Project Details
RRTC for Children's Mental Health Study 5: Accessibility of Mental Health Services: Identifying and Measuring Organizational Factors Associated with Reducing Mental Health Disparities
Description
Purpose
The overall purposes of Study 5 are to (1) identify and (2) describe measurable systemic organizational factors associated with increased accessibility for ethnically/racially diverse children with serious emotional/behavioral disorders and their families to an array of quality mental health services/supports and (3) develop a cultural competence organizational assessment protocol. Our particular focus will be to identify which systemic organizational practices, rather than clinical practices, operate within systems of care that demonstrate improved access to mental health services. In addition to describing these systemic organizational practices, a protocol for organizational assessment will be created based on (a) information collected from the field, (b) existing research literature, (c) opinions of experts, and (d) published cultural competence standards and measures.For the purposes of this study, cultural competence is defined as “a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enable them to work effectively in cross-cultural situations” (Cross, Bazron, Dennis, & Isaacs, 1989, p.13). Fundamental to this concept is the notion that systems of care must both acknowledge and incorporate the importance of culture at all levels of functioning to provide optimal access to mental health services for racially/ethnically diverse populations.
Research Questions
The premise of this study is that to increase utilization of mental health services by diverse children and their families, culturally-competent systemic, organizational access practices must be present along with a culturally and linguistically adapted and appropriate array of services and supports. The research questions for the proposed study focus on diverse children and families from four groups (Asian/Pacific Islanders, Latinos/Hispanics, Native Americans and African Americans), based on revised Office of Management and Budget standards (1997). The research questions are:· Are there observable and measurable field-based organizational practices within systems of care that are associated with improved access and utilization of mental health services by ethnically/racially diverse children with serious emotional disturbances and their families? · How do these observable field-based systemic organizational practices compare and contrast with best practices identified in the literature? · How are field-based and literature-based practices organized and rated for importance by a national stakeholder group that includes researchers, practitioners and family members?· Can the measurement of these factors distinguish between systems of care that have varying systemic organizational capacities for cultural competence?
Design
The study uses a four-phased mixed qualitative and quantitative research design including multiple methods of stakeholder input, data collection, and data analysis (Cresswell, 2003; Greene, Caracelli, & Graham, 1989). This design conceptualizes and implements methods interactively across phases, each with expected results and products that contribute to the next phase (Greene, et al., 1989). Data collection represents point in time, retrospective and opinion-based information.Phase I used an case study design with multiple cases (Yin, 2003). Case studies were conducted through site visits and telephone interviews with selected organizations and their representatives. The unit of analysis was observable and measurable field-based organizational practices for increasing access to an array of services for racially/ethnically diverse children/families. Some cases included site visits with interviews, document review and observations, while others used telephone interviews and document review. Criteria were developed to determine which sites participated in site visits and which participated in telephone interviews. The ultimate goal of this process is to find common themes across exemplary organizations and across racial/ethnic groups served. Themes that are identified through the case studies will be converted into a list of systemic organizational factors; a review of the literature will allow these factors to be compared and contrasted with the current evidence-base. Phase II will involve a modified concept mapping procedure where stakeholders representing different perspectives will categorize and rank factors identified through the Phase I literature review and case studies. The exercise will ask participants to rate the relative importance of the identified factors and comment on their validity. Case study themes, concept mapping and the literature review findings will be integrated into a draft of an organizational cultural competence assessment protocol. Phase III will involve a panel of experts in providing feedback for the development of the organizational assessment protocol. The protocol will be aimed at meeting the need for monitoring and quality improvement as well as serving as a self-assessment and research tool. Once developed, 10 selected sites will participate in assessing the protocol’s utility, feasibility and practical application. This field-testing will provide preliminary validation of the operationalized factors from Phases I and II, and will inform further revisions to the protocol and training materials.
Phase IV will continue to test and gather feedback for developing the final organizational cultural competence assessment protocol.
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