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Disparities in Mental Health Service Utilization among Low-Income African American Adolescents: Closing the Gap by Enhancing Practitioner’s Competence

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ABSTRACT

The lack of racial and ethnic match as a barrier to care in mental health treatment services has received considerable attention. In systems of care, which provide public mental health services to African American adolescents, the provider base is largely non-African American. This difference presents a challenge for African American adolescents and their parents who want a provider who is sensitive to the issues, which define their lives. Racial disparities in the utilization of mental health treatment services are well documented; and many providers want to development mental health treatment interventions, which increase access and utilization. However, the findings associated with increasing access and utilization are generally predicated on the structural barriers to care. Very little attention has been given to the non-structural barriers for access to and utilization of mental health treatment services. The purpose of this paper is to increase practitioners’ knowledge of the interpersonal barriers to treatment, which can result from the socio-cultural environment of many African American adolescents. Enhancing the provider knowledge base is viewed as one strategy to closing the racial disparity gap in access to and utilization of adolescent mental health services for African Americans.

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References

  • Abe-Kim S., Takeuchi D. T., (1996). Cultural competence and quality of care: Issues for mental health services delivery in managed care Clinical Psychology Science and Practice 3: 273–295

    Article  Google Scholar 

  • Allen-Meares P., (1995). Social work with children and adolescents Longman White Plains

    Google Scholar 

  • Allen R. L., (1998). The media, group identity, and self esteem among African Americans: A program of research African American Research Perspectives 4: 61–67

    Google Scholar 

  • Anderson R., (1995). Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior 36(March): 1–10

    Article  Google Scholar 

  • Bachrach C., Newcomer S. F., (2002). Addressing bias in intervention research: Summary of a workshop Journal of Adolescent Health 31(4): 311–321

    Article  PubMed  Google Scholar 

  • Barkley L. C., (2000). Make an impact before that teen leaves your office Minority Health Today 1(4): 25–30

    Google Scholar 

  • Betancourt J. R., Green A. R., Carrillo J. E., (2002). Culture competence in health care: Emerging frameworks and practical approaches The Commonwealth Fund New York

    Google Scholar 

  • Betancourt J. R., Green A. R., Carrillo J. E., Ananeh-Firempong O., (2003). Defining culture competence: A practical framework for addressing racial/ethnic disparities in health and health care Public Health Reports 118: 293–302

    PubMed  Google Scholar 

  • Boldero J., Fallon B., (1995). Adolescent help-seeking: Who do they get help for and from whom? Journal of Adolescence 18: 193–209

    Article  Google Scholar 

  • Brach C., Fraserirector I., (2000). Can cultural competency reduce racial and ethnic disparities? A review and conceptual model Medical Care and Research and Review 57(1): 181–217

    Article  Google Scholar 

  • Broman C. L., (1997). Race-related factors and life satisfaction among African Americans Journal of Black Psychology 23: 36–49

    Google Scholar 

  • Brooks-Gunn J., Duncan G., (1997). The effects of poverty on children The Future of Children: Children and Poverty 7(2): 54–71

    Google Scholar 

  • Brown E. R., Ojeda V. D., Wyn R., Levan R., (2000). Racial and ethnic disparities in access to health insurance and health care Kaiser Los Angeles

    Google Scholar 

  • Buston K., (2002). Adolescents with mental health problems: What do they say about health services? Journal of Adolescence 25(2): 231–242

    Article  PubMed  Google Scholar 

  • Caldwell C. H., (1996). Predisposing, enabling, and need factors related to patterns of help-seeking among African American women In Neighbors H. W., Jackson J. H., (Eds.), Mental health in black America Sage Thousand Oaks (pp. 146–169)

    Google Scholar 

  • Canino I. A., Spurlock J., (1994). Culturally diverse children and adolescents The Guilford Press New York

    Google Scholar 

  • Caple F., Salcido R. M., Di Cecco J., (1999). Engaging effectively with cultural diverse families and children In Ewalt P., Freeman E. M., Kirk S., Poole D., (Eds.), Multicultural issues in social work NASW Press Washington, DC (pp. 366–381)

    Google Scholar 

  • Carlson J., Lewis J., (Eds.). (2002). Counseling the adolescent: individual, family, and school intervention Love Publishing Co Denver

    Google Scholar 

  • Carter R. T., Desole L., Sicalides E. I., Glass K., Tyler F., (1997). Black racial identity and psychosocial competence: A preliminary study Journal of Black Psychology 23(1): 58–73

    Google Scholar 

  • Cauce A. M., Domenech-Rodriguez M., Paradise M., Cochran B. N., Shea J. M., Srebnik D., Baydar N., (2002). Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth Journal of Consulting and Clinical Psychology 70(1): 44–55

    Article  PubMed  Google Scholar 

  • Clemento R., (2004). Counseling Culturally and Ethnically Diverse Youth. In Vernon A. (Eds.), Counseling children and adolescents Denver Love

    Google Scholar 

  • Cross T. L., Bazon B. J., Dennis K. W., Issacs M. R., (1989). Toward a culturally competent system of care Georgetown University Child Development Center, CASSP Technical Center Washington, DC

    Google Scholar 

  • Cuffe S. P., Waller J. L., Cuccaro M. L., Pumariega A. J., Garrison C. Z., (1995). Race and gender differences in the treatment of psychiatric disorders in young adolescents Journal of the American Academy of Child and Adolescent Psychiatry 34: 1536–1543

    Article  PubMed  Google Scholar 

  • Cunningham M., (1999). African American adolescent males’ perceptions of their community resources and constraints: A longitudinal analysis Journal of Community Psychology 27(5): 569–588

    Article  Google Scholar 

  • Dubow E. F., Lovko K. R. Jr., Kausch D. F., (1990). Demographic differences in adolescents’ health concerns and perceptions of helping agents Journal of Clinical Child Psychology 19(1): 44–54

    Article  Google Scholar 

  • Erikson E., (1963). Childhood and society W. W. Norton & Company Inc New York

    Google Scholar 

  • Fellin P., (1996). Mental health and mental illness; Policies, programs and services F. E. Peacock Itasca, IL

    Google Scholar 

  • Fiscella K., Franks P., Gold M. R., Clancy C. M., (2000). Inequality in quality: Addressing socioeconomic, racial, and ethnic disparities in health care Journal of the American Medical Association 283: 2579–2584

    Article  PubMed  Google Scholar 

  • Flaskerud J. H., (1986). The effects of culture-competence intervention on the utilization of mental health services by minority clients Community Mental Health Journal 22: 75–92

    Article  Google Scholar 

  • Freimuth V. S., Quinn S. Q., Thomas S. B., Cole G., Zook E., Duncan T., (2001). African American’s views on research and the Tuskegee syphilis study Social Science and Medicine 52: 797–808

    Article  PubMed  Google Scholar 

  • Fong R., Mokuau N., (1999). Not simply “Asian Americans”: Periodical literature on Asians and Pacific Islanders In Ewalt P. W., Freeman E. M., Kirk S. A., Poole D. L., (Eds.), Multicultural issues in social work NASW Press Washington (pp. 269–281)

    Google Scholar 

  • Gamble V. N., (1997). Under the shadow of Tuskegee: African Americans and health care American Journal of Public Health 87(11): 1773–1778

    PubMed  Google Scholar 

  • Garland A. F., Hough R. L., Landsverk J. A., McCabe K. M., Yeh M., Granger W.C., et al., (2000). Racial and ethnic variations in mental health care utilization among children in foster care Children’s Services: Social Policy, Research, and Practices 3: 133–146

    Google Scholar 

  • Grant D., Haynes D., (1999). A developmental framework for cultural competence training with children In Ewalt P. W., Freeman E. M., Kirk S. A., Poole D. L., (Eds.), Multicultural issues in social work NASW Press Washington, DC (pp. 382–398)

    Google Scholar 

  • Guerra N. G., Jagers R., (1998). The importance of culture in the assessment of children, youth In Mcloyd V.C., Steinberg L., (Eds.), Studying minority adolescents: Conceptual, methodological, and theoretical issues Erlbuam Mahwah, NJ (pp. 123–142)

    Google Scholar 

  • Hines P. M., Preto N. G., McGoldrick M., Almeida R., Weltman S., (1999). Culture and the family life cycle In Carter B., McGoldrick M., (Eds.), The expanded family life cycle (3rd ed). Allyn & Bacon Boston pp. 69–87

    Google Scholar 

  • Institute of Medicine (IOM) (2003). Unequal treatment: Confronting racial and ethnic disparities in health care The National Academies Press Washington

    Google Scholar 

  • Jerrell J., (1998). Effect of ethnic matching of young clients and mental health staff Cultural Diversity and Mental Health 4(4): 297–302

    Article  PubMed  Google Scholar 

  • King G., Williams D. R., (1995). Race and health: A multidimensional approach to African American health In Amick B. C., Levine L., Tarlov A. R., Walsh D. C., (Eds.), Society and health Oxford New York pp. 93–130

    Google Scholar 

  • Kirchheimer S., (2003). Racism should be a public health issue British Medical Journal 326: 65–66

    Article  Google Scholar 

  • Klonoff E. A., Landrine H., (1997). Distrust of whites, acculturation, and AIDS knowledge among African American Journal of Black Psychology 23: 50–57

    Google Scholar 

  • Krauss B. J., Goldsamt L., Bula E., Sember R., (1997). The white researcher in the multicultural community: Lessons in HIV prevention education learned in the field Journal of Health Education 28(6): 67–71

    Google Scholar 

  • Latimer, L.Y. (2003). Family matters. The Crisis, 110 (September/October)

  • Leigh J. W., (1998). Communicating for cultural competence Waveland Press Prospect Heights

    Google Scholar 

  • Lee P. R., Estes C. L., (2003). The nation’s health Jones & Bartlett Boston

    Google Scholar 

  • Lewis J., (2002). Working with adolescents: The cultural context In Carlson J., (Eds.), Counseling the adolescent: Individual, family, and school intervention Love Publishing Co Denver (pp. 3–16)

    Google Scholar 

  • Littell J. H., Alexander L. B., Reynolds W. W., (2001). Client participation: Central and under investigated elements of interventions Social Service Review 75(1): 1–15

    Google Scholar 

  • Longest, B. B. (2002). Health policy making in the US (3rd ed.). Association of University Programs in Health Administration (AUPHA): Health Administration Press (HAP)

  • Lum D., (1999). Culturally competent practice Brooks/Coles Pacific Grove

    Google Scholar 

  • Lynch E. W., Hanson M. J., (1998). Developing cross-cultural competence (2nd ed.) P. H. Brookes Baltimore

    Google Scholar 

  • Macran S., Ross H., Hardy G. E., Shapiro D. A., (1995). The importance of considering clients perspectives in psychotherapy research Journal of Mental Health 8: 325–337

    Article  Google Scholar 

  • Marin G., Burhansstipanov L., Connell C. M., Helitzer-Allen D., Lorig K., Morisky D. E., et al., (1995). A research agenda for health education among underserved population Health Education Quarterly 22(3): 346–363

    PubMed  Google Scholar 

  • Martin D. G., (2003). Clinical practice with adolescents Brooks/Cole Pacific Grove, NJ

    Google Scholar 

  • Mays V. M., Caldwell C. H., Jackson J. S., (1996). Mental health symptoms and service utilization patterns of help-seeking among African American women In Neighbors H. W., Jackson J. H., (Eds.), Mental health in black American Sage Thousand Oaks (pp. 161–176)

    Google Scholar 

  • McCabe K., Yeh M., Hough R., Landsverk J., Hulburt M., Culver S., et al., (1999). Racial/ethnic representation across five public sectors of care for youth Journal of Emotional and Behavioral Disorders 7: 72–82

    Article  Google Scholar 

  • McClure F., Teyber E., (2003). Casebook in child and adolescent treatment: cultural and family contexts Brooks/Cole Canada

    Google Scholar 

  • McKay M. M., Harrison M. E., Gonzales J., Kim L., Quintana E., (2002). Multiple-family groups for urban children with conduct difficulties and their families Psychiatric Services 53: 1467–1648

    Article  PubMed  Google Scholar 

  • McKenzie J. F., Smeltzer J. L., (1997). Planning, implementing, and evaluating health promotion programs Allyn & Bacon Boston

    Google Scholar 

  • McPhatter A. R., (1997). Culture competence in child welfare: What is it? How do we achieve it? What happens without it? Child Welfare LXXVI(1): 256–278

    Google Scholar 

  • Miller D. B., (1999). Racial socialization and racial identity: Can they promote resiliency for African American adolescents? Adolescence 34(1): 493–501

    PubMed  Google Scholar 

  • Moorse J. K., Johnson D. J., Heyliger S. O., (2000). Understanding ethnic disparities in the treatment of affective disorders Minority Health Today 2(1): 24–27

    Google Scholar 

  • National Association of Social Workers (2001). NASW standards for cultural competence in social work practice Author Washington, DC

    Google Scholar 

  • National Center for Cultural Competence (1999). Rationale for cultural competency in primary health care (Policy Brief No. 1) Georgetown University, Child Development Center, Center for Child Health and Mental Health Policy Washington, DC

    Google Scholar 

  • National Committee for Quality Assurance (1995). Medicaid hedis: An adaptation of the health plan employer data and information set (Version 2.0/2.5) [Data File] NCQA Washington, DC

    Google Scholar 

  • National Council of Disability (2002). The well being of our nation: An inter-generational vision of effective mental health services and support. Retrieved, 11/27/02 from www.ncd.gov/newsroom/publications/mentalhealth.html

  • National Research Council and Institute of Medicine (2000). After school program to promote child and adolescent development; summary of a workshop. committee on community—level programs for youth In Goodman J. A., (Eds.), Board on children, youth, and families, commission on behavioral and social sciences sand education National Academy Press Washington

    Google Scholar 

  • Neighbors H. W., Jackson J., (1996). Mental health in black America: Psychosocial problems, help-seeking behavior In Neighbors H. W., Jackson J. H., (Eds.), Mental health in black American Sage Thousand Oaks (pp. 1–36)

    Google Scholar 

  • Phinney J. S., (2000). Identity formation across cultures: The interaction of personal, societal, and historical change Human Development 43: 27–31

    Article  Google Scholar 

  • Porter N., Garcia M., Jackson H., Valldez D., (1997). The rights of children and adolescents of color Women and Therapy 20(2): 57–74

    Google Scholar 

  • Proctor E., Davis L., (1996). The challenge of racial difference: Skills for clinical practice In Ewalt P., Freeman E. M., Kirk S., Poole D., (Eds.), Multicultural issues in social work NASW Press Washington, DC (pp. 97–114)

    Google Scholar 

  • Proctor, B. D. & Delaker, J. (2003). Poverty in the United States: 2002. US Census Bureau, Current Population Reports (pp. 60–222), Poverty in the United States: 2002, U.S. Government Printing Office, Washington, DC

  • Putnam M. L., (2002). Problems of adolescents In Carlson J., Lewis J. A., (Eds.), Counseling the Adolescent Love Denver (pp. 43–86)

    Google Scholar 

  • Richardson L. A., (2001). Seeking and obtaining mental health services: What do parents expect? Archives of Psychiatric Nursing 15: 223–231

    Article  PubMed  Google Scholar 

  • Shaffer D., Fisher P., Dulcan M. K., Davies M., Piacentini J., Schwab-Stone M.E., et al., (1996). The NIMH diagnostic interview schedule for children version 2.3 (DISC-2.3): Description, acceptability, prevalence rates, and performance in the MECA Study, Methods for Epidemiology of Child and Adolescent Mental Disorders Study Journal of the American Academy of Child and Adolescent Psychiatry 35: 865–877

    Article  PubMed  Google Scholar 

  • Simms M. D., Freundlich M., Battistelli E. S., Kaufmann N. D., (1999). Delivering health and mental health care services to children in family foster care after welfare and health care reform Child Welfare 78(1): 166–183

    PubMed  Google Scholar 

  • Snowden L. R., Hines A. M., (1999). A scale to African American acculturation Journal of Black Psychology 25(1): 36–47

    Google Scholar 

  • Snowden L. R., (1998). Managed care and ethnic minority populations Administration and Policy in Mental Health 25: 581–592

    Article  Google Scholar 

  • Snowden L. R., (2003). Bias in mental health assessment and intervention: Theory and evidence American Journal of Public Health 93(2): 239–242

    Article  PubMed  Google Scholar 

  • Spencer M. B., Dupree D., Swanson D. P., Cunningham M., (1996). Parental monitoring an adolescents’ sense of responsibility for their own learning: an examination of sex differences Journal of Negro Education 65(1): 30–43

    Article  Google Scholar 

  • Spencer, M. B., Swanson, D. P., & Cunningham, M. (1991). Ethnicity, ethnic identity, and competence formation: adolescent transition and cultural transformation. Journal of Negro Education, 60(3), 366–387.

    Article  Google Scholar 

  • Spencer M. S., Kohn L. P., Woods J. R., (2002). Labeling vs. early identification: The dilemma of mental health services under-utilization among low-income African American children African American Perspectives 8(2): 1–14

    Google Scholar 

  • Stork E., Scholle S., Greeno C., Copeland V. C., Kelleher K., (2001). Monitoring and enforcing cultural competence in Medicaid managed behavioral health care Mental Health Services Research 3(3): 169–177

    Article  PubMed  Google Scholar 

  • Stroman C. A., (2000). Explaining illness to African Americans: Employing cultural concerns with strategies In Whaley B., (Eds.), Explaining illness Lawrence Erlbaum Associates Mahwah, NJ (pp. 299–316)

    Google Scholar 

  • Sue D. W., Sue S., (1999). Counseling the culturally different: Theory and practice (3rd ed.) Wiley New York

    Google Scholar 

  • Sue S., (1997). Community mental health services to minority groups: Some optimism, some pessimism American Psychologist 32: 616–624

    Article  Google Scholar 

  • Taylor J., (1998). Cultural conversion experiences: implications for mental research and treatment In Jones R. L., (Eds.), African American identity development Cobb & Henry Publishers. Hampton (pp. 85–97)

    Google Scholar 

  • Taylor J., Brown A. B., Denton S. E., (1996). Milliones’ developmental inventory of Black consciousness In Jones R. L., (Eds.), Handbook of test and measurements for Black populations Cobb & Henry Hampton (pp. 191–206)

    Google Scholar 

  • Taylor R. J., Jackson J. S., Chatters L. M., (Eds.). (1997). Family life in Black America Sage Thousand Oaks

    Google Scholar 

  • Taylor R. J, Hardison C. B., Chatters L. M., (1996). Predisposing, enabling, and need factors related to patters of help-seeking among African American women In Neighbors H.W., Jackson J. H., (Eds.), Mental health in Black American Sage Thousand Oaks (pp. 130–145)

    Google Scholar 

  • Thomlison B., (2002). Family assessment handbook Brooks/Cole United States

    Google Scholar 

  • Thompson V. L. S., (1999). Variables affecting racial-identity salience among African Americans The Journal of Social Psychology 139: 748–761

    Article  PubMed  Google Scholar 

  • US Department of Health and Human Services (2002). Women’s health USA (HRSA & MCHB). Health Resources and Services Administration HRSA Information Center Merrifield

    Google Scholar 

  • US Department of Health and Human Services (1999). Mental health: A report of the surgeon general SAMHSA Washington, DC

    Google Scholar 

  • US Department of Health and Human Services (2001). Mental health: Culture, race, and ethnicity—A supplement to mental health: A report of the surgeon general. (SAMHSA & CMHS) Rockville, MD. US Department of Health and Human Services, Substance Abuse and Mental Health Services, Center for Mental Health Services

  • US Public Health Services (2000). Report of the surgeon general’s conference on children’s mental health: A national action agenda. Washington, DC

  • Vernon A., (2004). Working with children, adolescents, and their parents: Practical application of developmental theory In Vernon A., (Eds.), Counseling children and adolescents Love Denver (pp. 1–34)

    Google Scholar 

  • Walker J. S., (2001). Caregivers’ views on the cultural appropriateness of services for children with emotional or behavioral disorders Journal of Child and Family Studies 10(3): 315–331

    Article  Google Scholar 

  • Williams, D., Lavizzo-Mourey, R., & Warren, R. (1999). Race in the health of America. In Ma, G. X. & Henderson, G. (Eds.), Rethinking ethnicity and health care, 25–31. Springfield, Illinois: Thomas.

    Google Scholar 

  • Williams D. R., Rucker T. D., (2000). Understanding and addressing racial disparities in health care Minority Health Today 2: 30–39

    Google Scholar 

  • Williams D. R., Spencer M. M., Jackson J. S., (1999). Race stress and physical health: The role of identity In. Contrada R. J., Ashmore R. D., (Eds.), Self, social identity and physical health: Interdisciplinary explorations Oxford University Press New York (pp. 71–100)

    Google Scholar 

  • Wright O. L., Anderson J. P., (1998). Clinical social work with urban African American families. Families in Society: The Journal of Contemporary Human Services, 79, 197–205

    Google Scholar 

  • Wurzbach M. E., (Eds.). (2002). Community health education and promotion: A guide to program design and evaluation (2nd ed.) Aspen Gaithersburg

    Google Scholar 

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Acknowledgements

This work was supported, in part, by grants from the National Institute of Mental Health to the University of Pittsburgh’s School of Social Work Center for Mental Health Services Research (MH56620); and the EXPORT Health Project at the Center for Minority Health, Graduate School of Public Health, University of Pittsburgh, NIH/NCMHD Grant No. P60 MD-000-207-02.

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  1. School of Social Work, University of Pittsburgh, 2228 Cathedral of Learning, Pittsburgh, PA, 15260, USA

    Valire Carr Copeland Ph.D., MPH

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Correspondence to Valire Carr Copeland Ph.D., MPH.

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The author would like to thank Aurora Jackson, Carol Anderson, Ina Jones, and Michael Newman for their comments on earlier drafts of this manuscript.

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Copeland, V.C. Disparities in Mental Health Service Utilization among Low-Income African American Adolescents: Closing the Gap by Enhancing Practitioner’s Competence. Child Adolesc Soc Work J 23, 407–431 (2006). https://doi.org/10.1007/s10560-006-0061-x

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