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Creating Culturally Competent and Responsive Mental Health Services: A Case Study Among the Amish Population of Geauga County, Ohio


Providing effective mental health services requires knowledge about and cultural competence across a wide array of beliefs and practices. This study provides an example of a successful project to improve public mental health service delivery in an Amish community. County boards of mental health in a rural area of Northeast Ohio contacted researchers in 1998 to provide assistance in reaching the Amish community because of a concern that mental health services were not being utilized by the Amish population. Following meetings with community leaders, changes were made to improve the relationships of service providers and public funding agencies with the local Amish community, disseminate information about mental health concerns and services, and improve accessibility to mental health services. In 2013, a follow-up analysis of records found a 320% increase in public mental health service utilization by the Amish community within the first five years after these changes were made.

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    For the purposes of this paper, the authors operationalize “cultural competence” using Betancourt et al.’s definition: “understanding the importance of social and cultural influences on patients’ health beliefs and behaviors; considering how these factors interact at multiple levels of the health care delivery system (e.g., at the level of structural processes of care or clinical decision-making); and, finally, devising interventions that take these issues into account to assure quality health care delivery to diverse patient populations.”1(p. 297)

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    Noted Amish scholar Hostetler borrows Hall’s notion to describe the Amish as a “high-context culture.”18 In high-context cultures, deep connections and unspoken knowledge exist between actors.18 This practice emphasizes importance of place within networks and allows new contacts to place one another socially.


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Correspondence to Sarah C. Miller-Fellows MA, MPH.

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The authors have no conflicts of interest to disclose.

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Miller-Fellows, S.C., Adams, J., Korbin, J.E. et al. Creating Culturally Competent and Responsive Mental Health Services: A Case Study Among the Amish Population of Geauga County, Ohio. J Behav Health Serv Res 45, 627–639 (2018).

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