Rural African American Clergy: An Exploration of Their Attitudes and Knowledge of Alzheimer's Disease

Rural African American clergy's ability to recognize Alzheimer's Disease (AD) and their capacity to provide support to elders with this illness has been neglected in the literature. Using a mental health literacy framework, the purpose of this research was to explore rural African American clergy knowledge and beliefs of AD. In-depth interviews were conducted with 9 African American clergy who oversaw churches in central Kentucky. Although few had direct experience with providing pastoral care to elders with AD, all clergy were literate and aware of the need for additional training. This study seeks to further clarify the role of African American clergy and their understanding of AD to inform the future development of appropriate interventions and establish better collaborative community treatment relationships.     

Gender Differences in Determinants of Self-Rated Health Among African American in Omaha Nebraska: A Church-Based Study

Abstract

This study assessed the gender differences in determinants of fair/poor self-rated health among African American churchgoers in Omaha, Nebraska. Using data collected from 353 African American (245 women and 108 men) by the Center for Reducing Health Disparities at the University of Nebraska Medical Center in 2017, univariate and multivariate logistic regressions were performed to examine the gender differences in the relationships between fair/poor self-rated health and potential health determinants. Overall, 14.3% of women and 17.6% of men reported fair/poor self-rated health. There was a significant association between depression and poor/fair self-rated health among women (p?=?0.044) and men (p?=?0.001). For women, the fully controlled model confirmed the crude association between perceived poor/fair self-rated health and heart disease (OR = 3.10) and education (OR = 2.19). For men, the final model identified significant determinants of perceived fair/poor self-rated health such as depression (OR = 12.51) and diabetes (OR = 3.89). When assessing gender differences in determinants of self-rated health, similarities are higher than differences between the two groups. In both groups, the presence of depression was the strongest determinant of poor health. Future research should assess the immunological aspects of the association between psychological factors and perceived chronic diseases.     

Social Support and Self-Rated Health of African American Women Informal Caregivers: Urban and Rural Differences

In this study, we examined how geographic location might differently influence social support and self-rated health for rural and urban African American women caregivers. We used cross-sectional data from 253 urban and 263 rural women primary caregivers. Controlling for key demographic factors, we regressed caregivers’ self-rated health on social engagement, structural, and functional aspects of social support for urban and rural caregivers separately. The perception of family functioning was positively associated with urban and rural caregivers’ self-rated health. Urban caregivers reported having significantly more contact with their family and more informal helpers compared to rural caregivers. Furthermore, church attendance, a measure of social engagement, was significant for urban caregivers’ self-rated health, but not rural caregivers. Our findings affirmed the importance of foregrounding context and disaggregating social support, and point to the need for interventions targeting family functioning and paying attention to geographic location.     

Structuring Mental Health Within Senior Services: A Case Study of an Outpatient Mental Health Clinic Serving Latinos

The article presents a case study of an outpatient mental health clinic serving Latino older adults. The study explored staff perceptions on the clinic development and the context within an immigrant multicultural community. The study used in-depth, semistructured interviews with support staff, clinical social workers, and administrators. Interviews were analyzed using a thematic content analysis. The mental health clinic formation was perceived by staff as an ecological process stemming from the needs of the Latino immigrant senior clients. A close knit and interdependent culture allowed the clinic to adjust to diversity and changing cultural contexts.     

Involvement in the Juvenile Justice System for African American Adolescents: Examining Associations with Behavioral Health Problems

While researchers have found that African American youth experience higher levels of juvenile justice involvement at every system level (arrest, sentencing, and incarceration) relative to their other ethnic counterparts, few studies have explored how juvenile justice involvement and number of contacts might be correlated with this broad range of problems. A convenience sample of 638 African American adolescents living in predominantly low-income, urban communities participated in a survey related to juvenile justice involvement. Major findings using logistic regression models indicated that adolescents who reported juvenile justice system involvement versus no involvement were 2.3 times as likely to report mental health problems, substance abuse, and delinquent or youth offending behaviors. Additional findings documented that the higher the number of juvenile justice system contacts, the higher the rates of delinquent behaviors, alcohol and marijuana use, sex while high on drugs, and commercial sex. These findings suggest that identifying and targeting youth who have multiple juvenile justice system contacts, especially those in low-resourced communities for early intervention services, may be beneficial. Future research should examine whether peer network norms might mediate the relationships between juvenile justice involvement and youth problem behaviors.     

Mental Health Service Utilization Among Frail,Low-Income Elders

Abstract

This study was conducted to determine the extent to which service providers in a community-based care program accurately identified and referred elders with symptoms of depression. Interviews were conducted with 79 frail, low-income elders, with the CES-D used to gauge depressive symptomatology. Reviews of their case files were then conducted to determine first, the extent to which case managers recognized depressive symptoms and second, the extent to which respondents who screened with significant symptoms were referred for mental health services. Results suggest an imperfect association between CES-D scores and case managers' perceptions and referrals. Less than 1/3 (31%) of those who screened for depression received counseling.     

A Meta-Analysis of Culturally Sensitive Interventions Designed to Reduce High-Risk Behaviors Among African American Youth

ABSTRACT

This study sought to determine the effectiveness of culturally sensitive interventions (CSIs) in reducing high risk behaviors with African American youth. A meta-analysis was conducted to assess the effectiveness of CSIs across seven studies. African American youth who participated in CSIs were less likely to engage in high risk behaviors compared to those who did not participate. The effect size was moderate (g = .35). Although the findings should be considered tentative, the results provide an initial quantitative assessment of CSI effectiveness that future evaluations and meta-analyses can build upon as CSI research expands.     

Predicting Retention in Three Substance Abuse Treatment Modalities Among Anglo,African American,and Mexican American Juvenile Offenders

Abstract

Many of the same factors that predict delinquent behavior also predict adolescent drug use. This study examined factors that predict, and interventions that maximize, substance abuse treatment retention in three modalities among high-risk Anglo, Mexican American, and African American juvenile offenders. The study sample includes youth (N = 211) who were discharged from probation supervision and who received substance abuse services through a CSAT-funded federal demonstration project. The key predictors examined included the stage-of-change (i.e., precontemplation, contemplation, preparation) in which a juvenile fell, various dimensions captured by the Comprehensive Addiction Severity Index for Adolescents, and other intervention status (probation, case management, and mental health treatment). The research questions were addressed using statistical models known as survival analysis that treated time from entry into substance abuse treatment to exit from substance abuse treatment as the outcomes. Among key findings were that females were 73% more likely to leave day treatment relative to males; for each additional family problem ever experienced, Mexican American adolescents were 15% more likely to leave residential treatment compared with African American adolescents; and African American and Mexican American adolescents in the contemplation stage-of-change were 50% less likely to leave day treatment compared with Anglo adolescents. Applications for practice and research with this population are discussed.     

“老来得子”幸福吗？--农村地区大龄生子与心理健康分析

从生育行为主体出发、基于子女性别结构,利用2013年中国社会综合调查（ CGSS）数据,分析了大龄生子群体的心理健康状况。初步研究发现,大龄生子群体的心理健康低于非大龄生子群体,“老来得子”忧大于喜;“38岁前仅生女、38岁及以后生子”群体的心理健康低于“38岁前已生子、38岁及以后生子／女”群体。这说明,男孩偏好下的“老来得子”并不必然提高心理健康;生育作为复杂的人口事件,子女数量、子女性别以及生育年龄等均成为心理健康的扰动因素。     

A Culturally Competent Family Enhancement and Empowerment Model for African American Parents

The National Association of Social Worker's Standards for Cultural Competence (2002 National Association of Social Workers. 2002. NASW standards for cultural competence in social work practice, Washington, DC: Author.  [Google Scholar]) mandates social work practices that recognize the cultural preferences of different groups in the United States. The NASW Code of Ethic (1996 National Association of Social Workers. 1996. Code of ethics, Washington, DC: NASW Press.  [Google Scholar]) states that social workers have a responsibility to understand culture and its function and to further recognize the strengths that exist in all cultures. This article addresses the void in the social work literature on culturally based and strengths‐oriented family interventions for African American parents. The article describes a culturally competent intervention model developed by the MAAT Center for Human and Organizational Enhancement, Inc. in Washington, D.C. for parents of African American male youths who live in high‐risk environments. The family enhancement and empowerment model (FEEM) is based on Africentric social work principles that are grounded in a strengths perspective. The article describes the FEEM program, including a discussion of practical strategies for building trust and offering support to African American parents and families.     

Social Context in Mental Health Service Use Among Young Adults

Examining the sources of health communication that young adults with mental health challenges receive regarding service use is critical to curbing the societal concern of unmet mental health needs of this population. Semistructured interviews were conducted with 59 young adults, all of whom were diagnosed with a mood disorder and used public mental health services and additional public systems of care during childhood. Thematic analysis was utilized. Of the 59 participants, 45 nominated at least one supportive adult, with a total of 97 relationships analyzed. Results indicate that the majority of messages came from informal supports (e.g., family) who spoke positively about mental health services. Fewer messages came from formal supports (e.g., professionals). Messages included statements surrounding beliefs toward services, social norms (approval and disapproval), self-efficacy, and image considerations around using services. These findings can suggest ways that mental health service engagement interventions can leverage communication from informal supports. Future research can explore what messages young adults find most influential in persuading them to use mental health care consistently and the relationship between messages and health behavior.     

Correlates of Treatment Retention Among Persons with Serious Mental Illness Receiving Integrated Care in a Community Mental Health Setting

ABSTRACT

Knowledge about methods to retain community mental health (CMH) clients in integrated primary and behavioral health care (PBHC) programs is needed to address longstanding health disparities. A preexisting data set that contained the clinical records of 446 PBHC program participants was used to examine whether baseline sociodemographic, health, and psychosocial characteristics predicted retention in care at 6 months post-enrollment. Results indicated that less than half of PBHC participants (43.7%) were retained in care, and approximately 17% of the variance in retention was explained by the inclusion of seven predictors in the model (overall health, medications, laboratory data, primary care provider, disorder type, transportation, and living arrangement). Clients with thought disorders were almost twice as likely as those with mood disorders to be retained in care, and greater frequency of prescribed medications also increased the likelihood of treatment continuation (ORs = 1.99 and 1.20, respectively). Future research should identify factors that improve retention in integrated PBHC programs overall, and among persons with mood disorders, in particular.     

An Inclusive Approach to Knowledge for Mental Health Social Work Practice and Policy

As the integration of health and social care services progressesin the mental health sector, there is concern that mental healthsocial workers are disadvantaged, relative to health professionals,because they cannot identify the knowledge base for their practice.This paper argues that this concern is partly the product ofassuming that the knowledge base has to be premised upon randomizedcontrolled trials. Instead, it proposes a non-hierarchical frameworkbased on that developed in health research in Canada by Upshurand colleagues that generates a typology of knowledge whichis congruent with the main forms of inquiry that are relevantto mental health social work practice. The framework recognizesthe contribution of randomized controlled trials to the knowledgebase but also validates knowledge drawn from qualitative, epidemiological,practitioner and user knowledge. It is argued that the frameworkprofiles a wider knowledge base than that promoted by conventionalevidence-based practice, and also could be a basis for futuredevelopment of the research agenda in mental health social work.     

Development of a Multimodal Assessment Framework for Helping Older African American Women Transition Out of Homelessness

Increasingly vulnerability to homelessness is affecting older African American women because more than any other group these women are susceptible to even minor changes in socioeconomic conditions. This article describes the evolution of an assessment strategy and process found to be useful in planning older African American women's transition from homelessness. The assessment strategy was developed as part of a multimethod, multilevel research and development program the purpose of which is to identify and test tools and interventions useful in helping older African American women leave homelessness. The article offers background on the action research project in which the assessment framework was developed, examines the method for the construction of the framework, describes the assessment process, and considers the integration of specific assessment tools into the advocacy process.     

经济社会地位、年龄与心理健康：一项基于上海的实证研究

本文从社会结构的角度出发,以“2008年中国家庭动态调查（上海卷）”的数据为基础,考察了心理健康在社会各阶层间的分布以及这些分布在年龄组间的变化。结果显示,教育、收入、职业地位、社会地位与心理健康正面相关,而经济困难和不公正待遇则与心理健康负面相关。年龄和心理健康的关系呈现出“∩”型发展趋势;职业类型及教育程度对心理健康的作用在不同年龄组中出现了不同程度的变化。失业者较好的心理状态及青年技术人员较差的心理健康状况则需要做进一步的研究。     

The Third-Age African American Seniors: Benefits of Participating in Senior Multipurpose Facilities

This article examines the contexts and benefits of African American seniors' participation in multipurpose facilities. Using qualitative data from 15 in-depth participant interviews and 6-month on-site participant observations as well as a survey result, research revealed the physical, emotional, and social benefits that African American seniors reported as a result of their participation in various activities offered in a multipurpose senior center in Atlanta Georgia. The study presents a social context in which African American seniors constructed their new third age identities that is different from the wide-spread negative images depicted by the mainstream about this minority group. Findings from this study increase the knowledge about African American seniors' participation in multipurpose facilities and provide a better understanding for the diverse socio-economic backgrounds of African American seniors. Study results will have policy implications for a better development of senior centers for minority population in the United States for the promotion of productive and successful aging.     

Implementing a Gero-Infused Curriculum in Advanced-Level MSW Courses in Health,Mental Health and Substance Abuse: An Evaluation

This article presents evaluation results from a curricular innovation aimed at increasing the capacity of social work graduates to serve older adults in health, mental health, and substance abuse settings. Working as a team, faculty developed, incorporated, and evaluated gerontology-infused syllabi and teaching modules in multiple sections of the 3 courses, with 2 sections serving as a comparison group. Results indicated that students exposed to the gero-infused curriculum increased their age-related knowledge and self-competence from pre- to posttest, and achieved a greater increase in knowledge than did the comparison group. Implications of the findings to social work education are discussed.     

Using Photovoice to Identify Service Needs of Older African American Methadone Clients

ABSTRACT

This article presents findings from a photovoice project designed to identify service needs of older-adult African American methadone clients, as well as their current barriers to and supports for abstinence. The project involved 10 participants (aged 53 to 63 years old) recruited from a methadone maintenance program in a large Northeastern U.S. city. Thematic analysis techniques were used to analyze participants’ narratives of their pictures. Transportation emerged as a significant challenge to accessing services, and caregiving was a motivation for remaining abstinent. Future research should use similar participatory methods and engage a broader group of aging people struggling with substance abuse.