Therapist Effects on Disparities Experienced by Minorities Receiving Services for Mental Illness

OBJECTIVES: The authors examine if some of the reason clients from racial and ethnic minority groups experience outcome disparities is explained by their therapists. METHOD: Data from 98 clients (19% minority) and 14 therapists at two community mental health agencies where clients from racial and ethnic minority groups were experiencing outcome disparities were analyzed using hierarchical linear modeling with treatment outcomes at Level 1, client factors at Level 2, and therapists at Level 3. RESULTS: There were substantial therapist effects that moderated the relationship between clients' race and treatment outcomes (outcome disparities). Therapists accounted for 28.7% of the variability in outcome disparities. CONCLUSIONS: Therapists are linked to outcome disparities and appear to play a substantial role in why disparities occur.     

Interpersonal Perspectives on Black–White Health Disparities: Social Policy Implications

There are large and persistent disparities between the health status of Blacks and Whites in the United States. On average, the mental and physical health of Blacks is much poorer than Whites. In this article, we discuss several potential direct causes of Black–White disparities in health status, which include biological or genetic factors, prejudice and related processes, and socioeconomic factors. We also consider how the system-level, patient-level, and provider-level components of healthcare contribute to disparities in health status. We examine in detail the psychological processes associated with patient- and provider-level factors that may produce healthcare disparities. Of particular interest is the potential impact of racial attitudes and stereotypes on provider–patient interactions. Finally, we propose possible directions for future research on health disparities and discuss policy changes that might reduce disparities in health status and healthcare between social groups.     

Access to Healthcare Among Working‐Aged Hispanic Adults in the United States*

Objectives. The purpose of this research is to examine differences in access to and sources of healthcare for working‐aged adults among major Hispanic subpopulations of the United States. Nativity, duration in the United States, citizenship, and sociodemographic factors are considered as key predictors of access to and sources of care. Methods. Using pooled National Health Interview Surveys from 1999–2001, logistic and multinomial logistic regression models are estimated that compare Mexican Americans, Puerto Ricans, Cuban Americans, and other Hispanics with non‐Hispanic blacks and non‐Hispanic whites. Results. Mexican Americans, Puerto Ricans, and other Hispanics display significantly less access to care than non‐Hispanics whites, with immigrant status and socioeconomic status variables accounting for some, but not all, of the differences. For sources of care, Mexican‐American, Puerto Rican, and other Hispanic adults were all much more likely than non‐Hispanic whites to report clinics or emergency rooms as their source of regular care. Conclusions. There are wide differences in access to and sources of care across racial and ethnic groups in the United States. Mexican‐American adults, regardless if born in Mexico or the United States, appear to be most in need of access to regular and high‐quality care. Naturalization may be an especially important factor in greater access to regular and high‐quality care for Hispanic immigrants.     

Racial Diversity,Representative Bureaucracy,and Equity in Multiracial School Districts*

Objective. This study examines the conditions under which minorities will face policy inequity within the educational system. It turns to the theory of representative bureaucracy as one possible explanation, and extends the literature by considering whether African‐American students benefit from the presence of Latinos on teaching faculties and vice versa. This study also tests competing theories of how racial context influences minority educational policy outcomes. Methods. This study combines original survey data with data gathered by the U.S. Census to predict levels of academic grouping in U.S. school districts as reported by the Office of Civil Rights. Results. Minority teachers lower levels of discrimination among all minority students, not just co‐ethnics. Moreover, minority teachers do so consistently and with a substantive impact that occasionally rivals that of co‐ethnic teachers. The findings also suggest that greater levels of racial/ethnic diversity within a district are associated with lower levels of discrimination. Conclusion. Theories of race relations must move beyond black‐Anglo or Latino‐Anglo relations to consider how multiple racial/ethnic groups interact, and how such interactions affect the lives of minority groups differently.     

Question worth 20 million lives: Why federal housing assistance has not had its Obamacare

The equitable character of a policy determines its progressiveness, yet some domestic policies are more equitable than others. The question of how and why this is the case is addressed by studying federal housing and health policies in the United States, a critical case known for its rampant inequalities in both sectors. Although social equity is a fundamental aspect of welfare provision, explaining differences in coverage and government support among policy areas remains a weakness in the literature. This comparative historical analysis shows that both housing assistance and health care suffered from inequities almost as early as their inception. But a progressive reform took shape with the Affordable Care Act (ACA) and extended coverage to 20 million people formerly uninsured. This essay tackles an unsolved puzzle: Why has such grand policy reform never taken place in housing where more than 20 million people are eligible for assistance but do not receive help? We found that it is largely explained by housing assistance distinctiveness with regard to its weak constituency, racial connotation and low public concern. We conclude with the analytical payoffs of studying social equity, both for political scientists and observers of social affairs.     

Disparities in the Quality of Pediatric Dental Care: New Research and Needed Changes

In the United States, there are significant disparities in the oral health of children from families with high and low socioeconomic status and between majority and minority children. Extant research on these health differences has focused predominately on caregiver knowledge, beliefs, and practices as well as structural barriers such as Medicaid coverage, dentist availability, and transportation issues. Little attention has been paid to the quality of care families experience when taking their child to the dentist or the ways in which dental schools train their students to work with young children. This policy report describes some of the experiences of low-income and ethnically diverse young children and their parents in dental clinics and highlights some of the weaknesses of dental training. We contend that increasing the standards for dental training and practice are necessary for improving young children's oral health and reducing these disparities.     

美国族群问题及其破解对策

美国是一个多族群的国家,族群之间的矛盾和斗争充斥着整个美国历史发展过程。"二战"之后,特别是20世纪80年代以来,由于白人至上主义和极右思潮的抬头,美国族群关系更趋于紧张。然而,在前苏联、南斯拉夫这些多族群国家解体的后冷战时代,美国却能够保持相对稳定的族群关系。这主要得益于其不断完善的法律制度、多元与一体的相对平衡,以及不断改进的社会保障制度等因素。由于美国族群政策是建立在资本主义私有制基础之上的,具有不可避免的局限性,因而对美国的族群政策应重于研究、分析,慎于借鉴。     

Nice to Know You? Testing Contact,Cultural, and Group Threat Theories of Anti‐Black and Anti‐Hispanic Stereotypes*

Objective. Many racial/ethnic policies in the United States—from desegregation to affirmative action policies—presume that contact improves racial/ethnic relations. Most research, however, tests related theories in isolation from one another and focuses on black‐white contact. This article tests contact, cultural, and group threat theories to learn how contact in different interactive settings affects whites' stereotypes of blacks and Hispanics, now the largest minority group in the country. Method. We use multi‐level modeling on 2000 General Social Survey data linked to Census 2000 metropolitan statistical area/county‐level data. Results. Net of the mixed effects of regional culture and racial/ethnic composition, contact in certain interactive settings ameliorates anti‐black and anti‐Hispanic stereotypes. Conclusions. Cultural and group threat theories better explain anti‐black stereotypes than anti‐Hispanic stereotypes, but as contact theory suggests, stereotypes can be overcome with relatively superficial contact under the right conditions. Results provide qualified justification for the preservation of desegregation and affirmative action policies.     

Racial Disparities in Welfare Dependence and Financial Independence: Links to Human Capital,Local Economy,and State Temporary Assistance for Needy Families Policies

This secondary data analysis examined racial disparities in associations betwen welfare dependence/financial independence and human capital, local economy, and state TANF policies. A sample of 6,737 parents was extracted from the public-use data set titled “National Longitudinal Survey of Youth.” Results showed that restrictive TANF policies reduced African Americans’ likelihood of welfare use and increased likelihood of their financial independence. Multinomial logistic results also showed that, among Hispanics, employment growth in neighboring counties promoted welfare use; whereas among Caucasians such growth promoted financial independence. County poverty increased (a) Caucasians’ likelihood of welfare use and (b) Hispanics’ likelihood of being working poor; it decreased Caucasians’ and African Americans’ likelihood of financial independence. Across ethnic groups, education reduced likelihood of welfare use and working poor status; across minority groups, education increased likelihood of financial independence, but among Caucasians it decreased such likelihood. Across ethnic groups, occupational skills hindered dependence and improved odds of employment (regardless of welfare or poverty status). This study concluded the studied TANF policies and job markets were not color-blind. Interventions this study implies include less-restrictive TANF policies, generous support services, TANF staff cultural-competence training, and antidiscrimination rules. Research investigating particular TANF policies’ and services’ effects by ethnicity might prove useful.     

The Influence of Sociodemographic and Psychosocial Factors on Advance Care Planning

This study investigated sociodemographic and psychosocial factors that enhance or impede the completion of advance care planning, analyzing data from the Health and Retirement Study. The analytic subsample included the panel participants who died between 2006 and 2010 and who had answered the psychosocial and lifestyle questionnaire when they were alive. Multinomial logistic regression was executed to answer the research question (N = 1,056). The study found that persons who were older, who were women, who identified themselves as White, and who had higher levels of income and education were more likely to be motivated to complete advance care planning. Having greater sense of control was found to weaken the adverse relationship between being African American and the completion of advance directives. Having cancer, suffering from the illnesses for longer periods of time, and having experience of nursing home institutionalization also predicted the completion of advance care planning. Implications include incorporating a culturally tailored approach for racial/ethnic minorities and using advance directives that are clear and easily understood. In addition, future research needs to include a larger minority population and examine the extent to which variations between racial/ethnic groups exist in relation to advance care planning.     

Intergenerational Relations: Theory, Research, and Policy

The dramatic increase in life expectancy and lowered fertility, especially in more advantaged countries, has resulted in people living longer and in more complex family structures. Other important changes affecting the family include greater geographical mobility, increased racial and ethnic diversity, new patterns of immigration and identity reformulation, as well as changing work and family roles. With reduced governmental resources available, it is especially important to understand the changing nature of multigenerational family structures, functioning, and roles in individual well-being in order to maximize the effectiveness of informal and formal supports available to those in need. This special issue addresses basic factors related to multigeneration support systems that will be needed to anticipate, understand, and design support programs to cope with the challenges facing individuals in all generation positions, families, and communities in the United States and around the world.     

Racial/Ethnic Inequality Among Older Workers: Focusing On Whites,Blacks, and Latinos Within the Cumulative Advantage/Disadvantage Framework

The experience of older racial/ethnic minority workers may differ from that of their non-Hispanic White counterparts because of persistent racial/ethnic differences; however, our knowledge of older minority workers is fragmentary. Using the cumulative advantage/disadvantage framework, this study aimed to identify factors that explain older Americans’ labor market participation after age 65 and whether racial/ethnic differences exist among those factors. Using the 2004 and 2008 waves of the Health and Retirement Study data, racially separate analyses were performed to systematically compare factors by race. The results showed that factors influencing labor force participation after age 65 were indeed conditioned by race. Health and meaning of work significantly influenced non-Hispanic Whites, whereas home ownership increased the odds of working among non-Hispanic Blacks, and Latinos were concerned with health alone. The findings suggest that older ethnic minorities appear to experience a greater vulnerability to involuntary labor market exit—as opposed to personal preference or financial necessity. This racial/ethnic inequality should be understood not as sudden occurrences in old age, but as a by-product of the interplay between the individuals’ lifetime experiences and the social structures that impose cumulative advantages/disadvantages on them. Continued research will help reduce racial gaps in the next generation of older workers.     

Care earnings in the United States and 24 European countries: The role of social policy and labour market institutions

Care occupations are gendered and remain relatively poorly paid, particularly in the United States. Prior research on the ‘care penalty’ primarily points to individual, relational, and market-valuation factors in explaining the relative earnings of care workers. This study integrates these explanations with a comparative institutional perspective. Using higher-quality data and methods than previous comparative research in the field—that is, harmonized micro-data from the Current Population Survey and EU-SILC from 2005 to 2016, country and year fixed effects models, and a counterfactual analysis—we find that national variance in labour market and welfare state institutions explains most of the difference in the relative earnings of reproductive care workers between the United States and European countries. Higher rates of collective bargaining coverage, stronger employment protection and welfare state spending contribute to higher relative earnings for reproductive care occupations, and lower relative earnings for high-status nurturant care occupations. Differences in the relative earnings of care workers appear to be mostly a construct of social policy and labour market institutions rather than individual, relational, and market-valuation factors.     

"Just like I'm saving money in the bank": client perspectives on care coordination services

Older adults face many challenges to community living. The literature has not sufficiently explored the roles of care coordination in the maintenance of housing and access to health care among older adults, particularly from their own perspectives. This qualitative study analyzes the findings from 25 interviews and 6 focus group discussions (48 participants) with a multiethnic sample of older adults in the New York City area. Care coordination services appear to assist older adults access health care, and to a lesser extent, maintain affordable housing. Disparities in access to care coordination appear to remain for immigrant, minority and suburban populations.     

“Just Like I'm Saving Money in the Bank”: Client Perspectives on Care Coordination Services

Older adults face many challenges to community living. The literature has not sufficiently explored the roles of care coordination in the maintenance of housing and access to health care among older adults, particularly from their own perspectives. This qualitative study analyzes the findings from 25 interviews and 6 focus group discussions (48 participants) with a multiethnic sample of older adults in the New York City area. Care coordination services appear to assist older adults access health care, and to a lesser extent, maintain affordable housing. Disparities in access to care coordination appear to remain for immigrant, minority and suburban populations.     

Chapter 18. The Aging Network and the Future of Long-Term Care

SUMMARY

Federal and state governments face a significant challenge in meeting the long-term care needs of an older population that will double in size between 2000 and 2020 and continue to increase through 2050. States have made significant improvements in their long-term care systems for the elderly. However, they are still spending a significant proportion of their long-term care funds on nursing homes. Any effort to improve long-term care for the elderly qualitatively, and not just on the margins, must be focused on developing a more flexible and balanced long-term care system that is responsive to consumer choice.

The Aging Services Network is poised to play a significant role in this transformation process. The strengths of the Network include the ability to develop and manage consumer-driven community-based programs; to assess the needs and resources of individual older persons and provide cost-effective community supports; to operate within fixed, capped budgets; and to identify and maintain roles for informal caregivers. Now is the time for national aging organizations, state units on aging, and area agencies on aging to use existing opportunities to move towards the establishment of a balanced system of long-term care.     

Ideology,Diversity, and Imprisonment: Considering the Influence of Local Politics on Racial and Ethnic Minority Incarceration Rates*

Objective. To test the influence of local (county) politics on minority incarceration rates. Methods. Data are collected at the county level in California to create a pooled cross‐sectional data set. OLS regression models predicting black, Hispanic, and white incarceration rates (in state prison) are used in the analysis. Results. Counties' ideological orientations and racial and ethnic contextual characteristics significantly impact minority incarceration rates. Greater ideological conservatism within counties is associated with higher rates (as a proportion of their population) of both black and Hispanic incarceration. Consistent with racial threat theory, results show counties with greater racial and ethnic diversity are more likely to incarcerate blacks and Hispanics. Tests for interaction effects indicate that greater county diversity decreases the punitive effects of ideological conservatism on minority incarceration. Conclusion. Political forces nested within states systematically shape how state government incarceration power is distributed across different racial and ethnic groups.     

The rights of the child and ethnic minority families in Sweden

The United Nations Convention on the Rights of the Child (UNCRC) was launched in 1989 and is ratified in most countries. The UNCRC is considered by child welfare authorities worldwide to be an essential document that aims to improve the rights of children. However, contemporary research indicates that the UNCRC is an obstacle to social work because it emphasizes the legal equality between children and adults. This finding prompts the question of how Western child protection agencies conduct child protection encounters with families with a non-Western ethnic background. The present article aims to examine if specific articles in the UNCRC can serve as a medium for improving social work with ethnic minority families within the child protection sector in Sweden. This article is based on a research project concerning youths with an ethnic minority background in out-of-home care. Relevant articles in the UNCRC are revealed to be potentially helpful to child protection programmes involving ethnic minority families because these articles emphasize considering the perspective of the child and strengthening parenting skills. However, child protection agencies must consider how the UNCRC can be used to teach parents or guardians to understand and acknowledge the perspective of the child without violating the values of the family.     

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.