A qualitative investigation to inform yoga intervention recruitment practices for racial/ethnic minority adolescents in outpatient mental health treatment

ObjectiveYoga is recognized as an effective approach to improving overall physical and mental health; however, there may be perceived barriers to yoga participation, particularly among populations most at risk for mental health issues. We conducted qualitative formative research to help inform recruitment practices for a future study and to specifically understand the barriers and facilitators to engagement in yoga practice among racial/ethnic minority adolescents, as well as adolescents in outpatient mental health treatment.MethodsQualitative data were collected at a community health clinic that serves low income families in southeastern Florida. Using semi structured interviews with racial and ethnic minority adolescents between 12 and 17 years old, participants were asked about beliefs and perceptions about yoga, as well as recommendations on recruiting peers. A thematic analysis approach was used to identify and examine common themes.ResultsTwenty interviews were conducted and eight major themes emerged from the data. Themes were grouped as (1) Facilitators to recruitment and (2) Barriers to recruitment.InterpretationAdvertising free yoga that emphasizes the social, physical, and mental benefits can help assuage negative perceptions of yoga and promote the advantages of yoga among teenagers. Having recruitment materials and modalities that highlight inclusivity of all genders and physical abilities in the yoga classes are also important in facilitating participation. Understanding perceptions of yoga, as well as perceived barriers and facilitators, among racially/ethnically diverse adolescents in outpatient mental health treatment, can assist recruitment efforts, increase yoga intervention participation, and ultimately, improve mental health outcomes for underserved populations.     

The importance of ethnic similarity in the therapist‐patient dyad among Surinamese migrants in Dutch mental health care

Empirical evidence is equivocal on whether ethnic matching in the therapist‐patient dyad is preferred by ethnic minority patients and whether it leads to treatment satisfaction. The aim of this study was to establish the importance of ethnic similarity in mental health care among Surinamese migrants in the Netherlands. A convenience sample of Surinamese out‐patients in community mental health care (N = 96) was interviewed. Data were analysed using logistic multivariate techniques. The majority of the Surinamese out‐patients (in particular recently residing participants) rated ethnic matching as relevant; a considerable minority considered compassion and expertise to be more relevant than ethnic background. Most out‐patients reported to be satisfied with the services, especially females and respondents treated by an ethnically similar therapist. Ethnic similarity in the patient‐therapist dyad is a strong predictor for satisfaction with mental health care services. However, although it is preferred by many, ethnic matching per se is no must ‐ empathy, expertise and world view sharing are reported to be of considerable importance as well.     

Addressing mental health disparities through clinical competence not just cultural competence: the need for assessment of sociocultural issues in the delivery of evidence-based psychosocial rehabilitation services

Recognition of ethnic/racial disparities in mental health services has not directly resulted in the development of culturally responsive psychosocial interventions. There remains a fundamental need for assessment of sociocultural issues that have been linked with the expectations, needs, and goals of culturally diverse consumers with severe and persistent mental illness. The authors posit that embedding the assessment of sociocultural issues into psychosocial rehabilitation practice is one step in designing culturally relevant empirically supported practices. It becomes a foundation on which practitioners can examine the relevance of their interventions to the diversity encountered in everyday practice. This paper provides an overview of the need for culturally and clinically relevant assessment practices and asserts that by improving the assessment of sociocultural issues the clinical competence of service providers is enhanced. The authors offer a conceptual framework for linking clinical assessment of sociocultural issues to consumer outcomes and introduce an assessment tool adapted to facilitate the process in psychosocial rehabilitation settings. Emphasizing competent clinical assessment skills will ultimately offer a strategy to address disparities in treatment outcomes for understudied populations of culturally diverse consumers with severe and persistent mental illness.     

Pathways to suicidality across ethnic groups in Canadian adults: the possible role of social stress

BACKGROUND: Ethnicity is an important determinant of mental health outcomes including suicidality (i.e. suicidal ideation and suicide attempt). Understanding ethnic differences in the pathways to suicidality is important for suicide prevention efforts in ethnically diverse populations. These pathways can be conceptualized within a social stress framework. METHOD: The study examines ethnic differences in the pathways to suicidality in Canada within a social stress framework. Using data from the Canadian Community Health Survey Cycle 1.1 (CCHS 1.1) and path analysis, we examined the hypotheses that variations in (1) socio-economic status (SES), (2) sense of community belonging (SCB), (3) SES and SCB combined, and (4) SES, SCB and clinical factors combined can explain ethnic differences in suicidality. RESULTS: Francophone whites and Aboriginals were more likely to report suicidality compared to Anglophone whites whereas visible minorities and Foreign-born whites were least likely. Disadvantages in income, income and education, income and its combined effect with depression and alcohol dependence/abuse led to high rates even among the low-risk visible minority group. Indirect pathways for Asians differed from that of Blacks and South Asians, specifically through SCB. With the exception of SCB, Aboriginals were most disadvantaged, which exacerbated their risk for suicidality. However, their strong SCB buffered the risk for suicidality across pathways. Disadvantages in education, income and SCB were associated with the high risk for suicidality in Francophone whites. CONCLUSIONS: Francophone whites and Aboriginals had higher odds of suicidality compared to Anglophone whites; however, some pathways differed, indicating the need for targeted program planning and prevention efforts.     

Introduction to the special section on multicultural and community psychology: clinical psychology in context

Human behavior occurs in the contexts of culture and community. Yet, clinical psychology has traditionally focused on the individual, neglecting the individual's context. The purpose of this Special Section is to address the underlying conceptual issues in integrating multicultural and community psychology within a common framework. The integration of etic and emic approaches distinguishes the research programs in these articles from others that have solely focused on universal or culture-specific approaches. Issues facing ethnic minority populations are addressed, including identification of risk and protective factors, obstacles to mental health service use, and optimal treatment effectiveness. The integration of culture and community contexts into clinical psychology is necessary for it to remain relevant in an increasingly diverse 21st century.     

Cultural Competence and Quality of Care: Issues for Mental Health Service Delivery in Managed Care

Models of mental health service delivery in managed care have evolved without considering the needs of ethnic minorities in any systematic manner. Consequently, these new systems may pose additional barriers to access and treatment. In this article, the impact of the health care crisis on mental health service delivery to ethnic minorities in terms of access, cost, and quality of care issues in managed care systems is explored. A quality-of-care framework is used for addressing the notion of cultural competence as a critical dimension of quality of care for ethnic minority populations. Research in minority mental health and quality of care is integrated in order to explore how various structures, processes, and outcomes in managed care systems (e.g., cost containment structures for controlling the supply and demand of mental health services, utilization management and gatekeeping processes) may impact mental health service delivery to ethnic minorities. Cultural competence is conceptualized as a critical component of quality care for ethnic minority populations.     

Ethnicity and clinical psychology: a content analysis of the literature

As the demographics of the U.S. population continues to change and become increasingly diverse, clinical psychologists will need to demonstrate their competence in providing culturally appropriate treatments to a wide variety of populations. This article summarizes a comprehensive content analysis of five of the leading scholarly journals in clinical psychology over a 17-year period (1980-1997). Results indicate that only 29.3% of the published articles in the clinical psychology literature included ethnic minority participants. Furthermore, only 5.4% of the articles actually focused specifically on ethnic minority populations. Thus, the clinical psychology literature does not contain adequate coverage of ethnically diverse populations in the U.S., despite their growing numbers. This content analysis provides the field with a baseline for future comparison to determine whether the field in general is responding to the needs of an increasingly diverse society, and to help gauge whether clinical psychologists have the scholarly resources available to assist them with becoming more culturally competent. Implications for the paucity of research and recommendations to ameliorate the problem are discussed.     

Clinical Child Psychology in the 1990's: Broadening Our Scope

Examined trends in population demographics, education, technologies and economics for the 1990s, particularly as they relate to clinical child psychology and the mental health service delivery system. These trends indicate that the mental health system will encounter a rapidly changing ethnic mix, a growing proportion of new immigrants, few minority mental health professionals, and increasing poverty for young children in our society. Our current mental health service delivery system faces a shortage of well-trained professionals to work with children and diverse ethnocultural groups; problems in distribution, coordination, and integration of our limited mental health resources; and overdependence on traditional service models that may be ineffective with new, difficult-to-serve populations. Innovative service delivery models that overcome many of these obstacles are discussed in the context of recommendations for the future.     

A need for ethnic similarity in the therapist–patient interaction? Mediterranean migrants in Dutch mental‐health care

Evidence concerning a preference for ethnic matching in the therapist-patient dyad and the effects of ethnic matching on treatment satisfaction is equivocal. This study examined the importance of ethnic similarity in mental-health care in the Netherlands. A convenience sample of 82 Turkish and 58 Moroccan outpatients in the community mental-health care was interviewed. Quantified data were analyzed using multivariate techniques. The majority of the respondents did not value ethnic matching as important; clinical competence and compassion were considered to be more relevant than ethnic background. An ethnically dissimilar therapist treated the majority of the outpatients. Outpatients treated by a native Dutch therapist reported similar satisfaction with the services provided as those treated by an ethnically similar therapist. According to Turkish and Moroccan outpatients in Dutch mental-health care, ethnic matching is not considered to be preferential nor essential for treatment satisfaction. Other health-care characteristics such as empathy, expertise, and sharing of worldview are considered to be as important.     

Cultural and contextual influences in mental health help seeking: a focus on ethnic minority youth

In this article, a mental health help-seeking model is offered as a framework for understanding cultural and contextual factors that affect ethnic minority adolescents' pathways into mental health services. The effects of culture and context are profound across the entire help-seeking pathway, from problem identification to choice of treatment providers. The authors argue that an understanding of these help-seeking pathways provides insights into ethnic group differences in mental health care utilization and that further research in this area is needed.     

Using the PRACTICE mnemonic to apply cultural competency to genetics in medical education and patient care.

Medical education curricula increasingly are incorporating courses on cultural competency and skills development in working with ethnically diverse patient populations as well as courses on genetics and genomics. The authors support these efforts and believe the next step is integration of genetics into cultural competency programs and similarly, cultural competency into genetics curricula. In this paper, the authors describe the work of the Genetics in Primary Care Faculty Development Working Group on Cultural Competency, a federally-funded initiative to prepare generalist faculty to teach genetics as part of ambulatory education. Over a 12-month period, this team wrote a module on cultural competency and nine new clinical cases, and developed the PRACTICE mnemonic (prevalence, risk, attitude, communication, testing, investigation, consent, empowerment) to help health care professionals integrate cultural competency skills in genetics into primary care. More specifically, the PRACTICE mnemonic integrates information emerging from experts in health disparities and doctor-patient communication to build a comprehensive model for addressing the relevance of culture and ethnicity in the delivery of genetic services. Lastly, this paper illustrates a systematic method of covering key areas of cultural competency through discussion of a patient with a genetic disorder as well as presents an argument as to why cultural competency is highly relevant to the delivery of genetic services especially as part of generalists' clinical practice.     

Integrating Decision Making and Mental Health Interventions Research: Research Directions

The importance of incorporating patient and provider decision-making processes is in the forefront of the National Institute of Mental Health (NIMH) agenda for improving mental health interventions and services. Key concepts in patient decision making are highlighted within a simplified model of patient decision making that links patient-level/"micro" variables to services-level/"macro" variables via the decision-making process that is a target for interventions. The prospective agenda for incorporating decision-making concepts in mental health research includes (a) improved measures for characterizing decision-making processes that are matched to study populations, complexity, and types of decision making; (b) testing decision aids in effectiveness research for diverse populations and clinical settings; and (c) improving the understanding and incorporation of preference concepts in enhanced intervention designs.     

Defining mental health needs for black patients with AIDS in Alameda County

This study examines the impact of race and psychiatric symptomatology on the treatment of black patients with acquired immunodeficiency syndrome (AIDS). The study consisted of two parts: 1) focused group discussions with AIDS health professionals, and 2) a retrospective chart review of 44 hospitalized AIDS patients. The group discussions revealed that there are specific gaps in mental health services for all AIDS patients and that psychiatric and medical services must be delivered in an ethnically sensitive manner to be effective with black patients. The chart review revealed no statistically significant difference between black and white patients in terms of prevalence of psychiatric symptoms. The results of this study suggest that ethnically sensitive psychiatric diagnosis and treatment may have important clinical implications in the long-term management of black patients with AIDS.     

Examining the effects of ethnic‐specific services: An analysis of cost‐utilization and treatment outcome for Asian American clients

Ethnic‐specific mental health services have developed to meet the unique cultural and linguistic needs of the ethnic client. It has been assumed that this type of service configuration provides more accessible, culturally‐responsive mental health care, which in turn, encourages utilization and enhances outcomes. Previous studies have found that ethnic‐specific services (ESS) increase utilization of mental health services, but there has only been inconsistent evidence that ESS results in better outcomes. This study compared patterns of the cost‐utilization and outcomes of Asian American outpatients using ESS to those Asians using mainstream services. Consistent with earlier studies, cost‐utilization for ESS Asian clients was higher than that for mainstream Asian clients. Better treatment outcome was found for ESS clients compared to their mainstream counterparts, even after controlling for certain demographics, pretreatment severity, diagnosis, and type of reimbursement. Moreover, there was a significant relationship between cost‐utilization and outcome for ESS clients, whereas for mainstream clients, this relationship was not significant. The findings strongly suggest that mental health services with an ethnic‐specific focus provide more effective and efficient care for at least one ethnic minority group. Implications for the delivery of culturally‐competent mental health services are discussed. © 2000 John Wiley & Sons, Inc.     

EXPLORING THE ROLE OF ETHNIC IDENTITY IN FAMILY FUNCTIONING AMONG LOW‐INCOME PARENTS

The majority of research on ethnic identity (EI) has highlighted its role in mitigating risks associated with racial discrimination; however, discrimination is only one of many stressors that ethnic minority individuals face. The current study examined the relationships between EI, emotional distress, and the parent–child relationship among ethnically diverse, low‐income parents. Results indicated significant associations between EI and emotional distress, and EI and the parent–child relationship for African American parents, but not for their Latino or European American counterparts. Furthermore, when examined separately by gender, stronger EI buffered the impact of economic hardship on emotional distress for African American fathers. The current study provides preliminary evidence that EI plays an important role in the lives of ethnically diverse parents who are facing economic hardship. Methods for embracing and fostering EI may be valuable to incorporate into therapeutic services and strength‐based intervention programming, especially when serving low‐income African American individuals.     

Barriers to Community Mental Health Services for Latinos: Treatment Considerations

The underutilization of mental health services by Latinos has been a growing concern in research and clinical practice. This has become increasingly important as the population of Latinos in the United States rapidly rises and the evidence that many are not receiving needed mental health services accumulates. To provide an understanding of the issues, this article provides an overview of risk factors that may influence the mental health of Latinos and examines prevalence rates of psychopathology and service utilization trends. This article then presents a comprehensive review of the socioeconomic, cultural, and psycho-therapeutic barriers that prevent Latinos from receiving community mental health services. Treatment recommendations to increase the access and utilization of community mental health services by Latinos are discussed.     

Fulfilling the promise of mental health technology to reduce public health disparities: Review and research agenda

Despite significant promise, the full impact of mental health technologies has yet to be realized. With overall mental health service utilization still below 50%, those with a disorder, racial/ethnic minority, low SES, and rural populations receive services at even lower rates. Mental health technologies have been designed and proposed to address the barriers exacerbating these disparities and low utilization. However, research on these tools, which to date has appropriately prioritized effectiveness, requires significant shifts to test the ways these tools may reduce disparities. This article reviews these tools and outlines a potential framework for research that can guide the translation of these technologies into data‐driven dissemination and implementation strategies.     

Black and Minority Ethnic women's decision-making for risk reduction strategies after BRCA testing: Use of context and knowledge

Within the field of breast cancer care, women concerned about their family history are offered genetic testing and subsequent treatment options based on several factors which include but are not limited to personal and family cancer disease histories and clinical guidelines. Discussions around decision-making in genetics in Black and Minority Ethnic (BME) groups are rarely documented in literature, and information regarding interactions with genetics services is usually discussed and linked to lack of scientific knowledge. As such, counselling sessions based only on scientific and medical information miss out the many reasons participants consider in making health decisions, information which can be used to encourage BME women to engage in cancer genetics services. 10 BME women with a mixed personal and family history of breast and ovarian cancer backgrounds, were interviewed in a study exploring issues of knowledge about familial breast cancer syndromes, to understand how they created and used familial knowledge for health decisions, with a particular focus on attitudes towards risk reducing strategies.Study results show that our participants are not unique in the ways they make decisions towards the use of cancer genetics and risk reduction strategies and as such, there are no specific ethnically defined pathways for decision-making. Our participants demonstrated mixed biomedical, social and individual cultural reasons for their decision-making towards risk reduction surgeries and treatment options which are similar to women from different ethnicities and are individual rather than group-specific. Narratives about suspicion of scientific utility of genetic knowledge, the perceived predictive value of mutations for future cancers or the origin of mutations and family disease patterns feature heavily in how participants evaluated genetic information and treatment decisions. The diversity of results shows that our participants are interested in engaging with genetic information but use multiple sources for evaluating the extent of involvement in genetic services and the place of genetic information and treatment options for themselves and their families. Genetic information is considered within various bio-social scenarios before decision-making for risk reduction is undertaken. BME women are shown to undertake evaluative processes which clinicians are encouraged to explore for better patient support. Continuing to focus on links between superficial and un-representative meanings of ethnicity, ethnic identity and attitudes and behaviours by only searching for differences between ethnic groups, are unhelpful in further understanding how women from those diverse backgrounds make decisions towards risk reduction interventions. Future research must find ways of investigating and understanding populations in ways that are not focussed solely on ethnic differences but on how meaning is created out of social circumstances and experiences.     

Responding to the mental health needs of Latino children and families through school-based services

This article highlights the value and utility of school-based mental health services in addressing the unmet mental health needs of Latino children and families in the United States. To better understand our nation's rapidly growing Latino population, such critical factors as demographic characteristics, cultural values, and family structure are examined. Special attention is devoted to the daunting challenges and resultant trauma experienced by many of these children and families who have recently immigrated to this country from war-torn home-lands in Central America. The mental health status of Latino children is addressed, along with various service delivery issues and psychotherapeutic modalities to facilitate their personal adjustment and social adaptation in a culturally sensitive manner. The article concludes with the presentation of an innovative school-based mental health program that offers a range of services of demonstrated effectiveness in aiding Latino children and their families. Specific strategies for replicating the program model in other culturally diverse settings are also discussed.