motivators for practice among health professions students Advances in Mind-Body Medicine Brems, C., Justice, L., Sulenes, K., Girasa, L., Ray, J., Davis, M., Freitas, J., Shean, M., Colgan, D. 2015; 29: 6-13
  • Underuse of Yoga as a Referral Resource by Health Professions Students JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Sulenes, K., Freitas, J., Justice, L., Colgan, D., Shean, M., Brems, C. 2015; 21 (1): 53–59

    Abstract

    Nearly 38% of U.S. adults use complementary and alternative medicine approaches to manage physical conditions (e.g., chronic pain, arthritis, cancer, heart disease, and high blood pressure) and psychological or emotional health concerns (e.g., post-traumatic stress disorder, anxiety, and depression). Research evidence has accumulated for yoga as an effective treatment approach for these conditions. Further, yoga has increased in popularity among healthcare providers and the general population. Given these trends, this study explored perceptions about yoga as a viable complementary treatment to which health professions students would refer patients.More than 1500 students enrolled in health professions programs at a Pacific Northwest school were enrolled; data were obtained from 478 respondents.The study assessed willingness to refer patients to yoga as a complementary and alternative medicine for 27 symptoms (identified in the literature as having evidence for yoga's utility), which were subsequently grouped into skeletal, physical, and psychological on the basis of factor analysis. Responses were assessed using a mixed-model analysis of variance with health profession and yoga practitioner as between-subjects variables and symptoms as a within-subjects factor.In descending order of likelihood to refer patients to yoga were students in occupational therapy, physician assistant program, psychology, physical therapy, pharmacy, dental hygiene, speech and audiology, and optometry. All groups perceived yoga's greatest utility for skeletal symptoms, followed by psychological and physical symptoms. Findings also revealed a significant positive relationship between level of personal yoga practice and willingness to refer patients to yoga.Although students expressed some openness to referring patients to yoga, ratings of appropriateness were not accurately aligned with extant evidence base. Personal experience seemed to be a salient factor for accepting yoga as a referral target. These findings suggest the importance of developing strategies to make health professionals more aware of the merits of yoga, regardless of whether they themselves are yoga practitioners.

    View details for DOI 10.1089/acm.2014.0217

    View details for Web of Science ID 000349145600001

    View details for PubMedID 25268564

  • A Yoga Stress Reduction Intervention for University Faculty, Staff, and Graduate Students. International journal of yoga therapy Brems, C. 2015; 25 (1): 61–77

    Abstract

    Yoga can be an effective intervention for physical and psychological symptoms and decreased ability to cope with physical, emotional, vocational, or academic stress. One group of individuals challenged regarding adequate self-care in the face of stress are personnel in university training programs for helping professions (e.g., psychology, nursing, nutrition). This feasibility study explored engagement in and effectiveness of a systematic 10-week yoga program aimed at university faculty, staff, and students. The intervention consisted of 10 weekly 90-minute sessions that were structured to include conceptual grounding, breathing, postures, and meditation. Weekly class outlines were made available to students for home practice. Participants signed informed consents, liability waivers, and health screenings. Self-reports of home practice, barriers to practice, perceived stress, and stress symptoms were used to evaluate whether the intervention was successful in engaging participants and reducing stress-related symptoms. Engagement was demonstrated by study adherence in the first 10-week series (88%; 44 of 50 enrolled), as well as re-enrollment for at least one additional 10-week series (64%; 28 of 44). Intervention success was demonstrated through repeated measure s ANOVAs of 44 participants' data, which showed significant improvement after a single 10-week series in perceived stress, as well as self-reported psychological, behavioral, and physical symptoms of stress. The study demonstrates feasibility of a yoga intervention in an academic setting and provides preliminary evidence for efficacy in stress reduction. It also supplies 10 detailed session protocols for intervention replication.

    View details for DOI 10.17761/1531-2054-25.1.61

    View details for PubMedID 26667290

  • HIV/AIDS RESEARCH IN CORRECTIONAL SETTINGS: PERSPECTIVES ON TRAINING NEEDS FROM RESEARCHERS AND IRB MEMBERS AIDS EDUCATION AND PREVENTION Kondo, K. K., Johnson, M. E., Ironside, E. F., Brems, C., Eldridge, G. D. 2014; 26 (6): 565–76

    Abstract

    Being disproportionately represented by individuals living with HIV/AIDS, correctional facilities are an important venue for potentially invaluable HIV/AIDS epidemiological and intervention research. However, unique ethical, regulatory, and environmental challenges exist in these settings that have limited the amount and scope of research. We surveyed 760 HIV/AIDS researchers, and IRB chairs, members, and prisoner representatives to identify areas in which additional training might ameliorate these challenges. Most commonly identified training needs related to federal regulations, ethics (confidentiality, protection for participants/researchers, coercion, privacy, informed consent, and general ethics), and issues specific to the environment (culture of the correctional setting; general knowledge of correctional systems; and correctional environments, policies, and procedures). Bolstering availability of training on the challenges of conducting HIV/AIDS research in correctional settings is a crucial step toward increasing research that will yield significant benefits to incarcerated individuals and society as a whole.

    View details for DOI 10.1521/aeap.2014.26.6.565

    View details for Web of Science ID 000346879100006

    View details for PubMedID 25490736

    View details for PubMedCentralID PMC4469272

  • Conducting Ethical Research with Correctional Populations: Do Researchers and IRB Members Know the Federal Regulations? Research ethics Johnson, M. E., Brems, C., Hanson, B. L., Corey, S. L., Eldridge, G. D., Mitchell, K. 2014; 10 (1): 6–16

    Abstract

    Conducting or overseeing research in correctional settings requires knowledge of specific federal rules and regulations designed to protect the rights of individuals in incarceration. To investigate the extent to which relevant groups possess this knowledge, using a 10-item questionnaire, we surveyed 885 IRB prisoner representatives, IRB members and chairs with and without experience reviewing HIV/AIDS correctional protocols, and researchers with and without correctional HIV/AIDS research experience. Across all groups, respondents answered 4.5 of the items correctly. Individuals who have overseen or conducted correctional research had the highest scores; however, even these groups responded correctly only to slightly more than half of the items. These findings emphasize the need for ongoing training in federal guidelines governing correctional research, particularly for those individuals who are embarking on this type of research.

    View details for PubMedID 26097498

  • COLLEGE STUDENTS' KNOWLEDGE ABOUT FETAL ALCOHOL SPECTRUM DISORDER JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY Brems, C., Johnson, M. E., Metzger, J. S., Dewane, S. L. 2014; 21 (2): E159–E166

    Abstract

    Fetal Alcohol Spectrum Disorders (FASDs) are the leading known preventable birth defects in North America. Knowledge surveys about FASD have been conducted with various health and allied healthcare providers and have proven useful in identifying gaps in knowledge and differences among provider groups to support prevention efforts. To date, no research has been conducted exploring FASD knowledge among college students.This study explored FASD knowledge in a sample of college students, a group at particularly high risk for alcohol-exposed pregnancies. Findings are compared to professionals in several healthcare and affiliated professional groups who were previously surveyed with the same FASD-related items.Surveys from 1,035 college students at a northwestern university were analyzed. Included with the ACHA-National College Health Assessment II were questions regarding FASD. College students' knowledge was compared with that of professionals in key healthcare and affiliated positions to define their relative awareness of FASD risk.Overall, findings revealed adequate FASD knowledge among college students. Although minor differences emerged when comparing students and professionals' responses, most respondent groups answered with an 85% accuracy rate or higher.College students demonstrated adequate knowledgeable about FASD. Future research must explore whether such knowledge translates into lower risk behavior and consequent reduction in alcohol-exposed pregnancies.

    View details for Web of Science ID 000216292800001

    View details for PubMedID 24866985

  • Alternative and Complementary Treatment Needs and Experiences of Women with Breast Cancer JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Brems, C., Barnett, J., Parret, V., Metzger, J., Johnson, M. E. 2013; 19 (7): 657–63

    Abstract

    The study objectives were to explore the potential need for and use of complementary and alternative (CAM) services among women diagnosed with breast cancer and to investigate reasons for nonreceipt of CAM.The Alaska Breast Cancer Needs Assessment Survey was completed by female breast cancer survivors in Alaska. The survey assessed physical and psychologic symptoms, services received, satisfaction with treatment, communication with providers, and informational needs. Survey responses were obtained from 309 women with breast cancer, with a mean age of 56 years and high level of education.Results revealed that most breast cancer survivors have significant needs for CAM services, and yet only a small proportion actually receives them. For example, virtually all women reported symptoms potentially amenable to treatment via individual counseling or nutritional interventions; however, only 29% and 45%, respectively, received such services. Women who did and those who did not receive CAM services (e.g., counseling, massage, meditation, and supplementation) generally did not differ in terms of their need for such services as measured via symptoms that could be supported by these interventions. However, the majority failed to be referred for such treatments or were unable to access them if referred.Results suggest that while access to services played a small role in nonreceipt of CAM services, the largest reason for CAM nonreceipt was failure to recognize their potential benefit on the part of providers and at least some patients. Raising awareness about the potential value of CAM among care providers for women with breast cancer is crucial, as it will likely lead to more CAM acceptance and utilization. Once providers accept and refer for CAM, patients' quality of life may be considerably enhanced, as the extant literature has demonstrated the potential value of CAM for breast cancer survivors.

    View details for DOI 10.1089/acm.2012.0161

    View details for Web of Science ID 000321262700011

    View details for PubMedID 23373443

  • Ethical Challenges in Conducting HIV/AIDS Research in Correctional Settings JOURNAL OF CORRECTIONAL HEALTH CARE Eldridge, G. D., Robinson, R., Corey, S., Brems, C., Johnson, M. E. 2012; 18 (4): 309–18

    Abstract

    To explore ethical challenges in the conduct and oversight of HIV/AIDS research in correctional settings, 92 researchers; IRB chairs, members, and prisoner representatives; research ethicists; and prison administrators were asked the question, "If you had to pick the single most important ethical challenge to HIV/AIDS research with incarcerated people, what would it be?" Data were analyzed with NVivo 8.0 software and revealed that key concerns were confidentiality and privacy; autonomy and informed consent; and justice and access. Characteristics of people who are incarcerated, the nature of correctional institutions, and state and federal regulatory issues contributed to these challenges. These findings provide insights into ethical challenges that affect the conduct of HIV/AIDS research in correctional settings.

    View details for DOI 10.1177/1078345812456194

    View details for Web of Science ID 000208989300006

    View details for PubMedID 22952319

  • Changes in sexual activity following substance dependence treatment JOURNAL OF SUBSTANCE USE Johnson, M. E., Hanson, B. L., Metzger, J. S., Brems, C., Dewane, S. L. 2012; 17 (4): 340–47
  • Prevention of fetal alcohol spectrum disorders: Educational needs in academia Journal of Alcohol and Drug Education Brems, C., Boschma-Wynn, R., Dewane, S., Edwards, A., Robinson, R. 2011; 55: 15-37
  • "If Only Someone Had Told Me ...": Lessons From Rural Providers JOURNAL OF RURAL HEALTH Chipp, C., Dewane, S., Brems, C., Johnson, M. E., Warner, T. D., Roberts, L. W. 2011; 27 (1): 122-130

    Abstract

    Health care providers face challenges in rural service delivery due to the unique circumstances of rural living. The intersection of rural living and health care challenges can create barriers to care that providers may not be trained to navigate, resulting in burnout and high turnover. Through the exploration of experienced rural providers' knowledge and lessons learned, this study sought to inform future practitioners, educators, and policy makers in avenues through which to enhance training, recruiting, and maintaining a rural workforce across multiple health care domains.Using a qualitative study design, 18 focus groups were conducted, with a total of 127 health care providers from Alaska and New Mexico. Transcribed responses from the question, "What are the 3 things you wish someone would have told you about delivering health care in rural areas?" were thematically coded.Emergent themes coalesced into 3 overarching themes addressing practice-related factors surrounding the challenges, adaptations, and rewards of being a rural practitioner.Based on the themes, a series of recommendations are offered to future rural practitioners related to community engagement, service delivery, and burnout prevention. The recommendations offered may help practitioners enter communities more respectfully and competently. They can also be used by training programs and communities to develop supportive programs for new practitioners, enabling them to retain their services, and help practitioners integrate into the community. Moving toward an integrative paradigm of health care delivery wherein practitioners and communities collaborate in service delivery will be the key to enhancing rural health care and reducing disparities.

    View details for DOI 10.1111/j.1748-0361.2010.00314.x

    View details for Web of Science ID 000285891700014

    View details for PubMedID 21204979

    View details for PubMedCentralID PMC3057882

  • Ethical challenges in conducting psychiatric or mental health research in correctional settings American Journal of Bioethics - Primary Research Eldridge, G. D., Johnson, M. E., Brems, C., Corey, S. L. 2011; 2: 42-51
  • Knowledge, attitudes, and behaviors of health, education, and service professionals as related to fetal alcohol spectrum disorders INTERNATIONAL JOURNAL OF PUBLIC HEALTH Johnson, M. E., Robinson, R., Corey, S., Dewane, S. L., Brems, C., Casto, L. 2010; 55 (6): 627–35

    Abstract

    We explored differences in fetal alcohol spectrum disorders (FASD) knowledge, attitudes, and behaviors across six groups of professionals in key position to provide primary and secondary prevention efforts (physicians, educators, correctional staff, social workers, public health nurses, and substance abuse counselors).Achieving a 60.1% response rate, 2,292 professionals returned surveys, providing data on basic knowledge of FAS, FASD-associated risks and cognitive deficits, and willingness to confront and recommend treatment to alcohol-consuming pregnant women.Across groups, findings revealed ample FASD knowledge and willingness to confront and recommend treatment to alcohol-consuming pregnant women that increases as consumption becomes more frequent and severe. However, results revealed significant between-group differences data that provide valuable guidance for targeted future FASD education efforts.Public health initiatives regarding FASD have been effective in increasing knowledge among a broad range of professionals. However, between-group differences indicate the need for targeted, discipline-specific interventions. These differences highlight the need for all professional groups to provide a consistent public health message regarding maternal alcohol consumption.

    View details for DOI 10.1007/s00038-010-0186-8

    View details for Web of Science ID 000284652200016

    View details for PubMedID 20809348

  • Health Care Providers' Reports of Perceived Stigma Associated with HIV and AIDS in Rural and Urban Communities JOURNAL OF HIV-AIDS & SOCIAL SERVICES Brems, C., Johnson, M. E., Warner, T. D., Roberts, L. 2010; 9 (4): 356–70
  • TRAINING NEEDS OF HEALTHCARE PROVIDERS RELATED TO CENTERS FOR DISEASE CONTROL AND PREVENTION CORE COMPETENCIES FOR FETAL ALCOHOL SPECTRUM DISORDERS JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY Brems, C., Boschma-Wynn, R. V., Dewane, S. L., Edwards, A. E., Robinson, R. V. 2010; 17 (3): E405–E417

    Abstract

    Fetal alcohol spectrum disorders (FASDs) are birth defects directly linked to consumption of alcohol during pregnancy and hence completely preventable. Many health and allied health professionals are in prime positions for primary prevention of FASDs through work with women of childbearing age and secondary prevention through work with affected individuals whose lives can be greatly improved via tailored intervention.To develop educational guidelines for FASD prevention.Interviews were conducted with 26 individuals representing eight health or allied health professions. Participants were asked about professional groups with which they had sufficient experience to describe FASD-related competencies and educational needs for the given group(s). For each group, participants were asked for their perceptions of group members' FASD awareness, knowledge, and skills application as related to the seven core competencies for FASD practice developed by the Centers for Disease Control and Prevention (CDC).Findings revealed that competence, especially when viewed separately in terms of knowledge versus capacity for application of information, in the area of FASDs is unevenly distributed among and throughout healthcare provider groups.Based on this information, recommendations are offered for optimal health and allied health education efforts to prevent and treat FASDs, framed along FASD core competencies recommended by the CDC.

    View details for Web of Science ID 000213560900010

    View details for PubMedID 21063036

  • Health Risk Factors in an Adolescent Psychiatric Residential Treatment Facility RESIDENTIAL TREATMENT FOR CHILDREN & YOUTH Chipp, C., Corey, S., Johnson, M., Brems, C. 2010; 27 (4): 314–25
  • BRIEF MOTIVATIONAL INTERVENTIONS FOR HIV/STI RISK REDUCTION AMONG INDIVIDUALS RECEIVING ALCOHOL DETOXIFICATION AIDS EDUCATION AND PREVENTION Brems, C., Dewane, S. L., Johnson, M. E., Eldridge, G. D. 2009; 21 (5): 397–414

    Abstract

    This HIV/STI risk reduction clinical trial implemented in short-term alcohol detoxification employed a randomized block design to evaluate three intervention conditions for feasibility, safety, and potential for changing sexual risk attitudes, motivations, and behavior: (a) nonintervention control (standard HIV information dissemination), (b) brief motivational intervention (BMI) for resolution of ambivalence and sex risk reduction planning, and (c) BMI with biological feedback based on testing for sexually transmitted infections (STIs). Findings revealed that BMI can be feasibly implemented during detoxification treatment with individuals with significant substance impairment. BMI, whether coupled with biological feedback or not, enhanced motivation for increasing behaviors that protect from STI. Sexual risk behavior did not change in any of the groups to a statistically significant degree; however, additional analyses suggest negative biological feedback may have resulted in slightly increased level of sexual activity, undoing behavioral effects of increased motivation for sexual risk reduction, perhaps by distorting participants' perception of risk.

    View details for DOI 10.1521/aeap.2009.21.5.397

    View details for Web of Science ID 000271437000001

    View details for PubMedID 19842825

  • When Providers and Patients Come from Different Backgrounds: Perceived Value of Additional Training on Ethical Care Practices TRANSCULTURAL PSYCHIATRY Roberts, L. W., Johnson, M. E., Brems, C., Warner, T. D. 2008; 45 (4): 553-565

    Abstract

    Fostering the therapeutic alliance, safeguarding confidentiality, gaining informed consent, and enhancing treatment adherence are critical aspects of patient care. We examined whether multidisciplinary health care providers perceive additional training on these areas as helpful in their work with patients from different ethnic backgrounds than the provider. Data are drawn from a National Institute on Drug Abuse-funded survey of 1555 providers in 8 disciplines in New Mexico and Alaska. Clinicians viewed additional training as moderately helpful for ensuring treatment adherence, establishing the therapeutic alliance, safeguarding confidentiality, and engaging in informed consent processes, in that order. Women were more receptive than men to additional training. Modest differences were detected between behavioral and physical health providers and between minority and majority providers. Implications of providers' only modest interest in such training are discussed.

    View details for DOI 10.1177/1363461508100782

    View details for Web of Science ID 000262346400002

    View details for PubMedID 19091725

  • Receiver operating characteristics for the Brief Symptom Inventory Depression, Paranoid Ideation, and Psychoticism scales in a large sample of clinical inpatients PSYCHOLOGICAL REPORTS Johnson, M. E., Chipp, C. L., Brems, C., Neal, D. B. 2008; 102 (3): 695–705

    Abstract

    A commonly used screening tool for psychopathology, the Brief Symptom Inventory, provides normative data for assessing current mental functioning across multiple domains. Using data from 654 psychiatric inpatients, receiver operating characteristic (ROC) analyses were conducted for three scales, Depression, Paranoid Ideation, and Psychoticism. t ratios identified significant group differences on the Depression scale between patients diagnosed with or without depression but no differences on the Paranoid Ideation and Psychoticism scales between patients diagnosed with or without schizophrenia. Area under the curve for Depression was .65, indicating that the scale improved diagnostic prediction somewhat beyond chance; for Paranoid Ideation, the area was .52 and for Psychoticism, the area was .53, indicating that these two scales did not significantly improve diagnostic prediction beyond chance.

    View details for DOI 10.2466/PR0.102.3.695-705

    View details for Web of Science ID 000258463000007

    View details for PubMedID 18763438

  • Brief motivational interventions for sexual risk reduction in alcohol detoxification Brems, C., Johnson, M. E., Dewane, S. L., Eldridge, G. D. PSYCHOLOGY PRESS. 2008: 80–81
  • Overlapping relationships of rural and urban providers with their patients Johnson, M., Brems, C., Mills, M. E., Warner, T. D., Roberts, L. W. PSYCHOLOGY PRESS. 2008: 438
  • Psychiatric symptomatology among individuals in alcohol detoxification treatment ADDICTIVE BEHAVIORS Johnson, M. E., Brems, C., Mills, M. E., Fisher, D. G. 2007; 32 (8): 1745–52

    Abstract

    The coexistence of psychiatric symptomatology among individuals receiving longer-term treatment for alcohol use disorders has been well-established; however, less is known about comorbidity among individuals receiving alcohol detoxification. Using the Brief Symptom Inventory [BSI; Derogatis, L. R. (1992). BSI: Administration, scoring, and procedures manual--II. Towson, MD: Clinical Psychometric Research], we compared psychiatric symptomatology among 815 individuals receiving short-term detoxification services with normative data from non-patients, psychiatric patients, and out-of-treatment individuals using street drugs. Findings revealed that individuals in the current sample reported a wide range of psychiatric symptoms with over 80% meeting BSI criteria for diagnosable mental illness. These BSI scores were significantly more severe than those reported by out-of-treatment individuals using street drugs and most closely resembled BSI scores reported for adult psychiatric inpatients. Findings suggest that routine screening for severe mental health symptoms appears warranted in detoxification units. Such screening would greatly increase the chance that coexistence of substance use and other psychiatric disorders would be properly addressed in ongoing treatment.

    View details for DOI 10.1016/j.addbeh.2006.12.007

    View details for Web of Science ID 000247302800021

    View details for PubMedID 17239548

    View details for PubMedCentralID PMC2232900

  • Hearing consumer voices: Planning HIV/sexually transmitted infection prevention in alcohol detoxification JANAC-JOURNAL OF THE ASSOCIATION OF NURSES IN AIDS CARE Brems, C., Dewane, S. 2007; 18 (1): 12–24

    Abstract

    The literature has provided ample evidence that individuals abusing or dependent upon alcohol are at high risk for contracting HIV and other sexually transmitted infections (STIs). Despite the documented need of this vulnerable group for targeted HIV/STI prevention efforts, no prior research has explored the efficacy and feasibility of HIV/STI prevention for individuals in alcohol detoxification. The current study sought the voices of consumers of such services to get their guidance about successful and necessary features of HIV/STI prevention programs targeted to their needs. Two focus groups conducted yielded exceptionally helpful information. Consumers clearly want to be educated about HIV/STI, seeing this as crucial to their physical well-being and safety. They voiced preferences for nonjudgmental counselors who meet with them on an individual basis in contexts that protect consumer privacy. A clear set of guidelines emerged for an intervention structure that, if carefully honored, has strong likelihood of success in protecting individuals in alcohol detoxification from HIV/STI.

    View details for DOI 10.1016/j.jana.2006.11.002

    View details for Web of Science ID 000245388900003

    View details for PubMedID 17338982

  • Exploring differences in caseloads of rural and urban healthcare providers in Alaska and New Mexico PUBLIC HEALTH Brems, C., Johnson, M. E., Warner, T. D., Roberts, L. W. 2007; 121 (1): 3-17

    Abstract

    Although it is commonly accepted that rural healthcare providers face demands that are both qualitatively and quantitatively different from those faced by urban providers, this conclusion is based largely on data from healthcare consumers and relies on qualitative work with small sample sizes, surveys with small sample sizes, theoretical reviews and anecdotal reports. To enhance our knowledge of the demands faced by rural healthcare providers and to gain the perspectives of healthcare providers themselves, this study explored the caseloads of rural providers compared with those of urban providers.An extensive survey of over 1500 licensed clinicians across eight physical and behavioural healthcare provider groups in Alaska and New Mexico was undertaken to explore differences in caseloads based on community size (small rural, rural, small urban, urban), state (Alaska, New Mexico) and discipline (health, behavioural).Findings indicated numerous caseload differences between community sizes that were consistent across both states, with complex case presentations being described most commonly by small rural and rural providers. Substance abuse, alcohol use, cultural diversity, economic disadvantage and age diversity were issues faced more often by providers in rural and small rural communities than by providers in small urban and urban communities. Rural, but not small rural, providers faced challenges around work with prisoners and individuals needing involuntary hospitalization. Although some state and discipline differences were noted, the most important findings were based on community size.The findings of this study have important implications for provider preparation and training, future research, tailored resource allocation, public health policy, and efforts to prevent 'burnout' of rural providers.

    View details for DOI 10.1016/j.puhe.2006.07.031

    View details for Web of Science ID 000243804800002

    View details for PubMedID 17169386

  • Survey return rates as a function of priority versus first-class mailing PSYCHOLOGICAL REPORTS Brems, C., Johnson, M. E., Warner, T., Roberts, L. W. 2006; 99 (2): 496-501

    Abstract

    Prior research indicates survey procedures that signal significance and individualized mailings have higher response rates. Thus, it was hypothesized that surveys delivered via Priority mail would result in higher return rates than surveys delivered via First-Class. 260 surveys were sent to individuals randomly selected from lists of licensed physical and behavioral healthcare providers in Alaska and New Mexico. Half of the selected individuals were assigned randomly to receive mailings using Priority mail, the other half received First-Class mailings. Return rate was 39% for First-Class and 35% for Priority. Z tests of proportion indicated no statistically significant differences between methods. Given increased costs with no resultant increase in response rate, sending surveys to potential participants via Priority mail does not appear warranted.

    View details for DOI 10.2466/PR0.99.2.496-501

    View details for Web of Science ID 000242197800023

    View details for PubMedID 17153820

  • Moderating effects of control on the relationship between stress and change ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH Johnson, M. E., Brems, C., Mills, M. E., Neal, D. B., Houlihan, J. L. 2006; 33 (4): 499–503

    Abstract

    Given the well-documented impact of stress on employees, it is important to understand moderating factors, especially in behavioral health treatment settings, where constant change occurs. Staff members at four mental health (n=663) and four substance abuse (n=256) treatment agencies completed questionnaires inquiring about perceptions of direct and indirect agency changes, stress experienced due to changes, and control and input into the changes. Results revealed that as direct and indirect change increased, stress increased; as level of control and input into changes increased, stress decreased. Control and input served as a moderating variable between stress and direct change, but not for indirect change.

    View details for DOI 10.1007/s10488-005-0002-6

    View details for Web of Science ID 000239016500009

    View details for PubMedID 16220241

  • Rural-urban health care provider disparities in Alaska and New Mexico ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH Johnson, M. E., Brems, C., Warner, T. D., Roberts, L. W. 2006; 33 (4): 504-507

    Abstract

    Compared to their urban counterparts, rural residents face numerous disparities in obtaining health care, including limited access to care providers. We assessed disparities in provider availability in rural versus urban Alaska and New Mexico, with emphasis on professionals likely to provide mental health care. Using lists of licenses, we categorized physical and mental health care providers into rural versus urban and calculated rural versus urban disparity ratios. Rural residents had significantly less access to health care providers and discrepancies grew with level of required provider education and specialization. Addressing disparities via creative strategies is crucial to improving rural care delivery.

    View details for DOI 10.1007/s10488-005-0001-7

    View details for Web of Science ID 000239016500010

    View details for PubMedID 16220242

  • Depression as measured by the Beck Depression Inventory-II among injecting drug users ASSESSMENT Johnson, M. E., Neal, D. B., Brems, C., Fisher, D. G. 2006; 13 (2): 168–77

    Abstract

    This study conducts a confirmatory factor analysis of the Beck Depression Inventory-II (BDI-II) with a sample of 598 individuals who reported recent injecting drug use. Findings indicate that out of four models tested, the best model for this sample is a three-factor solution (somatic, affective, and cognitive) previously reported by Buckley, Parker, and Heggie. The findings that nearly 50% of participants provided BDI-II scores indicating significant depressive symptomatology reveals that these individuals are in need of treatment for their psychiatric symptoms as well as substance use. Somatic symptoms are endorsed more strongly than affective or cognitive symptoms of depression, suggesting a possible, but yet poorly defined, relationship between depressive symptomatology and drug use that centers on shared somatic symptomatology.

    View details for DOI 10.1177/1073191106286951

    View details for Web of Science ID 000238190100004

    View details for PubMedID 16672731

  • Preferences of Alaska and New Mexico psychiatrists regarding professionalism and ethics training ACADEMIC PSYCHIATRY Roberts, L. W., Johnson, M. E., Brems, C., Warner, T. D. 2006; 30 (3): 200-204

    Abstract

    To identify the preferences of practicing licensed psychiatrists in two rural states regarding ethics training.All licensed psychiatrists in Alaska and New Mexico were mailed a survey exploring differences in ethical and practice issues between rural and urban health care providers. Data were collected from 97 psychiatrists.Findings indicated a moderate level of interest in training related to a diverse set of ethics topics. Although women expressed greater interest in most topics than did men, ranking of topics was similar across genders. Level of interest in training was inversely related to number of years in practice.The psychiatrists in this study indicated some interest in professionalism and ethics training, but did not express the level of need or enthusiasm documented in many studies of physicians-in-training. Creating continuing medical education initiatives that are attuned to the distinct needs and preferences of psychiatrists in clinical practice thus poses many challenges. This may be particularly true for certain aspects of practice, such as ethics and professionalism, that have long been recognized as vital to clinical care, but now are viewed as core competency areas.

    View details for Web of Science ID 000237768600004

    View details for PubMedID 16728766

  • Patient requests and provider suggestions for alternative treatments as reported by rural and urban care providers COMPLEMENTARY THERAPIES IN MEDICINE Brems, C., Johnson, M. E., Warner, T. D., Roberts, L. W. 2006; 14 (1): 10-19

    Abstract

    Explored the relationship between different types of care providers' willingness to suggest alternative and complementary treatments (CAM), patients' requests for CAM, and provider perceptions about CAM as barriers to effective healthcare.Large survey.Alaska and New Mexico.Survey responses from 1528 physical and behavioral healthcare providers.Over 97% of providers suggested CAM; over 97% reported patients asked for CAM. Providers were more likely to suggest CAM than perceived CAM as a barrier to care. Healthcare providers who were female, from small rural areas, or specializing in behavioral healthcare were more likely to suggest CAM and less likely to perceive CAM as a barrier. Patients of physical healthcare providers asked for CAM more often than patients of behavioral healthcare providers, yet physical care providers suggested CAM less frequently.Healthcare providers of all disciplines, regions, and gender are sensitive to patients' desire for CAM and do not perceive CAM as a barrier to care.

    View details for DOI 10.1016/j.ctim.2005.07.009

    View details for Web of Science ID 000239334500003

    View details for PubMedID 16473749

  • Barriers to healthcare as reported by rural and urban interprofessional providers. Journal of interprofessional care Brems, C., Johnson, M. E., Warner, T. D., Roberts, L. W. 2006; 20 (2): 105-118

    Abstract

    The research literature is replete with reports of barriers to care perceived by rural patients seeking healthcare. Less often reported are barriers perceived by the rural healthcare providers themselves. The current study is an extensive survey of over 1,500 healthcare providers randomly selected from two US states with large rural populations, Alaska and New Mexico. Barriers consistently identified across rural and urban regions by all healthcare professionals were Patient Complexity, Resource Limitations, Service Access, Training Constraints, and Patient Avoidance of Care. Findings confirmed that rural areas, however, struggle more with healthcare barriers than urban and small urban areas, especially as related to Resource Limitations, Confidentiality Limitations, Overlapping Roles, Provider Travel, Service Access, and Training Constraints. Almost consistently, the smaller a provider's practice community, the greater the reports of barriers, with the most severe barriers reported in small rural communities.

    View details for PubMedID 16608714

  • Ethical considerations in rural health care: A pilot study of clinicians in Alaska and New Mexico COMMUNITY MENTAL HEALTH JOURNAL Warner, T. D., Monaghan-Geernaert, P., Battaglia, J., Brems, C., Johnson, M. E., Roberts, L. W. 2005; 41 (1): 21-33

    Abstract

    To investigate differences in the experiences of rural versus non-rural clinicians, we surveyed caregivers in New Mexico and Alaska regarding ethical aspects of care provision. Consistent with past literature, rural compared to non-rural clinicians perceived patients as having less access to health care resources. They reported more interaction with patients and less awkwardness in relationships with their patients outside of work. Rural clinicians also reported their patients expressed more concern about knowing them in both personal and professional roles, had more concerns over confidentiality, and experienced more embarrassment concerning stigmatizing illnesses. Ethical issues and implications of these results for providing care in rural areas are discussed.

    View details for DOI 10.1007/s10597-005-2597-1

    View details for Web of Science ID 000228674000003

    View details for PubMedID 15934173

    View details for PubMedCentralID PMC1599854

  • Utility of the Behavior and Symptom Identification Scale (BASIS-32) at an Alcohol Detoxification Unit ALCOHOLISM TREATMENT QUARTERLY Johnson, M. E., Brems, C., Mills, M. E., Freemon, M. 2005; 23 (1): 17–29
  • Consumer perspectives on services needed to prevent psychiatric hospitalization ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH Brems, C., Johnson, M. E., Covey, S., Podunovich, A., Burns, R. 2004; 32 (1): 57–61
  • Comorbidity in Alaska: evidence and implications for treatment and public policy. Alaska medicine Brems, C., Johnson, M. E. 2004; 46 (1): 4–17

    View details for PubMedID 15468989

  • Childhood abuse history and substance use among men and women receiving detoxification services AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE Brems, C., Johnson, M. E., Neal, D., Freemon, M. 2004; 30 (4): 799–821

    Abstract

    According to data collected from women and adolescents, a strong link exists between childhood abuse history and substance abuse. Using a sample of 274 women and 556 men receiving detoxification services, we explored whether the same pattern emerged across genders and types of abuse. Results revealed 20% of men and more than 50% of women reported childhood physical or sexual abuse. Sexual or physical abuse had negative sequelae, regardless of gender. Individuals with abuse history reported earlier age of onset of drinking, more problems associated with use of alcohol/drugs, more severe psychopathology, and more lifetime arrests, arrests related to substance use, and arrests related to mental health. Prevention and proactive intervention activities are crucial to prevent negative sequelae of childhood victimization.

    View details for DOI 10.1081/ADA-200037546

    View details for Web of Science ID 000225572500006

    View details for PubMedID 15624550

  • A comparison of schizophrenic patients with or without coexisting substance use disorder PSYCHIATRIC QUARTERLY Farris, C., Brems, C., Johnson, M. E., Wells, R., Burns, R., Kletti, N. 2003; 74 (3): 205–22

    Abstract

    Increasing numbers of research investigations have documented psychosocial, demographic, and treatment course differences between schizophrenic patients with and without additional substance use disorder. However, many of these studies have failed to control for additional psychiatric diagnoses. This study sought to elucidate differences between schizophrenic patients with versus without coexisting substance use disorder, while controlling for the possible confounding impact of additional Axis I or Axis II diagnoses. We explored the records of 308 psychiatric inpatients who were either solely diagnosed with schizophrenia or solely diagnosed with coexisting schizophrenia and substance use disorder. We compared these two groups on a variety of psychosocial, demographic, and clinical variables shown in prior research to differentiate these two types of patients. Findings revealed that substance use interacts with schizophrenia to increase psychiatric admissions and decrease lengths of stay upon admission. Findings also revealed that patients with coexisting substance use and schizophrenia have unique psychosocial and demographic presentations that reflect more challenging life circumstances. Differences were not revealed between groups in terms of legal and criminal involvement. Based on pure diagnostic groupings, findings indicate that an additional substance use disorder is associated with psychosocial, demographic, and treatment course differences among individuals with a schizophrenia diagnosis. When screening, developing treatment, and planning aftercare, it is crucial to not view individuals with schizophrenia diagnoses as a monolithic group, but rather to consider the presence of a substance abuse diagnosis; such consideration will increase the likelihood of appropriate treatment and successful outcomes.

    View details for DOI 10.1023/A:1024162819540

    View details for Web of Science ID 000184167900001

    View details for PubMedID 12918597

  • HIV and other infectious disease prevention activities at mental health and substance abuse treatment agencies in Alaska ADMINISTRATION AND POLICY IN MENTAL HEALTH Brems, C., Johnson, M. E., Watkins, K. 2003; 30 (4): 355–59

    View details for DOI 10.1023/A:1024041401700

    View details for Web of Science ID 000183963400005

    View details for PubMedID 12870560

  • Relationship among gender, depression, and needle sharing in a sample of injection drug users PSYCHOLOGY OF ADDICTIVE BEHAVIORS Johnson, M. E., Yep, M. J., Brems, C., Theno, S. A. 2002; 16 (4): 338–41

    Abstract

    The authors explored the relationships among gender, needle sharing, and depression in a sample of 392 male and 121 female street drug users. Using the Risk Behavior Assessment (National Institute on Drug Abuse, 1991) and the Beck Depression Inventory-2 (A. T. Beck, R. A. Steer, & G. K. Brown, 1996), the authors found that women reported higher levels of depression than men and that sharers endorsed higher levels of depression than nonsharers. Further, the authors found that female sharers reported the highest levels of depression of all groups, that is, as compared with male sharers, female nonsharers, and male nonsharers, who did not differ from one another. This suggests the presence of a special dynamic between gender and depression that is related to higher rates of needle sharing among women.

    View details for DOI 10.1037//0893-164X.16.4.338

    View details for Web of Science ID 000179815100008

    View details for PubMedID 12503907

  • Comorbidity training needs at a state psychiatric hospital ADMINISTRATION AND POLICY IN MENTAL HEALTH Brems, C., Johnson, M. E., Bowers, L., Lauver, B., Mongeau, V. A. 2002; 30 (2): 109–20

    Abstract

    This study explored training issues relevant to work with comorbid clients (those with both psychiatric and substance abuse diagnoses) among members of a psychiatric hospital clinical staff (N=147). Respondents reported that they had received limited training for working with comorbid or substance abusing clients; they perceived comorbid clients as presenting with particular concerns, especially regarding referral to treatment services and management of acting-out behaviors; and they attached great importance to the need for training in comorbidity. With high proportions of clients at psychiatric hospitals being comorbid, it is imperative that staff members receive training to deal with substance abuse and comorbidity. These results suggest that such training has not been available, but it is needed and wanted.

    View details for DOI 10.1023/A:1022581001193

    View details for Web of Science ID 000181876800002

    View details for PubMedID 12680616

  • Rates and sequelae of the coexistence of substance use and other psychiatric disorders. International journal of circumpolar health Brems, C., Johnson, M. E., Wells, R. S., Burns, R., Kletti, N. 2002; 61 (3): 224–44

    Abstract

    OBJECTIVES: Despite a growing body of investigations documenting the coexistence of substance use and other psychiatric disorders in a variety of patient populations, no data about comorbidity in the inpatient mental health system in Alaska have been published in scientific journals, and only limited data exist nationwide about coexistence rates in public psychiatric hospitals.METHODS: A retrospective population based study was performed on the entire population of psychiatric patients hospitalized at Alaska Psychiatric Institute (API) between 1993 and 2001. To explore rates of comorbidity, 5,862 patients (who accrued 10,656 visits) were classified according to their diagnostic status; to explore clinical and socio-demographic difference between patients with and without coexisting disorder, univariate analyses were calculated.RESULTS: The study revealed startlingly high rates of comorbidity that have been rising steadily since the early 1990's. In fact, comorbidity has become the rule, not the exception, among patients receiving services at API, with over 60% presenting with coexisting substance use symptoms. Complicating issues even further, these comorbid patients presented with more complex social and interpersonal circumstances, more complex clinical issues, different courses of treatment, and greater symptom complexity than psychiatric-only patients.CONCLUSIONS: 1.) Individual patient level--Providers for psychiatric inpatients must become more prepared to deal with coexisting substance abuse symptoms; policy makers must become more aware of the need for such patients to have smooth transitions from mental health to substance abuse treatment systems. 2.) Systemic-administrative level--Educators must better prepare providers to deal with this challenging clientele.

    View details for PubMedID 12369112

  • The relationship of childhood abuse history and substance use in an Alaska sample SUBSTANCE USE & MISUSE Brems, C., Namyniuk, L. 2002; 37 (4): 473–94

    Abstract

    This study confirms a strong link between childhood abuse history and substance misuse based upon data obtained from an ethnically diverse (largely Alaska Native) sample of 192 pregnant women in substance misuse treatment in the mid-1990s. Nearly three-quarters of the women reported childhood victimization. Compared to women with no abuse history, abused women were significantly younger at the age of onset of substance misuse, used substances more frequently, had experienced more blackouts, had more family members with substance-misuse concerns, were more likely to have been raped, revealed more psychological problems, and had less formal education. Risk patterns differed slightly for women with physical versus sexual abuse histories, with the experience of physical violence having a stronger relationship with adulthood problem behaviors than the experience of sexual molestation. Overall, findings suggest an interactive cycle of violence and substance misuse that begins very early in childhood, especially for women who were physically abused, and continues in adulthood, though no cause-end-effect conclusions can be drawn. Treatment and prevention implications of these findings are discussed.

    View details for DOI 10.1081/JA-120002806

    View details for Web of Science ID 000176016600004

    View details for PubMedID 12064430

  • Recognizing comorbidity among drug users in treatment AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE Johnson, M. E., Brems, C., Burke, S. 2002; 28 (2): 243–61

    Abstract

    This study identified comorbidity (coexistence of substance abuse and mental health diagnoses) rates and characteristics among 104 clients in a substance abuse treatment setting. To identify commonly collected intake variables that can be used for early identification of drug users with coexisting mental health concerns, participants completed a demographics questionnaire, brief symptom inventory, behavior and symptom identification scale (BASIS-32), and a drug and alcohol assessment. Results revealed a comorbidity rate of 45% and significant relationships between comorbidity and the following variables: absence of prior treatment, greater rates of unemployment, poorer physical health, poorer functioning in a variety of areas, greater symptom severity regarding drug use, poorer mental health, and greater rates of homelessness. Of these, the first four variables were the most powerful predictors of comorbidity. It can be concluded that unemployment without looking for work, difficulties relating to self and others, not having received prior outpatient treatment, and having poorer physical health can signal the possible presence of coexisting mental health problems. Implications for early detection and subsequent treatment planning are discussed.

    View details for DOI 10.1081/ADA-120002973

    View details for Web of Science ID 000175385000004

    View details for PubMedID 12014815

  • Self-reported levels of psychopathology of drug abusers not currently in treatment JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT Johnson, M. E., Brems, C., Fisher, D. G. 1996; 18 (1): 21–34

    View details for DOI 10.1007/BF02229100

    View details for Web of Science ID A1996UP37000002

  • ASSESSMENT OF FAIRNESS IN CHILD-CUSTODY DECISIONS CHILD ABUSE & NEGLECT BREMS, C., CARSSOW, K. L., SHOOK, C., STURGILL, S., CANNAVA, P. 1995; 19 (3): 345–53

    Abstract

    Court-appointed child advocates, attorneys, guardians ad litem, and therapists were asked to rate preferred traits for mothers and fathers, and to make custody decisions and abuse likelihood ratings for children in one of two vignettes that varied only as to whether mother or father was described as incompetent to parent without threat of further abuse. Results revealed that this sample of professionals did not hold double standards with respect to attributes important for mothers versus fathers. To the contrary, interpersonal sensitivity traits, traditionally identified as most prevalent among women, were valued equally in mothers and fathers and preferred for both parents to interpersonal potency, traditionally ascribed more readily to men. Further, decisions about custody and placement or abuse likelihood were not affected by any sex-role stereotypes professionals held about parents, nor by professionals' gender or specific occupation. The only factor that affected custody judgments and abuse likelihood ratings was the competence of the parent in question. These findings suggest that biases with regard to gender to gender or traditional sex-role preferences for parents are disappearing among professionals who make important placement decisions in the lives of abused children. Future studies must assess whether these theoretical findings translate into actual behavior in real-life abuse cases for the professional groups represented in this sample.

    View details for DOI 10.1016/S0145-2134(94)00135-9

    View details for Web of Science ID A1995QJ49100011

    View details for PubMedID 9278734

  • PERSON DRAWINGS BY TRANSSEXUAL CLIENTS, PSYCHIATRIC CLIENTS, AND NONCLIENTS COMPARED - INDICATORS OF SEX-TYPING AND PATHOLOGY ARCHIVES OF SEXUAL BEHAVIOR BREMS, C., ADAMS, R. L., SKILLMAN, G. D. 1993; 22 (3): 253–64

    Abstract

    The drawings by 31 transsexual clients, 61 psychiatric inpatients, and 62 nonclient college students were compared to derive information about whether they differed with regard to sex-typing and psychopathology. Transsexuals did not differ from nonclients or psychiatric patients as far as their conceptualization of masculinity is concerned, nor are they more or less sex-role stereotyped. However, their conceptualization of femininity of women differs significantly from that of the other groups in that transsexuals view women as more feminine than either of the other groups. Finally, transsexuals differed from both nonclients and psychiatric patients in inconsistent patterns across other variables, indicating that they are neither similar to nonpathological controls, nor to psychiatric inpatients. This uniqueness of the transsexual group is discussed in the context of multiple possible interpretations.

    View details for DOI 10.1007/BF01541770

    View details for Web of Science ID A1993LA69900006

    View details for PubMedID 8494492