Disparities in Treating Culturally Diverse Children and Adolescents

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This article considers disparities in the psychiatric care of racial and ethnic children and adolescents, with respect to their under-utilization and under-treatment, especially with psychotropic medications. Culturally adapted psychotherapeutic approaches are discussed, as well as the notion of a culturally competent clinician who strives to apply his or her clinical skills while constantly making adjustments to the beliefs, habits, and circumstances of culturally diverse children and their parents, one patient at a time.

Section snippets

Evolving diversity in the United States: some background

The United States is the destination country for immigrants from all over the world. Welcoming new immigrants has long been an American cultural heritage. By and large, most European immigrants were well received and readily assimilated into the mainstream American social and cultural fabric.2 In contrast, non-European immigrants were not always welcomed. In fact, non-European immigration was legally curtailed or actively controlled. The Chinese Exclusion Act of 1882 is one example; this

Race, ethnicity, and culture

Race, ethnicity, and culture are social constructs. Race refers to a population considered distinct from others for certain outward, physical characteristics. Ethnicity is a term representing “social groups with a shared history, sense of identity, geography, and cultural roots.”6 Culture is defined as a group of people's “shared patterns of belief, feeling, and knowledge that ultimately guide everyone's conduct and definition of reality.”7 There are no established biological criteria for

Under-Utilization of Services

The outstanding issue in minority mental health is that racial and ethnic minorities—children and adults alike—do not use mental health services as often as Caucasians do. In 2001, the Office of the United States Surgeon General released its Report on Mental Health and its supplement, “Mental Health: culture, race, and ethnicity.” The Report states that the under-utilization of mental health services by racial and ethnic minorities is “a major public health threat.”1 It continues, “Minorities

Cultural factors in under-utilization

The under-utilization of mental health care by ethnic minorities stems from the interplay of a myriad of sociocultural issues not only in initiating the treatment, but also in staying in treatment, once started. Because mental health care takes place in a cultural context involving both the giver and the receiver of care, much research has been done to explore and understand what cultural factors in the dyadic relationship might serve as the root causes of the under-utilization phenomenon.

Culturally competent psychotherapy research

In their recent review article, “The Case for Cultural Competency in Psychotherapeutic Interventions,” Sue and colleagues31 state that “culturally adapted interventions provide benefit to intervention outcomes. This added value is more apparent in the research on adults than on children or youths…” In the following sections, three culturally adapted treatment approaches for minority children and their families are reviewed. These studies or their variations may be applicable to other treatment

The culturally competent clinician

Sue and colleagues31 offer an operational definition of cultural competence in clinicians as follows: “Competence is usually defined as an ability to perform a task or the quality of being adequately prepared or qualified. If therapists or counselors are generally competent to conduct psychotherapy, they should be able to demonstrate their skills with a range of culturally diverse clients.” Cross and colleagues37 delineated the functional qualities of a culturally competent clinician more

Summary

“The Child is father of the Man,” a poet once said. How a child is treated by society determines not only the child's future but the future of the society. In the United States, a large segment of its future “father of the Man” is deprived of psychiatric care, which they need. This article discusses how racially and ethnically diverse children in the United States are denied access to psychiatric services. Many of them often go under-treated or untreated, especially in out-patient psychiatric

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