Culturally competent practice with African American juvenile sex offenders.

African American juveniles adjudicated for sexual offenses may struggle with the mistrust of both the judicial and treatment systems. Unlike general mental health services, juvenile sex offender treatment is often mandated by the court or child welfare services, thus these youths and their families must engage in the treatment process. Without clinicians and services that can acknowledge and respond to a minority youth's experience in a sensitive, culturally competent manner, there could be significant resistance to treatment. Traditional treatment approaches fail to prioritize issues involving cultural competence. This article addresses the unique challenges of African American juvenile sex offenders and makes recommendations for creating culturally competent practice for these youth and their families.

Individual and contextual-level factors associated with continuity of care for adults with schizophrenia.

This retrospective cohort study examined rates of conformance to continuity of care treatment guidelines and factors associated with conformance for persons with schizophrenia. Subjects were 8,621 adult Ohio Medicaid recipients, aged 18-64, treated for schizophrenia in 2004. Information on individual-level (demographic and clinical characteristics) and contextual-level variables (county socio-demographic, economic, and health care resources) were abstracted from Medicaid claim files and the Area Resource File. Outcome measures captured four dimensions of continuity of care: (1) regularity of care; (2) transitions; (3) care coordination, and (4) treatment engagement. Multilevel modeling was used to assess the association between individual and contextual-level variables and the four continuity of care measures. The results indicated that conformance rates for continuity of care for adults with schizophrenia are below recommended guidelines and that variations in continuity of care are associated with both individual and contextual-level factors. Efforts to improve continuity of care should target high risk patient groups (racial/ethnic minorities, the dually diagnosed, and younger adults with early onset psychosis), as well as community-level risk factors (provider supply and geographic barriers of rural counties) that impede access to care.

Adult day services: a service platform for delivering mental health care.

OBJECTIVES: The purpose of this study was to understand the degree to which mental health services targeting anxiety and depression disorders are offered by adult day services (ADS) centers in the US. In addition, researchers wanted to determine whether staffing and organizational characteristics are associated with the provision of medication management, individual counseling, and group counseling for participants with anxiety or depression. METHOD: Data were drawn from the MetLife National Study of ADS. Hierarchical logistic regression analyses were conducted to determine which staffing and organizational factors were associated with the provision of services to treat anxiety and depression. RESULTS: Approximately, three in four adult day programs provided medication management for the treatment of anxiety and depression while 38% provided individual counseling and almost 30% group counseling. Programs offering medication management were more likely to have more registered nurse (RN) service hours available per shift and higher costs. Programs that provided individual and group counseling for participants with anxiety or depression were more likely to have more hours of RN and social work services available and a lower percentage of participants who pay privately for services. CONCLUSION: The results suggest that ADS are well positioned to act as a platform for delivering mental health care to older persons with anxiety or depression.

How family factors impact psychosocial functioning for African American consumers with schizophrenia.

There is a critical need to test how family contextual factors impact outpatient consumer functioning in schizophrenia. This is the first study of two companion studies reported here that tests family factors' influence on consumer functioning. Ninety-three low income inner-city African American consumer-family dyads were tested to see the possible impact of family factors, based on the EE and family caregiver burden literatures, on consumer psychosocial functioning (work, social, and independent living). The results supported a model wherein greater amounts of family contact had a significant relationship with better consumer psychosocial functioning. Additionally, family dysfunction had a direct negative relationship to consumer psychosocial functioning while family pressures and resources had an indirect negative relationship to consumer psychosocial functioning. Results are in marked contrast to what impacted consumer clinical functioning for the same sample. The findings appear to confirm that family factors differently impact the domains of clinical and psychosocial functioning. These findings are new for understanding the contextual factors that impact consumer functioning, especially psychosocial functioning.

A comprehensive analysis of the quality of online health-related information regarding schizophrenia.

Social workers are major mental health providers and, thus, can be key players in guiding consumers and their families to accurate information regarding schizophrenia. The present study, using the WebMedQual scale, is a comprehensive analysis across a one-year period at two different time points of the top for-profit and nonprofit sites that provide information regarding schizophrenia. Results demonstrate that the majority of sites offer comprehensive information and useful features. For-profit sites had higher ratings than nonprofit sites. Likewise, there was somewhat greater inconsistency for nonprofit sites across the two rating periods. The results demonstrate that systematic evaluation of online health information about schizophrenia can contribute to a "gold standard" for Internet health-related information. In addition, the results provide information that social workers can use with consumers and their families to guide them to quality online health information. A brief list of top sites is provided for social workers to give to consumers and families.

An exploratory factor analysis of the Burden Assessment Scale with a sample of African-American families.

It remains unclear if the factor structures of commonly used caregiver burden scales normed on white samples are similar with samples from different ethnic communities. Our study tests the factor structure of the Burden Assessment Scale (BAS) using Exploratory Factor Analysis (EFA) with data from low-income, African American families caring for a family member with schizophrenia. The EFA solution included a 2 factor structure of subjective burden and objective burden with strong loadings demonstrating a clear differentiation between the factors. Our results suggest that low income, African American families appear to experience caregiving burden as one major or broad component in their lives similar to other areas that demand ongoing coping and adaptation. Likewise, the factor structure found with this sample as compared to the factor structure found with white samples suggests differences in the perception of and/or the reporting of burden. Study limitations as well as implications for practice are provided.

The importance of consumer perceived criticism on clinical outcomes for outpatient African Americans with schizophrenia.

This is the second of two studies that tests the impact of family factors on consumer functioning. This study tests the impact of the consumer's perception of being criticized by the family (consumer perceived criticism) on the consumer's clinical functioning. It likewise, concurrently tests the impact that other family factors have on perceived criticism. The sample was ninety-three consumer-family dyads. Results showed that none of the family factors directly contributed to level of perceived criticism, but more consumer perceived criticism was significantly related to higher levels of psychiatric symptoms. The findings suggest that an important component of treatment for symptom stabilization for African American consumers involves perceptions of the family being critical toward the consumer. The finding confirms for a sample of poor outpatient African American consumers what was found in previous research with African Americans. Results are in marked contrast to what impacted consumer psychosocial functioning in the companion study, suggesting that clinical and psychosocial functioning domains are distinct, particularly for African American consumers. This should be reflected in the interventions that are developed for African American consumers and their families.

The relationships among perceived criticism, family contact, and consumer clinical and psychosocial functioning for African-American consumers with schizophrenia.

This study examined whether Perceived Criticism (PC) was related to community functioning in a sample of African-American consumers with schizophrenia. The study tested assumptions from the Expressed Emotion literature that were based primarily on samples of white consumers. The study found that PC affected psychiatric symptomatology but not psychosocial functioning. Greater family contact was strongly related to better psychosocial functioning. Findings suggested that the nature and impact of contact between consumer and family for this sample of African-Americans appears different from what has been found in white, middle-class samples.