Culturally Competent Systems of Care for Children’s Mental Health: Advances and Challenges

Child and Adolescent Psychiatry, East Tennessee State University, 204 McWherter Hall, Box 70567, Johnson City, TN 37614, USA.
Community Mental Health Journal (Impact Factor: 1.03). 11/2005; 41(5):539-55. DOI: 10.1007/s10597-005-6360-4
Source: PubMed


There has been a remarkable growth in cultural diversity in the United States over the past 20 years. The population of minority groups has increased at a much faster rate than the European-background population in America, and faster even among children and youth. At the same time, minority youth face increasing disparities in their mental health and in access to mental health services. These are related to the multiple challenges they already face in socioeconomic status, but are aggravated by the lack of culturally competent services that can address their specific mental health needs within the context of their culture, family, and community. This paper reviews the current knowledge about the mental health of culturally diverse youth in the United States, and provides guidance on approaches to address the disparities they face.

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Available from: Eugenio Rothe, Aug 22, 2014
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    • "Several epidemiologic studies have shown that only one in five children with emotional and behavioral disorders receive mental health services [1-3]. Low-income and ethnically diverse children lag well behind their middle class, Caucasian counterparts in rate of service utilization [3,4]. Access barriers, such as lack of specialized services in low-income communities, high cost,and poor service quality, and stigma have been found to affect service utilization by ethnically diverse children [5-9]. "
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    ABSTRACT: Urban schools lag behind non-urban schools in attending to the behavioral health needs of their students. This is especially evident with regard to the level of use of evidence-based interventions with school children. Increased used of evidence-based interventions in urban schools would contribute to reducing mental health services disparities in low-income communities. School-wide positive behavioral interventions and supports (SWPBIS) is a service delivery framework that can be used to deliver universal preventive interventions and evidence-based behavioral health treatments, such as group cognitive behavioral therapy. In this article, we describe our ongoing research on creating internal capacity for program implementation. We also examine the cost-effectiveness and resulting school climate when two different levels of external support are provided to personnel as they implement a two-tier SWPBIS program.Methods/design: The study follows six K - 8 schools in the School District of Philadelphia randomly assigned to consultation support or consultation-plus-coaching support. Participants are: approximately 48 leadership team members, 180 school staff and 3,900 students in Tier 1, and 12 counselors, and 306 child participants in Tier 2. Children who meet inclusion criteria for Tier 2 will participate in group cognitive behavioral therapy for externalizing or anxiety disorders. The study has three phases, baseline/training, implementation, and sustainability. We will measure implementation outcomes, service outcomes, child outcomes, and cost. Findings from this study will provide evidence as to the appropriateness of school-wide prevention and treatment service delivery models for addressing services disparities in schools. The effectiveness and cost-effectiveness analyses of the two levels of training and consultation should help urban school districts and policymakers with the planning and deployment of cost-effective strategies for the implementation of evidence-based interventions for some of the most common behavioral health problems in school children.Trial registration: identifier: NCT01941069.
    Implementation Science 01/2014; 9(1):12. DOI:10.1186/1748-5908-9-12 · 4.12 Impact Factor
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    • "Greater perception of social support was related to fewer withdrawn/depressed and anxious/depressed symptoms in tenth grade. Overall, these findings are consistent with the research conducted with non-immigrant populations that has demonstrated the importance of social support in adolescent socio-emotional functioning (Cauce, Mason, Gonzales, Hiraga, & Liu, 1994; Clark-Lempers, Lempers, & Ho, 1991; Pumariega, Rogers, & Rothe, 2005). Further, anxious/depressed symptoms decreased even when acculturative stress is included in the model. "
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    ABSTRACT: This longitudinal study of 286, urban residing, first- and second-generation immigrant adolescents examined the degree to which acculturative stress is related to the developmental trajectories of mental health problems and the role of social support in this process. Participants were recruited when they entered 10th grade and two additional waves of data were gathered at 12-month intervals. Using individual growth curve modeling, the results show significant decline in internalizing mental health problems during the high school years. At the same time, greater exposure to acculturative stress predicted significantly more withdrawn/depressed, somatic, and anxious/depressed symptoms. Additionally, social support moderated the relation between acculturative stress and anxious/depressed symptoms. Gender and generation status differences were found only at baseline (10th grade).
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    • "Reports in the literature identify several obstacles that prevent minorities from using routine outpatient treatment. These obstacles include avoidance of defining personal distress as mental illness due to stigma and a preference for culturally sanctioned alternatives (Pumariega et al. 2005; Roberts et al. 2005), mistrust of providers and of the mental health treatment system (Thompson et al. 2004), and limited proficiency in English (Fiscella et al. 2002). By preventing them from seeking other forms of mental health treatment, and in so doing, by entering the mental health treatment system via non-emergency care routes, these obstacles appear to channel minorities into crisis care. "
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    ABSTRACT: For children and youth making a mental health crisis visit, we investigated ethnic disparities in whether the children and youth were currently in treatment or whether this crisis visit was an entry or reentry point into mental health treatment. We gathered Medicaid claims for mental health services provided to 20,110 public-sector clients ages 17 and younger and divided them into foster care and non-foster care subsamples. We then employed logistic regression to analyze our data with sociodemographic and clinical controls. Among children and youth who were not placed in foster care, African Americans, Latinos, and Asian Americans were significantly less likely than Caucasians to have received mental health care during the three months preceding a crisis visit. Disparities among children and youth in foster care were not statistically significant. Ethnic minority children and youth were more likely than Caucasians to use emergency care as an entry or reentry point into the mental health treatment, thereby exhibiting a crisis-oriented pattern of care.
    Journal of Child and Family Studies 11/2009; 18(5):512-519. DOI:10.1007/s10826-008-9253-7 · 1.42 Impact Factor
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