Cathleen E Willging
Biographic Data
| ID | 78686 |
|---|---|
| NAME | Cathleen E Willging |
| GIVEN NAMES | Cathleen E |
| FAMILY NAME | Willging |
| SIGNATURE | WILLGING C E |
| AFFILIATIONS | Pacific Institute For Research and Evaluation |
| ORCID | 0000-0001-6446-5083 |
| VERIFIED | Yes |
| TOTAL WORKS | 42 |
| TOTAL CITATIONS | 114 |
| AUTHOR COUNT | 42 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1997 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 7 |
Barriers to Same-Day Pre-exposure Prophylaxis (PrEP) Implementation in Federally Funded HIV Clinics Within High-Burden Areas of the U.S
Navigating Cultural Adaptation
As the number of forcibly displaced persons worldwide increases, the number of children either forcibly displaced or born as refugees also multiplies. In addition to struggling with basic needs upon resettlement, disruption of daily life can lead to numerous stressors for forcibly displaced parents that may cause friction in the relationship between parent and child. Evidence-based parenting programs may help forcibly displaced parents reconceptu…
A Multigroup Structural Equation Modeling Approach for Analyzing Differences Among Sexually Diverse Youth
High rates of negative behavioral health outcomes among sexually diverse (SD) youth are consistently documented, but population-level trends obscure within-group differences. Social dynamics intersect in youths' lives in ways that cannot be accounted for by summing their independent effects. An intersectional perspective is essential to understanding the behavioral health outcomes of SD youth. We performed multigroup structural equation modeling …
Promises and challenges of cultural exchange for use of research evidence in child welfare
Incorporating research evidence within child welfare systems can improve services and health equity for vulnerable youth. Bidirectional collaboration between researchers and system-level actors may foster evidence-informed policies and programs through cultural exchange. This anthropological analysis of longitudinal qualitative data from the Community-Academic Partnership for Translational Use of Research Evidence (CAPTURE) illuminates the comple…
Implementation of LGBTQ+ affirming care policies in the Veterans Health Administration
Background: In the United States Department of Veterans Affairs (VA), veterans who are lesbian, gay, bisexual, transgender, queer, and similar gender and sexual minoritized people (LGBTQ+) experience health disparities compared to cisgender, heterosexual veterans. VA's LGBTQ+ Health Program created two healthcare policies on providing LGBTQ+ affirming care (healthcare that is inclusive, validating, and understanding of the LGBTQ+ population). The…
It’s hard because it’s something new”
Purpose Parent–child relationships formed in early childhood have profound implications for a child’s development and serve as a determinant for bio-social outcomes in adulthood. Positive parenting behaviors play a strong role in this development and are especially impactful during times of crisis because they buffer stressors that may lead to externalizing and internalizing behaviors. Children of forced migrants experience numerous extreme stres…
Readiness to implement screening, brief intervention, and referral to treatment in school‐based health centers
The purpose of this study was to evaluate the readiness of a university‐based school‐based health center (SBHC) program to implement the screening, brief intervention, and referral to treatment (SBIRT) model. We completed preimplementation surveys and interviews with providers, staff, and administrators at participating SBHCs ( N = 19) to measure current protocols for and barriers to addressing adolescent substance use and barriers and facilitato…
Causes and Consequences of Not Having a Personal Healthcare Provider Among American Indian Elders
Having a regular relationship with a healthcare provider contributes to better health outcomes and greater satisfaction with care for older adults. Although members of federally recognized American Indian tribes have a legal right to healthcare, American Indian Elders experience inequities in healthcare access that may compromise their ability to establish a relationship with a healthcare provider. This multi-year, community-driven, mixed-method …
Findings from a Structured Adaptation Process for the SafeCare Parenting Program to Address Family Needs in a Diverse Refugee Community
Social workers can promote resiliency among refugee families by referring them to evidence-based programs to reduce the stressors of resettlement. The purpose of this study was to complete a structured adaptation process with the SafeCare® program for implementation in a refugee resettlement community. Participants included 21 members of an adaptation team made up of administrators, supervisors, and family service providers from three community a…
Getting to know
American Indian (AI) Elders are the heart of the community. Existing research explores links between specific health behaviors and social determinants of health , but there is little theory explaining patient behaviors in the context of the Indian Health Service (IHS) system of care. We drew from a multiyear mixed-methods participatory study of Elder healthcare experiences to identify the systemic, interpersonal, and historical factors in the IHS…
Intimate Partner Violence and Structural Violence in the Lives of Incarcerated Women
Intimate partner violence (IPV) is a common feature in the lives of incarcerated women returning to rural communities, enhancing their risk of mental ill-health, substance use, and recidivism. Women's experiences of IPV intersect with challenges across multiple social-ecological levels, including risky or criminalizing interpersonal relationships, geographic isolation, and persistent gender, racial, and economic inequities. We conducted quantitat…
Adaptation and implementation of a parenting curriculum in a refugee/immigrant community using a task-shifting approach
The need for adapting of evidence-based programs and delivery methods for specific populations continues to be an important research question in implementation science. The goal of this study is to better understand an adaptation process and delivery method for three unique populations. We hope the study will inform other efforts to deliver health intervention to refugee communities and ultimately improve refugee health
Macro- and meso-level contextual influences on health care inequities among American Indian elders
Findings point to recommendations to improve the prevention and treatment of illness among American Indian elders by meeting their unique health care and insurance needs. Policies and practices must target meso and macro levels of contextual influence. Although Medicaid expansion under the ACA enables providers of essential services to elders, including the IHS, to enhance care through increased reimbursements, future policy efforts must improve …
A randomized control trial to test a peer support group approach for reducing social isolation and depression among female Mexican immigrants
This study was registered with ClinicalTrials.gov on 2/3/20, Identifier # NCT04254198
Production and maintenance of the institutional in/visibility of sexual and gender minority students in schools
This research investigates how school professionals, as institutional actors, influence school climates experienced by lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth. Although research links institutional characteristics to outcomes for LGBTQ youth, scholars do not yet fully understand the mechanisms. We address this gap through a mesolevel analysis of staff perspectives on schools' responsibilities to LGBTQ students. Us…
Using Concept Mapping to Understand Gender- and Age-Specific Factors Influencing Health Care Access among American Indian Elders
Inequities in access to health care create barriers to physical and mental health treatment for the rapidly aging American Indian population in the United States. This study uses concept mapping-a participatory, mixed-methods approach to understanding complex phenomena-to examine the perceived impacts of multilevel factors influencing Elders' ability to access and use health care and how these perceptions vary according to gender and age, with th…
Producing insecurity
Although health care is a treaty-guaranteed right for members of federally recognized tribes, decades of research describe persistent disparities in health and access to health services for American Indians. Despite gains in insurance enrollment after the passage of the 2010 Affordable Care Act, underfunding of the Indian Health Service and national debate over the new health law contributes to insecurity, especially among the majority of America…
Applying a Structural‐Competency Framework to the Implementation of Strategies to Reduce Disparities for Sexual and Gender Minority Youth
BACKGROUND: Sexual and gender minority youth (SGMY) are at high risk for adverse health outcomes. Safer schools decrease this risk. The US Centers for Disease Control and Prevention has identified 6 practices that can make schools safer for SGMY, yet few US schools implement them all. We apply a structural competency framework to elucidate factors contributing to this implementation gap. METHODS: We conducted 75 interviews and 32 focus groups wit…
Enacting competition, capacity, and collaboration
Funders increasingly encourage social and health service organizations to strengthen their impact on public health through the implementation of evidence-based interventions (EBIs). Local governments in the U.S. often utilize market-based contracting to facilitate EBI delivery via formal relationships with non-governmental community-based organizations (CBOs). We sought to understand how the discourses embedded within contracting to compete and p…
Ambivalence in how to address adolescent marijuana use
As part of a larger study to evaluate the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) at school-based health centers (SBHCs), we interviewed 12 SBHC providers regarding their perceptions of substance use among adolescents seen at their SBHCs, experiences providing care for students with substance use and other mental health concerns, and their concerns around marijuana. Six themes emerged from the interviews…
Health Care Access and Utilization for American Indian Elders
Findings suggest that improvements in access to and utilization of health care among AIEs will require actions across multiple domains, including health system navigation services, workforce improvements, and tribal, state, and federal policy. A multilevel socioecological approach is necessary to organize and undertake these actions
Structural competency in emergency medicine services for transgender and gender non-conforming patients
In this formative qualitative research, we draw upon the concepts of structural vulnerability and structural competency to examine how transgender and gender non-conforming (TGGNC) patients and healthcare personnel experience service delivery in Emergency Departments (EDs), and how this experience can be improved upon. Between October 2016 and June 2017, we undertook 31 semi-structured interviews with TGGNC patients (n = 11) and physicians (n = 6…
The good coach
This paper demonstrates that coaching can accomplish more than provision of EBI fidelity support. Stakeholders characterized coaches as operating as boundary spanners who link inner and outer contexts to enable EBI implementation and sustainment
A Mixed-Method Assessment of a Pilot Peer Advocate Intervention for Rural Gender and Sexual Minorities
Structural Inequality and Social Support for Women Prisoners Released to Rural Communities
Incarceration and community reentry for rural women reflect gendered processes. We draw upon in-depth semi-structured interviews and focus groups to examine the return of women prisoners to underserved rural communities, while attending to the perspectives of their closest social supporters. Our findings underscore the complexity of the reentry process for rural women and its particular impact on their families. We challenge dominant discourses o…
Safety-Net Institutions Buffer the Impact of Medicaid Managed Care
Objectives. This project used a long-term, multi-method approach to study the impact of Medicaid managed care. Methods. Survey techniques measured impacts on individuals, and ethnographic methods assessed effects on safety-net providers in New Mexico. Results. After the first year of Medicaid managed care, uninsured adults reported less access and use (odds ratio [OR] = 0.46; 95% confidence interval [CI] = 0.34, 0.64) and worse barriers to care (…
Power, Blame, and Accountability
I examine the provision of mental health services to Medicaid recipients in New Mexico to illustrate how managed care accountability models subvert the allocation of responsibility for delivering, monitoring, and improving care for the poor. The downward transfer of responsibility is a phenomenon emergent in this hierarchically organized system. I offer three examples to clarify the implications of accountability discourse. First, I problematize …
Structural competency in emergency medicine services for transgender and gender non-conforming patients
In this formative qualitative research, we draw upon the concepts of structural vulnerability and structural competency to examine how transgender and gender non-conforming (TGGNC) patients and healthcare personnel experience service delivery in Emergency Departments (EDs), and how this experience can be improved upon. Between October 2016 and June 2017, we undertook 31 semi-structured interviews with TGGNC patients (n = 11) and physicians (n = 6…
Medicaid Managed Care for Mental Health Services
Few accounts document the rural context of mental health safety net institutions (SNIs), especially as they respond to changing public policies. Embedded in wider processes of welfare state restructuring, privatization has transformed state Medicaid systems nationwide. We carried out an ethnographic study in two rural, culturally distinct regions of New Mexico to assess the effects of Medicaid managed care (MMC) and the implications for future re…
Producing insecurity
Although health care is a treaty-guaranteed right for members of federally recognized tribes, decades of research describe persistent disparities in health and access to health services for American Indians. Despite gains in insurance enrollment after the passage of the 2010 Affordable Care Act, underfunding of the Indian Health Service and national debate over the new health law contributes to insecurity, especially among the majority of America…
Community Participation in New Mexico's Behavioral Health Care Reform
In 2005, New Mexico implemented a unique reform in managed behavioral health services that seeks to ensure delivery of consumer-driven, recovery-oriented care to low-income individuals. Distinguishing features of the reform are the Local Collaboratives (LCs), regionally based community organizations designed by state government to represent behavioral health concerns of New Mexico's diverse cultural populations. We examine community response to t…
"Substance Abuse Treatment Provider Views of "Culture
Mandates for culturally competent substance abuse and mental health services call for behavioral health providers to recognize and engage cultural issues. These efforts to incorporate culture typically focus on client culture, but provider views of culture can also influence the provision of services. Analysis of 42 semistructured interviews with behavioral health providers suggests that culture is considered by many to be an obstacle to help see…
Hitting the Wall
We examine the experience of boredom and its relationship to troublemaking and drug use among rural youth in southwestern New Mexico. We draw on qualitative research with area youth to describe what they think about drug use and how they situate it within their social circumstances. We then locate youth drug use within globalized processes affecting this setting, including a local economic environment with limited educational and employment oppor…
An ethnography of clinic "noise" in a community-based, promotora-centered mental health intervention
A Mixed-Method Assessment of a Pilot Peer Advocate Intervention for Rural Gender and Sexual Minorities
Research-Supported Intervention and Discretion Among Frontline Workers Implementing Home Visitation Services
Workers dynamically negotiated multiple system- and provider-level (or outer- and inner-contextual) demands influencing RSI provision for clients with complex service needs. Results affirm the need to attend to the unintended consequences of implementing new contract, reimbursement, and other system organizational processes and to address the "committed work" supporting RSI delivery
Health Care Access and Utilization for American Indian Elders
Findings suggest that improvements in access to and utilization of health care among AIEs will require actions across multiple domains, including health system navigation services, workforce improvements, and tribal, state, and federal policy. A multilevel socioecological approach is necessary to organize and undertake these actions
Interagency Collaborative Team model for capacity building to scale-up evidence-based practice
An Old Way to Solve an Old Problem
The goal of recovery has emerged as a core value in the reformation of public and private mental health services in the last twenty years. However, definitions of recovery remain as varied as methods of implementation. Through an ethnographic lens, we examine meanings of recovery in the context of a major statewide reform of mental health services in New Mexico, focusing specifically on provider-voiced concerns regarding recovery and recovery-ori…
It’s hard because it’s something new”
Purpose Parent–child relationships formed in early childhood have profound implications for a child’s development and serve as a determinant for bio-social outcomes in adulthood. Positive parenting behaviors play a strong role in this development and are especially impactful during times of crisis because they buffer stressors that may lead to externalizing and internalizing behaviors. Children of forced migrants experience numerous extreme stres…
Findings from a Structured Adaptation Process for the SafeCare Parenting Program to Address Family Needs in a Diverse Refugee Community
Social workers can promote resiliency among refugee families by referring them to evidence-based programs to reduce the stressors of resettlement. The purpose of this study was to complete a structured adaptation process with the SafeCare® program for implementation in a refugee resettlement community. Participants included 21 members of an adaptation team made up of administrators, supervisors, and family service providers from three community a…
Ambivalence in how to address adolescent marijuana use
As part of a larger study to evaluate the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) at school-based health centers (SBHCs), we interviewed 12 SBHC providers regarding their perceptions of substance use among adolescents seen at their SBHCs, experiences providing care for students with substance use and other mental health concerns, and their concerns around marijuana. Six themes emerged from the interviews…
The good coach
This paper demonstrates that coaching can accomplish more than provision of EBI fidelity support. Stakeholders characterized coaches as operating as boundary spanners who link inner and outer contexts to enable EBI implementation and sustainment
The Impact of State Behavioral Health Reform on Native American Individuals, Families, and Communities
In 2005, the State of New Mexico undertook a sweeping transformation of all publicly funded behavioral health services. The reform was intended to enhance the cultural responsiveness and appropriateness of these services. To examine achievement of this objective, we conducted a qualitative study of the involvement of Native Americans in reform efforts and the subsequent impacts of reform on services for Native Americans. We found that the reform …
Preparing for a Public Sector Mental Health Reform in New Mexico
The Health of Native Americans
The Health of Native Americans: Towards a Biocultural Epidemiology. T. Kue Young. New York: Oxford University Press, 1994 (cloth), ix + 275 pp. Aboriginal Health in Canada: Historical, Cultural, and Epidemiological Perspectives. James B. Waldram, D. Ann Herring, and T. Kue Young. Toronto: University of Toronto Press, 1995 (cloth and paper), xii + 334 pp
Safety-Net Institutions Buffer the Impact of Medicaid Managed Care
Objectives. This project used a long-term, multi-method approach to study the impact of Medicaid managed care. Methods. Survey techniques measured impacts on individuals, and ethnographic methods assessed effects on safety-net providers in New Mexico. Results. After the first year of Medicaid managed care, uninsured adults reported less access and use (odds ratio [OR] = 0.46; 95% confidence interval [CI] = 0.34, 0.64) and worse barriers to care (…
Clanship andK'È
I examine the significance of clanship ties among mental health clinicians and patients in a counseling center on the Navajo Nation. Navajo clans are matrilineal, exogamous, and geographically dispersed social units. Clan relatives are expected to observe the rules of conduct embodied in the behavioral code of k'È. This code structures social interaction among clan relatives, obliging each party to employ intimate, age-appropriate kin designation…
Power, Blame, and Accountability
I examine the provision of mental health services to Medicaid recipients in New Mexico to illustrate how managed care accountability models subvert the allocation of responsibility for delivering, monitoring, and improving care for the poor. The downward transfer of responsibility is a phenomenon emergent in this hierarchically organized system. I offer three examples to clarify the implications of accountability discourse. First, I problematize …
I'm Not That Innocent”
There is a dearth of research, anthropological and otherwise, focused on the mental health needs of sexual and gender minorities in rural areas. The risk for mental illness is greater for such groups due to their repeated exposure to psychosocial stressors associated with discrimination, stigmatization, and violence. The consequences of such exposure may be exacerbated in rural areas, where mental health resources are typically insufficient for t…
An ethnography of clinic "noise" in a community-based, promotora-centered mental health intervention
"Substance Abuse Treatment Provider Views of "Culture
Mandates for culturally competent substance abuse and mental health services call for behavioral health providers to recognize and engage cultural issues. These efforts to incorporate culture typically focus on client culture, but provider views of culture can also influence the provision of services. Analysis of 42 semistructured interviews with behavioral health providers suggests that culture is considered by many to be an obstacle to help see…
Medicaid Managed Care for Mental Health Services
Few accounts document the rural context of mental health safety net institutions (SNIs), especially as they respond to changing public policies. Embedded in wider processes of welfare state restructuring, privatization has transformed state Medicaid systems nationwide. We carried out an ethnographic study in two rural, culturally distinct regions of New Mexico to assess the effects of Medicaid managed care (MMC) and the implications for future re…
Community Participation in New Mexico's Behavioral Health Care Reform
In 2005, New Mexico implemented a unique reform in managed behavioral health services that seeks to ensure delivery of consumer-driven, recovery-oriented care to low-income individuals. Distinguishing features of the reform are the Local Collaboratives (LCs), regionally based community organizations designed by state government to represent behavioral health concerns of New Mexico's diverse cultural populations. We examine community response to t…
Preparing for a Public Sector Mental Health Reform in New Mexico
An Old Way to Solve an Old Problem
The goal of recovery has emerged as a core value in the reformation of public and private mental health services in the last twenty years. However, definitions of recovery remain as varied as methods of implementation. Through an ethnographic lens, we examine meanings of recovery in the context of a major statewide reform of mental health services in New Mexico, focusing specifically on provider-voiced concerns regarding recovery and recovery-ori…
The Impact of State Behavioral Health Reform on Native American Individuals, Families, and Communities
In 2005, the State of New Mexico undertook a sweeping transformation of all publicly funded behavioral health services. The reform was intended to enhance the cultural responsiveness and appropriateness of these services. To examine achievement of this objective, we conducted a qualitative study of the involvement of Native Americans in reform efforts and the subsequent impacts of reform on services for Native Americans. We found that the reform …
Culturally Competent Services Within a Statewide Behavioral Healthcare Transformation
In 2005, New Mexico created a single health plan to administer all publicly funded behavioral health services. Our mixed‐method study combined surveys, document review, and ethnography to examine this reform's influence on culturally competent services (CCS). Participants were executives, providers, and support staff of behavioral healthcare agencies. Key variables included language access services and organizational supports, i.e., training, sel…
Interagency Collaborative Team model for capacity building to scale-up evidence-based practice
Hitting the Wall
We examine the experience of boredom and its relationship to troublemaking and drug use among rural youth in southwestern New Mexico. We draw on qualitative research with area youth to describe what they think about drug use and how they situate it within their social circumstances. We then locate youth drug use within globalized processes affecting this setting, including a local economic environment with limited educational and employment oppor…
Research-Supported Intervention and Discretion Among Frontline Workers Implementing Home Visitation Services
Workers dynamically negotiated multiple system- and provider-level (or outer- and inner-contextual) demands influencing RSI provision for clients with complex service needs. Results affirm the need to attend to the unintended consequences of implementing new contract, reimbursement, and other system organizational processes and to address the "committed work" supporting RSI delivery
Structural Inequality and Social Support for Women Prisoners Released to Rural Communities
Incarceration and community reentry for rural women reflect gendered processes. We draw upon in-depth semi-structured interviews and focus groups to examine the return of women prisoners to underserved rural communities, while attending to the perspectives of their closest social supporters. Our findings underscore the complexity of the reentry process for rural women and its particular impact on their families. We challenge dominant discourses o…
Coaching mental health peer advocates for rural LGBTQ people
Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) people are affected by mental health disparities, especially in rural communities. We trained peer advocates in rural areas in the fundamentals of mental health, outreach, education, and support for this population. The peer advocates were coached by licensed mental health professionals. We evaluated this process through iterative qualitative analysis of semi-structured intervi…
A Mixed-Method Assessment of a Pilot Peer Advocate Intervention for Rural Gender and Sexual Minorities
The good coach
This paper demonstrates that coaching can accomplish more than provision of EBI fidelity support. Stakeholders characterized coaches as operating as boundary spanners who link inner and outer contexts to enable EBI implementation and sustainment
Health Care Access and Utilization for American Indian Elders
Findings suggest that improvements in access to and utilization of health care among AIEs will require actions across multiple domains, including health system navigation services, workforce improvements, and tribal, state, and federal policy. A multilevel socioecological approach is necessary to organize and undertake these actions
Structural competency in emergency medicine services for transgender and gender non-conforming patients
In this formative qualitative research, we draw upon the concepts of structural vulnerability and structural competency to examine how transgender and gender non-conforming (TGGNC) patients and healthcare personnel experience service delivery in Emergency Departments (EDs), and how this experience can be improved upon. Between October 2016 and June 2017, we undertook 31 semi-structured interviews with TGGNC patients (n = 11) and physicians (n = 6…
Applying a Structural‐Competency Framework to the Implementation of Strategies to Reduce Disparities for Sexual and Gender Minority Youth
BACKGROUND: Sexual and gender minority youth (SGMY) are at high risk for adverse health outcomes. Safer schools decrease this risk. The US Centers for Disease Control and Prevention has identified 6 practices that can make schools safer for SGMY, yet few US schools implement them all. We apply a structural competency framework to elucidate factors contributing to this implementation gap. METHODS: We conducted 75 interviews and 32 focus groups wit…
Enacting competition, capacity, and collaboration
Funders increasingly encourage social and health service organizations to strengthen their impact on public health through the implementation of evidence-based interventions (EBIs). Local governments in the U.S. often utilize market-based contracting to facilitate EBI delivery via formal relationships with non-governmental community-based organizations (CBOs). We sought to understand how the discourses embedded within contracting to compete and p…
Ambivalence in how to address adolescent marijuana use
As part of a larger study to evaluate the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) at school-based health centers (SBHCs), we interviewed 12 SBHC providers regarding their perceptions of substance use among adolescents seen at their SBHCs, experiences providing care for students with substance use and other mental health concerns, and their concerns around marijuana. Six themes emerged from the interviews…
Medicine (30 works) · Psychology (29 works) · Sociology (28 works) · Political science (26 works) · Nursing (20 works) · Health care (15 works) · Qualitative research (15 works) · Social Psychology (15 works) · Mental health (13 works) · Population (13 works)