Organizational structure,leadership and readiness for change and the implementation of organizational cultural competence in addiction health services

Increasing representation of racial and ethnic minorities in the health care system and on-going concerns about existing health disparities have pressured addiction health services programs to enhance their cultural competence. This study examines the extent to which organizational factors, such as structure, leadership and readiness for change contribute to the implementation of community, policy and staffing domains representing organizational cultural competence. Analysis of a randomly selected sample of 122 organizations located in primarily Latino and African American communities showed that programs with public funding and Medicaid reimbursement were positively associated with implementing policies and procedures, while leadership was associated with staff having greater knowledge of minority communities and developing a diverse workforce. Moreover, program climate was positively associated with staff knowledge of communities and having supportive policies and procedures, while programs with graduate staff and parent organizations were negatively associated with knowledge of and involvement in these communities. By investing in funding, leadership skills and a strategic climate, addiction health services programs may develop greater understanding and responsiveness of the service needs of minority communities. Implications for future research and program planning in an era of health care reform in the United States are discussed.     

Who intermarries in Britain? Explaining ethnic diversity in intermarriage patterns

This paper investigates trends, patterns and determinants of intermarriage (and partnership) comparing patterns among men and women and among different ethnic groups in Britain. We distinguish between endogamous (co‐ethnic), majority/minority and minority/minority marriages. Hypotheses are derived from the theoretical literatures on assimilation, segmented assimilation and opportunity structures. The empirical analysis is based on the 1988–2006 General Household Surveys (N = 115,494). Consistent with assimilation theory we find that, for all ethnic minority groups, the propensity to intermarry is higher in the second generation than in the first. Consistent with ideas drawn from segmented assimilation theory, we also find that substantial differences in propensity to form majority/minority marriages persist after controls for individual characteristics such as age, educational level, generation and length of residence in Britain, with men and women of Indian, Pakistani or Bangladeshi background having higher propensities to form endogamous partnerships. However, we also find that opportunity structures affect intermarriage propensities for all groups alike, with individuals in more diverse residential areas (as measured by the ratio of majority to minority residents in the area) having higher likelihood to form majority/minority partnerships. We conclude then that, beginning from very different starting points, all groups, both minority and the majority groups exhibit common patterns of generational change and response to opportunity structures. Even the groups that are believed to have the strongest community structures and the strongest norms supporting endogamy appear to be experiencing increasing exogamy in the second generation and in more diverse residential settings. This suggests that a weak rather than a strong version of segmented assimilation provides the best account of British patterns.     

The validity of assessing mental health needs with social indicators.

Selection of the appropriate number and types of social indicators for use in mental health planning has been a perennial problem. Social indicators have been associated with several concepts (quality of life, community disorganization, populations at risk) of varying relevance for planning mental health services, and abstracting social indicators from these conceptual domains poses a variety of validity issues. The issues are discussed, and the viability of social indicators in mental health planning is reexamined.     

The barriers to the effectiveness of culturally sensitive practices in health and social care services for Chinese people in Britain

This paper studies the problem that health and social care practitioners, intending to satisfy their ethnic minority users’ cultural preferences, end up providing services against their wishes. In particular it points out that this problem is caused by over-emphasising two key assumptions of ethnic minority groups. The first assumption is that all members of the same ethnic minority group organise their health and social care according to their cultural principles. The second assumption is that their cultural principles are monolithic. Demonstrating that these two assumptions may not necessarily be applicable to all ethnic minority groups, this paper discusses the diverse strategies used by Chinese people in Britain to organise their health and social care, and the differences between their two important cultural principles, Taoism and Confucianism. In order to demonstrate to professionals and the Government that they should not over-emphasise these two assumptions and that they need to pay attention to ethnic minority groups’ diverse needs, the paper suggests that different ethnic minority groups may need to unite to increase their influence in the service provision process. However it also warns that this tactic may lead to the subordination of minority group interests in the articulation of those large groups.

     

Capacity-building needs of minority health nonprofits

This article reports on the results of a statewide assessment of the capacity-building needs of organizations that provide health services to ethnic minority groups in Ohio. The research addressed gaps in knowledge about the specific needs of these organizations for improved effectiveness and long-term sustainability. A telephone survey of 659 organizations, supplemented by focus groups with 37 participants in the state's largest cities, indicated substantial need and interest in capacity-building technical assistance in areas such as revenue-generating activities, marketing and public relations, information technology training, program evaluation, and board leadership development. The limited ability of these organizations to pay for the needed assistance creates challenges for planning approaches to meet these vital needs.     

A Study of Utilization and Satisfaction

This article describes the utilization and satisfaction patterns of Native Hawaiian elders with the Ke Ola Pono No Na Kupuna ("Good Health and Living for the Elderly") project funded under Title VI-B of the Older Americans Act. Data were collected through a self-administercd questionnaire. Its unique, one of a kind, culturally specific program, which includes traditional Native Hawaiian meals, has a number of implications for policy considerations in designing aging programs that can serve ethnic minority aged more effectively..Changes in current federal policy that would enable federally mandated aspects of programs to provide for greater flexibility in providing culturally relevant programs and services for ethnic minorities would help to surmount some of the current problems and barriers to service delivery and utilization by ethnic minority groups. Allowing for greater involvement of ethnic minorities in program design will help to assure culturally relevant and appropriate activities and services and may increase the likelihood of success due to a sense of personal ownership and self-responsibility on the part of those involved.     

Young African American Males: Barriers to Access to Health Care

African American males continue to experience an unacceptable and disproportionate number of health disparities when compared with other racial and ethnic groups. Young African American males can expect to live the least amount of time when compared to any other ethnic minority or racial sub-group. Understanding the obstacles and barriers that impede access to health care and wellness services among young African American males is essential to begin the process of decreasing health disparities. The goal of this qualitative study was to explore and identify the barriers experienced by young African American males in accessing health care services while also creating a rare opportunity to give voice to young African American males. The study results indicate that young African American males have multiple perceptions of barriers to health care services. Their perceptions fell into three categories: the negative impact of environment or community, lack of finances or no insurance, and distrust of medical practices associated with race history resulting in accessing healthcare as a last resort. Additional research is needed to craft community-based programs to: a) educate young African American males on the importance of preventative strategies to maintain wellness; and b) ensure that the appropriate medical and wellness services are available and reaching young African American males in need.     

A study of utilization and satisfaction: implications for cultural concepts and design in aging services

This article describes the utilization and satisfaction patterns of Native Hawaiian elders with the Ke Ola Pono No Na Kupuna ("Good Health and Living for the Elderly") project funded under Title VI-B of the Older Americans Act. Data were collected through a self-administered questionnaire. Its unique, one of a kind, culturally specific program, which includes traditional Native Hawaiian meals, has a number of implications for policy considerations in designing aging programs that can serve ethnic minority aged more effectively. Changes in current federal policy that would enable federally mandated aspects of programs to provide for greater flexibility in providing culturally relevant programs and services for ethnic minorities would help to surmount some of the current problems and barriers to service delivery and utilization by ethnic minority groups. Allowing for greater involvement of ethnic minorities in program design will help to assure culturally relevant and appropriate activities and services and may increase the likelihood of success due to a sense of personal ownership and self-responsibility on the part of those involved.     

Family carers' views of services for people with learning disabilities from Black and minority ethnic groups: a qualitative study of 30 families in a south London borough

In 2001, the UK Government identified the widespread neglect of the needs of people with learning disabilities from Black and minority ethnic communities. In this qualitative study informal interviews were held with 30 family carers of adults with learning disabilities from Black and minority ethnic communities. Their views were sought regarding services received and services needed, and cultural or communication barriers faced in accessing appropriate services. The study showed that although carers were largely satisfied with services actually received, service provision was highly inadequate and ineffective. Even very elderly and ill carers and those caring for people with severe disabilities received little support. Social worker support was negligible, and future planning rare. It is clear that the needs of carers from Black and minority ethnic communities are not being met. The situation would be considerably eased by adequate social worker support. Stereotypes of supportive family networks, (especially regarding south Asian families) proved to be unfounded.     

The ‘compliant’, the ‘pacified’ and the ‘rebel’: experiences with Swiss disability insurance

Switzerland’s social policies in the field of disability have been significantly reshaped over the last two decades by reducing the number of allowances awarded and by increasing the recourse to vocational rehabilitation measures. What stances do individuals who experience the implementation of these policies adopt? What kind of tests are they subjected to? How can we explain the posture they adopt – be it ‘compliant’, ‘pacified’ or ‘rebellious’ – when facing the (re)assignations of their identity and professional status? Drawing on interviews conducted with individuals who have recently been involved in programmes set up by Swiss disability insurance, we highlight their uncertainties and concerns relating to their place in society, as well as their reactions to disability insurance’s interventions.     

The limits of multiculturalism in elder care services

Over the past decade, policymakers and practitioners in the field of aging have been increasingly challenged to develop appropriate health and social services for elders from diverse ethnic communities. This has largely resulted from concerns regarding the significant barriers to care faced by disenfranchised elders. However, advances in the articulation of multicultural practice and policy dealing with ethnic communities have focused almost exclusively on developing competency skills based on individual communication and understanding between formal service providers and clients rather than on exposing and altering institutional structures and power relations marked by racism. Indeed, antiracist agendas are rarely articulated in gerontological settings. This article reports on some of the central findings of a qualitative institutional ethnographic study on health care access among ethnic elderly women. It addresses the question of how multicultural programs and policies operate in elder care services and how they are experienced by ethnic elderly female clients and their service providers.     

Every Child Matters? A critical review of child welfare reforms in the context of minority ethnic children and families

This paper critically reviews some key government papers that together largely provide the foundation for the relevant child welfare reforms in England and Wales. The context of this review was to evaluate whether these papers and documents made sufficient reference to improving policies and practices for minority ethnic children and families involved in child welfare matters, given the research evidence from the early 1990s suggesting that such families may experience particular disadvantages or discriminations within the UK child welfare system. The research evidence cited draws upon studies that have considered the experiences of different minority ethnic groups from the point of referrals through to long term services, including those children who have been looked after in local authority care and those families that have been subject to care proceedings. This paper concludes that more is needed under the Every Child Matters agenda to both acknowledge and address the specific needs of minority ethnic children and their families, as identified in the range of studies published post Children Act 1989. Copyright © 2008 John Wiley & Sons, Ltd.     

Longitudinal trends in substance use and mental health service needs in child welfare

Caregiver substance use and mental health problems have long been discussed as concerns in promoting positive child welfare outcomes. Yet the absence of longitudinal data focused on racial/ethnic differences in service needs and substance use has limited child welfare systems in their ability to address potential disparities. This study examines racial/ethnic trends in service needs and patterns of substances used among child welfare-involved caregivers over a 15-year period (2000–2015) from a large, urban county located in the Midwestern United States. Substance use service needs showed an increase over time among White non-Hispanic individuals, and declined over time for all racial/ethnic minority groups. Mental health service needs increased over time, with White non-Hispanic individuals experiencing the largest increase. Co-occurring service needs showed a moderate increase for all groups. Trends associated with service needs across the lifespan were relatively similar across racial and ethnic groups, with needs peaking between ages 30 and 35. When examining specific substances used, cocaine use decreased over time for all individuals. However, marijuana use increased substantially for Black/African American individuals, while opioid use increased substantially for White non-Hispanic individuals. These results highlight key areas where trends among child welfare-involved caregivers differ from population-based trends and suggest that improved coordination between child welfare agencies, mental health and substance use treatment providers may be a key step in reducing the disparities observed.     

How many hours do you have to work to be integrated? Full‐time and part‐time employment of native and ethnic minority women in the Netherlands

Labour market integration of ethnic minority women is central for economic integration, as they may experience a double disadvantage: both as a woman and as a migrant. This presumed double disadvantage has recently become the focus of both Dutch integration and emancipation policy. To test several assumptions underlying this, we analyse to what extent labour market participation of different groups of women and the hours they work are influenced by human capital and household characteristics. Our results show some remarkable differences in employment patterns. Controlling for educational level, partnership and the presence of children, it was found that native women more often work in part‐time jobs than ethnic minority women. For native Dutch women, the number of children influences both the employment decision and the number of hours worked, whereas for ethnic minority women, this only effects full‐time employment.     

Ethnic Diversity and Child Protection

SUMMARY: Black and minority ethnic children in need of protection receive a poor response from health and social services. Practitioners are reluctant to intervene, and when intervention does take place it reflects a eurocentric approach that fails to engage with the ethnic diversity of vulnerable children. Increasing the levels of safety far all children, black and white, suffering or likely to suffer significant harm, requires taking positive action: collecting ethnically relevant data, a commitment to an equitable distribution of resources, consulting children and parents and involving them in planning and designing services.     

A comparative study of health delivery systems of India and China

The medical systems which most of the developing countries have, are ad hoc adoptions inherited from their colonial masters and have met with little success in making health planning as part of their national planning. Very few countries have been able to overcome the resistance of the medical profession and the bureaucratic inertia which is a major obstacle in the transformation of this system to a broad based social service and integrating it with the process of socio-economic development planning. The adoption of this system by developing countries is a typical example of technological misfit. A cheap and labour intensive model for developing countries shall be a proper solution for the development of a health care delivery system for the masses. A solution to this problem is a mix or hybrid of the traditional and modern medicines which very recently have been exploited both in India and China. How far India and China have been successful and what is needed to be done is the subject matter of this paper.     

Perceived Stigma and Depression among Black Adolescents in Outpatient Treatment

Despite the high prevalence of depression among children and adolescents, most that need mental health treatment do not seek care. This is especially true for ethnic minority adolescents. Prior research has shown that perceived stigma may act as a barrier to the initiation of and adherence to depression treatment, yet few studies have examined the relationship between stigma and depression among Black adolescents. This exploratory study examined the relationship between Black adolescents' depression severity and their current level of perceived stigma in an outpatient sample. Face-to-face interviews were conducted with a clinical sample of adolescents referred for mental health services at a community-based outpatient clinic (n =108), participating in a prospective pilot study on adolescents' patterns of mental health service use. The analyses revealed that greater depression severity was significantly associated with higher perceived stigma (p < .05), particularly among females. The results also suggest that Black adolescents appear to exhibit an appropriate level of self-assessment regarding their need for mental health services. These results are interpreted in relation to previous literature, and limitations and directions for future research are discussed.     

Moving college health research forward: Reconsidering our reliance on statistical significance testing

Understanding the unique health needs of college students and establishing best practices to address them depend, heavily, on the inherent quality and contribution of the research identifying these needs. College health-focused publications currently exemplify less than ideal statistical reporting practices. Specifically, college health practitioners and researchers continue to rely heavily upon null hypothesis significance testing (NHST) as the sole standard for effectiveness, validity, and/or replicability of scientific studies, even though NHST itself was not designed for such purposes. Herein we address the following questions: (a) What is NHST? (b) What are the inherent limitations of NHST? (c) What are recommended alternatives to NHST? and (d) How can editorial policies promote adopting NHST alternatives? Using college health data from the CORE 2011 Alcohol and Drug survey, we provide a heuristic example demonstrating how effect sizes do not suffer from the same limitations as NHST.     

Representing the Views of Disabled People in Community Care Planning

The 1990 NHS and Community Care Act requires social services departments in Britain to involve representatives of service users in the preparation of their annual community care plans. This paper gives a critical account of the different ways in which the views of disabled people are sought and represented in community care planning; and of the organisational and practical barriers which disabled people and their organisations are likely to encounter in representing their views to service planners. People with learning disabilities, older disabled people, people with sensory impairments and disabled people from Black and ethnic minority communities are particularly likely to be excluded from current consultation procedures. The paper concludes that present methods of representation place considerable burdens on both individual disabled people and on their organisations. Consequently, disabled people may increasingly question the effectiveness and usefulness of their involvement in community care planning, in the light of the many other issues which are important to them.     

A survey of Colorado's migrant farmworkers: access to health care

This report utilizes data collected in a 1986 sample survey of 329 adult (18 to 50 years old) migrant farmworkers in Colorado to determine their health needs, health services utilization, and overall access to care. Health needs include selected indices of medical, dental, nutrition, and reproductive health. About 1/4 of the population had no usual source of health care. Upstream states such as Colorado are responsible as the primary providers of health services for those who either have no source of health care at their home base or experience a variety of barriers in their attempts to access services. Women are most likely to have had a medical visit over the past 12 months and are more likely to have experienced hospitalization. Unfortunately, although their contact with medical professionals is more frequent, the family planning needs of women are not being met. A large disparity exists between ideal family size and number of pregnancies and live births. The findings of this survey document the inferior health status of the migrant farmworker population in Colorado. Hunger, poverty, and environmental hazards increase the risk of illness, while at the same time, barriers to care often prevent migrants from accessing needed health services. Recommendations include 1) promoting and funding family planning and reproductive health services for migrant farmworker women and their partners, 2) incorporating trained family planning promoters in the migrant health delivery system, 3) maintaining successful models of restorative dental care for adults, 4) increasing access to services in nontraditional settings, 5) increasing use of ancillary personnel to provide services, especially dental services, 6) maintaining outreach programs in the available food programs, and 7) encouraging migrant health programs to provide leadership in the development of alternative food sources.