Ethnic and class factors affecting mental health clinic service

Service delivery by a mental health clinic to clients from an older suburban catchment area containing both lower and middle class blacks and whites was studied. The epidemiologic method was employed, relating service delivery to the characteristics of the various population groups within the catchment. The findings indicate that low service rates for blacks were not related to ethnicity alone, but to the combination of black ethnicity and low social status; however, middle class blacks and middle class whites who entered treatment received similar service. Poor blacks had higher admission rates than poor whites with similar need indicators. In continued treatment, poor blacks received lowest service rates while minority status poor whites living in a predominantly black area received highest service rates. Social class mediated black service utilization. Severity of illness, interacting with social class and minority status mediated white service utilization. Outreach is suggested not only for poor blacks but also for poor whites, especially those living in areas in which they represent an ethnic minority.     

The relationship between socioeconomic status and infant mortality in a metropolitan aggregate, 1989–1991

This paper presents the results of an ecological analysis of the relationship between infant mortality and economic status in a metropolitan aggregate comprised of seven of the larger cities in Ohio during the three years centering on the 1990 census. Using a summary income score derived for the census tract of mother's usual residence, the census tracts in the seven metropolitan centers were divided into broad income groupings and three-year average infant mortality rates were computed for each area, by age, sex, race, and selected causes of death. The most important conclusion to be drawn from the data is that in spite of some remarkable declines in overall levels of infant mortality during the past few decades, there continues to be a very clear and pronounced inverse association between income status and infant mortality. The general inverse association is observed for both sexes, for whites and nonwhites, and for all major causes of infant death. At the same time, the data reveal notable differences in the magnitude of the relationship by sex, and especially by age at death, race, and cause of death. Explanations of these differences are suggested, and a conclusion notes some of the difficulties encountered in developing programs aimed at closing the infant mortality gap between the richest and poorest segments of the society.This is an expanded version of a paper presented at the annual meetings of the Eastern Sociological Society in Baltimore, Maryland (March 17–20, 1994).     

Social services for sexual minority youth: Preferences for what,where, and how services are delivered

As part of an internet-based study to investigate experiences of sexual minority youth in the U.S., 544 youth, ages 14–19, were surveyed about their need for services, where they preferred to receive these services, and their preferred method of service delivery. The survey was anonymous and youth were recruited from LGBTQ-specific listservs and venues as well as through social networking sites as a way of reaching youth often not represented in LGBTQ surveys. Youth highly endorsed many types of services, settings, and modes of delivery. Some subgroup differences emerged. Transgender youth and those uncertain about their gender identity expressed stronger interest than others in services to address stress, family issues, and self-defense, and in receiving support and guidance from LGBTQ adults. Few differences in service preferences along demographic lines such as race/ethnicity emerged; however, African American youth were more likely than others to prefer services offered in a place of worship. Contrary to predictions, geographic and community variables were not related to service type, delivery format, or location preferences.     

The Educational Expectations of South African Youth

Abstract

Educational expectations, in particular the relationship between race/ethnicity and educational expectations, have been understudied in less developed countries. We use data from the Cape Area Panel Study (CAPS) to examine the educational expectations of black (African), coloured (mixed race), and white (European ancestry) youth in Cape Town, South Africa. The educational expectations of all three racial groups are high, although coloured youth are less likely than black and white youth to expect to complete postsecondary or postgraduate schooling. Supporting research on educational expectations in the United States and other more developed countries, our findings indicate that socioeconomic status and academic performance matter for educational expectations in South Africa, although their importance varies by racial group. In contrast to U.S. studies that have found effects of family composition for whites only, we found virtually no effects of family composition on the educational expectations of whites or nonwhites. Our findings suggest possible similarities and differences across social contexts in the processes shaping the educational expectations of youth from disadvantaged groups.     

Racial and Ethnic Differences in Experiences of Discrimination in Accessing Social Services Among Transgender/Gender-Nonconforming People

Members of the transgender/gender-nonconforming (GNC) community experience higher rates of discrimination based on their gender compared to their cisgender counterparts. Similarly, people of color experience higher rates of discrimination than White people. This study examines the difference in experiences of discrimination among transgender/GNC individuals in accessing social services providers by race/ethnicity (White and people of color). The data collected in a national cross-sectional survey (N = 6,451) and analyzed via chi-square test of independence and binary logistic regression demonstrate the disproportionate prevalence of discrimination based on race/ethnicity within the transgender/GNC population when accessing social services such as drug treatment centers, mental health clinics, domestic violence shelters, and rape crisis centers. Social workers are the most common provider of social services to the community, and have an ethical commitment to provision of services without discrimination. High rates of discrimination in accessing social services among transgender/GNC people, with even higher rates of discrimination for transgender/GNC people of color, highlight the need for improvement in social work education and practice.     

Case management: lessons from earlier efforts

Case management is a major, new initiative in the provision of community support services to implement public policy of maintaining mental patients in the community. A review of the case management function as used in the anti-poverty program in the 1960s, shows that a case manager works in a task environment consisting of a multitude of independent service agencies, works within the culture of a core service agency, and relates to chronic clients. The case manager's position is shaped by each of these relationships. Each provides dimensions for a formative evaluation of the program. Case management evaluation can identify issues, and document problems to contribute to the rational redesign of our service system.     

Are services to prevent foster care effective?

The prevention of foster care became an important issue for child welfare services during the 1970s. Two main types of prevention models have emerged: crisis intervention programs intended to prevent imminent placement and intensive service programs designed to avert those crisis situations that precipitate placement. A critical analysis of several project evaluations leads to the conclusion that neither model has been markedly successful. Low nominal project placement rates seem attributable to inability to predict placements and to client selection biases. From a strictly financial perspective, preventive services have been considerably more expensive than regular services, including temporary family foster care. Data from a new demonstration project in New Jersey illustrate various problems in providing and evaluating preventive services to families referred to protective service agencies. Implications of the findings for prevention programs and policies are discussed, and a new direction focused on truly early intervention with children and families is proposed.     

Neighborhood-Based Services: Organizational Change and Integration Prospects

Prospects for service integration between settlement houses, or traditional neighborhood centers that offer services for individuals ranging from preschool children to the elderly, and family resource centers, agencies that provide support for families and early childhood education programs, are explored in this Rochester, New York, case study. Although the target populations of these two types of organizations overlap, service integration is not likely in the short run due to differing organizational philosophies and the adaptation of each organization to unique funding sources. Increased funding pressures and demands for greater efficiency in service delivery may make collaboration more attractive in the future.     

Racial/Ethnic Differences in Court Referred Pathways to Mental Health Services for Children in Foster Care

Racial/Ethnic disparity in placement patterns and service utilization among children in foster care has been documented in a variety of studies. This study examined the role of the court process in referring children in foster care to mental health services and tested for racial/ethnic differences in the patterns of referral and service use. Court records for 142 children ages 2–16, representing Caucasian, African American, and Hispanic racial/ethnic groups were reviewed. Results indicate that the court process does play a significant role in referring children to services. Significant differences by race and ethnicity in mental health service utilization prior to the child's protective placement, as well as service orders, and post-placement service use were identified. Caucasian youth were more likely to receive orders for psychotherapy and to have documented use of psychotherapy than were African American and Hispanic youth, even when the possible confounding effects of age and type of maltreatment were controlled. Implications for the effective delivery of supportive services to those children most in need are discussed.     

Prevention validation and accounting platform: a framework for establishing accountability and performance measures of substance abuse prevention programs

The field of substance abuse prevention has neither an overarching conceptual framework nor a set of shared terminologies for establishing the accountability and performance outcome measures of substance abuse prevention services rendered. Hence, there is a wide gap between what we currently have as data on one hand and information that are required to meet the performance goals and accountability measures set by the Government Performance and Results Act of 1993 on the other. The task before us is: How can we establish the accountability and performance measures of substance abuse prevention programs and transform the field of prevention into prevention science? The intent of this volume is to serve that purpose and accelerate the processes of this transformation by identifying the requisite components of the transformation (i.e., theory, methodology, convention on terms, and data) and by introducing an open forum called, Prevention Validation and Accounting (PREVA) Platform. The entire PREVA Platform (for short, the Platform) is designed as an analytic framework, which is formulated by a collectivity of common concepts, terminologies, accounting units, protocols for counting the units, data elements, and operationalizations of various constructs, and other summary measures intended to bring about an efficient and effective measurement of process input, program capacity, process output, performance outcome, and societal impact of substance abuse prevention programs. The measurement units and summary data elements are designed to be measured across time and across jurisdictions, i.e., from local to regional to state to national levels. In the Platform, the process input is captured by two dimensions of time and capital. Time is conceptualized in terms of service delivery time and time spent for research and development. Capital is measured by the monies expended for the delivery of program activities during a fiscal or reporting period. Program capacity is captured by fourteen measurement units, tapping into the dimensions of staff resources and community assets. Staff resources are, in turn, operationalized in terms of staff size, staff certification status, staff turnover rate, and the accreditation status of a provider agency. Community assets are operationalized by the number of community centers accessible to the funded agency, number of formalized teams or antidrug coalitions active in the catchment area, and other social/human services providers with whom the prevention agency has formalized networks. The totality of process output from all sources of program activities is reduced to eighteen classes of measures. These are operationalized by thirty-three summary measures. Some of these include: total count of events facilitated; total number of clients served; average number of clients served per event; clients served by single and multiple program sessions; classification of target population in terms of the severity of risk as defined by the Institute of Medicine; age groups and race/ethnicity of clients served; number of program participants retained by recurring programs; number of clients who have completed the program; penetration rates to the target population; client attrition rates; average referral rates per provider per time interval; referral success rates; and so on. All process output measures specified in the Platform are derived from two broad classes of events classified as either products or services. The collectivity of these measures is expected to present a cost-effective, parsimonious, yet comprehensive picture of the entire spectrum of the process output, i.e., "what came out of the program as program activities". For the measurement of performance outcomes, two types of data are incorporated into the Platform: outcome data from individuals and the behavior (or performance) of social indicators from aggregated data bases. Individual data are used to evaluate the outcome of substance abuse programs     

The effect of race/ethnicity on the relation between substance use disorder diagnosis and substance use treatment receipt among male serious adolescent offenders

The high rates of substance disorders in the juvenile justice system, as well as the relation between substance use and reoffending, suggest the importance of substance use treatment service and understanding the factors that influence treatment provision. The current study tested whether race/ethnicity affects the relation between substance use disorder diagnosis and the receipt of substance use treatment services among a sample of male serious juvenile offenders (N = 638). Findings showed that among adolescents with a substance use disorder diagnosis, there were no race/ethnicity differences in substance use treatment receipt. However, among adolescents without a substance use disorder diagnosis, non-Hispanic Caucasians were more likely to receive substance use treatment than were Hispanics or African-Americans. Additionally, findings showed that there were race/ethnicity differences in service receipt at moderate levels of substance use problems, such that non-Hispanic Caucasians were more likely to receive substance use treatment than Hispanics or African-Americans. There were no race/ethnicity differences in treatment receipt when substance use problems were either very severe or very low. Results suggest that race/ethnicity may play a role in service provision in the juvenile justice system when levels of need are less clear.     

The status of race in public sector work: Implications for emotion management and job satisfaction

ABSTRACT

African Americans consistently report lower levels of job satisfaction relative to whites. Using survey data from 1,456 public service employees, we examine whether racial disparities in job satisfaction are related to how African Americans and whites manage their emotions while at work. We contend that race acts as a master status within the workplace that locates African Americans in a subordinate social position to whites and may contribute to greater emotion management effort and greater work-related consequences. The results indicate that, together with traditional indicators of job satisfaction, extensive emotion management efforts of African Americans explain their lower levels of job satisfaction relative to whites.     

Testing the Model Minority Stereotype: Youth Behaviors across Racial and Ethnic Groups

Using data from a large nationally representative sample of adolescents attending school, this study tests the stereotype that youth of Asian Pacific Islander ethnicity (API) are the model minority. The results suggest that, except for substance use, API American youth do not report fewer delinquent behaviors than white youth; in fact, API American youth report slightly higher numbers of aggressive offenses than white youth, and female API American youth report greater numbers of nonaggressive offenses than white female youth. Also, API American youth report higher rates of nonaggressive offenses and substance use than do black youth. The mental health and social service needs of API American youth are thus at least as great as those of white youth. The need for such services increases with the length of residency in the United States.     

Female victims of domestic violence: which victims do police refer to crisis intervention?

Factors associated with activation of a volunteer-based crisis intervention services program for victims of police-reported intimate partner violence (IPV) were examined to determine if those for whom services were activated were representative of the overall eligible population. The study population comprised 2,092 adult female victims of male-perpetrated police-reported IPV. Crisis intervention services were requested by responding patrol officers in 415 (19.8%) of these incidents. Activation of crisis intervention services was more likely for victims who were married to their abusive partner, pregnant, or of Latina or Asian race/ethnicity and among IPV incidents involving physical abuse, visible victim injuries, and arrest of the abusive partner. Additionally, one of the city's five police precincts was less likely than the remaining four to utilize these services. Activation of crisis intervention services was associated with factors related to need and feasibility of service delivery, but differential activation at the precinct level was also found to be influential.     

Ethnicity and Health Service Use in a Women's Prison

ABSTRACT

This paper highlights the findings in relation to health need, ethnicity, and health service use among a sample of women in prison. Medical records review for 129 women and interviews with 15 women were conducted to determine factors associated with differential service use. Statistical analyses reveal that ethnicity and an interaction between ethnicity and whether one is on medication at prison admission (a health need variable) significantly predict extent of service use. Women of color use fewer services overall, with the exception of those on medication. Qualitative analyses reveal that women of color view the quality of medical care and the ways they are treated less positively than White women. Implications for equitable service provision are explored.     

纽约城市转型与绿色发展对北京的启示

纽约城市转型表现为由制造业到服务业再到高端知识型服务业和绿色发展的城市演变轨迹,其特征主要表现为重视创新驱动、高端服务业集群、人才教育培养、城市功能融合、城市绿化建设等。借鉴纽约城市转型经验,北京应加强城市功能的均衡化疏解、基本公共服务均等化,加强产业多中心集聚和分散布局,大力发展教育、医疗、卫生、文化休闲等服务业,完善公共交通系统,加快绿色产业、绿色技术创新和城市绿化建设,促进城市转型与绿色发展。     

The impacts of accessible child protection services on services, jobs, and families

This multi-faceted study assessed the differences between accessible and central child protection service delivery sites in Ontario on: (1) family functioning; (2) front-line child protection service providers' satisfaction with services; (3) parents' satisfaction with services; (4) the services and supports available to families; (5) front-line service job satisfaction; and (6) front-line helping relationships in child welfare. A quasi-experimental outcome design gathered data from parents at case-opening and approximately 10 months later. Semi-structured individual or group qualitative interviews were conducted with parents, front-line service providers, and supervisors/managers. Information also was gathered from agency files. Front-line service providers completed an employment questionnaire. Findings indicated that the accessible sites were able to foster a greater proportion of cooperative helping relationships with families and to create more service partnerships. Parents at the accessible sites were more positive about their service involvements and more willing to ask for help again in the future. Front-line child protection service providers at both service delivery models described positive aspects of their jobs as well as frustrations with the expectations of the formal child protection system.     

Targeting Services to Those Most at Risk

Abstract

The budget crises facing many state Medicaid programs have increased interest in the goal of linking services and housing as a way to provide more options to people with disabilities at less cost than institutional care. This article examines some of the premises underlying this interest, especially with respect to linking supportive services and federally subsidized housing for older persons. The first section provides a brief history of the activity in this area. The second section examines the risk factors associated with nursing home admission and how those factors match the characteristics of renters receiving subsidies. The third section focuses specifically on the likelihood that subsidized renters will also become eligible for Medicaid. The fourth section explores the capacity of housing programs to meet the challenges associated with service delivery. Finally, the conclusion examines the implications for public policy decision-makers interested in linking services and housing in order to address the long-term care (LTC) needs of older persons with modest incomes.     

A cohort analysis of employment status and homicide victimization in the United States

ABSTRACT

The purpose of the study was to examine the impact of employment status on homicide victimization among cohort members. Data were derived from the US National Longitudinal Mortality Study. Cox proportional hazards regression models were fitted to the data. Analysis showed that employment status was significantly associated with homicide. The unemployed were over 50% more likely to become homicide victims than the employed. Persons not in the labor force were 1.3 times more likely to be victimized than employed cohort members. Results also showed that race was significantly associated with homicide. Non-Hispanic Blacks were over 4.5 times as likely to die as whites. Hispanics were nearly 1.9 times as likely to be victims as Non-Hispanic whites. When the sample was stratified by race/ethnicity, unemployment was highly significant for both non-Hispanic white and non-Hispanic African American men. Employment status is a significant risk factor for homicide victimization.