Latinos’ Access to Online and Formal Mental Health Support

Research on mental health services disparities affecting minority populations of the USA tends to neglect online mental health support (OMHS). The main objective of this study was to investigate online mental health support and help-seeking of Latino citizens living in US communities by estimating associations linking OMHS with a selection of individual and community variables. In addition, the extent to which unmet mental health treatment needs among adults are associated with key variables was examined. Variables of interest included economic resources, health insurance and coverage, confidentiality, perceived stigma, and accessibility. Data are from 39,630 Latino adult participants in the National Surveys on Drug Use and Health (NSDUH), 2004–2010. Results indicate that for every 10,000 US Latino adults, fewer than 25 individuals received recent OMHS, as compared to a recently published estimate of 270–330 per 10,000 for the US population generally. Among Latinos with self-described unmet mental health needs, an estimated 40% identified cost of treatment as a prominent barrier that explained why they had not received formal mental health treatment services. Research and policy health disparities implications are discussed.     

A Qualitative Exploration of Mothers’ Experiences Receiving Mental Health Services in a Supermarket Setting

Objectives Innovative mental health care delivery models have been proposed as a method to address disparities in access and utilization. The aim of this study is to characterize patients’ perspectives and experiences of participating in one such innovative delivery model, group cognitive behavioral therapy within a supermarket setting. Methods In this qualitative study, 16 mothers were interviewed to explore their experiences and perspectives of receiving group-based cognitive behavioral therapy in a supermarket setting, as part of their participation in an academic-community research collaborative whose mission is to address mental health needs within low-resourced communities. Data from semi-structured interviews were analyzed using inductive coding. Results Five themes related to receiving mental health services in a supermarket setting emerged from the data: (1) Participants reported a convergence of life stressors and their introduction to supermarket-based services; (2) Participants perceived the supermarket setting as convenient; (3) Participants perceived the supermarket setting as less stigmatizing; (4) Participants perceived services in the supermarket as an acceptable form of mental health treatment; and (5) Participants described the program staff as an influential component of their treatment experience. Conclusions Understanding patient experiences of various service delivery models is critical to improving access to treatment and addressing disparities in mental health service utilization and outcomes. This study supports the use of innovative delivery models to increase access to mental health services in low-resourced communities.

     

California’s Historic Effort to Reduce the Stigma of Mental Illness: The Mental Health Services Act

In a historic effort to reduce the stigma of mental illness, California voters approved the Mental Health Services Act in 2004. The law funds a comprehensive statewide prevention initiative that places stigma and discrimination reduction at its center, with 25 projects providing interventions at the institutional, societal, and individual levels.Stakeholders selected specific strategies from the research-based California Strategic Plan on Reducing Stigma and Discrimination. Strategies range from social marketing to increase public knowledge to capacity building at the local level, including training that emphasizes participation by consumers of mental health services and cultural competence. Collectively, these strategies aim to foster permanent change in the public perception of mental illness and in the individual experience of stigma.We examined the context, planning, programming, and evaluation of this effort.MORE THAN A DECADE AGO, the US surgeon general identified the stigma of mental illness as the most formidable obstacle to progress in improving mental health.1 Goffman refers to stigma as a spoiled identity.2 In the case of mental illness, stigma includes negative beliefs (e.g., people with mental health problems are dangerous), prejudicial attitudes (e.g., desire to avoid interaction), and discrimination (e.g., failure to hire or rent property to such people). The desire to avoid labeling oneself negatively or to conceal one’s problems from others appears to cause treatment avoidance, increase dropping out, and reduce adherence.3 Today, California is addressing this social injustice and improving the well-being of its communities through a comprehensive statewide initiative supported by Proposition 63, the Mental Health Services Act (MHSA).4Passed by California voters in 2004 amid calls for fundamental changes to mental health care, the MHSA begins to fulfill California’s 30-year-old promise to build a community-based mental health system as an alternative to institutionalization.4 By imposing a 1% tax on personal income in excess of $1 million, the MHSA provides funding and a framework to transform California’s traditional community mental health system to one focused on prevention and wellness, while expanding services to underserved populations and California’s diverse communities.In several ways, the MHSA resembles a blueprint for fulfilling the transformative goals identified in the New Freedom Commission’s Achieving the Promise: Transforming Mental Health Care in America in 2003.5 The MHSA provides resources to mend a fragmented service delivery system, invest in strategies that support recovery from symptoms, promote community integration rather than institutionalization, and empower clients of mental health services (consumers) and their families to direct their own care. Like the commission’s report, the MHSA makes an explicit commitment to reduce stigma and its negative consequences. Furthermore, following the surgeon general’s call to apply a public health approach to mental health,1 the MHSA requires that 20% of all funds (which average $1 billion annually) must support a wide range of prevention and early intervention strategies,6 including programs to reduce not only the stigma of mental health diagnosis and treatment but also discrimination against people with mental illness.7 Efforts supported by the MHSA aim to improve knowledge, change attitudes, increase help-seeking behaviors, reduce stigma, and challenge discriminatory policies.     

Racial and Ethnic Disparities in the Continuation of Community-Based Children’s Mental Health Services

This paper examines racial and ethnic disparities in continuation of mental health services for children and youth in California and how English language proficiency moderates the effect of race/ethnicity on the continuation of service. While previous research indicated racial/ethnic or geographic disparities in accessing mental health services among children and youth, few studies specifically focused on the continuation of mental health care. The authors used administrative data from California county mental health services users under age 25. Applying logistic regression, English language proficiency was found to be the major determinant of continuation of mental health services in this age group. With the exception of children of Asian descent, non-English speaking children and youth of diverse racial/ethnic background were significantly less likely to continue receiving mental health services compared with White English-speaking peers, even after controlling for sociodemographic, clinical and county characteristics.     

Oral Health Need and Access to Dental Services: Evidence from the National Survey of Children’s Health, 2007

This study examines associations between parents’ report of their children’s oral health and receipt of a dental visit for preventive care. We conducted a cross-sectional analysis of oral health status and receipt of a preventive dental visit among US children and youth, ages 1–17 years, using data from the 2007 National Survey of Children’s Health (n = 86,764). Survey-weighted logistic regression was used to estimate associations between perceived oral health status and receipt of a preventive dental health visit in the prior 12 months. Overall, 78 % of children and youth received at least one preventive dental health visit in the prior year. Among the youngest children, lower oral health status was associated with higher odds of receiving a preventive dental visit; among older children, lower oral health status was associated with lower odds of receiving a dental visit for preventive care. Use of preventive dental health care is below national target goals. Younger children in worse oral health are more likely, and older youth less likely, to receive preventive dental care. Public health efforts to educate parents to seek early and ongoing preventive oral health care, rather than services in response to problems, may yield oral health benefits later in childhood and over the life course.     

Patterns of Health Insurance Discontinuity and Children’s Access to Health Care

Objectives This study classified patterns of discontinuous health insurance coverage, including change in coverage type and gaps in coverage, and described their associations with children’s access to health care. Methods Using the 2011–2013 National Health Interview Survey data, we determined children’s insurance coverage over the past year, and whether children had a usual source of care, had to delay getting care, or had unmet health care needs. Using multivariable logistic regression, we compared measures of access to care across insurance coverage patterns, classified as continuous private coverage; continuous public coverage; continuous lack of coverage; change in coverage type (public versus private) without gaps in coverage; and any gap in coverage. A subgroup analysis repeated this comparison for children with a caregiver-reported chronic physical illness. Results The analysis included 34,105 children, of whom 7% had a gap in coverage and 1% had a change in coverage type. On multivariable analysis, gaps in coverage were associated with increased likelihood of unmet health care needs, compared to continuous private (OR 6.9; 95% CI 5.9, 8.0) or continuous public coverage (OR 5.1; 95% CI 4.4, 6.0). Seamless changes in coverage were also associated with greater likelihood of unmet health care needs [OR vs. private: 3.8 (95% CI 2.3, 6.1); OR vs. public: 2.8 (95% CI 1.8, 4.6); all p < 0.001]. Results were similar for other study outcomes, and among children with chronic physical illness. Conclusions for Practice Both gaps in coverage and seamless changes between coverage types were associated with limited health care access for children.

     

Exploring Social Service Providers’ Perspectives on Barriers to Social Services for Early Adjustment of Immigrant Adolescents in South Korea

Recently arrived immigrant adolescents experience difficulties in adjusting to school in South Korea. However, the existing social services do not meet their psychosocial needs. This study investigates the perspectives of social service providers about challenges in providing services for immigrant adolescents early in their adjustments. We conducted qualitative, in-depth interviews with 27 South Korean social service providers. We identified barriers to social services, categorized into three themes: (1) Initial Contact Phase; (2) Service Delivery Phase; and (3) Structural Challenges. We suggest interventions concerning work-related stress for the social service providers, family-level involvement, diversity training, and integrated and collaborative immigration services. An examination of social service providers’ challenges in working with immigrant adolescents is a necessary first step toward the development of programs and policies.     

Breaking Down Barriers in Pediatric Mental Health Consultations: Understanding Patients’ Use of I DON’T KNOW

Barriers to effective provider–patient communication take many forms that can be difficult to recognize and appropriately address. This paper offers probabilistic indicators for one such form, patient-produced “I don’t know” (IDK), distinguishing its use as a cognitive claim and its use as a strategy for resisting discussion of sensitive topics. A total of 95 audio-recorded psychiatrist–child interactions are drawn from a US-wide corpus of physician–patient consultations. From these, 376 patient-produced IDKs are extracted and coded for linguistic/social factors, including form, function, prosody, age, gender, and primary diagnosis. Two multiple logistic regressions are performed to determine the predictors of cognitive and resistive IDK functions respectively. Cognitive IDK uses are associated with the full form (p < 0.01) and unstressed prosody (p < 0.01). Use of resistive IDK is correlated with decreasing patient age (p < 0.01) and emotionally labile mental health diagnoses (p < 0.01). Cognitive and resistive IDK uses have distinctive linguistic and social distributions in psychiatrist–child interactions, where cognitive uses have two objectively identifiable linguistic characteristics and resistive uses are associated with certain patient types. Providers may learn to recognize cognitive and resistive IDK uses, thus acquiring the ability to correctly interpret interactional cues relevant to the diagnosis and treatment of pediatric mental health conditions.     

Integration of Oral Health Care and Mental Health Services: Dental Hygienists’ Readiness and Capacity for Secondary Prevention of Eating Disorders

Often the first to observe overt health effects of eating disorders, dentists and dental hygienists play a fundamental role in the secondary prevention of eating disorders. The purpose of this study was to explore readiness and capacity for integration of oral health and mental health services. Employing a randomized cross-sectional study based upon the Transtheoretical and Health Belief Models, data were collected from 378 dental hygienists. Results reveal that the majority do not currently engage in secondary prevention practices. Only 18% of respondents indicated referring patients exhibiting oral manifestations of eating disorders to treatment. Significantly increasing the likelihood of assessment, referral, and case management included modifying factors regarding greater perceived self-efficacy, and knowledge of oral cues of disordered eating, as well as the individual’s perception pertaining to severity of eating disorders. Implications for bridging dental care to mental health services include increasing behavioral capacity among dental hygienists via consciousness raising and improved self-efficacy. Stacey B. Plichta ScD, is an associate professor of School of Community and Environmental Health, Old Dominion University, 140c Spong Hall, Norfolk, VA 23529, USA. Lisa A. Tedesco PhD, is a vice president and secretary of The University of Michigan, 2014 Fleming Administration Building, 503 Thompson Street, Ann Arbor, MI 48109-1340, USA. Wendy E. Kerschbaum, RDH, MPH, is an associate professor and director of Dental Hygiene in the Department of Periodontics, Prevention, & Geriatrics, University of Michigan, School of Dentistry, 1011 N. University, Ann Arbor, MI 48109-1078, USA.     

Women Chefs’ Access Barriers to Michelin Stars: A Case-Study Based Approach

The higher the status in the “haute cuisine” field, the fewer women are employed in prestigious positions. Although cooking is considered a feminine competence, it becomes masculine when it is considered a professional job. Therefore, there are recognized gender barriers for women to achieve chef positions in the field. This article discusses the case of six female chefs who were awarded three Michelin stars in 2014 and one with two stars. The goal was to research how these women met the criteria of the Michelin Guide and which were the specific aspects that distinguished them from the rest. Although in their discourse, gender barriers were not highly accentuated, however, passion, the feminine approach to management, and family support were considered mandatory for their success.     

Siege and Response: Reception and Benefits of Residential Children’s Mental Health Services for Parents and Siblings

This paper presents the results of a qualitative study with 29 parents of children who have been in residential mental health care. It examines three main patterns identified by parents: (a) the importance of respite, (b) feeling welcomed and understood, and (c) improved personal and family functioning. It argues that benefits for parents and siblings of placed children deserve equal valuation with the needs of children in residential care and that the processes of achieving such gains are independent considerations from creating systems of care for troubled children or engaging family members in treatment plans for these children.

Urban and Rural Immigrant Latino Youths’ and Adults’ Knowledge and Beliefs about Mental Health Resources

Immigrant Latino youth experience mental health problems in the U.S. Cultural beliefs and knowledge may influence help-seeking behaviors. Two hundred thirty-four immigrant Latino respondents between 12 and 44 years of age completed a questionnaire assessing knowledge of and cultural beliefs regarding mental health resources for adolescents, symptoms, and help-seeking. Multivariate analyses showed that rural respondents were significantly less likely to know of mental health resources than urban-based immigrant Latinos. Knowledge and belief outcomes were also affected by age, gender, and length of time living in the community. Immigrant Latinos appear willing to seek professional help for mental health problems but may not know how to access this type of care, or may lack available services. Future research to inform interventions that increase awareness of accessible mental health services is suggested. Findings support systems-level changes including increased availability of culturally-specific mental health services, especially in rural areas.     

Correction to: Inequalities in Access and Utilization of Maternal,Newborn and Child Health Services in sub‑Saharan Africa: A Special Focus on Urban Settings

Maternal and Child Health Journal -     

Social Network Members’ Roles and Use of Mental Health Services Among Drug Users in New York City

Depression is more common among drug users (15–63 %) than the general population (5–16 %). Lack of social support network members may be associated with low mental health service (MHS) use rates observed among drug users. We investigated the relationship between social network members’ roles and MHS use among frequent drug users using Social Ties Associated with Risk of Transition into Injection Drug Use data (NYC 2006–2009). Surveys assessed depression, MHS use, demographics, drug use and treatment, and social network members’ roles. Participants reporting lifetime depressive episode with start/end dates and information on social/risk network members were included (n = 152). Adjusting for emotional support and HIV status, having one or more informational support network members remained associated with MHS use at last depressive episode (adjusted odds ratio (AOR) 3.37, 95 % confidence interval (CI) 1.38–8.19), as did history of drug treatment (AOR 2.75, 95 % CI 1.02–7.41) and no legal income (AOR 0.23, 95 % CI 0.08–0.64). These data suggest that informational support is associated with MHS utilization among depressed drug users.     

Ethnic Health Care Advisors: A Good Strategy to Improve the Access to Health Care and Social Welfare Services for Ethnic Minorities?

Empirical studies indicate that ethnic minorities have limited access to health care and welfare services compared with the host population. To improve this access, ethnic health care (HC) advisors were introduced in four districts in Amsterdam, the Netherlands. HC advisors work for all health care and welfare services and their main task is to provide information on health care and welfare to individuals and groups and refer individuals to services. Action research was carried out over a period of 2 years to find out whether and how this function can contribute to improve access to services for ethnic minorities. Information was gathered by semi-structured interviews, analysing registration forms and reports, and attending meetings. The function’s implementation and characteristics differed per district. The ethnicity of the health care advisors corresponded to the main ethnic groups in the district: Moroccan and Turkish (three districts) and sub-Sahara African and Surinamese (one district). HC advisors reached many ethnic inhabitants (n = 2,224) through individual contacts. Half of them were referred to health care and welfare services. In total, 576 group classes were given. These were mostly attended by Moroccan and Turkish females. Outreach activities and office hours at popular locations appeared to be important characteristics for actually reaching ethnic minorities. Furthermore, direct contact with a well-organized back office seems to be important. HC advisors were able to reach many ethnic minorities, provide information about the health care and welfare system, and refer them to services. Besides adapting the function to the local situation, some general aspects for success can be indicated: the ethnic background of the HC advisor should correspond to the main ethnic minority groups in the district, HC advisors need to conduct outreach work, there must be a well-organized back office to refer clients to, and there needs to be enough commitment among professionals of local health and welfare services.     

Employers’ Role in Helping Latino Workers Obtain Access to Health Care Services: Results of a Community-Based Pilot Demonstration Project

A coalition of employers in the hotel and restaurant industries collaborated with community-based organizations to undertake a unique demonstration project, called the Employed Latino Health Initiative, aimed at improving access to basic health care services for low-wage Latino workers in Columbus, Ohio. With grant funding from the Robert Wood Johnson Foundation, the project developed and tested protocols allowing Latino workers from participating companies to obtain basic health care screenings, referrals to medical providers, health education training, and the services of a qualified community health navigator. Data from the pilot project indicated high screening participation rates, extensive referrals to providers for follow-up care, and a substantial need for facilitation services by community health navigators. The project provides a model for how employers can potentially promote their own interests in boosting work productivity through facilitating expanded access to basic medical services among vulnerable workers, despite the absence of conventional health insurance coverage.     

The Focus They Deserve: Improving Women Veterans’ Health Care Access

PurposeVeterans Health Administration (VHA) initiatives aim to provide veterans timely access to quality health care. The focus of this analysis was provider and staff perspectives on women veterans' access in the context of national efforts to improve veterans’ access to care.MethodsWe completed 21 site visits at Veterans Health Administration medical facilities to evaluate the implementation of a national access initiative. Qualitative data collection included semistructured interviews (n = 127), focus groups (n = 81), and observations with local leadership, administrators, providers, and support staff across primary and specialty care services at each facility. Deductive and inductive content analysis was used to identify barriers, facilitators, and contextual factors affecting implementation of initiatives and women veterans’ access.ResultsParticipants identified barriers to women veterans' access and strategies used to improve access. Barriers included a limited availability of providers trained in women's health and gender-specific care services (e.g., women's specialty care), inefficient referral and coordination with community providers, and psychosocial factors (e.g., childcare). Participants also identified issues related to childcare and perceived harassment in medical facility settings as distinct access issues for women veterans. Strategies focused on increasing internal capacity to provide on-site women's comprehensive care and specialty services by streamlining provider training and credentialing, contracting providers, using telehealth, and improving access to community providers to fill gaps in women's services. Participants also highlighted efforts to improve gender-sensitive care delivery.ConclusionsAlthough some issues affect all veterans, problems with community care referrals may disproportionately affect women veterans’ access owing to a necessary reliance on community care for a range of gender-specific services.     

Review of U.S. Health Resources and Services Administration’s Find a Health Center Locator

In addition to questions about diagnoses, wellness guidelines, and treatment concerns, librarians are sometimes confronted with questions about access to care from uninsured clients. The U.S. Health Resources & Services Administration (HRSA) provides an easy-to-use online “Locator” service for its network of Federally Qualified Health Centers serving low income and/or uninsured individuals across the country. This Locator tool is an important resource for consumer health librarians serving uninsured individuals.