Disproportionality and Differential Response of Systems

Two approaches to tailoring treatment for cultural minority adolescents

Cultural minority adolescents experience more severe substance-related consequences and are less likely to receive treatment. This article presents the existing literature on motivational interviewing with cultural minority groups (adult and adolescent) and proposes two approaches for evaluating and adapting this (or other) behavioral interventions, and elucidates the rationale, strengths, and potential liabilities of each tailoring approach.

Cultural competence in outpatient substance abuse treatment: Measurement and relationship to wait time and retention

Effective implementation of culturally competent practices is dependent on organizational practices. This study used a nationally representative sample of outpatient substance abuse treatment programs to examine organizational practices and managers’ culturally sensitive beliefs relationship with wait time and retention in OSAT organizations that treat Latinos and African American clients.

The Role of Statistical and Taste Discrimination in Racial Disparities

Abstract: “The theoretical literature on discrimination has proposed two main reasons why differential outcomes can arise for observationally equivalent individuals of different races. Taste-based theories postulate that differences in outcomes can develop if economic agents have a distaste or prejudice towards a p articular racial group. On the other hand, statistical discrimination models attribute these outcomes to decision-making evaluators having incomplete information about the individuals under consideration. If evaluators believe that an individual’s unobservable skill level is correlated with their racial background, they will have an economic incentive to take an individual’s racial group into account when assessing their skill level. Although there is an extensive empirical literature studying discrimination, most studies have focused on quantifying how much of the outcome differentials between racial groups can be attributed to discriminatory behavior. Very few studies have attempted to empirically determine whether these practices have arisen from taste or statistical discrimination. This is an important distinction because the effectiveness of policies to reduce discriminatory behavior depends upon the type of discrimination that is present. My dissertation provides empirical evidence on why discrimination arises by distinguishing between these two theories. The first chapter investigates whether people statistically discriminate when evaluating the skill level of others in the environment of the television game show Street Smarts. The second chapter develops an empirical test that determines whether racial differences in motor vehicle searches are due to racial prejudice on the part of police troopers. The third chapter evaluates whether taste discrimination on the part of customers might be responsible for the wage differential between black and white professional basketball players.”

Racial and Ethnic Disparities in Health Status Among California Adults: The Roles of Socioeconomic Position and Discrimination

Abstract: “Racial/ethnic minorities fare worse on a number of health indicators, including higher morbidity and mortality rates, and they rate their health status lower when compared to non-Latino Whites. This study investigated the association between race/ethnicity and disparities in self-rated health status and physical and emotional functional limitations. Data were drawn from the 2001 California Health Interview Survey (CHIS 2001); a random digit dial survey of adult California residents (N=55,428) interviewed between November 2000 and October 2001. The specific aims were: 1) To determine if self-rated health status, physical functional limitation, and emotional functional limitation vary as a function of race/ethnicity; 2) To examine the relationships between race/ethnicity, socioeconomic position (SEP), and health status, including physical and emotional functional limitations; 3) To test whether a composite measure for SEP explains a greater proportion of racial/ethnic health inequalities compared to individual SEP indicators; 4) To determine whether the relationship between risk factors and health status varies as a function of race/ethnicity. (The risk factors included sociodemographic factors, psychosocial factors, and medical factors.); and 5) To examine the effect of acculturation on the relationship between race/ethnicity, health status, and physical and emotional functional limitations among a Latino sub-sample of the CHIS, 2001 population. The analytic approach employed multiple linear regression and logistic regression. Findings show that racial/ethnic minorities had significantly poorer self-rated health status and higher rates of emotional functional limitations when compared to non-Latino Whites. Conversely, racial/ethnic minorities reported fewer physical functional limitations. SEP proved to be a highly significant predictor of health for all racial/ethnic groups, but race/ethnicity also had an independent effect on health. Neither citizenship status nor time spent in the U.S. was significant predictors for Latino self-rated health, however, limited English proficiency was an important predictor of worse health.”


Abstract: “Racial/ethnic minority patients receive poorer quality medical care when compared to White patients who have similar levels o f access to health care and are comparable on a number o f sociodemographic characteristics. This dissertation asks why these racial/ethnic disparities in health care exist. Using scholarship in cognitive social psychology, I develop a model o f micro-level mechanisms underlying racial/ethnic interaction in health care contexts. I argue that racial/ethnic cognitions, which correspond to widely held cultural beliefs about racial/ethnic groups, are among factors contributing to poorer quality care for minority patients. These cognitions are mostly automatic, but they nevertheless shape medical decisions in ways that disadvantage minority patients, especially in healthcare contexts characterized by high stress, such as in managed care settings. I evaluate the proposed model using survey and experimental methods. The survey study uses data from a probability sample o f privately insured Americans. I find that controlling for insurance policies, characteristics o f health care, and sociodemographic factors, Blacks, Hispanics, and members o f other minority groups evaluate the quality o f the care they received during their last visit to their primary care physician less favorably than do Whites. The adjusted differences between Whites and Hispanics interviewed in English are larger when managed care policies are used than when these policies are not used. Disparities between Whites and Hispanics interviewed in Spanish and between Whites and non-Black, non-Hispanic minority individuals are more common in managed care contexts than in other contexts. The experimental study focuses on the role o f physicians’ racial/ethnic cognitions in medical decisions under varying levels o f stress. I find that under high stress, physicians whose implicit cognitions about Blacks or Hispanics were activated by subliminal exposure to Black or Hispanic stimuli evaluated a hypothetical patient’s condition as less serious compared to physicians subliminally exposed to White or neutral stimuli. Similar effects were not obtained under low stress or for explicit cognitions. Taken together, the two studies suggest that implicit (but not explicit) cognitions may contribute to racial/ethnic disparities in health care, especially in stressful contexts, and that stress-inducing managed care cost containment policies may exacerbate racial/ethnic disparities.”

Educational Parity, Health Disparities: Differential Health Returns to Education by Race/Ethnicity in Young Adulthood

Abstract: “Empirical evidence has repeatedly demonstrated that higher levels of educational attainment are associated with lower levels of morbidity and mortality (Conti, Heckman and Urzua 2010; Cutler and Lleras-Muney 2006; Elo and Preston 1996). The improvements in health associated with higher levels of educational attainment are called “health returns to education”. It is also well documented that health returns to education vary significantly across racial/ethnic groups (Crimmins and Saito 2001; Ferraro and Farmer 2005; Masters, Hummer and Power 2011), although most of this literature focuses on middle-aged and older adults. Scholars have recently advocated for an investigation of mechanisms that contribute to these differential returns by assessing living and learning conditions earlier in the life course (Ferraro and Farmer 2005; Hayward et al 2000). Using multiple waves of the National Longitudinal Survey of Adolescent Health (Add Health), I assess whether there are racial/ethnic health returns to education for self-rated health, obesity and hypertension during the transition from adolescence to young adulthood. I also assess whether living and learning conditions significantly contribute to racial/ethnic disparities in health returns to education. I find differential health returns to education by race/ethnicity for all health indicators, although the extent and direction of the return varies by race/ethnic group and indicator. I also find that living and learning conditions in adolescence contribute to widening racial/ethnic disparities in health returns for self-rated health, obesity and hypertension while living conditions in young adulthood narrow racial/ethnic disparities in health returns to education for self-rated health and obesity. This research highlights the need to investigate why processes linking living and learning conditions to health returns to education vary across race/ethnicity and health outcome. It also provides guidance to policymakers on how education policy can be used ass as health policy to improve population health.”


Abstract: “Serious emotional disturbance, including disruptive disorders (i.e., attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder), affects large numbers of adolescents, with costly and tragic consequences. Adolescents with disruptive disorders are likely to be arrested, drop out of school, and have poor treatment outcomes. There is an urgent need to identify strengths-based factors associated with improvement in adolescents’ behavioral and social functioning to help them achieve their full potential. The purpose of this study was to determine whether change in adolescent personal strengths and change in family functioning over 12 months predicted changes in behavioral and social functioning for adolescents with disruptive disorders who participated in a System of Care (SOC) program and if findings varied by race. De-identified data from 179 adolescents, aged 12 – 17 years, with disruptive disorders and their caregivers were included in this secondary analysis. Data were analyzed using Pearson correlations, t-tests, chi-square tests, and multivariate multiple regressions. Upon admission to the program, caregiver ratings indicated that African American adolescents had greater personal strengths (p = .001), fewer behavior problems (p < .001), and less functional impairment (p < .001) compared to their Caucasian counterparts. Girls had more behavior problems (p = .05) and fewer personal strengths than boys (p < .001). Increase in caregiver-rated adolescent personal strengths was significantly associated with improvement in caregiver-rated adolescent behavioral and social functioning (p < .001). Change in caregiver-rated family functioning was not significantly associated with change in caregiver-rated adolescent behavioral and social functioning (p = .171). The strength and direction of predictors did not vary by race. The adolescents in the study participated in a SOC program that emphasized their strengths versus, primarily, focusing on their deficits. Change in caregiver ratings of adolescent personal strengths was a significant predictor of change in adolescent behavioral and social functioning over a 12 month period. Findings provide evidence for psychiatric mental health professionals to focus on enhancing adolescent personal strengths to improve behavioral and social functioning in adolescents with disruptive disorders. Future research is needed to understand the impact of family variables on adolescents’ treatment outcomes.”


Abstract: “Objectives: To determine the effect of race as a predictor of child welfare outcomes. Methods: A secondary analysis was conducted using data from the National Study o f Protective, Preventive, and Reunification Services Delivered to Children and their Families The final sample consisted of 2109 cases were selected through a stratified and random process. The selected cases came from within public child welfare agencies providing protective, preventive and reunification services to children and their families. The cases represented families where child maltreatment had been investigated. Results: Three of the four child welfare outcomes were found to have statistically significant differences at the .05 level when African American families were compared to Caucasian families. The odds ratios were 0.38 for child maltreatment substantiated; 1.06 for services; 1.41 for placement in out of home care; 2.18 for remaining in out o f home care. Poverty was only statistically significant for one o f the four child welfare outcomes: worker provided services. The odds ratios were 0.76 for child maltreatment substantiated; 0.69 for services; 0.84 for placement in out o f home care and 0.81 for remaining in out of home care. Conclusion: This study confirms the importance of race as a predictor of child welfare outcomes. African American families do experience different rates of child maltreatment substantiation; placements in out of home care and remain longer in out of home care.”

An Assessment of Differential Response: Implications for Social Work Practice in Diverse Communities

Abstract: “Traditionally, the American child welfare system intervenes in cases of evident and severe child maltreatment. Families in need of help, but who have not yet reached a crisis level, are excluded from most government-provided family support services. Practitioners and researchers have recently promoted the incremental development of a complementary system. Under Differential Response (DR), families assessed as low-tomoderate risk are referred to community-based agencies that offer voluntary, home-based services and social service referrals. This study examined the first DR program implemented in the state of California, at three sites in Alameda County. The research addresses community aspects of the program’s implementation, outcomes for children and families, and staff and parent experiences with service delivery. A mixed-methods design was used. Interviews were conducted with all administrators (n=15), focus groups with all direct line staff (n=12), and telephone interviews with a convenience sample of clients (n=50). Transcripts were analyzed for emergent themes. A quasi-experimental static group design was used to examine client outcomes. All clients who completed services formed the treatment group (n=161); a comparison group was constructed with all families reported for child maltreatment in the same timeframe who were eligible for services, but were not referred because of program capacity (n=447). Survival analysis was used to compare rates of re-report and substantiated re-report for the treatment and comparison groups. In Differential Response, the community context plays a significant role. Geographic Information Systems software was used to analyze patterns in social service availability in the three DR target neighborhoods. Based on interviews with staff, the program appears robust and maintains fidelity to the model; social science theory also supports the model. However, while there was a trend toward positive effects of the intervention, it was not statistically significant. These findings are in line with meta-analyses of child maltreatment prevention studies, and other studies of DR. The intervention may achieve beneficial outcomes with regards to proximal goals including, for example, families’ connections to resources, however, the study design did not allow for examination of these effects.”

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