Continuity of mental health care for Mexican Americans with schizophrenia

¶ … Mental-Health Care for Mexican-Americans with Schizophrenia

What specific topic or subject area do you propose to explore?

Schizophrenia is a devastating mental illness that affects more than 2 million Americans and one percent of the world's population. Though some studies have speculated that diagnoses of schizophrenia is significantly more frequent in minority populations, it has recently been found that these are often misdiagnoses based on cultural differences between the client, the mental health professional, and the rather racially biased diagnostic tools currently available. Regardless of the validity of the diagnosis, it has been found that Hispanic patients diagnosed with schizophrenia are less likely to adhere to their prescribed medication regimen than non-Hispanic patients. While 43% of the Caucasian patients followed their regimen, only 37% of the Latino patients followed theirs, being either partially or completely non-adherent to the prescription. These findings are likely to be due to a unique combination of factors including cultural beliefs and expectations, as well as access to care and physiological differences in therapeutic response to treatment. In addition to the low adherence to a prescribed medication regimen, adherence other suggested avenues of continued mental health are just as unlikely, still showing a large disparity in comparison to the non-Hispanic population.

I am currently working with a small group of Mexican-Americans with Schizophrenia and their families. I am interested in identifying the barriers related to their continuity of mental-health care.

2. What is your working title?

Identifying Barriers to the Continuity of Mental-Health Care Among Mexican-Americans with Schizophrenia

3. What is the theoretical foundation for your work

The theoretical foundation of my work is the Qualitative Family Psycho educational approach. This approach was developed specifically for family intervention and therapy with families with schizophrenia and other severe chronic mental illnesses. The psychoeducational model purposefully moves away from the tendency of traditional treatments to lay blame on the toxicity of the family environment for the development of severe mental illness. Instead disorders are viewed as the product of the combination of both biological predisposition to the illness and environmental factors, which include but are not limited to the interaction of the family unit. The general attitude of the practitioner of a psychoeducational model is that the family is struggling with the severer cognitive, behavioral and emotional symptoms within their environment the best way they know how. The family members are considered valuable members of the care-giving team, and essential to the collaborators in the treatment process for the illness. Group interventions comprised of multifamily units are utilized to reduce the stress of the caretaking environment and are armed with practical information and management guidelines to help cope with the anticipated periods of high stress that are associated with prolonged mental illness. The family of the diagnosed individual is helped to develop new, functional coping skills and encouraged to develop a clear cooperative plan to deal with any crisis or extreme stress. Not only does this method provide support to the member diagnosed with the illness, and the family unit itself, but it also helps ease the stigma and isolation of the family due to the mental illness.

4. What is your research question (or questions)?

The question to be researched is what barriers to the continuity of mental health care among Mexican-Americans can be identified. These barriers are expected to be due to a combination of factors including cultural beliefs and expectations, access to care and physiological differences in therapeutic response to treatment.

5. What research methods do you propose to answer your research question?

I am currently working with nine individuals and their nuclear families. If my formal proposal is approved, all participants and their family members would complete the proposed outline interview guide. I have spoken with my supervisor who has given me tentative permission to conduct research with this particular group. I plan to code and analyze all data myself, and I will preserve confidentiality of all questionnaires answered by assigning numbers to each file. At this time I believe a series of t-tests on the individual answers may serve the purposes of this research question. Two groups will be determined from the client history of the nine sets: Those how have displayed a continuity of health care since diagnosis, and those who have displayed a lack of continuity in health care. The answers to the questionnaires will then be identified as either continuous (ie C1, C2, C3, etc.) or non-continuous (ie N1, N2, N3, etc.). After assigning the whole questionnaire to one group or another, the individual answers will then be evaluated to determine the presence or absence of self-reported factors in one group while absent in the other, and vice versa, and, if present in both groups, the frequency of the answer in one group vs. The second. It will then be determined by a performance of a t-test on each question whether the frequency of the answer is significantly different in each group. The statistically significant variances can then be correlated with being a factor in the continuity of health care for this group. I plan to share the results of my research with my supervisor and my group of Mexican-Americans with Schizophrenia and their families.

6. What is the purpose of your research?

To identify barriers that impede the continuity of Mental Health Care in Mexican-Americans with Schizophrenia. The identification of these barriers can be useful in determining the direction of future work in removing the ethnic disparities shown in the diagnosis, treatment, and overall mental health of minorities in this country. Once identified, research can then be conducted on how to effectively remove these barriers to allow better, more effective mental health care to Mexican-Americans.

7. What source material have you located thus far to support your research plans?

Andersen RM: Revisiting the behavioral model and access to health care: Does it matter? Journal of Health & Social Behavior 1995; 36:1-10

Briones DF, Heller Pl, Chalfant HP, et al.: Socioeconomic Status, ethnicity, Psychological distress, and readiness to utilize a mental health facility. American Journal of Psychiatry 1990; 147: 1333-1340

Burnam MA, Hough RL, Escobar JI, et al.: Six-month prevalence of specific psychiatric disorders among Mexican-Americans and non-Hispanic whites in Los Angeles. Archives of General Psychiatry 1987; 44:687-694

Cheung FK, Snowden LR, Community mental health and ethnic minority populations. Mental Health Journal 1990; 26: 277-291

Council on Scientific Affairs: Hispanic Health in the United States.

Journal of the American Medical Association 1991; 265:248-252

Estrada Al, Trevino FM, Ray LA: Health care utilization barriers among Mexican-Americans: Evidence from HHANES 1982-1984.

American Journal of Public Health 1990; 80 (supplement): 27-31

Hall LK: Providing culturally relevant mental health services for Central American immigrants. Hospital and community Psychiatry 1988; 39:

1139-1144

Higginbotham JC, Trevino FM, Ray LA,: Utilization of Curanderos by Mexican-Americans: Prevalence and predictor findings from HHANES

1982-1984. American Journal of Public Health 1990; 80 (supplement): 32-35

Hough RL, Landsverk JA, Karno M, et al.: Utilization of health and mental health services by Los Angeles Mexican

American and non-Hispanic whites. Archives of General Psychiatry 1987; 44: 702-709

Karno M, Hough Rl, Burman MA, et al.: Lifetime prevalence of specific psychiatric disorders among Mexican-Americans and non-Hispanic whites in Los Angeles.

Archives of General Psychiatry 1987; 44: 695-701

Keefe SE: Mexican-Americans underutilization of mental health clinics: An evaluation of suggested explanations. Hispanic Journal of Behavioral Sciences 1979; 1: 93-115

O

Sullivan MJ, Peterson PD, Cox GB, et al.: Ethnic populations:

Community mental Health Services ten years later. American Journal of Community Psychology 1989; 17:17-30

Rogler LH, Malgady RG, Constantino G, et al.: What do culturally sensitive mental health services mean? The case of Hispanics. American Psychologist 1987; 42: 565-570

Rogler LH, Malgady RG, Rodriguez O: Hispanics and Mental Health: A Framework for Research. Malabar, Florida, Robert E. Krieger Publishing

Company 1989

Sofaer S: Qualitative methods: What are they and why use them?

Health Services Research 1999; 34 (5Pt 2): 1101-1118

Solis, JM, Marks G, Garcia M. et al.: Acculturation, access to care, and use of preventive services by Hispanics: Findings from HHANES

1982-1984. American Journal of Public Health 1990: 80 (supplement): 11-19

Trevino FM, Moyer E, Valdez RB, et al.: Health insurance coverage and utilization of health services by Mexican-Americans, mainland Puerto

Ricans, and Cuban-Americans. The Journal of the American Medical

Association 1991;265: 233-237

U.S. Bureau of Census: Statistical Abstract of the United States, 111th Edition Washington DC, 1991

Wells KB, Hough RL, Golding JM, Burnam AM, et al.: Which Mexican-Americans underutilize mental health services? American Journal of Psychiatry 1987; 144:918-922

Wells KB, Hough RL, Golding JM, et al.: Acculturation and the probability of use of health services by Mexican-Americans. Health Services

Research 1989; 24: 237-257

Woodward AM, Dwinell AD, Arons BS,: Barriers to mental health care for Hispanic-Americans: A literature review and discussion. The Journal of Mental Health Administration. 1992;19: 224-236

Zarate R, Kopelowicz a, Gonzales V, Tripodis K: Mental Health services for Latinos with serious mental illness. A literature review and discussion. Community Mental Health Journal, in press

ADDENDUM a OUTLINE of PROPOSED INTERVIEW GUIDE

How are you doing? Como esta Usted?

Is this a good time to talk for you? Es un buen momento para hablar con Usted?

Family and Social Network Supports

Sistemas de apoyo familiar

Social

A. Who lives with you in your household? Quien vive con usted en la casa?

B. Tell me about your family. Cuenteme acerca de su familia

C. What's a typical day like for you? With your Family? With your friends? Como pasa Usted el dia? Con su familia? Con sus amigos?

D. Tell me about your friends Cuenteme sobre sus amigos

E. Who are the people you can count on the most in time of need?

Quienes son las personas con las que puede contar cuando las necesita?

F. Do you belong to groups or organizations that you feel you get support from? Examples? What kind of support?

Pertenece an algun grupo u organizacion que le proporciona apoyo?

Pongame algun ejemplo, que tipo de apoyo?

G. How does the family and friends support you and your family?

Como le apoya la familiay/o amigos a usted y su familia?

Language

Idioma (About relative) (acerca del familiar)

A. What Languages do you speak fluently? Que idiomas habla Ud.

A con fluidez?

If Spanish: Do you read and write Spanish? Sabe usted leer y escribir en espanol?

If English:

Do you read and write English? Sabe usted leer y escribir en Ingles?

B. Do you find it easier talking to people in your native language?

Le parece mas facil hablar con la gente en su propio idioma?

C. If bilingual, where did you learn your second language?

Donde aprendio su segundo idioma?

D. What is your language of preference? What is your preference in Language when talking with your family? Friends? Strangers?

Cual es su idioma de preferencia? Que Idioma prefiere cuando habla con su familia? Amigos? Extranos?

E. Are most of your friends bilingual? Son la mayoria de sus amigos bilingues?

F. How difficult is for you to comprehend English? Cuan dificil es para ud. Comprender Ingles?

G. What is your level of education and where did you study?

Cual es su nivel educativo? Y donde estudio? (familiar)

Access Problems (Financial, insurance status, transportation and Child care)

Problemas de accesibilidad (economicos, seguro medico, transporte cuidado de los ninos) (acerca del paciente y su familia)

A. Who in your household works? Do you work?

Quien trabaja en su casa? Trabaja usted?

B. What do you use for transportation? Que medio de transporte usa?

A carro, bus etc.)?

C. Do you have access to childcare if needed? Tiene acceso a cuidado de ninos si lo necesita?

D. Do you have medical insurance? If so, what kind? If not so, how Do you manage with healthcare payments? Tiene seguro medico?

De que tipo? Como hace para pagar los gastos medicos?

IV. Experience of the Hospital Experiencia del Hospital

A. What's is like going to the hospital? Como se siente

Al hospital?

B. What do you like about going to the hospital? Que le gusta de ir al hospital? Why? Porque?

C. What do you dislike about going to the hospital?

Que no le gusta de ir al hospital? Why? Porque?

D. Do you procrastinate when going to the hospital?

Evita ir al hospital? Why? Porque?

E. Do you have obligations that impede going to the Hospital (such as job, financial problems, etc.)?

Tiene obligaciones que le impiden ir al hospital

Como trabajo, problemas economicos, etc.)?

F. Are there times when going to the hospital is time

Consuming? Example?

Hay veces que ir al hospital le supone por mucho tiempo? Pongame un ejemplo.

G. Is it difficult to travel to the hospital? Why or why not? Es dificil el transporte hasta el hospital? Por que si o por que no?