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Differences in Mental Health Service Sector Utilization among African American and Caucasian Youth Entering Systems of Care Programs

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Abstract

Differences in unmet need and access to services between African American and Caucasian youth have been established; less is known about differences in specific mental health service sectors. This study examined differences in past year outpatient, school-based, day treatment and residential/inpatient service utilization among African American and Caucasian youth (n = 3,649) entering a federally funded system of care program. Random effect logistic regression models were implemented to examine the relationship between race and past year service utilization. Analyses revealed that African American youth were less likely than Caucasian youth to have utilized school-based and residential/inpatient mental health services in the past year. Findings suggest that racial disparities exist in service use for certain types of service sectors and highlight the importance of understanding and identifying individual, family, and community factors that contribute to disparities in service utilization.

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References

  1. President’s New Freedom Commission on Mental Health. Achieving the promise: Transforming mental health care in American. Final Report. Rockville, MD: US Department of Health and Human Services; 2003.

  2. Kazdin AE, Wassell G. Predictors of barriers to treatment and therapeutic change in outpatient therapy for antisocial children and their families. Mental Health Services Research. 2000;2(1):27–40. doi:10.1023/A:1010191807861.

    Article  CAS  PubMed  Google Scholar 

  3. Stiffman AR, Hadley-Ives E, Dore P, et al. Youths’ access to mental health services: The role of providers’ training, resource connectivity, and assessment of need. Mental Health Services Research. 2000;2(3):141–154. doi:10.1023/A:1010189710028.

    Article  CAS  PubMed  Google Scholar 

  4. Snowden LR, Yamada A. Cultural differences in access to care. Annual Review of Clinical Psychology. 2005;1(1):143–166. doi:10.1146/annurev.clinpsy.1.102803.143846.

    Article  PubMed  Google Scholar 

  5. US Dept. of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: Substance Abuse and Mental Health Services Administration; 1999.

  6. Flisher AJ, Kramer RA, Grosser RC, et al. Correlates of unmet need for mental health services by children and adolescents. Psychological Medicine. 1997;27(5):1145–1154. doi:10.1017/S0033291797005412.

    Article  CAS  PubMed  Google Scholar 

  7. US Department of Health and Human Services. Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2001.

  8. Angold A, Erkanli A, Farmer EMZ, et al. Psychiatric disorder, impairment, and service use in rural African American and White youth. Archives of General Psychiatry. 2002;59(10):893–904. doi:10.1001/archpsyc.59.10.893.

    Article  PubMed  Google Scholar 

  9. Shaffer D, Fisher P, Dulcan MK, et al. The NIMH Diagnostic Interview Schedule for Children version 2.3 (DISC-2.3): Description, acceptability, prevalence rates, and performance in the MECA study. Journal of the American Academy of Child and Adolescent Psychiatry. 1996;35(7):865–877. doi:10.1097/00004583–199607000–00012.

    Article  CAS  PubMed  Google Scholar 

  10. Chabra A, Chavez GF, Harris ES, et al. Hospitalization for mental illness in adolescents: Risk groups and impact on the health care system. Journal of Adolescent Health. 1999;24(5):349–356. doi:10.1016/S1054-139X(98)00116-5.

    Article  CAS  PubMed  Google Scholar 

  11. Cunningham PJ, Freiman MP. Determinants of ambulatory mental health services use for school-age children and adolescents. Mental Health Services Research. 1996;31(4):409–427.

    CAS  Google Scholar 

  12. Kazdin AE, Stolar MJ, Marciano PL. Risk factors for dropping out of treatment among white and black families. Journal of Family Psychology. 1995;9(4):402–417. doi:10.1037/0893-3200.9.4.402.

    Article  Google Scholar 

  13. Garland AF, Lau AS, Yeh M, et al. Racial and ethnic differences in utilization of mental health services among high-risk youths. American Journal of Psychiatry. 2005;162(7):1336–1343. doi:10.1176/appi.ajp.162.7.1336.

    Article  PubMed  Google Scholar 

  14. Snowden LR, Masland MC, Libby AM, et al. Racial/ethnic minority children’s use of psychiatric emergency care in California’s public mental health system. American Journal of Public Health. 2008;98(1):118–124. doi:10.2105/AJPH.2006.105361.

    Article  PubMed  Google Scholar 

  15. Glied S, Garrett AB, Hoven C, et al. Child outpatient mental health service use: Why doesn’t insurance matter? Journal of Mental Health Policy and Economics. 1998;1(4):173–187. doi:10.1002/(SICI)1099-176X(199812)1:4<173::AID-MHP23>3.0.CO;2-7.

    Article  PubMed  Google Scholar 

  16. Slade E. Effects of school-based mental health programs on mental health service use by adolescents at school and in the community. Mental Health Services Research. 2002;4(3):151–166. doi:10.1023/A:1019711113312.

    Article  PubMed  Google Scholar 

  17. Lindsey MA, Korr WS, Broitman M, et al. Help-seeking behaviors and depression among African American adolescent boys. Social Work. 2006;51(1):49–58.

    PubMed  Google Scholar 

  18. Pumariega AJ, Atkins DL, Rogers K, et al. Mental health and incarcerated youth. II: Service utilization. Journal of Child and Family Studies. 1999;8(2):205–215. doi:10.1023/A:1022092002435.

    Article  Google Scholar 

  19. Knapp M, McCrone P, Fombonne E, et al. The Maudsley longterm follow-up of child and adolescent depression: Impact of comorbid conduct disorder on service use and costs in adulthood. British Journal of Psychiatry. 2002;180(1):19–23. doi:10.1192/bjp.180.1.19.

    Article  PubMed  Google Scholar 

  20. Canino IA, Spurlock J, eds. Culturally Diverse Children and Adolescents: Assessment, Diagnosis and Treatment. New York: Guilford; 1994.

  21. Clark R, Anderson NB, Clark VR, et al. Racism as a stressor for African Americans: a biopsychosocial model. American Psychologist. 1999;54(10):805–816. doi:10.1037/0003-066X.54.10.805.

    Article  CAS  PubMed  Google Scholar 

  22. Gonzalez MJ. Access to mental health services: The struggle of poverty affected urban children of color. Child and Adolescent Social Work Journal. 2005;22(3–4):245–256.

    Article  Google Scholar 

  23. Yeh M, McCabe K, Hurlburt M, et al. Referral sources, diagnoses, and service types of youth in public outpatient mental health care: A focus on ethnic minorities. Journal of Behavioral Health Services & Research. 2002;29(1):45–60. doi:10.1007/BF02287831.

    Article  Google Scholar 

  24. Alegria M, Canino G, Rios R, et al. Inequalities in use of specialty mental health services among Latinos, African Americans, and Non-Latino Whites. Psychiatric Services. 2002;53(12):1547–1555. doi:10.1176/appi.ps.53.12.1547.

    Article  PubMed  Google Scholar 

  25. Sturm R, Ringel JS, Andreyeva T. Geographic disparities in children’s mental health care. Pediatrics. 2003;112(4):308–315. doi:10.1542/peds.112.4.e308.

    Article  Google Scholar 

  26. Gibbs JT. African American children and adolescent. In: Gibbs JT, Huang LN, eds. Children of Color: Psychological Interventions with Culturally Diverse Youth. San Francisco, CA: Jossey-Bass; 2003:95–144.

    Google Scholar 

  27. Lewit EM, Terman DL, Behrman RE. Children and poverty: Analysis and recommendations. The Future of Children. 1997;7(2):4–24. doi:10.2307/1602384.

    Article  CAS  PubMed  Google Scholar 

  28. Garland AF, Besinger BA. Racial/ethnic differences in court referred pathways to mental health services for children in foster care. Children and Youth Services Review. 1997;19(8):651–666. doi:10.1016/S0190-7409(97)00060-1.

    Article  Google Scholar 

  29. Nguyen L, Huang LN, Arganza GF, et al. The influence of race and ethnicity on psychiatric diagnoses and clinical characteristics of children and adolescents in children’s services. Cultural Diversity and Ethnic Minority Psychology. 2007;13(1):18–25. doi:10.1037/1099-9809.13.1.18.

    Article  PubMed  Google Scholar 

  30. Cuffe SP, Waller JL, Cuccaro MLZ, et al. Race and gender differences in the treatment of psychiatric disorders in young adolescents. Journal of the American Academy of Child and Adolescent Psychiatry. 1995;34(11):1536–1543. doi:10.1097/00004583-199511000-00021.

    Article  CAS  PubMed  Google Scholar 

  31. Cohen P, Hesselbart CS. Demographic factors in the use of children’s mental health services. American Journal of Public Health. 1993;83(1):49–52.

    CAS  PubMed  Google Scholar 

  32. Verhulst FC, van der Ende J. Factors associated with child mental health service use in the community. Journal of the American Academy of Child and Adolescent Psychiatry. 1997;36(7):901–909. doi:10.1097/00004583-199707000-00011.

    Article  CAS  PubMed  Google Scholar 

  33. Wu P, Hoven CW, Bird HR, et al. Depressive and disruptive disorders and mental health service utilization in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry. 1999;38(9):1081–1090. doi:10.1097/00004583-199909000-00010.

    Article  CAS  PubMed  Google Scholar 

  34. Hines-Martin V, Malone M, Kim S, et al. Barriers to mental health care access in an African American population. Issues in Mental Health Nursing. 2003;24(3):237–256. doi:10.1080/01612840305281.

    Article  PubMed  Google Scholar 

  35. Cooper-Patrick L, Gallo JJ, Powe NR, et al. Mental health service utilization by African Americans and Caucasians: The Baltimore epidemiologic catchment area follow-up. Medical Care. 1999;37(10):1034–1045. doi:10.1097/00005650-199910000-00007.

    Article  CAS  PubMed  Google Scholar 

  36. Thompson VLS, Bazile A, Akbar M. African Americans’ perceptions of psychotherapy and psychotherapists. Professional Psychology, Research & Practice. 2004;35(1):19–26. doi:10.1037/0735-7028.35.1.19.

    Article  Google Scholar 

  37. Anglin DM, Link BG, Phelan JC. Racial differences in stigmatizing attitudes toward people with mental illness. Psychiatric Services. 2006;57(6):857–862. doi:10.1176/appi.ps.57.6.857.

    Article  PubMed  Google Scholar 

  38. Swartz MS, Wagner HR, Swanson JW, et al. Comparing use of public and private mental health services: The enduring barriers of race and age. Community Mental Health Journal. 1998;34(2):133–144. doi:10.1023/A:1018736917761.

    Article  CAS  PubMed  Google Scholar 

  39. Nickerson KJ, Helms JE, Terrell F. Cultural mistrust, opinions about mental illness and Black students’ attitudes toward seeking psychological help from white counselors. Journal of Counseling Psychology. 1994;41(3):378–385. doi:10.1037/0022-0167.41.3.378.

    Article  Google Scholar 

  40. Whaley A. Cultural mistrust: An important psychological construct for diagnosis and treatment of African Americans. Professional Psychology: Research and Practice. 2001;32(6):555–562. doi:10.1037/0735-7028.32.6.555.

    Article  Google Scholar 

  41. Cauce AM, Domenech-Rodriguez M, Paradise M, et al. Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth. Journal of Consulting and Clinical Psychology. 2002;70(1):44–55. doi:10.1037/0022-006X.70.1.44.

    Article  PubMed  Google Scholar 

  42. Lau AS, Garland AF, Yeh M, McCabe KM, Wood PA, Hough RL. Race/ethnicity and inter-informant agreement in assessing adolescent psychopathology. Journal of Emotional and Behavioral Disorders. 2004;12:145–156. doi:10.1177/10634266040120030201.

    Article  Google Scholar 

  43. Minsky S, Petti T, Gara M, Vega W, Lu W, Kiely G. Ethnicity and clinical psychiatric diagnosis in childhood. Administration and Policy in Mental Health. 2006;33:558–567. doi:10.1007/s10488-006-0069-8.

    Article  PubMed  Google Scholar 

  44. Center for Mental Health Services. Annual Report to Congress on the evaluation of the Comprehensive Community Mental Health Services for Children and Their Families program, 2001. Atlanta, GA: Macro International; 2001. Available from: http://mentalhealth.samhsa.gov/publications/allpubs/CB-E201/default.asp.

  45. Center for Mental Health Services. Comprehensive Community Mental Health Services for Children and Their Families Program, Evaluation findings—Annual Report to Congress, 2002–2003. Atlanta, GA: Macro International; 2003. Available from http://mentalhealth.samhsa.gov/publications/allpubs/SMA03-CBE2002/default.asp.

  46. Schafer JL, Graham JW. Missing data: Our view of the state of the art. Psychological Methods. 2002;7(2):147–177. doi:10.1037/1082-989X.7.2.147.

    Article  PubMed  Google Scholar 

  47. Rubin DB. Multiple imputation for nonresponse in surveys. New York: Wiley; 1987.

    Book  Google Scholar 

  48. Schafer JL. Analysis of incomplete multivariate data. Boca Raton, FL: Chapman & Hall/CRC; 1997.

    Google Scholar 

  49. Stuart E, Azur MA, Barksdale CL. Missing data and multiple imputation: An overview and application of techniques. Symposium session presented at the 21st Annual Conference on System of Care Research in Children’s Mental Health, Tampa, FL, February 2008.

  50. Stuart EA, Azur M, Frangakis CE, et al. (2009). Practical imputation with large datasets: A case study of the Children’s Mental Health Initiative. Health Services Research (in press).

  51. American Psychiatric Association, ed. Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Association; 1994.

  52. Hodges K. Child and Adolescent Functional Assessment Scale. Ypsilanti, MI: Department of Psychology, Eastern Michigan University; 1994.

  53. Hodges K. CAFAS manual for training coordinators, clinical administrators and data managers. Ypsilanti, MI: Eastern Michigan University; 1997.

  54. Hodges K, Wong M. Psychometric characteristics of a multidimensional measure to assess impairment: The Child and Adolescent Functional Assessment Scale. Journal of Child and Family Studies. 1996;5:445–467. doi:10.1007/BF02233865.

    Article  Google Scholar 

  55. Hodges K, Wong M. Use of the Child and Adolescent Functional Assessment Scale (CAFAS) to predict service utilization and cost. Journal of Mental Health Administration. 1997;24(3):278–290. doi:10.1007/BF02832662.

    Article  CAS  PubMed  Google Scholar 

  56. Hodges K, Doucette-Gates A, Kim C. Predicting service utilization with the child and Adolescent Functional Assessment Scale in a sample of youth with serious emotional disturbance served by Center for Mental Health Service-funded demonstrations. Journal of Behavioral Health Services & Research. 2000;27:47–59. doi:10.1007/BF02287803.

    Article  CAS  Google Scholar 

  57. Burns BJ, Costello EJ, Angold A, et al. Children’s mental health service use across service sectors. Health Affairs. 1995;14(3):147–159. doi:10.1377/hlthaff.14.3.147.

    Article  CAS  PubMed  Google Scholar 

  58. Cabiya JJ, Canino G, Chavez L, et al. Gender disparities in mental health service use of Puerto Rican children and adolescents. Journal of Child Psychology and Psychiatry. 2006;47(8):840–848. doi:10.1111/j.1469-7610.2006.01623.x.

    Article  PubMed  Google Scholar 

  59. Kataoka SH, Zhang L, Wells KB. Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. American Journal of Psychiatry. 2002;159(9):1548–1555. doi:10.1176/appi.ajp.159.9.1548.

    Article  PubMed  Google Scholar 

  60. Zahner GEP, Daskalakis C. Factors associated with mental health, general health, and school-based service use for child psychopathology. American Journal of Public Health. 1997;87(9):1440–1448.

    Article  CAS  PubMed  Google Scholar 

  61. Schafer JL. Multiple imputation: A primer. Statistical Methods in Medical Research. 1999;8(1):3–15. doi:10.1191/096228099671525676.

    Article  CAS  PubMed  Google Scholar 

  62. StataCorp LP, ed. Stata statistical software: Release 10. College Station, TX: StataCorp LP; 2007.

  63. Copeland VC. Disparities in mental health service utilization among low-income African American adolescents: Closing the gap by enhancing practitioner’s competence. Child and Adolescent Social Work Journal. 2006;23(4):407–431. doi:10.1007/s10560–006–0061-x.

    Article  Google Scholar 

  64. Flaherty LT, Weist MD, Warner BS. School-based mental health services in the United States: History, current models and needs. Community Mental Health Journal. 1996;32(4):341–352. doi:10.1007/BF02249452.

    Article  CAS  PubMed  Google Scholar 

  65. Anglin TM, Naylor KE, Kaplan DW. Comprehensive school-based health care: High school students’ use of medical, mental health, and substance abuse services. Pediatrics. 1996;97(3):318–330.

    CAS  PubMed  Google Scholar 

  66. Armburster P, Lichtman J. Are school based mental health services effective? Evidence from 36 inner city schools. Community Mental Health Journal. 1999;35(6):493–504. doi:10.1023/A:1018755100381.

    Article  Google Scholar 

  67. Garland AF, Aarons GA, Brown SA, et al. Diagnostic profiles associated with use of mental health and substance abuse services among high risk youths. Psychiatric Services. 2003;54(4):562–564. doi:10.1176/appi.ps.54.4.562.

    Article  PubMed  Google Scholar 

  68. Richardson LA. Seeking and obtaining mental health services: What do parents expect? Archives of Psychiatric Nursing. 2001;15:223–231. doi:10.1053/apnu.2001.27019.

    Article  CAS  PubMed  Google Scholar 

  69. Brannan AM, Heflinger CA. Child behavioral health service use and caregiver strain: Comparison of managed care and fee-for-service Medicaid systems. Mental Health Services Research. 2005;7(4):197–211. doi:10.1007/s11020-005-7452-z.

    Article  Google Scholar 

  70. Yeh M, McCabe K, Hough RL, et al. Racial/ethnic differences in parental endorsement of barriers to mental health services for youth. Mental Health Services Research. 2003;5(2):65–77. doi:10.1023/A:1023286210205.

    Article  PubMed  Google Scholar 

  71. McCabe K, Yeh M, Hough RL, et al. Racial/ethnic representation across five public sectors of care for youth. Journal of Emotional and Behavioral Disorders. 1999;7(2):72–82. doi:10.1177/106342669900700202.

    Article  Google Scholar 

  72. Mason M, Gibbs JT. Patterns of adolescent psychiatric hospitalization: Implications for social policy. American Journal of Orthopsychiatry. 1992;62(3):447–457. doi:10.1037/h0079361.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 808, Baltimore, MD, 21205, USA

    Crystal L. Barksdale PhD

  2. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 8th Floor, Baltimore, MD, 21205, USA

    Melissa Azur PhD

  3. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 819, Baltimore, MD, 21205, USA

    Philip J. Leaf PhD

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  1. Crystal L. Barksdale PhD
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  2. Melissa Azur PhD
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  3. Philip J. Leaf PhD
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Correspondence to Crystal L. Barksdale PhD.

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Barksdale, C.L., Azur, M. & Leaf, P.J. Differences in Mental Health Service Sector Utilization among African American and Caucasian Youth Entering Systems of Care Programs. J Behav Health Serv Res 37, 363–373 (2010). https://doi.org/10.1007/s11414-009-9166-2

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