Transcript Engaging African-Americans into Outpatient Mental Health

ENGAGING AFRICAN-AMERICANS IN
OUTPATIENT MENTAL HEALTH INTERVENTION
Reginald Simmons, Ph.D. & Gretchen Chase Vaughn, Ph.D.
WHY DOES THIS MERIT ATTENTION?
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African-Americans are under-represented in outpatient care
and over-represented in more restrictive or intensive
settings(DHHS, 2001; Sue & Chu, 2003; Thompson, Bazile &
Akbar, 2004)
Involvement in OP is often due to “coercive processes” that
may impede engagement, investment, and retention (Snowden,
2001; Gayles, Alston & Staten, 2005)
Increased involvement in OP can benefit the person and
society….how?
WHY DOES THIS MERIT ATTENTION?
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A-A’s more likely to use services inconsistently, seek treatment
later, end treatment early, and receive a poorer quality of care
(US DHHS, 2001; Snowden, 2003; Thompson, Bazile & Akbar,
2004; Kazdin, et al. 1995).
CULTURAL BELIEFS/NORMS ABOUT
PERCEPTION OF NEED
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At times, A-A’s may underestimate need
“John Henryism” (James, LaCroix, Kelimbaum & Strogatz,
1984)
Seeking therapy may be interpreted as a sign of “weakness”
and “diminished pride” (Thompson, Bazile & Akbar, 2004)
Belief that symptoms are due to spiritual issues may delay
help-seeking (Cauce, 2002)
Multiple stressors and/or disadvantage may impact
energy/ability to seek treatment
Mistrust of “helping institutions”
CULTURAL BELIEFS/NORMS ABOUT HELPSEEKING
What is the best remedy for the common cold?
 Chicken Soup?
 Vapor Rub?
 Culture: One group or people’s preferred way of
meeting their basic human needs
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Exercise adapted from National Indian Child
Welfare Association(NICWA)
CULTURAL BELIEFS/NORMS ABOUT HELPSEEKING
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When need is critical, A-A’s turn first to family, church, and
trusted local networks(Snowden, 1998; McMiller & Weisz,
1996; Davey & Watson, 2008)
 A-A’s only .37 times as likely as Whites to consult
professionals as the first step in help-seeking
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However, these trusted community entities may serve as either
a barrier or a bridge to engagement in formal mental health
services(Boyd-Franklin, 1989)….why?
WHEN LOCAL NETWORKS ARE NOT ENOUGH,
WHERE DO AFRICAN-AMERICANS SEEK FORMAL
HELP?
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Primary care
 But
quality of care has been questioned(Davey &
Watson, 2008).
 When referred to MH services, A-A’s often do not
follow-up with the referral (Davey & Watson, 2008).
HOW CAN OUTPATIENT MENTAL HEALTH PROVIDERS
ENGAGE AFRICAN-AMERICANS VOLUNTARILY?
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Step One: Collaborate with trusted local networks
Step Two: Involve community in assessing treatment
needs
Step Three: Have culturally-appropriate organizational
and clinical engagement practices
STEP ONE: COLLABORATE WITH TRUSTED LOCAL
COMMUNITY NETWORKS
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Culturally-Specific Formal Local Networks
 Churches, fraternal organizations
 Pastors may want support in addressing mental health
needs of their congregation
Culturally-Specific Informal Local Networks
 “Natural helpers” such as hairdressers and barbers
 “MindStylz” by CPA Ethnic Diversity Task Force
STEP TWO: INVOLVE COMMUNITY IN ASSESSING IT’S
TREATMENT NEEDS
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Community knows what it needs (Vera et al., 2005; BrelandNoble & King, 2008)
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Provider should regularly assess effectiveness and relevance of
it’s services (be nimble)
 Attend to patterns in presenting problems
 Satisfaction surveys, periodic focus groups, community
representation on Boards
STEP THREE: ENGAGING THE CLIENT:
ORGANIZATIONAL CHARACTERISTICS
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Culturally-welcoming, respectful organizational climate
Be invested in the community
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Have capacity to decrease stressors, increase social support
 Social support is related to mental health service use by AA’s (Harrison, McKay, & Bannon, 2004).
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Flexible Office Hours and Staffing Patterns
Ethnic Compatibility of Staff
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STEP THREE: ENGAGING THE CLIENT: PRACTICE
CHARACTERISTICS
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Engage in Collaborative and Active Problem-Solving at first
contact
 At intake, Identify and address barriers to participation
.…why might this aid engagement?
During first session, focus on problems the family wants to
change
-Use “we” to emphasize that process will be collaborative and
respectful
 Develop and implement an immediate intervention to
address at least one stressor….why?
(McKay, et al., 2004)
STEP THREE: ENGAGING THE CLIENT: PRACTICE
CHARACTERISTICS
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Therapist must be prepared to work with other agencies
involved with family, and link family to supportive services
(Boyd-Franklin, 2003)
 Case management is therapy!
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Take time to build trust and rapport
 Let clients tell their story
(Cooper-Patrick, et al. 1999; Nunez & Robertson, 2006).
SOME KEYS TO EFFECTIVE CROSS-CULTURAL
RELATIONSHIPS
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Therapists should understand the relationship between historic
oppression and current disparities in well-being of A-A’s (AllenMeares & Burman,1999).
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Therapist should be aware of cross-class differences
 Therapist must not assume he understands client’s
world…learn from client
SOME KEYS TO EFFECTIVE CROSS-CULTURAL
RELATIONSHIPS
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Therapists should assess their own biases, and worldviews
and seek to understand (and respect) the client’s worldview
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Therapist must be willing to “go there”, explore any perceptions
of the role of racism in presenting problems, especially with A-A
male clients
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Seek training and competent supervision
CONCLUSION
We must do better!
 For entire chapter and related topics, see
upcoming book due in August:
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T.P. Gullotta, R. Hampton, & R. Crowell (Eds.),
Handbook of African-American Health. New York:
Guilford Press.
Contact: [email protected], Dept. of
Criminology & Criminal Justice, Central Connecticut
State University
Thank You!