Structure and provision of services in Black churches in New Haven, Connecticut

Historically, Black (or African American) churches have played a central role as a center of religious and political life and also as a provider of human services and a healing community. This article examined the extent to which African American churches in 1 Northeastern urban environment are involved in the delivery of health and human service programs to their communities. It also explored how comfortable Black clergy are in referring their parishioners to the formal mental health system and identified the actual level of referrals. In addition, the analyses considered the individual and organizational characteristics that predict variations in the levels of support services and the likelihood of referral. Analyses revealed that African American churches deliver a broad range of services to the community. More than two thirds of the clergy feel comfortable in making a referral to a mental health agency or professional, and more than half have actually made a referral. Both service delivery and referral levels varied by several clergy and congregational characteristics. The implications of these findings for research and health policy are considered.     

Addressing the Mental Health Needs of the Rural Underserved: Findings from a Multiple Case Study of a Behavioral Telehealth Project

Behavioral telehealth is a reasonable solution to the accessibility to mental health care problem that exists in many rural communities. This paper reports the results of a multiple case study of a behavioral telehealth program administered through a marriage and family therapy training program. The results suggest that mental health services can be effectively delivered using existing distance education technology to underserved rural populations. Rural communities have unique barriers to accessing mental health care, some of which can be overcome through the distance delivery of services and some of which cannot. In order to effectively deliver treatment, accommodations to the technology must be made by both therapist and client.     

Community psychology in Hong Kong: Past,present, and future

The expansion of mental health services during the 1960s from a single remote mental hospital to centers and clinics in mainstream communities fostered the development of community psychology in Hong Kong. Few psychologists were initially involved in the local community mental health movement, but its momentum resulted in increasing numbers of practitioner psychologists working in community-based service settings. Community psychology in Hong Kong today consists primarily of service delivery, but also includes applied research, community organization/consultation, and community education. Despite having many parallels with the American situation, key concepts underpinning the practice of community psychology in the Territory possess their own character as a reflection of nuances in the local scene. Prospects for the continued development of community psychology in Hong Kong appear favorable. Of special relevance is the field's potential contribution to a better understanding of the psychological phenomena associated with the Territory's sociopolitical transformation in 1997.     

Succeeding in Rural Mental Health Practice: Being Sensitive to Culture by Fitting in and Collaborating

Sustainable solutions to the access to mental health care problems are complex and must address both the availability of mental health care resources and the acceptability of those resources to consumers. The purpose of this study was to determine how to address the acceptability problem by learning from medical and mental health care providers what mental health therapists need to know to be successful in providing care in rural communities. Using a qualitative design, focus groups were conducted in three rural communities (<2,500) with medical and mental health care providers practicing in these communities. Data were analyzed using inductive qualitative methods. Results indicate that in addition to sound clinical skill, mental health therapists should (A) be sensitive to the culture of the rural community in which they are working and (B) practice in a way that accommodates to the care culture of the community. The latter includes spending time with patients commensurate with what is expected by other providers, engaging in generalist practice, and collaborating with local providers in patient care. An important implication of these results is that mental health care must be acceptable to both the residents of the community and the gatekeepers to health care.     

At the crossroads: managed mental health care,the ethics code,and ethnic minorities

Mental health clinicians are facing an increasing number of ethical problems related to the delivery of managed mental health care services to ethnic minorities. The authors argue that (a) economic pressures have led to the development of the managed health care movement; (b) the combination of such economic pressures and the development of that managed care movement have influenced the promulgated ethical standards of the American Psychological Association; and (c) those influences may have a negative impact on the mental health services available to ethnic minority individuals and communities. The authors review some of the specific potential threats to mental health services for minorities in the face of such health management policy and psychologists' professional standards.     

Implementing a Comprehensive Program for the Prevention of Conduct Problems in Rural Communities: The Fast Track Experience

Childhood conduct problems are predictive of a number of serious long-term difficulties (e.g., school failure, delinquent behavior, and mental health problems), making the design of effective prevention programs a priority. The Fast Track Program is a demonstration project currently underway in four demographically diverse areas of the United States, testing the feasibility and effectiveness of a comprehensive, multicomponent prevention program targeting children at risk for conduct disorders. This paper describes some lessons learned about the implementation of this program in a rural area. Although there are many areas of commonality in terms of program needs, program design, and implementation issues in rural and urban sites, rural areas differ from urban areas along the dimensions of geographical dispersion and regionalism, and community stability and insularity. Rural programs must cover a broad geographical area and must be sensitive to the multiple, small and regional communities that constitute their service area. Small schools, homogeneous populations, traditional values, limited recreational, educational and mental health services, and politically conservative climates are all more likely to emerge as characteristics of rural rather than urban sites (Sherman, 1992). These characteristics may both pose particular challenges to the implementation of prevention programs in rural areas, as well as offer particular benefits. Three aspects of program implementation are described in detail: (a) community entry and program initiation in rural areas, (b) the adaptation of program components and service delivery to meet the needs of rural families and schools, and (c) issues in administrative organization of a broadly dispersed tricounty rural prevention program.     

Latino Family Participation in Youth Mental Health Services: Treatment Retention,Engagement, and Response

Although researchers have identified a multitude of factors that contribute to family participation in mental health services, few studies have examined them specifically for Latino youth and their families in the U.S., a population that continues to experience significant disparities related to the availability, accessibility, and quality of mental health services. Latino youth and their families are at greater risk of dropping out of treatment prematurely and demonstrating poor treatment engagement, both of which have subsequent negative effects on treatment response outcomes. In order to help to guide efforts to improve the accessibility and quality of mental health services for Latino youth and their families, the current paper integrates modern conceptualization of family participation in youth mental health services and provides a summary of contextual factors within an ecological framework (Bronfenbrenner in The ecology of human development: experiments by nature and design, Harvard University Press, Cambridge, 1979). The current review aims to integrate empirical research on the impact of various contextual factors across multiple levels (i.e., culture, community, mental health system, family, parent/caregiver, and child/adolescent) on Latino family participation in youth mental health services, including treatment retention, engagement, and response. Clinical implications will be discussed, and an integrated, conceptual model will be presented. Not only does this model help to demonstrate the way in which existing literature is conceptually linked, but it also helps to highlight factors and underlying processes that health care providers, administrators, and policy makers must consider in working to improve mental health services for Latino youth and their families living in the U.S.     

Substance Use Research with Indigenous Communities: Exploring and Extending Foundational Principles of Community Psychology

Many Indigenous communities are concerned with substance use (SU) problems and eager to advance effective solutions for their prevention and treatment. Yet these communities also are concerned about the perpetuation of colonizing, disorder‐focused, stigmatizing approaches to mental health, and social narratives related to SU problems. Foundational principles of community psychology—ecological perspectives, empowerment, sociocultural competence, community inclusion and partnership, and reflective practice—provide useful frameworks for informing ethical community‐based research pertaining to SU problems conducted with and by Indigenous communities. These principles are explored and extended for Indigenous community contexts through themes generated from seven collaborative studies focused on understanding, preventing, and treating SU problems. These studies are generated from research teams working with Indigenous communities across the United States and Canada—inclusive of urban, rural, and reservation/reserve populations as well as adult and youth participants. Shared themes indicate that Indigenous SU research reflects community psychology principles, as an outgrowth of research agendas and processes that are increasingly guided by Indigenous communities. At the same time, this research challenges these principles in important ways pertaining to Indigenous–settler relations and Indigenous‐specific considerations. We discuss these challenges and recommend greater synergy between community psychology and Indigenous research.     

Crisis intervention and the prevention of institutionalization: An interrupted time series analysis

In the context of the community mental health movement in Illinois, the evolution and development of a crisis intervention program aimed at avoiding state hospitalization and bringing more appropriate and efficacious resources to bear on the difficulties of the individual and/or family is described. This intervention program is characterized by a more active-seeking style of delivering mental health services. With the novel application of interrupted time series analysis to both the targeted and matched nonequivalent control communities the efficacy of this more active intervention in reducing the number of state hospital administrations diagnosed as "mentally ill" is highlighted. The cost/benefit to the taxpayer is also discussed.     

Being Examples to the Flock: The Role of Church Leaders and African American Families Seeking Mental Health Care Services

Within the context of Black churches, African American clergy have a significant role in the delivery of mental health care services for parishioners and their families. Working toward better linkages between faith-based communities and more formal mental health care could help to provide more culturally sensitive and timely mental health care for African American families. Using a salient part of an integrative model (Davey and Watson in Contemp Fam Ther 30:31–47, 2008), the roles Black church leaders have historically played for African American families seeking outside mental health care services are considered. We additionally provide an example of a recent collaborative partnership with a Black church that points toward some promising directions for future research and clinical collaborations between the field of couple and family therapy and the Black church community.     

Mental Health Identification Practices of Jails: The Unmet Needs of the “Silent” Population

The overrepresentation of individuals with mental illness in the criminal/legal system is well documented. While professional associations urge diversion towards treatment, little is known about the practices these institutions use to identify this population. One understudied space in the criminal/legal continuum is jails. This exploratory study compares two types of mental health identification at jail booking to assess jail‐ and community‐based service outcomes by identification type (N = 2956): (a) staff observation and (b) a standardized screening instrument. Individuals identified through staff observation were significantly more likely to receive jail‐ and community‐based services, even though current symptomology and substance misuse were both significantly higher for individuals identified only by the screening instrument. These findings point to the importance of jails in providing stabilizing services during incarceration, but further, show the impact that identification practices have on individuals as they transition to the community. Community context showed varied rates of jail staff observations of mental illness, showing greater risks for individuals in rural communities. Implications include a need for system‐level changes by instituting evidence‐based identification practices in jails, and improving professional collaboration practices between mental health and criminal/legal practitioners as individuals enter and exit jails.     

Transforming mental health care for children and their families

In April 2002, the President's New Freedom Commission on Mental Health was created by executive order to study the mental health care delivery system in our nation and to make recommendations for improvements so that individuals with serious mental disorders can live, work, learn, and fully participate in their homes and communities. In its report, "Achieving the Promise: Transforming Mental Health Care in America," the commission provided strategies to address critical infrastructure, practice, and research issues. This article focuses on the work of the commission's Subcommittee on Children and Families, describing its vision for mental health service delivery for children and providing suggestions for strengthening community-based care for youths with or at risk of behavioral health disorders. Training, research, practice, and policy implications for psychologists are discussed.     

Rural mental health in America

Mental health services are in short supply in rural America. This article describes both the mental health service needs in rural areas and the barriers to improving the availability, accessibility, and acceptability of rural mental health services. Federal programs in rural mental health care in the Departments of Health and Human Services, Agriculture, and Education are described, as well as selected congressional initiatives. The role of the federal Office of Rural Health Policy is emphasized, and policy recommendations for improving rural mental health care delivery are presented.     

Mental health attitudes among Middle Eastern/North African individuals in the United States

ABSTRACT

Middle Eastern/North African (MENA) individuals may have heightened risk for developing mental health problems due to unique cultural stressors. However, traditional cultural and religious practices and beliefs socialised within the family environment may reduce the likelihood of seeking mental health services. This qualitative study aimed to better understand the intersection of cultural, religious, and mental health attitudes among MENA individuals. Semi-structured telephone interviews were conducted with MENA adults who had received therapy services (N?=?13) and were analysed for emergent themes. Respondents reported lack of understanding of mental illness within their communities, and prominent levels of perceived and self-stigma. Families and religious practices/beliefs played an important role in responding to mental illness. Results suggest that incorporating psychoeducation and community awareness campaigns alongside religious services may help to reduce barriers to receiving mental health treatment.     

Call to Action: Family Therapy and Rural Mental Health

Rural communities experience considerable disparities in mental health. Research about this topic is limited, however, especially in the family therapy field. What is known comes primarily from work in other disciplines, which points to three primary barriers that prevent rural communities from accessing high quality mental health care: availability, accessibility, and acceptability of services. A search for papers published over the past 20 years in family journals yielded only 18 articles. A review of these articles in presented here, alongside a call for family clinicians and researchers to advance further contributions. Specific directions for such research are discussed, including telehealth technology, collaboration with existing structures and institutions in rural communities, and the need for more precise definitions and measures of rurality. Family clinicians and researchers are uniquely positioned to conceptualize systemic challenges that rural communities face, and would be advised to join other disciplines in developing innovative methods to address them.     

Therapist, Parent, and Youth Perspectives of Treatment Barriers to Family-Focused Community Outpatient Mental Health Services

This exploratory qualitative study describes treatment barriers to receiving family-focused child mental health services for youths with disruptive behavior problems from multiple perspectives. Data were collected during a series of focus groups and interviews, including: 4 therapist focus groups (n = 26), 3 parent focus groups (n = 14), and 10 youth (10–13 years) semi-structured interviews. Data analysis followed inductive, iterative processes typical of qualitative research using an editing style and thematic content analysis approach. Therapist, parent, and youth stakeholder participants discussed perceived barriers to effective treatment, the problems with current child outpatient therapy, and desired changes (i.e., policy, intervention, etc.) to improve mental health services. Results indicate similar themes around treatment barriers and dissatisfaction with services within and across multiple stakeholder groups, including inadequate service system support, lack of family involvement and feeling overwhelmed with the complexities of families’ needs; however, parents and therapists, in particular, identified different contributing factors to these barriers. Therapists highly endorse using family-focused therapy and desire parent participation; however, parents feel unsupported by their child’s therapist. Parents’ report feeling blamed and not heard by service providers which negatively impacts their attitude about service delivery, causing discomfort and resistance to participation in their youth’s treatment. Youth also discussed dissatisfaction with mental health services, specifically related to their direct experiences in therapy, and desired more active, directive family-focused approaches. Overall, stakeholders reported much frustration and dissatisfaction with current community-based outpatient child therapy services. Study findings can inform service provision, intervention development, and future research.     

Trying to remodel the children and youth service system: Observations about barriers and opportunities

From their perspective as participant observers, the authors discuss the initial phase of an attempt to remodel the child/family mental health service delivery system. Conceptualizing families as being at varying levels of risk for dismemberment is seen as: (a) providing a politically viable terminology, (b) permitting each agency to develop a continuum of services tailored to its mandate and clientele, and (c) facilitating legislative efforts to analyze simultaneously the budgets of all those state agencies with major responsibilities for children's services. A planning team endorsed cooperative planning between a state-level coordinating council and individual locales. Cultural communities were invited to participate in a manner paralleling the planning role of local communities. A model for a free standing case management entity is proposed. The concept of empowerment is discussed as a criterion for multi-level outcome evaluation.     

Community‐oriented primary care: a multidisciplinary community‐oriented approach to primary care?

Developing more of a local public health focus, and involving local communities in Great Britain in health care decision‐making, are key aspects of the radically changing face of primary care. Community‐oriented primary care (COPC) is an international model for innovative primary health care delivery historically applied in developing or deprived communities, but increasingly seen as having broader relevance for a wider range of primary care settings. COPC has a long history of development in deprived communities, it is still however seen as innovative. It fits the current requirements of clinical governance and the ‘Modern and Dependable NHS’, but does its long history also provide information about it's pitfalls? COPC is promoted as an approach that is applicable to community mental health problems, community psychologists can provide the expertise to facilitate addressing community mental health in COPC programmes. This paper describes the COPC model and highlights the relevance of the COPC philosophy and the problems of its implementation for community psychologists in primary care. Copyright © 2001 John Wiley & Sons, Ltd.