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.
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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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    • "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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