Clinician factors related to outcome differences between black and white patients at CMHCs.

OBJECTIVES: Data are limited on how clinicians contribute to outcome differences between black patients and white patients. Because the clinician-patient relationship is the foundation of mental health services, understanding clinicians' role in outcome differences may help identify evidence-based interventions that decrease disparities and capitalize on positive differences. Symptoms and functioning in a sample of black and white adults receiving outpatient services were examined to determine the effects of their primary clinician on those patterns. METHODS: The study included 551 patients (25% black) with serious mental illness and 62 mental health professionals (21% black) identified as the patients' primary clinician. Treatment outcomes were measured at baseline and two follow-ups (two and four months) with the Behavior and Symptom Identification Scale, a measure of symptoms and functioning. Data were analyzed with hierarchical linear modeling. Clinicians' levels of multicultural competence, burnout, and education were analyzed. RESULTS: Clinicians moderated the relationship between patient race and outcome differences. There was significant variability among clinicians: approximately 20% had black patients whose outcomes were worse than those of their white patients, and 40% had black patients with better outcomes than their white patients. The only clinician factor predicting these differences was clinician's general experiences and relationships with people from racial-ethnic and cultural groups other than their own. CONCLUSIONS: The occurrence of outcome differences varied across clinicians, with some clinicians magnifying outcome differences between black and white patients and others minimizing them. Factors other than clinicians' race, multicultural competence, education, and burnout may contribute to outcome differences between black and white patients.

Therapist Effects on Disparities Experienced by Minorities Receiving Services for Mental Illness.

OBJECTIVES: The authors examine if some of the reason clients from racial and ethnic minority groups experience outcome disparities is explained by their therapists. METHOD: Data from 98 clients (19% minority) and 14 therapists at two community mental health agencies where clients from racial and ethnic minority groups were experiencing outcome disparities were analyzed using hierarchical linear modeling with treatment outcomes at Level 1, client factors at Level 2, and therapists at Level 3. RESULTS: There were substantial therapist effects that moderated the relationship between clients' race and treatment outcomes (outcome disparities). Therapists accounted for 28.7% of the variability in outcome disparities. CONCLUSIONS: Therapists are linked to outcome disparities and appear to play a substantial role in why disparities occur.

State budget cuts, health care reform, and a crisis in rural community mental health agencies.

Between 2009 and 2011, states implemented significant budget cuts to community mental health agencies (CMHAs), which are frequently the sole provider of specialized behavioral health services in rural communities. Starting in 2010, federal policy changes created by health care reform and mental health parity are likely to increase the number of individuals who can afford to seek services for a mental illness. CMHAs under financial stress have begun to eliminate services and reduce staff. These trends could result in a growing gap between available behavioral health services and the number of people who can afford to seek treatment for a mental illness.

Preimmigration beliefs of life success, postimmigration experiences, and acculturative stress: South Asian immigrants in the United States.

This study retrospectively explored the links between preimmigration beliefs of life success and postimmigration experiences and their influence on acculturative stress among a group of parents who recently immigrated with their children from three non-English speaking countries-Bangladesh, India, and Pakistan-to the United States. The respondents, 75 sets of parents residing in New York City, participated in semistructured qualitative interviews. Discrepancies between the parents' anticipated life success in the United States and actual experiences after immigration were associated with the parents' expectations of their children fulfilling parents' own dreams of success. Two criteria specific to Asian culture that guided parental expectations were the responsibility of children in enhancing family pride and the role of education as a way to advance through the social class and the caste systems. Implications for understanding immigrant parents' sociocultural contexts, the potential negative impact of unrealistic expectations on children's development, and the significance of acculturative stress for parents as well as their children were discussed.