Integrating health care: The clear advantage for underserved diverse populations.

Integrating health care into primary and specialty physician practices and clinics has potential benefits for women; racial/ethnic minorities; and lesbian, gay, bisexual, transgendered populations, thus making a major contribution to the health disparities in America. Mounting evidence suggests that physical illnesses are accompanied and exacerbated by emotional, social, and cultural factors. Many of the chronic diseases, cardiovascular disease, HIV-AIDS, diabetes, and some cancers can be prevented and altered by behavioral changes and are thus considered behavioral diseases. In addition, nonadherence to medication is a significant factor in less-than-optimal treatment of any illness. Thus, medical treatment without coordinated attempts to also treat the behavioral and social factors compromises its effectiveness. Treatment is often complicated by the lack of timely diagnoses of issues such as domestic violence, substance abuse, and eating disorders. Furthermore, helping patients negotiate medical visits, treatment options, and disease prevention and management can be effectively addressed within an integrated primary care system of health delivery with better outcomes for minorities. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Benefits of comprehensive health care for improving health outcomes in women.

The American Psychological Association Health Care for the Whole Person Task Force was formulated to provide a rationale for integrating behavioral health services in primary care. Collectively, the task force called for a transformation of the biomedical system into one based on the biopsychosocial model. This article is a summary of the Women's Health Committee position paper that reviewed contextual factors in women's health, provided recommendations for clinical service action, and recommended an integrated primary health care system to address women's health needs. This article provides a vision of integrated care and a practical guide for psychology practitioners as they collaborate with other health care providers and health policy groups to improve health outcomes for women over the life course. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward evidence-based interventions for diverse populations: The San Francisco General Hospital prevention and treatment manuals.

Clinical trials have seldom included adequate samples of people of color. Therefore, practitioners serving ethnic minorities often do not have access to readily available evidence-based interventions. This article summarizes the development and empirical evaluation of prevention and treatment manuals designed for low-income ethnic minority populations at San Francisco General Hospital. The manuals were often designed by people of color familiar with the communities for which they were developed. Independent research teams in multi-site national and international clinical trials have evaluated many of these manuals with encouraging results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diverse faculty in STEM fields: Attitudes, performance, and fair treatment.

In an attempt to address concerns regarding the experiences of academic faculty who are members of often-marginalized groups (e.g., women and ethnic/racial minorities), a climate survey of faculty members at a large public university was developed as part of a larger effort to improve aspects of the policies, procedures, and work climate. Multivariate analysis of variance revealed differences in performance-related variables and equality of treatment for women and racial/ethnic minorities working in the STEM (science, technology, engineering, and mathematics) fields. Women in STEM fields and racial/ethnic minority non-STEM faculty generally reported more negative experiences, while ethnically diverse STEM faculty generally reported more positive experiences. The differential composition of the racial/ethnic minority STEM and non-STEM groups is thought to explain the discrepant findings between these 2 groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Clinical guidelines in cross-cultural mental health.

Reviews the book, Clinical guidelines in cross-cultural mental health edited by Lillian Comas-Diaz and Ezra E. H. Griffith (see record 1988-97772-000). This volume represents the latest work on psychotherapy with ethnic/racial minority populations, and was intended for mental health practitioners as well as academicians. The book is divided into three parts. The first section has six chapters addressing the role of "ethnosociocultural" factors such as ethnicity, family values, language, religion, politics, and race in the cross-cultural delivery of psychotherapeutic care. The second section focuses on clinical practice with specific ethnic/racial groups including Afro-Americans, Mexican-Americans, Puerto Ricans, Cubans, Southeast Asian refugees, and West Indians. A final section of one chapter by Comas-Diaz discusses the "state of the art" in cross-cultural mental health. Three factors set this book apart from previous ones on this topic: 1) devotion of an entire section to core ethnosociocultural factors; 2) use of case vignettes to illustrate important cross-cultural issues in mental health; and 3) provision of specific recommendations for the practitioner. Unfortunately, the effort falls short due to the strong academic approach to clinical issues evident throughout the book. Moreover, there was substantial variability in contributors' use of case material and provision of specific recommendations. This uneven coverage, one of the prime drawbacks of many edited volumes, may limit its appeal to practitioners. This book is an improvement over previous texts in this area, but it is by no means a clinician's guide to cross-cultural mental health because of the pervasive academic influence throughout. Consequently, there is an imbalance in favor of didactic over pragmatic approaches to cross-cultural mental health. Thus this book seems more suitable for clinicians in training than for clinicians in practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Family therapy with ethnic minorities.

Reviews the book, Family therapy with ethnic minorities by Man Keung Ho (see record 1987-98516-000). This book offers a coherent aggregation of theories for working with ethnic minority families in the United States. Its author focuses on an ecological family systemic approach, with emphasis on sociocultural and communication theories. Within this conceptual framework, he discusses six factors that distinguish ethnic minorities from the mainstream middle-class white American families and that bear implications for their treatment. Ho identifies them as: 1) ethnic minority reality, 2) impact of external system on minority cultures, 3) biculturalism, 4) ethnic differences in minority status, 5) ethnicity and language, and 6) ethnicity and social class. The book's strengths rest on the identification of the major ethnocultural issues affecting the treatment of ethnic minority families. Conversely, its weaknesses lie on the clinical illustrations of these issues. Although Ho states that he also utilizes psychodynamic and interpersonal perspectives, clinically he emphasizes sociocultural issues, neglecting other indexes, such as intrapsychic, interpersonal, and developmental variables. The major contribution of Family therapy with ethnic minorities lies in its efforts toward the development of a conceptualization of a family therapy model for working with ethnic minorities. Ho reviews existing theoretical paradigms and critically examines their applicability to ethnic minorities. He enriches the field by aiding in the development of a therapeutic structure that allows cultural diversity. Within this context, the book represents priority reading for the beginning family therapist working with ethnic minority individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Panel II: Macrosocial and environmental influences on minority health.

Ethnic minority populations show patterns of health, health care use, and mortality that differ from the overall U.S. population. Each of the broad groups of minorities (Asian. Hispanic, Native, and African Americans) has a unique background of sociocultural factors that influence these patterns. Thus. the larger social environment for ethnic populations, including political, environmental, historical, and economic factors, is a major variable in possible health outcomes. The individual portions in this panel report of the conference seek to identify such factors for each ethnic group and to suggest those macrosocial influences that are most important for observed health effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth.

In this article, a mental health help-seeking model is offered as a framework for understanding cultural and contextual factors that affect ethnic minority adolescents' pathways into mental health services. The effects of culture and context are profound across the entire help-seeking pathway, from problem identification to choice of treatment providers. The authors argue that an understanding of these help-seeking pathways provides insights into ethnic group differences in mental health care utilization and that further research in this area is needed, (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Migrants in family practice: their symptoms and diagnoses differ from the Dutch

OBJECTIVE: To determine to what extent Turks, Moroccans and Surinamese differ from the Dutch in health problems, while taking the impact of relevant background characteristics into account. DESIGN: Secondary analysis. SETTING: Dutch Institute for health care research, Utrecht, the Netherlands. PATIENTS AND METHODS: In 1987/'88, 161 general practitioners and their assistants in 103 general practices recorded all patient contacts during three months in four consecutive periods for the Dutch National Survey on Morbidity and Interventions in General Practice. Data on 1165 Turkish, 853 Moroccan, 1355 Surinamese and 1471 Dutch persons (a 1% sample) between 18 and 65 years of age were used. Differences in health problems (complaints and diagnoses) between groups were tested by means of logistic regression analysis. Sex, age, educational level, working situation, marital status, health insurance, region and urbanisation were included in the analyses as covariates, for which the data were corrected. RESULTS: The pattern of complaints and diagnoses of ethnic minorities agreed with that of the Dutch in many respects, but there were also clear differences. Surinamese differed the most. Digestive problems, acute and chronic, eye problems, acute musculoskeletal problems, especially muscle pain or fibrositis, respiratory infections and eczema occurred more often in all three minority groups. Surinamese had more diagnoses in the categories of blood and endocrine/metabolic disorders (diabetes mellitus), Moroccanshad fewer diagnoses of the circulatory system (hypertension). Turks and Surinamese had more general and social problems, while Surinamese also had more psychological problems. CONCLUSION: In some areas ethnic minorities have more health problems than Dutch patients who are comparable with them in background characteristics. This clearly suggests an 'ethnic' factor.     

Workplace harassment: Double jeopardy for minority women.

To date there have been no studies of how both sex and ethnicity might affect the incidence of both sexual and ethnic harassment at work. This article represents an effort to fill this gap. Data from employees at 5 organizations were used to test whether minority women are subject to double jeopardy at work, experiencing the most harassment because they are both women and members of a minority group. The results supported this prediction. Women experienced more sexual harassment than men, minorities experienced more ethnic harassment than Whites, and minority women experienced more harassment overall than majority men, minority men, and majority women. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Awards for Distinguished Contribution to Psychology in the Public Interest.

Discusses the contributions of Hortensia Amaro and Florence L. Denmark, the 1992 recipients of the Awards for Distinguished Contribution to Psychology in the Public Interest awarded by the American Psychological Association. Amaro is recognized for research and public policy leadership on behalf of ethnic minority communities and for advancement of issues confronting ethnic minority, particularly Hispanic, women. She is founder of the Latino Health Council, the Latino Health Network, and the Multicultural AIDS Coalition. Denmark is recognized for scholarship on the psychology of women; advocacy on behalf of ethnic minorities, children, persons with disabilities, the elderly, and gay men and lesbians; and writing on the pedagogical issues involved in integrating new scholarship on gender, race, ethnicity, and feminist and multicultural perspectives into psychology courses. Biographies of recipients are given. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health of minority women: Some special issues.

Discusses problems encountered in providing mental health services to ethnic minority women with respect to the limitations of pertinent theory and research, the potential pitfalls inherent in gender and ethnic/racial stereotypes, the social and economic consequences of racism and sexism, and the joint impact of all of these factors on the mental health status of minority women. In addition, some common structural barriers to adequate mental health care that arise from sex, race, and class biases reflected in therapeutic institutions are pointed out. General guidelines are established to assist professionals in providing sensitive and appropriate services. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section on recruiting and retaining minorities in psychotherapy research

This article introduces a special section devoted to the issue of recruiting and retaining ethnic minorities in psychotherapy research. Although minorities make up approximately 27% of the population of the United States (U.S. Bureau of the Census, 1994), the major psychotherapy studies conducted to date have been based almost exclusively on White populations. In March 1994, however, a new policy of the National Institutes of Health (NIH) mandated that women and members of ethnic minority groups be included in all NIH-funded projects involving human participants, unless a clear and compelling rationale justifies their exclusion. Knowledge about effective and culturally sensitive means of contacting, recruiting, and retaining minorities is an important resource for researchers who now wish to conduct NIH-funded studies. In the series of articles constituting this special section, strategies and advice are provided for researchers who want to recruit and retain minorities in psychotherapy research.     

Review of Strategies for building multicultural competence in mental health and educational settings.

Reviews the book, Stategies for building multicultural competence in mental health and educational settings edited by M. G. Constantine and D. W. Sue (2005). Strategies for Building Multicultural Competence in Mental Health and Educational Settings is an excellent resource designed for mental health professionals who may lack knowledge and expertise in working with diverse clients. It provides hands-on strategies and suggestions in a variety of contexts, using the Multicultural Guidelines as a framework. This book is strongly recommended for clinicians working with culturally diverse populations. The Surgeon General's report Mental Health: Culture, Race and Ethnicity (U.S. Department of Health & Human Services, 2001) clearly demonstrates the disparity in the mental health care of racial and ethnic minorities as compared with Whites. This book is useful not only to novices exploring diversity but also to those who are already cross-culturally competent. The authors successfully apply the APA Multicultural Guidelines in clinical practice and educational, training, and organizational settings while providing specific strategies for clinicians. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Congruence between culturally competent treatment and cultural needs of older Latinos.

This study investigated a new 2-factor construct, termed cultural congruence, which is related to cultural competence in the delivery of mental health services to ethnic minority clients. Cultural congruence was defined as the distance between the cultural competence characteristics of the health care organization and the clients’ perception of those elements according to their cultural needs. The measure evidenced both reliability and validity in predicting criterion-related indicators. Older Hispanic/Latino clients (N = 272) receiving mental health services either through integrated primary care or referral to specialized mental health care were assessed for depression and anxiety symptomatology and health status at baseline, 3-, and 6-month follow-up treatment. Results indicated that cultural congruence predicted treatment outcomes (reduction of symptomatology) independent of treatment and evidenced moderator effects with respect to depression, suicidality, anxiety, and physical health criteria. Cultural congruence was more effective under the condition of the enhanced specialty referral model than under the integrated primary care model. Results are discussed in terms of how the new construct of cultural congruence extends knowledge of culturally competent mental health practice among the older Hispanic/Latino population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meeting U.S. Health Care Needs: A Challenge to Psychology.

Is there really a growing need for primary care psychologists? U.S. population health statistics reveal a great deal of variability in the care Americans receive and in their associated health outcomes. Members of minority groups, the inner-city poor, and rural Americans bear a disproportionate burden of ill health. The decreasing pool of primary care physicians is documented as well as is the growing pool of nonphysician primary care providers. The need to expand the nature of psychological interventions in primary care is examined, and change in the training of professional psychologists is recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Demystifying the concept of ethnicity for psychotherapy researchers.

At a time when ethnic minority populations are increasing in the United States, few psychotherapy studies are including minorities in their samples. To include ethnic minorities in psychotherapy studies, the complex construct of ethnicity must be carefully measured. In this article, practical advice is offered for conceptualizing, measuring, and interpreting ethnic factors in psychotherapy studies. Also discussed are identifying pathways from ethnicity to psychotherapy outcomes. Pathways that may influence ethnic differences in psychotherapy outcome include cultural factors, minority status, socioeconomic status, acculturation, and immigration experiences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of minority stress on mental health and substance use among sexual minority women.

Objective: We examined the direct and indirect impact of minority stress on mental health and substance use among sexual minority women. Method: A combination of snowball and targeted sampling strategies was used to recruit lesbian and bisexual women (N = 1,381) for a cross-sectional, online survey. Participants (M age = 33.54 years; 74% White) completed a questionnaire assessing gender expression, minority stressors (i.e., victimization, internalized homophobia, and concealment), social–psychological resources (i.e., social support, spirituality), and health-related outcomes. We used structural equation modeling to test associations among these factors, with gender expression as an antecedent and social–psychological resources as a mediator between minority stress and health. Results: The final model demonstrated acceptable fit, χ2(79) = 414.00, p confirmatory fit index = .93, Tucker–Lewis index = .91, standardized root-mean-square residual = .05, root-mean-square error of approximation = .06, accounting for significant portions of the variance in mental health problems (56%) and substance use (14%), as well as the mediator social–psychological resources (24%). Beyond indirect effects of minority stress on health outcomes, direct links emerged between victimization and substance use and between internalized homophobia and substance use. Conclusions: Findings indicate a significant impact of minority stressors and social–psychological resources on mental health and substance use among sexual minority women. The results improve understanding of the distinct role of various minority stressors and their mechanisms on health outcomes. Health care professionals should assess for minority stress and coping resources and refer for evidence-based psychosocial treatments. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Research ethics for mental health science involving ethnic minority children and youths.

In response to U.S. Public Health Service projects promoting attention to disparities in the outcomes of mental health treatments, in July 2001, the American Psychological Association, the National Institute of Mental Health, and the Fordham University Center for Ethics Education convened a group of national leaders in bioethics, multicultural research, and ethnic minority mental health to produce a living document to guide ethical decision making for mental health research involving ethnic minority children and youths. This report summarizes the key recommendations distilled from these discussions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)