Collaborating with African American churches to overcome minority disaster mental health disparities: What mental health professionals can learn from Hurricane Katrina.

The purpose of this qualitative study was to explore how mental health professionals and African American pastors and their churches could collaborate to overcome minority disaster mental health disparities. Forty-one African American pastors of churches located in south Mississippi, in counties directly affected by Hurricane Katrina, participated in semi-structured interviews approximately 1 year after the storm. The majority of participants reported being interested in collaborating with mental health professionals to: (a) develop educational and outreach opportunities, (b) lead assessment procedures, (c) offer consultation activities, (d) provide clinically focused services, and (e) utilize spiritual resources and support. Participants provided further insight into how these collaborative activities could be modified to meet post-disaster needs and offered novel applications. Following from these discussions, the article provides a number of recommendations that can be used to aid in the development of disaster collaborative activities between African American pastors and churches and mental health professionals to serve minority communities while also decreasing disparities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Innovations in disaster mental health: Psychological first aid.

Professional psychologists are called upon to deal with a broad array of crises and traumatic events. However, training and expertise in crisis response varies widely among practitioners, and there has been considerable controversy about the value of widely disseminated mental health crisis intervention protocols that include "debriefing" as an essential feature. This article gives an overview of the developmental process, guiding principles, and core actions of the Psychological First Aid Field Operations Guide (PFA Guide), which provides guidance for practitioners in responding to immediate mental health needs of children, adults, and families who have recently experienced a disaster or terrorist event. Issues in training, provider self-care, and evaluation research are also presented. The PFA Guide presents approaches thought to be most consistently supported by current research and practice so that they can be taught, used, and evaluated in field settings. Although we expect further refinement as more systematic research becomes available, the PFA Guide represents a sustained collaborative effort to define current evidence-informed best practices that can be utilized now by practitioners involved in disaster mental health responses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meeting mental health needs following a natural disaster: Lessons from Hurricane Katrina.

Hurricane Katrina had a devastating impact on hundreds of thousands of Louisiana and Mississippi families. Housing was destroyed, jobs were lost, and family members were separated, sometimes in different states and without communication. Postdisaster stress reactions were common, with vulnerable individuals most affected. Mental health services were not adequate to meet immediate needs, and postdisaster mental health issues often emerge over time. This article describes the mental health needs of dislocated and evacuee children and families and the steps that were taken to develop mental health programs that would be sustainable over time to meet this new level of need. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hostility, relationship quality, and health among African American couples.

Objective: This study investigated the association between hostility and health and whether it is moderated by the quality of an individual's primary romantic relationship. Method: Longitudinal data were provided by 184 African Americans, including 166 women. Participants averaged 38 years old and were married or in long-term marriagelike relationships. Hostility and relationship quality were measured at the first assessment. Hostility was based on participants' responses to items tapping cynical attitudes about relationships. Relationship quality was based on trained observer ratings of videotaped couple interactions on behavioral scales reflecting warmth, support, and communication skills. At 2 assessments approximately 5 and 7 years later, participants provided health data. Health index scores were formed from responses to five scales of the SF-12 (Ware, Kosinski, & Keller, 1998) as well as to responses to questions about the number of chronic health conditions and the number of prescribed medications. Results: Stepwise regression analyses controlling for demographic variables and the earlier health score tested the main and interactive effects of hostility and relationship quality on longitudinal changes in health. Whereas no main effects were supported, the interaction of hostility and relationship quality was significant (p     

A Meta-Analytic Review of Racial-Ethnic Matching for African American and Caucasian American Clients and Clinicians.

A meta-analysis was conducted to evaluate the effectiveness of client-clinician matching on the basis of race-ethnicity on overall functioning, service retention, and total number of sessions attended for African American and Caucasian American adult populations in mental health services. The analysis included 10 published and unpublished studies between 1991 and 2001. A random effects meta-analysis model showed no significant differences between client-clinician dyads matched racially-ethnically and those dyads not matched with respect to overall functioning, service retention, and total number of sessions attended. The finding was consistent for both African American and Caucasian American clients. Further implications of the findings are discussed. The authors also encourage more complete reporting of data suitable for quantitative research synthesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of familism in stress and coping processes among African American and White dementia caregivers: Effects on mental and physical health.

Objective: To explore how familism, burden, and coping styles mediate the relationships between ethnicity and the mental and physical health of caregivers. Design: A probability sample of 65 White and 95 African Americans respondents caring for an older family member with dementia was used to test hypotheses from a sociocultural stress and coping model using path analysis. Main outcome measures: Measures of caregivers' health included subjective health, self-reported diseases, blood pressure, and heart rate. Mental health measures included self-reported depression and psychological symptoms. Results: Contrary to the hypothesis, familism had an adverse effect on outcomes and was related to low education levels rather than to African American ethnicity. A buffering effect of active coping between being African American and diastolic blood pressure was found even after controlling for levels of education. Conclusions: Findings supported a core stress and coping model in which more behavior problems of care recipients were associated with poorer mental health of caregivers via greater burden and more use of avoidant coping. Results also demonstrate that this core model can be extended to physical health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health service utilization among African American and Caucasian mothers and fathers.

Mental health services have been routinely underutilized. This study investigated the influence of parents' gender, race, and psychopathology on perceived barriers and attitudes toward mental health utilization for themselves and for their children. A unique contribution of this study is the examination of father, mother, and child factors influencing service utilization from the parents' perspective. A total of 194 African American and Caucasian parents were recruited from the community to participate. Parents completed measures on barriers and attitudes toward treatment for themselves and for their children, history of mental health service utilization for themselves and for their children, and their own current psychological symptoms. Results indicated that 36.3% and 19.4% of parents and children, respectively, had used mental health services during their lifetime. Parents perceived fewer barriers and had more positive attitudes toward seeking services for their children than for themselves. Race and gender differences were found in parents' perceptions of barriers and attitudes toward treatment. Furthermore, barriers, attitudes, and psychopathology predicted parents' plans for future utilization of mental health services. The clinical implications of this study and directions for future research are discussed. (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)     

School-based disaster mental health services: Clinical, policy, and community challenges.

The consequences of Hurricane Katrina have far-reaching implications for the mental health system in the Gulf Coast region, with some of the most vulnerable survivors being children and adolescents. School-based services have been proposed as an ideal way to provide care; however, significant challenges remain in providing trauma-informed services in schools postdisaster. The authors discuss the consultation and training activities of the Los Angeles Unified School District Trauma Services Adaptation Center for Schools and Communities following Hurricane Katrina. Issues related to the dissemination of evidence-based treatment in schools following a disaster are discussed, as are the particular needs of providers and school staff and the importance of community collaboration in identifying ways to adapt implementation strategies for specific communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological distress, acculturation, and mental health-seeking attitudes among people of African descent in the United States: A preliminary investigation.

This article investigates the relationship between psychological distress, acculturation, and help-seeking attitudes among people of African descent (N = 130). Psychological distress was measured using the Global Severity Index from the Brief Symptom Inventory (L. R. Derogatis & N. Melisaratos, 1983), acculturation was measured using the Measurement of Acculturation Strategies for People of African Descent (E. M. Obasi, 2005), and help-seeking attitudes were measured using the Attitudes Toward Seeking Professional Psychological Help scale (E. H. Fischer & J. I. Turner, 1970). Overall, as psychological distress increased, attitudes toward seeking professional psychological services became more negative. The negative relationship between psychological distress and confidence in therapist was significantly stronger for participants who expressed a cultural maintenance of traditional beliefs. Future directions for this body of research are discussed. (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)     

Building national capacity for child and family disaster mental health research.

Disaster mental health is a burgeoning field with numerous opportunities for professional involvement in preparedness, response, and recovery efforts. Research is essential to advance professional understanding of risk and protective factors associated with disaster outcomes; to develop an evidence base for acute, intermediate, and long-term mental health approaches to address child, adult, family, and community disaster-related needs; and to inform policy and guide national and local disaster preparedness, response, and recovery programs. To address the continued need for research in this field, we created the Child and Family Disaster Research Training and Education (DRT) program, which is focused specifically on enhancing national capacity to conduct disaster mental health research related to children, a population particularly vulnerable to disaster trauma. This paper describes the structure and organization of the DRT program, reviews the training curriculum, discusses implementation and evaluation of the program, and reviews obstacles encountered in establishing the program. Finally, key lessons learned are reviewed for the purpose of guiding replication of the DRT model to address other areas of community mental health. (PsycINFO Database Record (c) 2010 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)     

Cultural mistrust and mental health help-seeking attitudes among Filipino Americans.

As low as the rate of mental health help-seeking is among Asian Americans, Filipino Americans seek mental health services at a much lower rate even compared with other Asian Americans. Despite the field’s progress in identifying and understanding factors that may influence mental health help-seeking attitudes among Asian Americans, despite research on other minority groups suggesting that cultural mistrust may influence attitudes toward seeking professional psychological help, and despite the abundance of literature documenting the historical and contemporary experiences of oppression by Filipino Americans, the possibility that cultural mistrust may play a significant role in Filipino Americans’ mental health help-seeking attitudes have yet to be empirically investigated. Thus, using a sample of 118 Filipino Americans, the current study demonstrates that higher levels of cultural mistrust is related to lower likelihood of seeking professional psychological help. Furthermore, cultural mistrust predicted variance in mental health help-seeking attitudes that are not accounted for by income, generational status, loss of face, and adherence to Asian cultural values. Implications for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Deconstructing the monolith: Differences in attitudes about mammography among low-income African American women.

The purpose of this study was to explore how health beliefs may vary within a minority group. In this mixed-method study, 63 low-income African American women engaged in six focus groups discussing beliefs that inhibited or facilitated mammography. Differences in cognitive complexity, self-efficacy, and attributions of causality occurred across neighborhoods despite the geographic proximity and demographic similarity. The attitude change that occurred during the discussion suggested ways to construct effective health interventions. The data suggest (a) that women were similarly knowledgeable about mammography and cancer, (b) knowledge did not correspond with attitudes, (c) attitudes must be addressed before knowledge can be utilized, (d) attitudes are developed and maintained within neighborhood social networks and that stories maintain these attitudes, (e) increasing the discussion among peers should lead to greater attitude change and discussion leads to increased thought, and (f) motivation and follow through are connected to women’s roles within their communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal parenting and mental health of Mexican American youth: A bidirectional and prospective approach.

Understanding the bidirectional relation between parenting behaviors and youth mental health in Mexican American families is crucial because of the current need to improve the availability of high quality services for this underserved population and to broaden the reach of extant theories on this topic. Youth (14–19 years old; N = 88) were recruited from a public high school in an urban immigrant enclave and reported their internalizing and externalizing symptoms as well as six maternal parenting behaviors at two points approximately one year apart. Youth-reported parenting behaviors formed two factors: Supportive Parenting and Harsh Parental Control. T1 externalizing symptoms predicted higher T2 Harsh Parental Control, providing evidence for the coercive model. T1 internalizing symptoms predicted lower T2 Supportive Parenting, providing evidence for social interaction theory. However, T1 parenting factors did not predict T2 youth mental health symptoms as expected according to bidirectional theories. We advocate the use of eco-developmental models to interpret our findings and guide future research. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Race differences in psychopathology and disparities in treatment seeking: Community and jail-based treatment-seeking patterns.

Whites in community samples use mental health services at a much higher rate than African Americans (Kessler et al., 2005). Is this also the case among those in jails? In this study of jail inmates (229 African American, 185 White), there were no race differences in the overall need for mental health treatment (63% of participants had significant symptoms on the Personality Assessment Inventory), but race differences in the level and types of symptoms were evident. In addition, although Whites were more likely to report preincarceration treatment, there were no differences in treatment seeking or access to mental health programs while in jail, implying that if barriers to treatment in the community were removed (cost/insurance, location/transportation, time), racial disparities in treatment utilization may be reduced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drinking outcomes following drink refusal skills training: Differential effects for African American and non-Hispanic White clients.

Determining whether a particular treatment works for specific groups of people can help tailor dissemination of evidence-based alcohol treatments. It has been proposed that individuals from different racial groups might have better outcomes in treatments that are sensitive to sociocultural issues that impact alcohol use among these groups. The current study was a secondary analysis of data from the combined behavioral intervention (CBI) condition of the COMBINE study. Those randomly assigned to CBI (n = 776) had the opportunity to receive up to 9 skills training modules, which were chosen by the therapist. The goal of the current study was to determine whether receiving 1 of the CBI modules, drink refusal and social pressure skills training, predicted differential outcomes among African American clients. Results indicated that African American clients who received the drink refusal skills training module (n = 25) had significantly fewer heavy drinking days (d = 0.79) 1 year following treatment than African Americans clients who did not receive the module (n = 35). African American clients who received the module also had significantly fewer heavy drinking days (d = 0.86) than non-Hispanic White clients who received the module (n = 241). Good clinical outcomes at 1 year posttreatment were observed among 80% of African Americans who received the module, compared with 54% of African Americans who did not receive the module and 52% of non-Hispanic White clients who did receive the module. Although small sample size limits interpretation, findings provide preliminary evidence supporting the inclusion of drink refusal skills training as part of alcohol interventions for African American clients. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Our Katrina experience: Providing mental health services in Concordia Parish, Louisiana.

Responding to the call for psychologists to serve Louisiana and the Gulf Coast after Hurricane Katrina, 2 school psychologists spent almost 2 weeks in central Louisiana in early September 2005. They were located in a rural area and provided mental health services to evacuees from Hurricane Katrina in a number of small shelters, an RV park, and the schools. This article describes their experiences as mental health volunteers and the impact those experiences had on their professional and personal lives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)