Engaging African-Americans in Outpatient Mental Health Intervention

1. Reginald Simmons, Ph.D. & Gretchen Chase Vaughn, Ph.D. Engaging African-Americans in Outpatient Mental Health Intervention

2. African-Americans are under-represented in outpatient care and over-represented in more restrictive or intensive settings(DHHS, 2001; Sue & Chu, 2003; Thompson, Bazile & Akbar, 2004) Involvement in OP is often due to “coercive processes” that may impede engagement, investment, and retention (Snowden, 2001; Gayles, Alston & Staten, 2005) Increased involvement in OP can benefit the person and society….how? Why Does this Merit Attention?

3. A-A’s more likely to use services inconsistently, seek treatment later, end treatment early, and receive a poorer quality of care (US DHHS, 2001; Snowden, 2003; Thompson, Bazile & Akbar, 2004; Kazdin, et al. 1995). Why Does this Merit Attention?

4. At times, A-A’s may underestimate need “John Henryism” (James, LaCroix, Kelimbaum & Strogatz, 1984) Seeking therapy may be interpreted as a sign of “weakness” and “diminished pride” (Thompson, Bazile & Akbar, 2004) Belief that symptoms are due to spiritual issues may delay help-seeking (Cauce, 2002) Multiple stressors and/or disadvantage may impact energy/ability to seek treatment Mistrust of “helping institutions” Cultural beliefs/norms about perception of need

5. What is the best remedy for the common cold? • Chicken Soup? • Vapor Rub? • Culture: One group or people’s preferred way of meeting their basic human needs • Exercise adapted from National Indian Child Welfare Association(NICWA) Cultural beliefs/norms about help-seeking

6. When need is critical, A-A’s turn first to family, church, and trusted local networks(Snowden, 1998; McMiller & Weisz, 1996; Davey & Watson, 2008) • A-A’s only .37 times as likely as Whites to consult professionals as the first step in help-seeking • However, these trusted community entities may serve as either a barrier or a bridge to engagement in formal mental health services(Boyd-Franklin, 1989)….why? Cultural beliefs/norms about help-seeking

7. Primary care • But quality of care has been questioned(Davey & Watson, 2008). • When referred to MH services, A-A’s often do not follow-up with the referral (Davey & Watson, 2008). When local networks are not enough, where do African-Americans seek formal help?

8. Step One: Collaborate with trusted local networks Step Two: Involve community in assessing treatment needs Step Three: Have culturally-appropriate organizational and clinical engagement practices How can Outpatient Mental Health Providers engage African-Americans Voluntarily?

9. Culturally-Specific Formal Local Networks • Churches, fraternal organizations • Pastors may want support in addressing mental health needs of their congregation • Culturally-Specific Informal Local Networks • “Natural helpers” such as hairdressers and barbers • “MindStylz” by CPA Ethnic Diversity Task Force Step One: Collaborate with Trusted Local Community Networks

10. Community knows what it needs (Vera et al., 2005; Breland-Noble & King, 2008) • Provider should regularly assess effectiveness and relevance of it’s services (be nimble) • Attend to patterns in presenting problems • Satisfaction surveys, periodic focus groups, community representation on Boards Step Two: Involve Community in Assessing It’s Treatment Needs

11. Culturally-welcoming, respectful organizational climate • Be invested in the community • Have capacity to decrease stressors, increase social support • Social support is related to mental health service use by A-A’s (Harrison, McKay, & Bannon, 2004). • Flexible Office Hours and Staffing Patterns • Ethnic Compatibility of Staff SteP Three: Engaging the Client: Organizational Characteristics

12. Engage in Collaborative and Active Problem-Solving at first contact • At intake, Identify and address barriers to participation .…why might this aid engagement? • During first session, focus on problems the family wants to change -Use “we” to emphasize that process will be collaborative and respectful • Develop and implement an immediate intervention to address at least one stressor….why? (McKay, et al., 2004) Step Three: Engaging the Client: Practice Characteristics

13. Therapist must be prepared to work with other agencies involved with family, and link family to supportive services (Boyd-Franklin, 2003) • Case management is therapy! • Take time to build trust and rapport • Let clients tell their story (Cooper-Patrick, et al. 1999; Nunez & Robertson, 2006). Step Three: Engaging the client: Practice Characteristics

14. Therapists should understand the relationship between historic oppression and current disparities in well-being of A-A’s (Allen-Meares & Burman,1999). • Therapist should be aware of cross-class differences • Therapist must not assume he understands client’s world…learn from client Some keys to effective cross-cultural relationships

15. Therapists should assess their own biases, and worldviews and seek to understand (and respect) the client’s worldview Therapist must be willing to “go there”, explore any perceptions of the role of racism in presenting problems, especially with A-A male clients Seek training and competent supervision Some keys to effective cross-cultural relationships

16. We must do better! For entire chapter and related topics, see upcoming book due in August: T.P. Gullotta, R. Hampton, & R. Crowell (Eds.), Handbook of African-American Health. New York: Guilford Press. Contact: simmonsred@ccsu.edu, Dept. of Criminology & Criminal Justice, Central Connecticut State University Thank You! Conclusion