The Role for Public Funding of Faith-Based Organizations Delivering Behavioral Health Services: Guideposts for Monitoring and Evaluation

The paper reviews policies promoting faith-based organizations' (FBO) participation in publicly-funded programs since the Charitable Choice statute was enacted during the Clinton administration and then additional faith-based initiatives were implemented by the Bush administration. The paper focuses on research findings on FBO participation in publicly-funded human service programs under these policies. It then proposes a framework for evaluation to assess the appropriateness of public funding for behavioral health services delivered by FBOs, in order to address: (1) the programmatic and systemic effects resulting from the infusion of new players from the faith community, and the consequences to the profile of services and who gets served; and (2) the content and effectiveness of faith-infused services as a basis for identifying interventions appropriate for public funding. The analysis considers classification issues, theoretical bases of measured effects of faith-infused services, and the transferability of faith-based interventions across religious and secular applications in order to satisfy constitutional issues and client choice.     

HIV/AIDS Prevention, Faith, and Spirituality among Black/African American and Latino Communities in the United States: Strengthening Scientific Faith-Based Efforts to Shift the Course of the Epidemic and Reduce HIV-Related Health Disparities

Black/African American and Latino communities are disproportionately affected by the domestic HIV/AIDS epidemic. Blacks/African Americans and Latinos are also more likely to report a formal, religious, or faith affiliation when compared with non-Hispanic whites. As such, faith leaders and their institutions have been identified in the National HIV/AIDS Strategy as having a vital role to serve in reducing: (1) HIV-related health disparities and (2) the number of new HIV infections by promoting non-judgmental support for persons living with and at risk for HIV/AIDS and by serving as trusted information resources for their congregants and communities. We describe faith doctrines and faith–science partnerships that are increasing in support of faith-based HIV prevention and service delivery activities and discuss the vital role of these faith-based efforts in highly affected black/African American and Latino communities.     

Implementation and Preliminary Feasibility of an Individualized,Supportive Approach to Behavioral Care for Parents of Young Children Newly Diagnosed With Type 1 Diabetes

There are significant stressors related to parenting a young child with newly diagnosed type 1 diabetes (T1D). Despite these challenges, there are not yet clearly defined interventions to help promote psychological health and adherence for families with young children with T1D. First STEPS is a tailored stepped care design intervention to positively impact parents’ emotional functioning and children’s glycemic control in young children newly diagnosed with T1D. The First STEPS intervention is derived from a combination of Cognitive Behavioral Theory and Social Cognitive Theory to support family adjustment to T1D, promote parental mastery over T1D tasks, increase coping skills to manage stressors associated with T1D, and build on the strengths of families newly diagnosed with T1D to help them achieve positive health and wellbeing outcomes. We present details about the intervention and describe two pilot participants as case studies. Results indicated that the treatment and delivery model were acceptable to the pilot participants, as evidenced by treatment completion and satisfaction ratings. Future directions for this work include testing the efficacy of this new treatment in a randomized controlled trial.     

Faith-Based Organizations: Sexual Harassment and Health in Accra-Tema Metropolis

Sexual harassment occurs frequently in many faith-based organizations (FBOs). This study investigated whether sexual harassment in FBOs was a public health concern in Ghana. A cross-sectional exploratory approach was used to assess the prevalence and incidence of traditional or contrapower sexual harassment in FBOs. We also investigated the correlation between sexual harassment and health. Respondents completed a self-administered open-ended questionnaire in an anonymous survey about sexual harassment during the 12 months preceding the study. We hypothesized that both traditional and contrapower harassment were prevalent in FBOs of Ghana and also that the health effects were the same for both sexes in both forms of harassment. The two hypotheses were generally supported. We found that sexual harassment is a public health concern. Women were more likely to be sexually harassed (73%) than men were (27%). Sexual harassment negatively affects the victims’ health outcome. Secondly, both the traditional and contrapower forms of sexual harassment were prevalent in FBOs in Ghana. The health consequences of sexual harassment in Ghana are the same as in an industrialized country. The implications for policy and research are discussed.     

Building Capacity Among Laity: A Faith-Based Health Ministry Initiative

A systematic review of topic-specific faith-based health programs determined that health outcomes can be improved though faith-based health interventions. A university research team, in partnership with the Kansas United Methodist Church and a United Methodist philanthropy, facilitated planning and development of a statewide initiative to increase the capacity of laity-led health ministry teams. The purpose of this paper is to describe the processes utilized to design and implement an initiative to increase capacity for laity-led comprehensive health ministry among Kansas United Methodist Church congregations and to share the key elements of the initiative.     

School-Based Supports and Interventions to Improve Social and Behavioral Outcomes with Racially and Ethnically Minoritized Youth: A Review of Recent Quantitative Research

School discipline disproportionality has long been documented in educational research, primarily impacting Black/African American and non-White Hispanic/Latinx students. In response, federal policymakers have encouraged educators to change their disciplinary practice, emphasizing that more proactive support is critical to promoting students’ social and behavioral outcomes in school. Results from a literature review conducted nearly a decade ago indicated that there was, at that point, a paucity of empirical research related to considering students’ culture (e.g., race, ethnicity) and supporting school behavior. The purpose of this study is to replicate and expand the previous review to summarize the characteristics of the most recent school-based quantitative research addressing interventions to promote social and behavioral outcomes for racially and ethnically minoritized youth. We screened 1687 articles for inclusion in the review. Upon coding 32 eligible research studies, we found that intervention and implementer characteristics within these studies varied, but noted strong intervention effects in studies that included established evidence-based practices, adapted interventions, as well as new practices piloted with student participants. Results inform recommendations to continue to study interventions that promote positive social and behavioral outcomes for racially and ethnically minoritized students to disrupt a long history of subjection to exclusionary discipline disproportionately.

     

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.     

“Big Momma Had Sugar,Imma Have It Too” Medical Fatalism and the Language of Faith Among African–American Women in Memphis

This essay offers a theological exploration of the relationship between medical fatalism and religious belonging among African–American women in Memphis. Drawing on the work of black and womanist theologians and on conversations with participants in a diabetes intervention program administered by a faith-based community health provider, I argue that how we narrate the meanings of our bodies is irreducibly religious. The language we use to interpret and communicate the meaning of our bodily existence emerges from a set of assumptions, often unarticulated, about what is of ultimate value to us. The essay focuses on three interlocking features that link faith with fatalism or hope: (1) The idea that if “I don’t claim that” disease cannot enter my body; (2) the role of faith-based clinics in re-establishing trust with marginalized communities; and (3) how nuanced attention to the social location of health seekers can re-frame our understanding of patient compliance. Disrupting fatalism can only be done from within a health seeker’s own narrative, and therefore, healthcare providers who learn these narratives and respect their holiness will develop more effective interventions.     

The relationship between racial identity status attitudes, racism-related coping, and mental health among Black Americans

To date, few studies have examined how different strategies for coping with racism affect the mental health of Black Americans, and none have explored how racial identity status attitudes and racism-related coping affect mental health. This study sought to examine the relationship between racial identity status attitudes, the specific strategies used by Black Americans to cope with racism, and mental health outcomes. Participants were 233 Black adults, and cluster analysis identified four cluster groups that differed significantly with respect to the patterns of racial identity attitudes and racism-related coping strategies employed. Although the groups did not differ significantly in well-being, the group with predominantly high Internalization status attitudes and that used primarily Empowered Resistance racism-related coping strategies had the least psychological symptoms. Implications for mental health and research are discussed.     

As I See It: A Study of African American Pastors’ Views on Health and Health Education in the Black Church

The Black Church is the only institution that has consistently served the interest of African Americans, and there is no other institution in the African American community that rivals its influence (Camara, 2004). The spiritual well-fare, social support, health, and well-being of its people have been one of its main goals. With health disparities of African Americans still at an alarming rate, the Black Church has used informal education as a means to impart knowledge on health, as well as other non-religious and religious topics. One of the avenues least researched within the Black Church is the pastor’s perception of its educational role in health and wellness and its efforts to reduce health discrimination and health disparities between African American and European Americans in the U.S. Since social justice appears as a theme and concern in the traditions of many churches, it is only appropriate that, among other things, the Black Church should address the issue of health education and interventions. The purpose of this study was to explore African American pastors’ perceptions of the role of the Black Church in providing health care, health education, and wellness opportunities to African Americans. Many pastors reported their church provided some form of health education and/or health screenings. Their perceptions about the important issues facing their congregants versus African Americans in general were quite similar.     

Got Pain? Racial Bias in Perceptions of Pain

In the days of slavery, White people assumed that Black people felt less pain than did White people. This belief was used to justify slavery; it was also used to justify the inhumane treatment of Black men and women in medical research. Today, White Americans continue to believe that Black people feel less pain than do White people although this belief has changed from its historical, explicitly racist form. Racial attitudes do not moderate the bias, suggesting that racial bias in perceptions of others' pain is not rooted (solely) in racial prejudice. Moreover, Black Americans too believe that Black people feel less pain than do White people, suggesting that the bias is no longer grounded in intergroup dynamics. Rather, contemporary forms of this bias stem from assumptions that Black people face more hardship and “thus” can withstand more pain and assumptions that Black people's bodies are not only different but also superhuman. Although this new instantiation of the pain perception bias is decidedly more “benevolent”, it can nonetheless lead to negative outcomes. Here, we consider how racial bias in perceptions of others' pain may affect racial disparities in health care and intergroup relations more generally. We also discuss potential avenues for interventions aimed at preventing this bias among children and reducing this bias among adults.     

Explaining disproportionately high rates of adverse birth outcomes among African Americans: the impact of stress, racism, and related factors in pregnancy

Compared with European Americans, African American infants experience disproportionately high rates of low birth weight and preterm delivery and are more than twice as likely to die during their 1st year of life. The authors examine 5 explanations for these differences in rates of adverse birth outcomes: (a) ethnic differences in health behaviors and socioeconomic status; (b) higher levels of stress in African American women; (c) greater susceptibility to stress in African Americans; (d) the impact of racism acting either as a contributor to stress or as a factor that exacerbates stress effects; and (e) ethnic differences in stress-related neuroendocrine, vascular, and immunological processes. The review of literature indicates that each explanation has some merit, although none is sufficient to explain ethnic disparities in adverse birth outcomes. There is a lack of studies examining the impact of such factors jointly and interactively. Recommendations and cautions for future research are offered.     

Mental health counselling in the Black American Church: reflections and recommendations from counsellors serving in a counselling ministry

The goal of this study was to examine the relationship between “The Black Church”, the mental health needs of its members, and addressing those needs from the perspective of counsellors within the church. Four in-depth interviews were conducted with members of the mental health counselling team at one large, African American-serving church in the Midwest to explore their thoughts about their church pastor’s desire to expand their current ministry to a fully operating counselling centre. The findings suggest that “the Black Church” not only has a role and responsibility in addressing the mental health needs of African Americans within and outside of the church but can also use religiosity as a facilitator rather than a barrier to mental health service use among African Americans.     

Work engagement interventions can be effective: a systematic review

Work engagement is associated with important individual and organisational outcomes (e.g. employee health and well-being, performance). This narrative systematic review aims to synthesise the increasing number of work engagement interventions and inform future research by exploring: (1) the specific intervention foci, delivery methods and content of engagement interventions; (2) intervention effectiveness; and (3) underlying mediators and moderators. A systematic search for interventions employing a validated engagement measure revealed 40 studies. Five were personal resource building, twelve job resource building, three leadership training, eighteen health promotion, and two job and personal resource building. Twenty (50%) studies observed significant positive effects on work engagement, two (5%) had a negative effect, and eighteen (45%) had no effect. Job and personal resources, job demands and well-being were important mediators. Moderators included the specific intervention focus and delivery method, employee participation, manager support, and intervention level (top-down vs bottom-up). Bottom-up interventions, and job crafting and mindfulness interventions particularly, were most successful. Implementation difficulties were common, including poor response and attrition rates, and adverse factors (e.g. organisational restructuring, redundancy, economic downturn). We highlight implications for research and practice and stress the need to test underlying theories to build knowledge around how, why, and when interventions work.     

A Qualitative Study of Faith Leaders’ Perceptions of Health and Wellness

The effectiveness of faith-based health and wellness interventions is moderated by the attitudes, perceptions, and participation of key leaders within faith-based organizations. This qualitative study examined perceptions about the link between health, spirituality, and religion among a volunteer sample of faith leaders (n = 413) from different denominations. The major themes included: influences on health and wellness promotion and a relationship between spirituality and health. The results indicated that perceptions about the link among health, spirituality, and religion vary among faith leaders, regardless of denomination. Future faith-based interventions should be developed with consideration for denomination as a socially and culturally relevant factor.     

Physical activity and diabetes: An application of the theory of planned behaviour to explain physical activity for Type 1 and Type 2 diabetes in an adult population sample

Physical activity (PA) plays a key role in the management of Type 1 (T1D) and Type 2 diabetes (T2D) but there are few theory-based, effective programs to promote PA for individuals with diabetes. The purpose of this study was to investigate the utility of the Theory of Planned Behaviour (TPB) in understanding PA in an adult population with T1D or T2D. A total of 2311 individuals (691 T1D; 1614 T2D) completed self-report TPB constructs of attitude, subjective norms, perceived behavioural control (PBC), intention and PA at baseline and 1717 (524 T1D; 1123 T2D) completed the PA measure again at 6-month follow-up. Multi-group Structural Equation Modelling was conducted to: (1) test the fit of the TPB structure (2) determine the TPB structural invariance between the two types of diabetes and (3) to examine the explained variances in PA and compare the strength of associations of the TPB constructs in the two types of diabetes. The TPB constructs explained ≥40% of the variance in intentions for both diabetes groups. In cross-sectional models, the TPB accounted for 23 and 19% of the variance in PA for T1D and T2D, respectively. In prospective models, the TPB explained 13 and 8% of the variance in PA for T1D and T2D, respectively. When adjusting for past PA behaviour, the impact of PBC and intention on behaviour was reduced in both groups. The findings provide evidence for the utility of the TPB for the design of PA promotion interventions for adults with either T1D or T2D.     

Community‐Based Participatory Research With Black Churches

Black Americans are more likely than other racial/ethnic groups to rely on spiritual and religious resources for mental health support. As such, counselors must seek unique ways to reach and understand Black communities. This article provides an overview of Black Americans' help‐seeking behaviors, the significance and culture of the Black Church, and a framework for counselors and counseling researchers to form effective partnerships to conduct community‐based participatory research initiatives that will produce empirical outcomes and promote culturally responsive mental health and wellness programming in Black communities.     

Identifying effective mental health interventions for American Indians and Alaska Natives: a review of the literature

The pursuit of evidence-based practice (EBP) within the mental health professions has contributed to efficacious clinical intervention for individuals struggling with mental health problems. Within the context of the EBP movement, this article reviews the treatment outcome literature for mental health interventions directed specifically toward American Indians and Alaska Natives experiencing psychological distress. Fifty-six articles and chapters pertaining to the treatment of Native Americans with mental health problems were identified, though the vast majority of these did not systematically assess outcomes of specified treatments for Native American clients under scientifically controlled conditions. Of just nine studies assessing intervention outcomes, only two were controlled studies with adequate sample sizes and interpretable results relative to the identification of EBP among American Indians and Alaska Natives. The advantages and limitations of EBP for treatment of Native American mental health problems are discussed.     

Grassroots spirituality: What it is,why it is here,where it is going,by Robert K. Forman

Among Asian Americans, particularly within immigrant communities, religious leaders are respected and sought out for support and guidance. There is a need to examine how religious leaders, especially within non-Christian faiths, identify persons and ascribe meaning and attributions to mental health concerns. The aim of this paper was to address this knowledge gap by exploring the perceptions of five Vietnamese American Buddhist leaders in regards to mental illness. Using qualitative analytic techniques we identified appearance, behaviours, and cognitive impairments that leaders interpreted as indicators of a mental health condition. Religious leaders cited messy and overly adorned outer appearance, aggressive and violent behaviours, and abnormal cognitive functioning as indicative of mental health problems. They attributed mental illness to a variety of causes: daily stressors, mind-body imbalance, karma, virtuous deeds, and spiritual possession. Findings inform strategies for faith-based initiatives and mental health service delivery to religiously affiliated Asian Americans.