Alliances for Quality Education Rhonda Waller, PhD Director of Training and Technical Assistance

1. Caribbean-born Adults Living in the United States: The State of Mental Health and Substance Abuse Research and Treatment Alliances for Quality EducationRhonda Waller, PhDDirector of Training and Technical Assistance Nakia Brown, PhD Director of Research and Evaluation Nycal Anthony -Townsend, MHS President and CEO

2. Alliances for Quality Education (AQE) Specializes in building the capacity of academic, governmental and non-profit organizations to better serve their constituencies. Our mission is to improve the educational and health status of underserved people by expanding the capacity of the organizations and communities that serve them.

3. Purpose • Identify gaps in mental health (MH) substance abuse (SA) research and treatment for Caribbean-born adults living in the United States • Provide recommendations to enhance the quality of data collected on Caribbean-born populations to identify and address their MH/SA needs

4. Rationale • Race and ethnicity are treated as separate concepts in the United States (US) • Caribbean-born populations living in the US are included as “Black” unless they indicate otherwise

5. US Census Definition • Native-born: • Born in the US or one of it’s territories • Includes Puerto Rico, US Virgin Islands, Guam, & American Samoa • Foreign-born: • Any other country or territory • Includes Caribbean islands/countries

6. 2010 CensusRace & Ethnicity Categories • White: origins in Europe, Middle East, or North Africa • Black/African American/Negro: origins in any African racial group • Native Hawaiian/Other Pacific Islander : Hawaii, Guam (a US Territory), or Samoa • Hispanic or Latino: Origins in Cuba, Mexico, Puerto Rico (US Territory), South or Central America regardless of race • Other: “Some other race” or “two or more races”

7. Health Care Use Reporting: Race & Ethnicity Categories • Henry J. Kaiser Family Foundation (2009) National Report on Race, Ethnicity, and Healthcare Identifiers: • African American, non-Latino • Latino • White, non-Latino • Alliance for Health Reform’s (2006): Racial and Ethnic Disparities in Health Care Identifiers: • White, African American, Latino, and other racial and ethnic minorities

8. “Blacks” in the United States *does not include Cuba or the Dominican Republic Source: U.S. Census Bureau, 2007 American Community Survey

9. Top 10 Metropolitan Areas of Residence for the Caribbean-born in US (N=2.95 million) * • New York City/Long Island/North New Jersey (42%) • FL: Miami/Ft. Lauderdale (30%) • MA: Boston/Worcester/Lawrence (4%) • FL: West Palm Beach/Boca Raton (3%) • Washington, DC/Baltimore, MD (2%) • FL: Orlando (2%) • CA: Los Angeles/Riverside/Orange County (2%) • FL: Tampa/St. Petersburg/Clearwater, FL (2%) • Philadelphia, PA-Wilmington DE, Atlantic City, NJ (2%) • GA: Atlanta (1%)*includes Cuba and the Dominican RepublicSource: US Census Bureau, Census 2000, Migration Policy Institute.

10. Caribbean-born Population by Country of Birth, 2000 (n=2.9 million)

11. Mental Health (MH): Caribbean-born Adults • Small sample size of “Blacks” prevents within group comparison • Most studies conducted in the United Kingdom (not the US)

12. MH Research Findings • Higher rates of depression and aggression among Caribbean-born (Cohen et al., 1997) • Caribbean Blacks > US-born Blacks in psychological stress (Williams 2000) • Caribbean Blacks < US-born Blacks in reported rates of ‘heavy’ drinking (Dawson 1998) • Similar MH help-seeking behaviors (Woodard et al., 2008)

13. National Survey of American Life (NSAL) • 2001-2003 • University of Michigan • One of 3 NIMH-funded surveys • Used DSM-IV criterion

14. NSAL Findings: MH • Similar Overall Prevalence Rates • By Gender (Williams et al., 2007) • Men: Caribbean > US Blacks • Women: Caribbean < US Blacks • MH Service Use Rates (Jackson et al., 2007) • US Blacks > Caribbean

15. Substance Abuse Research: Caribbean-born Adults • Limited US published research • Caribbean-born < US Blacks (Williams et al., 2007) • Women: Caribbean-born < US Blacks (Broman et al., 2008 )

16. Number of MH/SA Facilities ( within a 5-mile Radius) MH Locator -- http://store.samhsa.gov/mhlocator SA Locator -- http://findtreatment.samhsa.gov/

17. National Registry of Evidence-Based Programs and Practices (NREPP) • Purpose • Connect public with intervention developers to help implement approaches • Evidence-Based Interventions (EBIs) Requirements • Positive behavioral outcomes • Experimental/quasi-experimental design • Peer-reviewed publication • Public use-ready

18. NREPP Search Criterion http://www.nrepp.samhsa.gov/

19. Current State of Affairs • Limited MH/SA Research • No US-based MH/SA EBIs for Caribbean-born populations • Lack of EBI evaluation on Caribbean-born populations

20. Fundamental Issue Caribbean-born populations that we are discussing traverse multiple categories, but may not adequately captured in any.

21. Standards for Federal Data on Race and Ethnicity • Race and Ethnicity • Immigration Status (optional) • Cuba and Dominican Republic • CPS, NHIS, and NHANES

22. Points to Consider • Heterogeneity among “Blacks” • Heterogeneity among Caribbean-born • Variation in MH/SA risk profiles • Impact of culture and contextual factors on treatment outcomes

23. Points of Emphasis • Important to understand health disparities in the US not just in terms of race/ethnicity, but also by culture, language, etc. • In US, there exists axes of diversity not only among native-born, but also among foreign-born

24. Recommendations: MH/SA Research • Increase self-select identification categories • Engage stakeholders to inform data collection • Use qualitative data collection to enhance research quantitative findings • Conduct longitudinal studies

25. Recommendations: MH/SA Services • Use data to develop or modify MH/SA EBIs • Evaluate EBIs for their effectiveness • Include stakeholders in EBI development

26. Thank You Rhonda R. Waller, Ph.D. Director of Training and Technical Assistance rwaller@aqe-inc.com Nakia C. Brown, Ph.D. Director of Research and Evaluationnbrown@aqe-inc.com Alliances for Quality Education, Inc. 1101 Mercantile Lane, Suite 104 Largo, MD 20774 Fax: (301) 583-8422 www.aqe-inc.com