Ukamaka Oruche

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https://hdl.handle.net/1805/14113

Dr. Ukamaka Oruche’s interdisciplinary intervention program supports parents and caregivers of adolescents with disruptive behavior disorders (DBD). Adolescents with DBD, characterized by ongoing patterns of antisocial and defiant behaviors, have lower educational achievement, greater involvement with the criminal justice system, and lower rates of stable, long-term placement in the child welfare system than adolescents without DBD.

These adolescents have complex treatment regimens that require active parent involvement with child service and mental health systems. Parents describe feeling stressed, disrespected, and blamed for their adolescents’ behavior problems. These negative experiences leave parents feeling disengaged from care and less likely to follow recommended treatment, which can contribute to poor adolescent outcomes.

Low-income urban parents, particularly African Americans, are at greater risk for aversive interactions with professionals because of socio-economic disadvantage. Dr. Oruche developed the theoretical-based Family Management Efficacy intervention to address the stress parents and caregivers experience in caring for their adolescents with DBD.

Her intervention research is designed to strengthen family member’s perceived self-efficacy to manage interactions both within the family and with child service system professionals. Research products include a standardized treatment manual, a facilitator guide, parent workbooks, and fidelity checklists.

Dr. Oruche’s work to support parents and caregivers of adolescents with DBD is another example of how IUPUI faculty are TRANSLATING RESEARCH INTO PRACTICE.

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    Research With Cognitively Impaired Participants
    (2009-10) Oruche, Ukamaka M.
    Illnesses that cause cognitive impairment are a considerable health problem in the United States. These include Alzheimer's disease, Huntington's chorea, cerebrovascular disease, psychiatric disorders, chronic alcoholism, and AIDS dementia complex. Illness associated with cognitive impairment may cause great suffering to the affected patients and their families. Research involving individuals who may be at risk for or have cognitive impairment is necessary to improve our understanding of these illnesses. For example, this may occur during efforts to develop effective therapies to treat them. However, research with participants who have cognitive impairment presents additional ethical concerns because they may be vulnerable to coercion. Therefore, nurse researchers must not only understand the principles of informed consent (i.e., autonomy, beneficence, nonmaleficence, and justice), but also the additional safeguards provided in the common rule to protect cognitively impaired participants in research. These safeguards include advanced informed consent, legal representative, and assent. Gaps exist in federal regulations related to adhering to these safeguards such as how to assess for decision-making capacity and variations on who can be a legal representative. The nurse researchers have potential roles as educators and advocates in research involving participants with cognitive impairment.
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    Predicting Treatment Response of Adolescents with Serious Emotional Disturbance
    (APNA 25th Annual Conference, 2011-10-20) Oruche, Ukamaka M.
    System of care (SOC) philosophy values child-guided and family-driven care and emphasizes that services must be delivered in a way that enhances dignity, respects wishes and goals, maximizes opportunities for active involvement for adolescents and their families. Our specific aim was to was to examine whether changes in adolescent personal strengths and family functioning over 12 months predicted changes in behavioral and social functioning for adolescents with disruptive disorders who participated in a SOC program.
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    Predicting Treatment Response of Adolescents with Serious Emotional Disturbance
    (2012-03-19) Oruche, Ukamaka Marian; Gerkensmeyer, Janis E.; Austin, Joan Kessner; Wright, Eric R.; Rawl, Susan M.; Perkins, Susan M.
    Serious emotional disturbance, including disruptive disorders (i.e., attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder), affects large numbers of adolescents, with costly and tragic consequences. Adolescents with disruptive disorders are likely to be arrested, drop out of school, and have poor treatment outcomes. There is an urgent need to identify strengths-based factors associated with improvement in adolescents’ behavioral and social functioning to help them achieve their full potential. The purpose of this study was to determine whether change in adolescent personal strengths and change in family functioning over 12 months predicted changes in behavioral and social functioning for adolescents with disruptive disorders who participated in a System of Care (SOC) program and if findings varied by race. De-identified data from 179 adolescents, aged 12-17 years, with disruptive disorders and their caregivers were included in this secondary analysis. Data were analyzed using Pearson correlations, t-tests, chi-square tests, and multivariate multiple regressions. Upon admission to the program, caregiver ratings indicated that African American adolescents had greater personal strengths (p = .001), fewer behavior problems (p < .001), and less functional impairment (p < .001) compared to their Caucasian counterparts. Girls had more behavior problems (p = .05) and fewer personal strengths than boys (p < .001). Increase in caregiver-rated adolescent personal strengths was significantly associated with improvement in caregiver-rated adolescent behavioral and social functioning (p < .001). Change in caregiver-rated family functioning was not significantly associated with change in caregiver-rated adolescent behavioral and social functioning (p = .171). The strength and direction of predictors did not vary by race. The adolescents in the study participated in a SOC program that emphasized their strengths versus, primarily, focusing on their deficits. Change in caregiver ratings of adolescent personal strengths was a significant predictor of change in adolescent behavioral and social functioning over a 12 months period. Findings provide evidence for psychiatric mental health professionals to focus on enhancing adolescent personal strengths to improve behavioral and social functioning in adolescents with disruptive disorders. Future research is needed to understand the impact of family variables on adolescents’ treatment outcomes.
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    Recruitment Strategies for Caregivers of Children with Mental Health Problems
    (2012-07) Oruche, Ukamaka M.; Gerkensmeyer, Janis E.; Austin, Joan K.; Perkins, Susan M.; Scott, Eric; Lindsey, Laura M.; Mullins, Kristen
    PURPOSE: The aim of this study was to describe strategies for recruiting participants into an intervention study that focused on improving problem-solving skills in caregivers of children with mental health problems. BACKGROUND: Caregivers of children with mental health problems report feeling physically and psychologically overwhelmed and have high rates of depression because of the demands of caregiving. Research on the needs of these caregivers and interventions to ameliorate their stress is needed. However, recruiting this population can be particularly difficult because of the stigma of mental illness. Available literature on recruitment of caregivers of persons with physical illness cannot be transferred to caregivers of children with mental health problems because of the different caregiving situations. There is a need to identify effective recruitment strategies to reduce cost and answer research questions. Clinical nurse specialists have the skills to facilitate the recruitment of research participants. We revised and expanded health system referrals, community outreach, and recruiting advertisement (ads). When these strategies did not increase recruitment, radio ads were used. The Andersen's Behavioral Model of Health Services Utilization was selected as a guiding framework. OUTCOME: Radio ads were the most effective strategy for recruiting caregivers of children with mental health problems for this study. CONCLUSION: Recruitment was ultimately successful because we were flexible and made decisions consistent with the Andersen's Behavioral Model of Health Services Utilization. IMPLICATIONS: Clinical nurse specialists who study this population of caregivers should really consider the use of radio ads and systematically track which recruitment strategies lead to the greatest number of participants screened, eligible, and enrolled into studies.
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    A nurse-physician led multidisciplinary team improves access, treatment, and management of diabetes and high blood pressure in adult residents of a rural community in Nigeria
    (Sigma Theta Tau International, 2012-08-01) Oruche, Ukamaka M.; Obiadazie, Okwudiri O; Obeime, Mercy
    Developing countries have limited resources contributing to high morbidity and mortality rates from chronic diseases. The purpose of this presentation is to describe an innovative nurse-physician led international collaboration to increase access to health care and improve treatment and behavioral management of diabetes and hypertension in adult residents of a rural community in Nigeria, West Africa.
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    The Described Experience of Primary Caregivers of Children with Mental Health Needs
    (2012-10) Oruche, Ukamaka M.; Gerkensmeyer, Janis; Stephen, Linda; Wheeler, Corrine A; Hanna, Kathleen M.
    About 10% of our nation's children have serious mental health needs that result in significant functional impairments. Although research has found that primary caregivers of children with mental health needs have high levels of depressive symptoms and distress, little is known about the challenges these caregivers face. Focus groups with 20 caregivers of children with mental health needs between 2 and 17 years of age revealed these themes: struggling with care systems, living in fear, being burdened and exhausted, worrying about the rest of the family, and having good things happen. Caregivers described extreme challenges and many unmet needs that are important to consider in efforts to improve both children's and caregivers' well-being.
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    Problems and Goals Identified by Primary Caregivers of Children with Mental Health Problems During a Problem-solving Intervention
    (The 26th Annual Children's Mental Health Research & Policy Conference, 2013-03-03) Gerkensmeyer, Janis E.; Oruche, Ukamaka M.
    Building Our Solutions and Connections intervention focused on enhancing problem-solving skills of 44 primary caregivers of children with mental health problems. Problems and goals were identified by individual caregivers during a nine week problem-solving intervention that included a face-to-face one-hour intervention followed by eight half-hour telephone interventions. The problem identified most often was child behavior (43 times). A summary of the problems and goals selected by these primary caregivers has been described.
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    Problem-solving Intervention for Caregivers of Children with Mental Health Problems
    (Midwest Nursing Research Society 37th Annual Research Conference, 2013-03-08) Oruche, Ukamaka M.
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    Barriers and facilitators to treatment participation by adolescents in a community mental health clinic
    (2013-05-17) Oruche, Ukamaka M.; Downs, Sarah M.; Holloway, Evan D.; Burke Draucker, Claire; Aalsma, Matthew C.
    An estimated 40–60% of children in mental health treatment drop out before completing their treatment plans, resulting in increased risk for ongoing clinical symptoms and functional impairment, lower satisfaction with treatment, and other poor outcomes. Research has focused predominately on child, caregiver, and family factors that affect treatment participation in this population and relatively less on organizational factors. Findings are limited by focus on children between 3 and 14 years of age and included only caregivers’ and/or therapists’ perspectives. The purpose of this descriptive qualitative study was to identify organizational factors that influenced participation in treatment, with special attention to factors that contributed to dropout in adolescents. The sample included 12 adolescent–caregiver dyads drawn from two groups in a large public mental health provider database. Analysis of focus group interview data revealed several perceived facilitators and barriers to adolescent participation in treatment and provided several practical suggestions for improving treatment participation. Implications of the findings for psychiatric mental health nurses and other clinicians who provide services to families of adolescents with mental health concerns are discussed.
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    Problem-Solving Intervention for Caregivers of Children with Mental Health Problems
    (2013-06) Gerkensmeyer, J. E.; Johnson, Cynthia S.; Scott, Eric L.; Oruche, Ukamaka M.; Lindsey, L. M.; Austin, Joan K.; Perkins, Susan M.
    Building Our Solutions and Connections (BOSC) focused on enhancing problem-solving skills (PSS) of primary caregivers of children with mental health problems. Aims were determining feasibility, acceptability, and effect size (ES) estimates for depression, burden, personal control, and PSS. Methods—Caregivers were randomized to BOSC (n=30) or wait-list control (WLC) groups (n=31). Data were collected at baseline, post-intervention, and 3 and 6 months post-intervention. Results—Three-months post-intervention, ES for burden and personal control were .07 and .08, respectively. ES for depressed caregivers for burden and personal control were 0.14 and 0.19, respectively. Conclusions—Evidence indicates that the intervention had desired effects.