Hispanic Client-Case Manager Matching: Differences in Outcomes and Service Use in a Program for Homeless Persons with Severe Mental Illness

Yale University School of Medicine, Department of Epidemiology and Public Health, Division of Health Policy and Administration, 60 College Street, P. O. Box 208034, New Haven, Connecticut 06520-8034, USA.
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 06/2002; 190(5):315-23. DOI: 10.1097/00005053-200205000-00008
Source: PubMed


Mental health professionals have responded to ethnic and racial disparities in mental health care by advocating increasing cultural relevancy in treatment. A central component of cultural relevancy is ethnic and racial pairing of clients and providers. This study examined the effects of client-case manager ethnic and racial matching among white and Hispanic clients who received assertive community treatment in the Access to Community Care and Effective Services and Supports Program. Twelve-month outcomes and service use were examined among 242 Hispanic and 2333 white clients seen in the first 3 years of the program. Analysis of covariance was used to evaluate the association of client-case manager ethnic and racial matching with changes in health status and service use from baseline to 12 months after program entry. At baseline, Hispanics had more serious problems than whites on several measures of psychiatric and substance abuse domains, and they also showed less improvement than whites over the next year on several measures of psychiatric status and service use. One significant association with ethnic matching was found: when treated by a Hispanic clinician, Hispanic clients showed less improvement in symptoms of psychosis. These results do not support the hypothesis that ethnic and racial matching improves outcomes or service use. Several explanations are offered for the results.

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Available from: Alexander N Ortega
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    • "Yet, most research among consumers receiving community-based PRS has been conducted without examining the effects of these factors on outcomes (Brekke, Ansel, Long, Slade, & Weinstein, 1999; Brekke & Long, 2000; Brekke, Long, Nesbitt, & Sobel, 1997). A small body of treatment outcome research has examined sociocultural factors among single ethnic minority groups such as: African Americans (Baker & Bell, 1999; Baker, Stokes- Thompson, Davis, Gonzo, & Hishinuma, 1999; Min, Wong, & Rothbard, 2004), Asian Americans (Kim, Snyder, & Lai-Bitker, 1996), and Latinos (Lopez et al., 2004; Ortega & Rosenheck, 2002). Other work that contributes to our understanding of sociocultural issues in the context of PRS is found in studies examining the effects of ethnicity among three or more ethnic groups. "
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    ABSTRACT: 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.
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