THE INFLUENCE OF RACE AND ETHNICITY IN CLIENTS' EXPERIENCES OF MENTAL HEALTH TREATMENT

Enhancing Equity on Crisis Lines: Understanding the Background, Practices and Learning Needs of Responders in Canada

Understanding the current state of equity, diversity, and inclusion (EDI) within the crisis line sector is essential to enhancing accessibility and acceptability of crisis line services for all. Through an intersectional lens, we examined 9-8-8 crisis line workers' personal and work demographics, training, resources, perceived competencies in supporting diverse populations. We conducted an electronic survey of crisis line responders and leadership in Canada. Data was analyzed using descriptive statistics, Fisher's test, and Mann-Whitney U/Kruskal-Wallis H tests. Open ended responses were analyzed using content analysis. 323 surveys were completed. Analysis revealed statistically significant associations between respondent demographics, training satisfaction, access to resources, and perceived competency in supporting diverse communities. Conclusion: The findings indicate the need for new approaches to recruitment and training in the crisis line sector to enhance the inclusivity of crisis services for all individuals seeking mental health support.

Psychosocial Experiences of African American Parents of Children With Cancer

OBJECTIVE

To explore the psychosocial experiences of African American families affected by childhood cancer.

METHODS

A qualitative investigation was conducted using grounded theory methods. Data collection consisted of in-depth semistructured interviews of purposively sampled participants. Eligible participants were English-speaking parents who self-identified as African American and whose children received cancer care at 3 US cancer centers. Interviews were conducted by a single trained interviewer via telephone or confidential video conference. The research team employed constant comparative analysis to analyze interview transcripts. The analytic process incorporated memoing and regular meetings to discuss the emergent theory.

RESULTS

Enrolled African American parents (n = 45) were primarily college-educated (n = 33; 73%) women (n = 37; 82%) from single-parent households (n = 23; 51%) with a household income of $50 000 or less (n = 26; 58%) from 3 cancer centers in the Eastern and Southern United States. The emergent theory of psychosocial experiences was magnified existential crisis, defined as emotional distress related to the child's illness and intensified by disconnected and discordant health care interactions and economic worries. These external threats (disconnected and discordant care, economic hardships) related to parents' membership within a marginalized population. Parents used coping resources (religiosity, spirituality, optimism, bolstering communication) to buffer the existential crisis.

CONCLUSION

This sample of African American parents of children with cancer experienced magnified existential crisis. This emergent theory may inform intervention development. Interventions that address both psychosocial and economic needs may be essential to reduce distress among African American parents of children with cancer.

Culturally Adapted Interventions for Anxiety and Trauma-Related Disorders in Marginalized Youth: A Systematic Review

Treatment inequities persist among marginalized youth who experience anxiety and trauma-related disorders. Culturally adapted interventions show potential for improving outcomes for marginalized youth. However, it is unclear the extent to which they improve engagement and can be successfully implemented in practice settings. This systematic review characterizes adaptations to anxiety treatments and their effectiveness for treatment engagement, clinical, and implementation outcomes. Twelve articles met inclusion criteria. Adaptations most frequently altered treatment procedures, language, or content, and least frequently altered treatment approach or goals based on cultural conceptualizations of mental health. Most adaptations targeted racially or ethnically minoritized youth and did not target intersectionality. Adapted treatments were overall effective in reducing anxious distress, yet rigorous study designs were lacking. Engagement outcomes for adapted treatments were inconsistent, and implementation outcomes (e.g., feasibility, acceptability, fidelity) were rarely assessed. The current literature is promising yet inconclusive about the benefits of adapted treatments over standard protocols.

Measuring Patient-Reported Acceptability Outcomes via the Program Acceptability Tool for Telehealth

Introduction: Assessing treatment acceptability is critical to understanding patient experiences in clinical trials, especially in telehealth settings where exposure and engagement experiences are unique. However, the use of patient-reported acceptability outcomes in mental health-focused trials has been mixed, with most published studies relying on objective behavior (e.g., dropout rates) or fit-for-use measures, rather than instruments rooted in a specific theoretical model. This study introduces the Program Acceptability Tool for Telehealth (PATT), a novel, theoretically grounded instrument designed to capture patient-reported acceptability in telehealth-based trials. Methods: Here, we describe the initial development and validation of the PATT, including its performance with 123 caregivers participating in an ongoing clinical trial that includes multiple types of interventions and support programs focused on caregiver well-being. Results: The final 12-item PATT demonstrated robust psychometric properties, including high internal consistency (α = 0.82-0.90) and content validity. Convergent validity was established through significant correlations between PATT scores and behavioral engagement metrics. Conclusions: Our findings suggest that the PATT is a reliable, valid tool for capturing patient acceptability, offering a nuanced perspective on program, process, and impact-related experiences. Further validation studies are recommended to confirm the PATT's utility in broader applications.

Research with Black Communities to Inform Co-Development of a Framework for Anti-Racist Health and Community Programming

Study BackgroundThe effects of systemic racism were exacerbated and amplified throughout the COVID-19 pandemic. The resurgence of the "Black Lives Matter" movement in North America brought awareness to the public, especially white people, of the impacts of systemic racism in society and the urgent need for large-scale and institutional anti-racism work.PurposeIn collaboration with a local Community Health Centre, this research focused on identifying priority areas for tailored and co-developed anti-Black racism interventions in health services and community programming, as well as examining how purposeful relationships can be created with African, Caribbean, and Black (ACB) communities in London, Ontario.MethodsSemi-structured interviews were conducted in either French or English with nine formal or informal leaders from London's ACB communities. Interpretive description methodology guided analysis and interpretation.ResultsParticipants indicated that anti-Black racism is ever-present in the community and in their lives, with systemic racism causing the most harm. Racism should be addressed by creating ACB-specific services, and education for non-Black communities; increased representation, inclusion, and engagement of ACB people within organizations, especially in leadership roles, are essential. A framework based on study findings to guide how organizations can develop authentic and purposeful relationships with ACB communities is presented.ConclusionsOrganizations will continue to perpetuate systemic racism unless they actively seek to be anti-racist and implement strategies and policies to this end. The proposed framework can guide partnerships between health and community organizations and ACB communities, and support co-development of strategies to address anti-Black racism.

Women's Menopausal Experiences in the UK: A Systemic Literature Review of Qualitative Studies

BACKGROUND

Menopause, defined as the cessation of periods for over 12 months, can have a profound impact on women in numerous ways. Understanding women's experiences of menopause can lead to improved care and support during this transformative period.

OBJECTIVES

The objective of this systematic review is to identify and summarise published qualitative studies that consider the lived experiences of women with menopause in the UK and to serve as a basis for future research in the field of menopause.

SEARCH STRATEGY

EMBASE, MEDLINE and PsycINFO databases were searched initially in March, and then updated in April 2024.

INCLUSION CRITERIA

Peer-reviewed papers with full text available in English, focused on women experiencing menopause in the UK, studies published from January 2000 to April 2024, qualitative or mixed methods study design with qualitative analysis.

DATA EXTRACTION AND SYNTHESIS

Two authors independently performed title and abstract screening for eligibility. Conflicting opinions were resolved with a third author. Reviewers familiarised themselves with the data and coded the text line by line. Thematic analysis was utilised to place the codes into broader themes. All studies were assessed using an appropriate quality assessment tool.

MAIN RESULTS

Thirty-two studies were included in the review with 3462 participants involved. 173 primary codes were extracted and organised into subthemes and 3 overarching themes. These key themes were the biopsychosocial dimensions of menopause, understanding of menopause and strategies to manage menopause.

DISCUSSION

Menopausal experiences documented in the literature are shaped by a range of individual and societal factors. While initiatives to support menopausal women are in place, this review also identifies key knowledge gaps and marginalised groups that would benefit from targeted research and interventions. It emphasises that menopause is not merely a collection of symptoms, but, for many, a pivotal life transition. A deeper understanding of these experiences allows us to more effectively support women through this significant phase of life.

CONCLUSIONS

This review concluded that the menopausal experience extends beyond physical symptoms, also affecting mental health, personal and professional life, and self-identity. Additionally, menopause is shaped by individual life experiences and various personal factors.

PATIENT OR PUBLIC CONTRIBUTIONS

The studies analysed in this review contain original data from women in the UK undergoing menopause. The qualitative data delves into their experiences with symptoms, accessing various sources of support from NHS and non-NHS sources as well as alternative therapies.

Ethnic identity commitment as a moderator for perceived access to health care among Latinx sexual minority men

OBJECTIVE

Gay, bisexual, and other sexual minority men (SMM) face more barriers to accessing health care compared to other men. In comparison to other SMM populations, Latinx SMM (LSMM) report having less access to health care. The purpose of the present study is to elucidate how theorized environmental-societal-level (i.e., immigration status, education level, and income level), community-interpersonal-level (i.e., social support and neighborhood collective efficacy [NCE]), and social-cognitive-behavioral-level factors (i.e., age, heterosexual self-presentation [HSP], sexual identity commitment, sexual identity exploration [SIE], and ethnic identity commitment [EIC]) may relate with perceived access to health care (PATHC) in a sample of 478 LSMM.

METHOD

We conducted a hierarchical regression analysis examining the hypothesized predictors of PATHC, as well as EIC as a moderator of the direct association between predictors and PATHC. We hypothesized that Latinx EIC would moderate relations between the aforementioned multilevel factors and PATHC.

RESULTS

LSMM perceived greater access to care when indicating the following: higher education level, more NCE, more HSP, more SIE, and more EIC. Latinx EIC acted as a moderator of four predictors of PATHC, including education, NCE, HSP, and SIE.

CONCLUSIONS

Findings inform outreach interventions of researchers and health care providers about psychosocial and cultural barriers and facilitators of health care access. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

An Exploratory Analysis of Child Characteristics Predicting Clinical Outcomes in Parent-Led Cognitive Behavioral Teletherapy for Anxiety in Autistic Children

Parent-led cognitive behavioral therapy (CBT) is an efficient, promising form of therapy that may be well suited for autistic youth with anxiety disorders. A recent clinical trial found that parent-led CBT - in which parents led their child through a guided CBT workbook with varying degrees of therapist support - was efficacious for reducing anxiety and associated functional impairment. While such findings demonstrate promise for future intervention development and dissemination efforts with this population, more work is needed to elucidate clinical factors that impact response to treatment as well as drop-out. Using data from the aforementioned clinical trial (N = 87), the present exploratory study examined pre-treatment patient characteristics, including family accommodation (FA), anxiety severity, autism features, and externalizing psychopathology, and their relationship with relevant treatment outcomes (i.e., anxiety severity and functional impairment) at both post-treatment and three-month follow-up and drop-out/completer status. Our findings did not reveal any consistent relations between pre-treatment patient characteristics and clinical outcomes, with several isolated exceptions: (a) baseline autism features were associated with greater post-treatment functional impairment; (b) non-male (vs. male) gender was associated with greater functional impairment at 3-month follow-up; and (c) Hispanic ethnicity (vs. non-Hispanic) was associated with greater likelihood of premature treatment drop-out. Findings are discussed in the context of the importance of continuing to elucidate unique patient characteristics predictive of optimal clinical outcomes for autistic youth with anxiety disorders.

Cultural and Social Aspects of Anxiety Disorders

Understanding the cultural and social aspects of anxiety disorders is necessary to ensure the design and implementation of effective, evidence-based methods for diagnosis, prevention, and treatment among diverse populations, particularly those who are minoritized, marginalized, and traditionally underserved. This article describes variations in anxiety disorder prevalence and the association between sociocultural characteristics and stressors known to increase risk for anxiety. The ways sociocultural context impacts anxiety phenomenology and expression is explored. Then, the literature examining differential help-seeking and service utilization among diverse populations is reviewed followed by a summary of culturally responsive, evidence-based practices for anxiety disorders.

Impacts of Racial and Gender Identities on Individuals' Intentions to Seek a Counselor

To understand the theoretical impact of racial and gender identities on counselor selection, an online experiment was conducted with 527 participants in which both the race and gender of a perspective counselor's online profile were manipulated. Results showed that participants had a higher intention to seek counseling when the counselor was from the same racial and/or gender group. These preferences existed above and beyond other identity-based evaluative metrics, such as those tied to group stereotypes (e.g., warmth and competence). The results advocate for the development and evaluation of culturally tailored digital health interventions and underscore the importance of further formative research in this area to enhance the accessibility and effectiveness of healthcare resources for all.

Healthcare professionals' experiences of delivering pain science education to adults from ethnically minoritised groups

BACKGROUND

Pain Science Education (PSE) seeks to increase patients understanding of their pain, to improve clinical outcomes. It has been primarily developed and tested within western cultures. There is a lack of research exploring its use with people from ethnically minoritised groups.

OBJECTIVE

To explore Healthcare Professionals (HCPs) experiences of delivering PSE to people with persistent pain from ethnically minoritised groups.

METHODS

In this qualitative study semi-structured interviews were carried out with a convenience sample of 14 HCPs who routinely deliver PSE to patients from ethnically minoritised groups. The interviews were analysed using reflexive thematic analysis.

RESULTS

Three themes were identified: 1) Biomedical model or disengagement, 2) Pain is a taboo topic, and 3) The importance of cultural competence. Participants believed that people from ethnically minoritised groups disengaged with PSE sooner in comparison to non-ethnically minoritised groups and this was rooted in a strong biomedical understanding of pain and preference for biomedical treatments. Addressing patients' beliefs was deemed difficult as participants felt that pain was considered a taboo amongst some ethnically minoritised groups and HCPs lacked sufficient training in cultural competency to confidently address their pain-related misconceptions.

CONCLUSIONS

Overall, HCPs found that many people from ethnically minoritised groups held strongly biomedical views and/or a cultural reluctance to discuss pain. These factors made pain discussions challenging leading to disengagement from PSE and a preference for passive care. Cultural competency training and access to culturally competent PSE resources may facilitate engagement with PSE for people from ethnically minoritised background.

Uncovering Patterns in Perceived Therapist Behaviour: A Latent Profile Analysis of Broaching Experiences Among Ethnic Minority Group Member Clients

OBJECTIVE

Recent research shows that for clients who identify as ethnic minority group members, therapists' effort to include ethnic-cultural topics in therapy conversations-that is, broaching-is important for clients' evaluations of therapy and symptom improvement. However, little is known about how this is experienced by clients and how different patterns of broaching behaviours are related to the therapeutic process. This study aimed to identify meaningful combinations of therapist broaching behaviours in a sample of clients that identify as ethnic minority group members in outpatient psychotherapy (N = 452; 64.6% women, 33.6% men, 1.3% nonbinary; 0.4% preferred not to say; Mage = 33.8).

METHODS

In the present research, we employed latent profile analysis to discern therapist profiles based on the similarity of their reported broaching behaviours. Group differences were analysed with Welch's analysis of variance.

RESULTS

Five profiles were delineated, each revealing specific broaching patterns. The obtained profiles were named Pending, Neutral, Inappropriate, Uninvolved and Engaged. Reported cultural identity concealment was lower and client-estimated improvement higher in the Pending and Engaged profiles compared to the Inappropriate profile. Both the Neutral and Uninvolved profiles yielded scores in between.

CONCLUSIONS

Pending and Engaged profiles are equally beneficial and the Inappropriate profile is the most harmful in terms of reported cultural concealment and client-estimated improvement. Implications of findings for practice, training and research are discussed.

Evaluating interventions that have improved access to community mental health care for Black men: A systematic review

BACKGROUND

Black men are one of the most disadvantaged groups when accessing mental health services in the UK. There is extensive guidance from qualitative research on how to bring equity, but it is unclear how this evidence is being implemented.

AIM

To systematically review interventions that help Black men access timely and appropriate mental health care and to explore their nature and effectiveness.

METHOD

We registered on PROSPERO (CRD42022345323). We searched electronic databases up to September 2023 for studies with at least 50% of Black male participants receiving an intervention to improve access to mental health support in community settings. We conducted a narrative synthesis of eligible studies.

RESULTS

Five studies met our inclusion criteria. An important characteristic was discussing thoughts and feelings through peer support, leading to a normalization of experiences.

CONCLUSIONS

There is a paucity of research into interventions that support Black men accessing community mental health support. Proactively testing interventions, not just seeking qualitative feedback, is required. Evidence-based strategies to support recruitment of Black men into research is necessary. Commissioners could consider evidence typically seen as less robust to mitigate against an underlying racial bias within research and stimulate the growth of an evidence base.

Workforce Initiatives to Advance Health Equity and Diverse Representation

The persistence of health inequity and the need for workforce diverse representation within child and adolescent psychiatry require systemic solutions. There are recommendations and strategies particularly for the training programs with "all of the above" approach to tackle these complex systemic issues. One of the ways is to think through existing and innovative training pipelines by making them less leaky, enhancing quality, expanding the type and size, and connecting them to reach children and adolescents in need.

The Psychedelic Future of Post-Traumatic Stress Disorder Treatment

Post-traumatic stress disorder (PTSD) is a mental health condition that can occur following exposure to a traumatic experience. An estimated 12 million U.S. adults are presently affected by this disorder. Current treatments include psychological therapies (e.g., exposure-based interventions) and pharmacological treatments (e.g., selective serotonin reuptake inhibitors (SSRIs)). However, a significant proportion of patients receiving standard-of-care therapies for PTSD remain symptomatic, and new approaches for this and other trauma-related mental health conditions are greatly needed. Psychedelic compounds that alter cognition, perception, and mood are currently being examined for their efficacy in treating PTSD despite their current status as Drug Enforcement Administration (DEA)- scheduled substances. Initial clinical trials have demonstrated the potential value of psychedelicassisted therapy to treat PTSD and other psychiatric disorders. In this comprehensive review, we summarize the state of the science of PTSD clinical care, including current treatments and their shortcomings. We review clinical studies of psychedelic interventions to treat PTSD, trauma-related disorders, and common comorbidities. The classic psychedelics psilocybin, lysergic acid diethylamide (LSD), and N,N-dimethyltryptamine (DMT) and DMT-containing ayahuasca, as well as the entactogen 3,4-methylenedioxymethamphetamine (MDMA) and the dissociative anesthetic ketamine, are reviewed. For each drug, we present the history of use, psychological and somatic effects, pharmacology, and safety profile. The rationale and proposed mechanisms for use in treating PTSD and traumarelated disorders are discussed. This review concludes with an in-depth consideration of future directions for the psychiatric applications of psychedelics to maximize therapeutic benefit and minimize risk in individuals and communities impacted by trauma-related conditions.

South Asian individuals' experiences on the NHS low-calorie diet programme: a qualitative study in community settings in England

BACKGROUND

Existing literature examines barriers to the provision of ethnically diverse dietary advice, however, is not specific to total diet replacement (TDR). There is a lack of literature from the UK, limiting the potential applicability of existing findings and themes to the UK context. This study addresses this gap in research by interviewing participants of South Asian ethnicity who have undertaken the National Health Service (NHS) low-calorie diet programme (LCD) for people with type 2 diabetes living with overweight or obesity. This study explores factors that may affect the uptake and acceptability of its TDR, food reintroduction and weight maintenance stages. This aims to provide rich data that can inform effective tailoring of future programmes with South Asian participants.

OBJECTIVE

To explore the perspectives of individuals of South Asian ethnicity on an NHS programme using TDR approaches for the management of type 2 diabetes (T2D).

DESIGN

Qualitative study.

SETTING

Individuals in the community undertaking the NHS LCD programme.

PARTICIPANTS

Twelve one-to-one interviews were conducted with individuals from a South Asian ethnicity participating in the NHS LCD.

MAIN OUTCOME MEASURES

Qualitative semistructured interviews conducted through different stages of the programme. Reflexive thematic analysis was used to analyse the transcripts.

RESULTS

Key themes highlighted positive and negative experiences of the programme: (1) more work is needed in the programme for person centeredness; (2) it is not the same taste; (3) needing motivation to make changes and feel better; (4) a mixed relationship with the coach; (5) social experiences; (6) culture-related experiences.

CONCLUSION

This study provides important experience-based evidence of the need for culturally tailored T2D programmes. Action to address these findings and improve the tailoring of the NHS LCD may improve experience, retention and outcomes on the programme for people of South Asian ethnicity and thereby reduce inequalities.

"It's Important to Work with People that Look Like Me": Black Patients' Preferences for Patient-Provider Race Concordance

A compelling body of research supports the race concordance hypothesis, which asserts that racially minoritized patients who share the same race and ethnicity with their provider have improved communication, better perceptions of care, and better health outcomes. Using a mixed methods approach, this study examined (1) the association between racial identity and patients' preference for race-concordant patient-provider dyads and (2) Black patients' subjective experiences of race concordance. Data were gathered from 47 Black caregivers who completed both a survey and participated in a focus group. Quantitative analyses revealed that the majority (83%) of caregivers reported that it is important to have a mental health provider of the same race and ethnicity. Greater racial centrality, but not private or public regard, was associated with a stronger race concordance preference. Thematic analysis of qualitative data revealed six themes related to race-concordant preferences: aspects related to the patient care experience, cultural humility, relatability, diversity in cultural experiences, role models for children, and intersecting identities. Patients with a race concordance preference felt more comfortable with their provider, perceived that it was easier to build a rapport with their provider, and emphasized the value of representation for themselves and their children. Patients who were neutral in their race concordance preference emphasized professionalism over race, valued diverse perspectives, and appreciated their providers' cultural awareness and willingness to self-educate. The integration of these findings will help to elucidate a more nuanced understanding of the factors that build the therapeutic relationship and cultivate a framework of comfort and understanding in the clinical setting.

Adverse childhood experiences contribute to race/ethnic differences in post-secondary academic performance among college students

OBJECTIVE

This study explores how adverse childhood experiences (ACEs) relate to race/ethnicity and academic achievement among a sample of college students.

PARTICIPANTS

Participants were students attending a large public university in the Southwest (n = 404). Methods: Online surveys captured ACE scores, demographics, and self-reported GPA.

RESULTS

Students of Color had higher ACE scores and lower GPAs than White students. Regression analyses also revealed that an ACE score of 4 or higher is associated with lower GPAs, but only for Students of Color (Black and Hispanic students), not for White students.

CONCLUSIONS

There are race/ethnic differences in the incidence and impact of adverse childhood experiences on post-secondary academic achievement. Thus, it is important for colleges and universities to create a trauma-informed campus culture and holistic mental health support system, particularly for Students of Color, who may not have had access to high quality care before attending college.

Redefining the Role of Public Health Professionals Serving Black Youths Seeking Mental Health Care: Implications for Training and Mentoring

Attrition rates for Black youths in mental health treatment settings are high, and the extant literature suggests this may be because treatment is not meeting their unique needs. Public health professionals, defined here as all individuals who work to increase the well-being of youths, can play a major role in changing these outcomes. The purpose of this article is to suggest a broader scope of practice, or a redefined role, for public health professionals who work with Black youths seeking outpatient mental health care and to explicate ways in which training and mentoring can help accomplish this goal. Bolstered by a socioecological conceptual model, we suggest 3 standards of practice that we believe must be satisfied to meet the requirement for this redefined public health professional role: using a sociocultural framework, exercising flexibility in one's assigned role, and understanding and incorporating culturally specific strengths and protective factors into care. (Am J Public Health. 2023;113(S2):S140-S148. https://doi.org/10.2105/AJPH.2022.307194).

Mediators of Ethnic Differences in Dropout Rates From a Randomized Controlled Treatment Trial Among Latinx and Non-Latinx White Primary Care Patients With Anxiety Disorders

ABSTRACT

Disparities in treatment engagement and adherence based on ethnicity have been widely recognized but are inadequately understood. Few studies have examined treatment dropout among Latinx and non-Latinx White (NLW) individuals. Using Andersen's Behavioral Model of Health Service Use (A behavioral model of families' use of health services. 1968; J Health Soc Behav. 1995; 36:1-10) as a framework, we examine whether pretreatment variables (categorized as predisposing, enabling, and need factors) mediate the relationship between ethnicity and premature dropout in a sample of Latinx and NLW primary care patients with anxiety disorders who participated in a randomized controlled trial (RCT) of cognitive behavioral therapy. Data from a total of 353 primary care patients were examined; 96 Latinx and 257 NLW patients participated. Results indicated that Latinx patients dropped out of treatment more often than NLW patients, resulting in roughly 58% of Latinx patients failing to complete treatment compared with 42% of NLW, and approximately 29% of Latinx patients dropping out before engaging in modules related to cognitive restructuring or exposure, relative to 11% of NLW patients. Mediation analyses suggest that social support and somatization partially explained the relationship between ethnicity and treatment dropout, highlighting the importance of these variables in understanding treatment disparities.

Nuestra Recuperación [Our Recovery]: using photovoice to understand the factors that influence recovery in Latinx populations

BACKGROUND

Photovoice is a form of visual ethnography intended to engage impacted communities in research followed by action to ameliorate the injustices under study. Photovoice has increased in use, especially in collaboration with Latinx communities addressing health inequities. The Latinx population comprises nearly 18% of the overall United States population and according to the census is projected to reach just under 30% by 2060. This diverse panethnic community faces significant structural barriers in accessing services. Racism and the resulting marginalization, specifically, contributes to limited access to recovery services and treatment. Making meaningful advances in substance use disorder training, intervention and policy necessitates learning alongside the Latinx community.

METHODS

We partnered with a Latinx serving integrated behavioral health and primary care setting in Boston Massachusetts to explore barriers and facilitators to recovery using photovoice. Spanish-speaking Latinx adults with a substance use disorder participated. The group met for three photovoice sessions over a six-week period. Together group members critically analyzed photographs using the SHOWeD method.

RESULTS

Findings indicate a sense of purpose and meaning, security, faith and housing are important elements of recovery. The results illustrated the importance of sources of connection in maintaining sobriety. Through this photovoice project, Latinx Spanish speaking participants highlighted barriers and facilitators to their substance use disorder recovery which spanned individual, community, and structural levels.

CONCLUSIONS

The experiences and voices of the Latinx community are crucial to drive discussions that advance policy (e.g., housing stability and access), enhance providers' understanding of Latinx Spanish-speakers' substance use disorder recovery, and inform culturally and linguistically appropriate services. This study demonstrated that photovoice is highly acceptable and feasible among Latinx clients receiving substance use disorder services. Visual images related to housing, faith, etc. communicate challenges, power structures, as well as hopes to policymakers at multiple levels (e.g., institution/ agency, state).

Client-rated facilitators and barriers to long-term youth anxiety disorder recovery

OBJECTIVE

This study examined client ratings of 26 facilitators and barriers to anxiety improvement approximately 6 years after randomization to treatment for anxiety.

METHOD

319 youth (average 17.12 years old; 82.1% Caucasian; 58.6% female) participated in the longitudinal follow-up study to child and adolescent anxiety multimodal study (CAMS), a randomized controlled trial of medication, cognitive-behavioral therapy (CBT), combination, and placebo.

RESULTS

Correcting for multiple comparisons, CBT components (i.e., problem solving, changing unhelpful thoughts, relaxation skills) were rated significantly more helpful among youth without, versus with, an anxiety disorder at follow-up. Barriers that differentiated youth with and without an anxiety disorder included being bullied and difficulty applying therapy content to new situations. Comparisons between youth with different anxiety disorder trajectories (e.g., stable remission, relapsed, or chronically ill) also revealed several differences.

CONCLUSION

Findings suggest that client-rated facilitators and barriers covary with anxiety disorder recovery and may serve as useful tools when evaluating long-term treatment efficacy.

A modified measurement-based care approach to improve mental health treatment engagement among racial and ethnic minoritized youth

Despite high levels of need, racial and ethnic minoritized (REM) youth are much less likely than their White peers to engage in mental health treatment. Concerns about treatment relevance and acceptability and poor therapeutic alliance have been shown to impact treatment engagement, particularly retention, among REM youth and families. Measurement-based care (MBC) is a client-centered practice of collecting and using client-reported progress data throughout treatment to inform shared decision-making. MBC has been associated with increased client involvement in treatment, improved client-provider communication, and increased satisfaction with treatment services. Despite its promise as a treatment engagement strategy, MBC has not been studied in this capacity with REM youth or systematically modified to address the needs of culturally-diverse populations. In this article, we propose a culturally-modified version of MBC, Strategic Treatment Assessment with Youth (STAY), to improve treatment engagement among REM youth and families. Specifically, STAY is designed to target perceptual barriers to treatment to improve treatment retention and ultimately, client outcomes. The four STAY components (i.e., Introduce, Collect, Share, and Act) are based on an existing MBC practice framework and modified to address perceptual barriers to treatment among REM youth. The clinical application of this model is presented via a case example. Finally, future research directions to explore the use of MBC as a treatment retention strategy with REM client populations are provided. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Disparities in Offered Anxiety Treatments Among Minorities

Purpose

The primary purpose of this article was to determine if race and ethnicity played a role in if primary care physicians offered anxiety treatment in office visits by adult patients who were diagnosed with an anxiety disorder(s).

Methods

This study pooled data from the 2011 to 2018 National Ambulatory Medical Care Survey (NAMCS) that included adult patients with an anxiety disorder and the type of treatment offered to them. Logistic regressions were performed to examine the odds of offered anxiety treatment in office visits by non-Hispanic Black, Hispanic, and other race/ethnicity patients compared to office visits by non-Hispanic White patients.

Results

Physicians offered anxiety treatment in more than half of office visits where the patient was diagnosed with an anxiety disorder. Providers offered counseling or talk therapy in less than 13% of all office visits. Office visits by non-Hispanic Black patients had half the odds of being offered counseling/talk therapy (P = .068) compared to those by non-Hispanic White patients.

Conclusions

These findings suggest that statistically significant differences in the offering of any anxiety treatments in office visits to minorities compared to non-Hispanic White patients do not exist; however, there are still differences in the rates of counseling/talk therapy offered in office visits by minorities versus non-minorities. Future studies may want to examine reasons for lower rates of counseling/talk therapy offered to minority and majority patients and the specific pharmacological or therapeutic treatments offered to different races.

Between and within race differences in patient-centeredness and activation in mental health care

OBJECTIVES

The aim of this study was to compare Black and White mental health care patients' perceptions of their providers' and their own participation in patient-centered mental health care. Perceptions of patient-centered care (PCC) in relation to the Multidimensional Model of Racial Identity were explored.

METHODS

Black and White veterans receiving mental health care (n = 82) completed surveys assessing patient activation, involvement in care, perceptions of PCC, and therapeutic alliance. Black participants (n = 40) also completed the Multidimensional Inventory of Black Identity.

RESULTS

There were no differences by race in perceived PCC, though Black participants had lower levels of therapeutic alliance with their mental health care provider and were less activated. Black identity centrality, private regard, and public regard were positively related to PCC and elements of PCC such as patient information seeking/sharing.

CONCLUSIONS

Intragroup identity variables such as racial centrality, regard, and ideology influenced perceived PCC among Black participants. Race identity variables should be explored in future research on racial disparities and PCC.

PRACTICE IMPLICATIONS

Mental health care providers serving Black patients should create opportunities to discuss racial identity and race-related experiences as part of their efforts to improve therapeutic alliance and increase the patient-centeredness of care.

Pathways from exposure to racial/ethnic discrimination to depression: Testing a social-cognitive model

RATIONALE AND OBJECTIVE

Interpersonal racial/ethnic discrimination is a risk factor for depression across the lifespan in minoritized racial/ethnic groups. This study tests a model proposing that social cognitive processes, including relational schemas, mediate the link between discrimination and depression. Relational schemas enable individuals to form mental representations of others, reflecting prior social learning and generating expectations about future social relations. Racism-related relational schemas include, among others, concerns about being rejected or invalidated, concerns about confirming negative stereotypes held by others, and cynical mistrust of others. Prior studies have typically examined the mediating role of one or two relational schemas in the association between discrimination and depression; less is known about the unique and combined effects of multiple dimensions of racism-related social cognition.

METHODS

The model was tested in a convenience sample of ethnically diverse, non-white participants recruited from two sites, a community medical center (N = 136; M_age = 38, SD = 13.0) and a private university (N = 120; M_age = 19.4, SD = 1.3), yielding a consolidated sample of 256 participants (64% women). Data were collected between September 2016 and April 2018. Participants completed paper-and-pencil self-report measures of exposure to interpersonal discrimination, depressive symptoms, and eight measures of relational schemas.

RESULTS

Confirmatory factor analysis indicated that the eight relational schemas defined three primary dimensions: concerns about rejection and invalidation, social vigilance, and mistrust. A structural equation model in which the association between exposure to discrimination and depressive symptoms operates through latent factors representing three social-cognitive dimensions demonstrated adequate fit (CFI = 0.96, RMSEA = 0.06, SRMR = 0.04). A significant mediational effect was found only for concerns about rejection and invalidation.

CONCLUSION

The conceptual model supported by this study may help inform psychological interventions aimed at mitigating the detrimental effects of racial/ethnic discrimination on mental health.

The Role of Human Support on Engagement in an Online Depression Prevention Program for Youth

Background: Depression is a significant public health problem for adolescents. The goal of this study was to evaluate the moderating role of human support in an online depression prevention program on both depression outcomes and overall engagement with the intervention. CATCH-IT is an Internet-based depression prevention program that has been shown to reduce symptoms for adolescents who report elevated depression symptom scores, compared to a health education (HE) control group. Participants in the CATCH-IT arm received human support (e.g., motivational interviewing, completed contacts). This study analyzes the moderating role of human support on depressive outcomes and engagement, and examines if engagement predicts depression outcomes. Methods: This secondary analysis consists of a randomized controlled trial for adolescents assigned to the CATCH-IT group. Mixed effects modeling, general linear models, and an exploratory multiple linear regression were used to explore the moderating relationship of human support between intervention and overall engagement. Study variables included depression outcomes (e.g., Center for Epidemiological Studies Depression Scale (CESD)), engagement components (e.g., modules completed, time on the site, and characters typed) and human support (e.g., motivational interviews and completed contacts.) Results: Results showed no significant relationship between contacts, motivational interviews, and depression scores. However, motivational interviews increased engagement with the intervention, such that those who received more motivational interviews completed significantly more modules, spent more time on the site, and typed more characters (p < 0.05). The number of contacts increased engagement with the intervention, and those who received more contacts spent more time on the site and typed more characters (p < 0.05). Exploratory multiple linear regression modeling demonstrated that male, African American/Black, and Hispanic/Latinx users were less engaged compared to other users. Lastly, engagement was not a significant predictor of depression outcomes (p > 0.05). Conclusions: The efficacy of CATCH-IT is not better explained by the degree to which participants received doses of human support from providers during the use of this online intervention. This may reveal the high potential of effective online interventions without the blended integration of human support for adolescents. To increase engagement of adolescents with an online depression prevention program, human support may be more efficient when utilizing MI rather than technical support.

Implementing Person-Centered Care Planning: A Randomized Controlled Trial

OBJECTIVE

Person-centered care is a key quality indicator and central to promoting integrated and recovery-oriented services. Person-centered care planning (PCCP) is a manualized intervention promoting the collaborative cocreation of a recovery-oriented care service plan on the basis of an individual's most valued life goals. This cluster randomized controlled trial tested the effect of PCCP training on person-centered care delivery in community mental health clinics.

METHODS

Fourteen clinic sites were randomly assigned to receive either PCCP training (N=7; experimental condition) or service planning as usual (N=7; control condition). Data were collected from online surveys, and service plans were completed by 60 provider teams. The Person-Centered Care Planning Assessment Measure was administered via chart review at baseline, 12 months, and 18 months, and surveys were used to measure supervision, implementation leadership, and program type. The main effect was examined with linear mixed-effects regression models, with observations over time.

RESULTS

Analyses controlling for service user and program characteristics revealed that at 12 months, the group assigned to PCCP training showed significant improvements in delivering person-centered care compared with the control group (b=1.10, SE=0.50, p=0.03). At 18 months, this effect was even more pronounced (b=1.47, SE=0.50, p=0.01), representing a medium-to-large effect size of d=0.71 (95% confidence interval=0.23-1.20).

CONCLUSIONS

These findings indicate that training providers in PCCP increases provider competency in delivering person-centered care. Using an objective measure of person-centered care, the authors show that a comprehensive training strategy can target both the philosophical shift and the technical skills needed to promote client recovery.

Talking With white Clients About Race

Most white people do not believe that race is an important feature of their lives, and this belief continues into the therapy room where race is rarely a topic of conversation, especially for all-white dyads. However, research shows that race and racism are highly salient for white people's mental health, and this gap in understanding has negative effects on the well-being of both white people and people of color. This paper argues to embrace the ethical and moral call to actively address race and racism in therapy between white therapists and white clients. This embrace can be particularly challenging for white therapists who believe themselves to be social justice-oriented people, but who nevertheless contribute to racism in both conscious and unconscious ways. A model is offered for how psychotherapists can bring up and work with the topics of race and racism during the course of therapy. The model includes ways for white therapists to engage in the long-term process of self-critique, ways to introduce the salience of race in the white client's life, and how to connect race and racism to the client's explicit goals for therapy. Finally, a case example is explored using a well-meaning, self-defined liberal white client.

Racial and Ethnic Differences in Depressive Profiles of Child Welfare-Involved Families Receiving Home Visitation Services

OBJECTIVE

Profiles of depressive symptoms were identified among Hispanic, Black, and White parents involved in the child welfare service system, including changes in symptoms over time.

METHODS

Participants (N=2,109) were parents receiving SafeCare, a home visitation intervention provided in a large, diverse child welfare system. Depressive symptoms were assessed with the Centers for Epidemiological Studies Depression Scale at baseline and at approximately every sixth home visit, up to a total of four times. Univariate tests examined the relationship between baseline symptoms, race-ethnicity, and service participation. Latent class growth analyses identified trajectories of depressive symptoms during participation in child welfare services.

RESULTS

Participation in services was affected by depressive symptoms. Forty percent of parents did not remain long enough in the program to complete a second CES-D assessment, and those who reported more symptoms at baseline were significantly less likely to do so. Among parents who engaged in services, distinct profiles of depressive symptoms emerged that differed by race-ethnicity. For non-Hispanic Black parents, no changes in depressive symptoms over time were noted, regardless of level of severity at baseline. Parents with the highest levels of symptoms did not improve over time.

CONCLUSIONS

Despite receipt of supportive and recovery-oriented services specifically focused on empowering child welfare-involved parents, many experienced elevated depressive symptoms. Integration of child welfare and community mental health systems may improve both service engagement and mental health among child welfare-involved families.

Windows of cultural opportunity: A thematic analysis of how cultural conversations occur in psychotherapy

A cultural opportunity is 1 of 3 pillars within multicultural orientation framework; it is defined as a moment in therapy when aspects of a client's background emerge, which can be deeply explored to better understand the salient aspects of a client's cultural identities. Research on cultural opportunities provides evidence that clients desire cultural conversations. However, no study to date has examined what cultural opportunities sound like in therapy and how therapists and clients utilize these opportunities. Accordingly, the purpose of this study was to examine the ways in which cultural conversations emerge during the first psychotherapy session and how clients and therapists engage in these cultural conversations. Psychotherapy sessions from diverse therapist-client pairings at a university counseling center (n = 22) were analyzed using (reflexive) thematic analysis. Qualitative findings revealed 4 themes around how cultural opportunities emerge (e.g., windowpane of feeling) and 3 themes in how they are responded to (e.g., look out the same window: using client's language to explore culture). Implications for therapist training and supervision are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Racial dynamics among clients in a residential substance use disorder treatment program in South Los Angeles and its impact on clients' treatment experiences

This study seeks to investigate racial dynamics among clients in a female-only residential substance use disorder treatment facility in South Los Angeles and its effects on treatment experiences. Clients were interviewed about their interracial interactions, perceptions of clients of races and ethnicities different from their own and how racial dynamics might affect their experiences in treatment. Nine interviews were conducted and analyzed using thematic analysis. Participants recounted that racial differences do not play a significant role in their treatment experiences, although racial identities shape social group formation. Motivation to recover from addiction and other shared lived experiences facilitate interracial harmony.

Inflammatory Bowel Disease Patient Experiences with Psychotherapy in the Community

This study aimed to characterize patient expectations for integrating mental health into IBD treatment, describe experiences with psychotherapy, and evaluate therapy access and quality. Adults with IBD were recruited online and via a gastroenterology practice. Participants, 162 adults with IBD, completed online questionnaires. The sample was primarily middle-aged, White, and female. Sixty percent had Crohn's Disease. Disease severity was mild to moderate; 38% reported utilizing therapy for IBD-specific issues. The greatest endorsed barrier to psychotherapy was its cost. Psychotherapy was perceived as leading to modest gains in quality of life, emotional well-being, and stress reduction. Participants reported a disparity between their desire for mental health discussions and their actual interactions with providers. The majority of participants (81%) stated there are insufficient knowledgeable therapists. A significant number of patients with IBD endorsed the desire for mental health integration into care. Disparities exist in reported provider-patient communication on these topics. There appears to be a dearth of IBD-knowledgeable therapists in the community.

Working well: a systematic scoping review of the Indigenous primary healthcare workforce development literature

BACKGROUND

Strong and effective workforce models are essential for improving comprehensive Indigenous primary healthcare service (PHC) provision to Indigenous peoples in Canada, Australia, New Zealand and the USA (CANZUS nations). This review systematically scoped the literature for studies that described or evaluated models and systems that support the sustainability, capacity or growth of the Indigenous PHC workforce to provide effective PHC provision.

METHODS

Eleven databases, 10 websites and clearinghouses, and the reference lists of 5 review articles were searched for relevant studies from CANZUS nations published in English from 2000 to 2017. A process of thematic analysis was utilised to identify key conditions, strategies and outcomes of Indigenous PHC workforce development reported in the literature.

RESULTS

Overall, 28 studies were found. Studies reported enabling conditions for workforce development as government funding and appropriate regulation, support and advocacy by professional organisations; community engagement; PHC leadership, supervision and support; and practitioner Indigeneity, motivation, power equality and wellbeing. Strategies focused on enhancing recruitment and retention; strengthening roles, capacity and teamwork; and improving supervision, mentoring and support. Only 12/28 studies were evaluations, and these studies were generally of weak quality. These studies reported impacts of improved workforce sustainability, workforce capacity, resourcing/growth and healthcare performance improvements.

CONCLUSIONS

PHCs can strengthen their workforce models by bringing together healthcare providers to consider how these strategies and enabling conditions can be improved to meet the healthcare and health needs of the local community. Improvement is also needed in the quality of evidence relating to particular strategies to guide practice.

Change in Patient Activation and Mental Illness Symptoms After Communication Training: A Multisite Study With a Diverse Patient Sample

OBJECTIVE

Patient activation involves patients' ability and motivation to communicate about their health and health care. Research has demonstrated that clinician or patient interventions may improve patient activation. This study explored the degree to which clinician and patient interventions affected both patient activation and symptoms of depression and anxiety in a racially and ethnically diverse clinical sample.

METHODS

Data were from a randomized clinical trial that included 312 patients and 74 clinicians from 13 Massachusetts community- and hospital-based outpatient behavioral health clinics. Patients completed measures of patient activation and depression and anxiety symptoms. Secondary data analyses were conducted to examine the effect of patient and clinician interventions (DECIDE-PA and DECIDE-PC, respectively) on depression and anxiety symptoms and patient activation. A multilevel, mixed-effects simultaneous-equation model was estimated to assess the relationship between the interventions, changes in patients' symptoms, and patient activation.

RESULTS

Clinicians' greater intervention dosage (i.e., more completed DECIDE-PC training sessions) was associated with patients' decreased anxiety symptoms, but associations with patient activation or depression symptoms were not significant. The effect of clinician training dosage on anxiety symptoms was stronger when patients and clinicians were not of the same race-ethnicity. The reduction in patients' anxiety symptoms appeared to increase patient activation.

CONCLUSIONS

Clinician interventions designed to boost patient-clinician communication and the therapeutic alliance may serve to lessen patients' anxiety and may ultimately improve patient activation.