Ethnic Differences in Perceived Impairment and Need for Care

University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico 00936-5067, USA.
Journal of Abnormal Child Psychology (Impact Factor: 3.09). 11/2010; 38(8):1165-77. DOI: 10.1007/s10802-010-9428-8
Source: PubMed


Latino children in the U.S. have high rates of unmet need for mental health services, perhaps due to biased perceptions of impairment and need for care by parents and providers. We tested this argument using an experimental vignette design. Vignettes described children with problems that varied on severity (mild vs. serious), nature of the problem (internalizing vs. externalizing), as well as gender and ethnicity (Latino vs. Anglo). Raters were Latino and Anglo parents (N = 185) and providers (N = 189). Vignettes with Latino names were viewed as more impaired by both parents and providers, and this effect was significantly stronger in Latino vignettes with less severe problems. Severity and Latino features of vignettes also interacted with judgments of need for service. At higher severity, vignettes with Anglo names were judged to need service more than vignettes with Latino names, despite the same judged levels of impairment. Results are discussed in the light of the unmet need for Latinos.

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Available from: Sheri Lapatin, Apr 24, 2014
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    • "A companion study to this project, the Patient Provider Encounter Study (Alegría et al. 2008), looked at initial evaluations between mental health providers and adult patients, and found that clinicians often make diagnostic judgments despite significant missing information about whether their patient fulfills clinical criteria for certain psychiatric disorders. Although this paper does not closely address the quantitative results described in Chavez et al. (2010), we note that the quantitative study successfully displayed significant differences between parent and provider participants, both Latino and non-Latino, that were found as a result of the manipulation of information displayed in the vignettes. "
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    ABSTRACT: To examine the development, feasibility, and use of a vignette approach as an important tool in health services disparities research. Interviews with vignette developers and qualitative data from a novel mental health services disparities study that used vignettes in two samples: (1) predominantly low-income parents of children attending mental health specialty care who were Latino or non-Latino White and (2) Latino and non-Latino mental health clinicians who treat children in their practice. We conduct a content analysis of qualitative data from patients and providers in the Ethnic Differences Study to explore the feasibility of vignette methodology in health services disparities research, and we identify lessons learned that may guide future vignette development. Vignettes provide a valuable approach that is acceptable to participants, elicits important insight on participant experience and services, and sheds light on factors that can help optimize study design for exploring health disparities questions. Researchers, clinicians, and others should consider a set of factors that help determine when a vignette approach is warranted in research, training, or for other uses, including how best to address identified weaknesses.
    Health Services Research 12/2011; 47(3 Pt 2):1345-62. DOI:10.1111/j.1475-6773.2011.01360.x · 2.78 Impact Factor
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    • "This could be due to factors such as impaired cognitive functioning, extreme demoralization or distress (Sellbom and Ben-Porath 2005), substance use issues (cf. Youngstrom et al. 2000), cultural differences in the conceptualization of problems (Chavez et al. 2010; Gonzalez et al. 2011), malingering (Henry et al. 2009), or multiple other considerations (Garb 1997; Groth-Marnat 1999). Clinicians may gauge these various issues in deciding how much weight to give to the perspectives of the different informants. "
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    ABSTRACT: The objectives of this study were to examine how often clinicians judged youths or caregivers to not be credible informants, to identify the associated features of youth or caregiver credibility, and to examine credibility's impact on the validity of mood and behavior checklists. Clinicians often have the experience of talking to a parent or a youth and judging that the credibility of the information offered is unusually poor. Little is known about the correlates of poor credibility or about the extent to which credibility changes the validity of commonly used checklists. Interviewers rated the credibility of 646 youths aged 5-18 and their primary caregivers after completing a Kiddie Schedule for Affective Disorders and Schizophrenia. Ratings and diagnoses were blind to the behavior checklists completed by caregivers, youths, and teachers. A subset of youths also had intelligent quotient tests and behavioral observations available. Caregivers were perceived as more credible on average than youths, though this dropped sharply with adolescents. Caregiver credibility was higher for better functioning families, more credible youths, younger youths, and more educated caregivers; it was unrelated to caregiver mood symptoms or being the mother. Youth credibility was strongly connected to age, cognitive ability, caregiver credibility, and independent observations of youth behavior. Credibility ratings markedly altered the validity of checklists compared with interview ratings, diagnoses, or cross-informant criteria. Clinicians' judgments about informant credibility are associated with different characteristics for youths versus caregivers, though youth age is important to both. Credibility affects the validity of information from checklists measured against several different independent criteria.
    Journal of child and adolescent psychopharmacology 10/2011; 21(5):407-15. DOI:10.1089/cap.2011.0032 · 2.93 Impact Factor
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    • "Even if the threshold for what is considered a mental health problem would be the same across ethnic groups there may be a reporting bias. A vignette study by Chavez et al [30] indicated that Latino children were judged as less in need of service than children with Anglo names, by parents as well as mental health care providers (se also [31]). The decision to seek help for a mental health problem may be associated with stigmatization [17,18,32,33]. "
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    ABSTRACT: In the Swedish society, as in many other societies, many children and adolescents with mental health problems do not receive the help they need. As the Swedish society becomes increasingly multicultural, and as ethnic and economic residential segregation become more pronounced, this study utilises ethnicity and neighbourhood context to examine referral pathways to child and adolescent psychiatric (CAP) clinics. The analysis examines four different sources of referrals: family referrals, social/legal agency referrals, school referrals and health/mental health referrals. The referrals of 2054 children aged 11-19 from the Stockholm Child-Psychiatric Database were studied using multilevel logistic regression analyses. Results indicate that ethnicity played an important role in how children and adolescents were referred to CAP-clinics. Family referrals were more common among children and adolescents with a Swedish background than among those with an immigrant background. Referrals by social/legal agencies were more common among children and adolescents with African and Asian backgrounds. Children with Asian or South American backgrounds were more likely to have been referred by schools or by the health/mental health care sector. A significant neighbourhood effect was found in relation to family referrals. Children and adolescents from neighbourhoods with low levels of socioeconomic deprivation were more likely to be referred to CAP-clinics by their families in comparison to children from other neighbourhoods. Such differences were not found in relation in relation to the other sources of referral. This article reports findings that can be an important first step toward increasing knowledge on reasons behind differential referral rates and uptake of psychiatric care in an ethnically diverse Swedish sample. These findings have implications for the design and evaluation of community mental health outreach programs and should be considered when developing measures and strategies intended to reach and help children with mental health problems. This might involve providing information about the availability and accessibility of health care for children and adolescents with mental health problems to families in certain neighbourhoods and with different ethnic backgrounds.
    Child and Adolescent Psychiatry and Mental Health 03/2011; 5(1):6. DOI:10.1186/1753-2000-5-6
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