American Indian identity in mental health services utilization data from a rural midwestern sample.

The governing bodies for psychiatry, psychology, and social work all publicly support culturally competent mental health care and have called for increased awareness of the importance of racial, ethnic, and cultural identity in mental health treatment and outcomes. However, since 1960 the population of people identifying as American Indian in the United States has grown faster than can be explained by birth rates, raising questions about the personal meaning of identity for newly self-designated American Indians. For this research, interviews were conducted with 14 self-identified American Indian clients receiving rural mental health care services in the Midwest. The goal was to assess clients' cultural connection to their racial identity and to understand what impact their American Indian identity had on their mental health care experiences. A modified Consensual Qualitative Research (CQR) method was used to develop the interview protocol and code responses. Interview data revealed that clients primarily based their racial identity on family stories of an American Indian ancestor and the majority did not feel their identification as American Indian was relevant to their mental health care. Regardless of lack of cultural connection, participants often reported feeling personal pride associated with identifying as American Indian. Implications for both researchers collecting self-reported race data and for mental health practitioners who might serve self-identified American Indian clients are discussed.

Student loan debt and mental health: a comprehensive review of scholarly literature from 1900 to 2019.

PURPOSE: The review had two purposes. The first was to examine the nature and extent of published literature on student loan and the second was to systematically review the literature on student loans and mental health. MATERIALS AND METHODS: Data from academic databases (1900-2019) were analyzed using two methods. First, topic modeling (a text-mining tool that utilized Bayesian statistics to extract hidden patterns in large volumes of texts) was used to understand the topical coverage in peer-reviewed abstracts (n = 988) on student debt. Second, using PRISMA guidelines, 46 manuscripts were systematically reviewed to synthesize literature linking student debt and mental health. RESULTS: A model with 10 topics was selected for parsimony and more accurate clustered representation of the patterns. Certain topics have received less attention, including mental health and wellbeing. In the systematic review, themes derived were categorized into two life trajectories: before and during repayment. Whereas stress, anxiety, and depression dominated the literature, the review demonstrated that the consequences of student loans extend beyond mental health and negatively affect a person's wellbeing. Self-efficacy emerged as a potential solution. DISCUSSION AND CONCLUSION: Across countries and samples, the results are uniform and show that student loan burdens certain vulnerable groups more. Findings indicate diversity in mental health measures has resulted into a lack of a unified theoretical framework. Better scales and consensus on commonly used terms will strengthen the literature. Some areas, such as impact of student loans on graduate students or consumers repaying their loans, warrant attention in future research.

Path Analysis of Effects of First-Generation Status on Physical Activity and 4-Year College Degree Completion.

PURPOSE: First-generation college students (FGCS) face a myriad of sociocultural, financial, and emotional challenges that impact their educational journey. With less academic capital and lower odds of obtaining a bachelor's degree than their non-FGCS peers, understanding the factors affecting their academic success is pivotal for social work professionals aiming to provide tailored interventions and support systems. This study delved into the potential differences between these groups concerning physical activities, which are linked to learning, cognition, and overall well-being, and evaluated their influence on degree completion. METHOD: A path model was developed to analyze the relationship between degree completion, physical activities, FGCS status, and background variables, using a sample of 1,625 participants. RESULTS: The model showed a strong fit (CFI = 0.979, RMSEA = 0.055, SRMR = 0.010) and accounted for 29.5% of the variance in degree completion. Walking to school was positively associated with degree attainment. FGCS status was associated with decreased walking to school, reduced degree completion, and increased walking for exercise. An indirect effect suggested that FGCS were less likely to achieve their degree, potentially due to a greater reliance on transportation like buses or cars. DISCUSSION: The findings emphasize the critical role of campus resources for FGCS. Enhancing access to fitness centers and offering affordable housing options nearer to campus may aid FGCSs' academic success. These insights can guide social work practices, highlighting the importance of environmental factors in the academic experiences of FGCS.

Comparing Naturalistic Mental Health Expressions on Student Loan Debts Using Reddit and Twitter.

PURPOSE: The primary objective of this study was to identify patterns in users' naturalistic expressions on student loans on two social media platforms. The secondary objective was to examine how these patterns, sentiments, and emotions associated with student loans differ in user posts indicating mental illness. MATERIAL AND METHOD: Data for this study were collected from Reddit and Twitter (2009-2020, n = 85,664) using certain key terms of student loans along with first-person pronouns as a triangulating measure of posts by individuals. Unsupervised and supervised machine learning models were used to analyze the text data. RESULTS: Results suggested 50 topics in reddit finance and 40 each in reddit mental health communities and Twitter. Statistically significant associations were found between mental illness statuses and sentiments and emotions. Posts expressing mental illness showed more negative sentiments and were more likely to express sadness and fear. DISCUSSION AND CONCLUSION: Patterns in social media discussions indicate both academic and non-academic consequences of having student debt, including users' desire to know more about their debts. Interventions should address the skill and information gaps between what is desired by the borrowers and what is offered to them in understanding and managing their debts. Cognitive burden created by student debts manifest itself on social media and can be used as an important marker to develop a nuanced understanding of people's expressions on a variety of socioeconomic issues. Higher volumes of negative sentiments and emotions of sadness, fear, and anger warrant immediate attention of policymakers and practitioners to reduce the cognitive burden of student debts.

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.

Trends in Health Care Utilization Among Adults With Serious Psychological Distress: 2003-2014.

OBJECTIVE: The purpose of this study was to assess trends in health care utilization among adults with serious psychological distress (SPD) from 2003 to 2014 and compare utilization patterns between adults with and without SPD. METHODS: The study sample came from the 2003-2014 National Health Interview Survey series. SPD was measured by the six-item Kessler Psychological Distress Scale. Logistic regressions were performed to test the overall trends in health care utilization stratified by SPD status. Postestimation methods were used to obtain predicted changes in the percentages of adults with and without SPD who utilized health care services. RESULTS: Adjusted analyses showed that from 2003 through 2014, the percentage of adults with four or more outpatient office visits per year decreased by .4% each year among adults without SPD and by .5% among adults with SPD. The percentage of adults with a hospital admission each year decreased by .1% among adults without SPD and .3% among adults with SPD. The percentage of adults with two or more emergency department (ED) visits each year decreased by .1% among adults without SPD and increased significantly by .2% among adults with SPD. Supplementary analyses suggested that the increasing trends in ED utilization among adults with SPD had leveled off since 2011. CONCLUSIONS: Adults with SPD utilized outpatient, inpatient, and emergency care at higher rates compared with adults without SPD. In particular, utilization of ED visits increased significantly over the past decade among adults with SPD, indicating a widening gap in the adequacy of services for this population.

Disparities in Health Services Use Among Multiracial American Young Adults.

Addressing disparities in health services utilization remains critical for improving minority health; however, most studies do not report on the health service use of multiracial young adults (age 22-34). This study compares past year health service use of self-identified multiracial (two or more races) young adults with monoracial White young adults. Weighted survey data from Add Health (N = 7296) and multivariate logistic regression analyses were used. Compared to monoracial White young adults, Black-White multiracial [OR 0.40, 95 % CI (0.17-0.90)] and Black-Native American multiracial [OR 0.23, 95 % CI (0.09-0.63)] young adults are less likely to report primary care service use in the past year. Multiracial young adults have different health care service utilization than their White monoracial peers with Black-Native American young adults appearing to be particularly vulnerable to under-utilization of primary care services. It is important to examine multiracial subgroups when studying patterns of health services utilization.

Provider advice on exercise and diet among adults with comorbid serious psychological distress and diabetes or diabetes risk factors.

PURPOSE: To examine the lifetime prevalence and correlates of provider advice to increase exercise and reduce dietary fat intake among adults with comorbid serious psychological distress (SPD) and diabetes or diabetes risk factors. METHODS: Study sample (n = 5942) was selected from the Medical Expenditure Panel Survey Household Component (MEPS-HC) series of 2007-2011. SPD was defined as a score of ≥13 on the Kessler Psychological Distress Scale (K6). Multivariate logistic regression was used to examine correlates of lifetime provider advice. RESULTS: Less than half of adults with SPD had been advised to increase exercise (49.4%) or reduce dietary fat intake (45.6%). The prevalence of receiving provider advice increased in a linear fashion as the number of diabetes risk factors increased and was the highest among those with diabetes. Provision of provider advice was strongly associated with clinical factors rather than individuals' sociodemographic characteristics and current health behaviors. CONCLUSIONS: Health care providers are missing opportunities to provide exercise and low-fat dietary advice to patients with SPD before they manifest clinical risk factors associated with diabetes. It is important that providers counsel them as early as possible about exercise and nutritional changes that reduce the risks associated with diabetes.

Clinician factors related to outcome differences between black and white patients at CMHCs.

OBJECTIVES: Data are limited on how clinicians contribute to outcome differences between black patients and white patients. Because the clinician-patient relationship is the foundation of mental health services, understanding clinicians' role in outcome differences may help identify evidence-based interventions that decrease disparities and capitalize on positive differences. Symptoms and functioning in a sample of black and white adults receiving outpatient services were examined to determine the effects of their primary clinician on those patterns. METHODS: The study included 551 patients (25% black) with serious mental illness and 62 mental health professionals (21% black) identified as the patients' primary clinician. Treatment outcomes were measured at baseline and two follow-ups (two and four months) with the Behavior and Symptom Identification Scale, a measure of symptoms and functioning. Data were analyzed with hierarchical linear modeling. Clinicians' levels of multicultural competence, burnout, and education were analyzed. RESULTS: Clinicians moderated the relationship between patient race and outcome differences. There was significant variability among clinicians: approximately 20% had black patients whose outcomes were worse than those of their white patients, and 40% had black patients with better outcomes than their white patients. The only clinician factor predicting these differences was clinician's general experiences and relationships with people from racial-ethnic and cultural groups other than their own. CONCLUSIONS: The occurrence of outcome differences varied across clinicians, with some clinicians magnifying outcome differences between black and white patients and others minimizing them. Factors other than clinicians' race, multicultural competence, education, and burnout may contribute to outcome differences between black and white patients.

State budget cuts, health care reform, and a crisis in rural community mental health agencies.

Between 2009 and 2011, states implemented significant budget cuts to community mental health agencies (CMHAs), which are frequently the sole provider of specialized behavioral health services in rural communities. Starting in 2010, federal policy changes created by health care reform and mental health parity are likely to increase the number of individuals who can afford to seek services for a mental illness. CMHAs under financial stress have begun to eliminate services and reduce staff. These trends could result in a growing gap between available behavioral health services and the number of people who can afford to seek treatment for a mental illness.

Brokering language and culture: can ad hoc interpreters fill the language service gap at community health centers?

The purpose of the research was to explore the ability of ad hoc interpreters to integrate into the organizational climate at a federally qualified community health clinic (CHC) and create satisfactory services for limited-English-proficiency clients. Survey and interview data were gathered from staff (n = 17) and Latino clients (n = 30). The data indicate that clients felt satisfied with interpreters. Some friction existed between the interpreters and the medical staff due to incongruent expectations. The CHC's organizational climate and the interpreters' commitment to the Latino community mediated the impact of these tensions on services and satisfaction. The study offers important insight into how ad hoc interpreters can become professional medical interpreters within a limited-resource service environment.

Recovery coaches and substance exposed births: an experiment in child welfare.

OBJECTIVES: Substance exposed infants present a major challenge to child welfare and public health systems. Prenatal substance exposure and continued substance abuse in the home are associated with a wide range of adverse social, emotional, and developmental outcomes. The objective of the current study is to evaluate the use of recovery coaches in child welfare. METHODS: The current study is longitudinal and utilizes an experimental design. The sample includes 931 substance abusing women enrolled in a Title IV-E Waiver Demonstration, 261 in the control group, and 670 in the experimental group. Women in the experimental group received traditional services plus the services of a recovery coach. Administrative records are used to indicate substance exposure at birth. RESULTS: Of the 931 women enrolled in the waiver demonstration, 21% of the control group and 15% of the experimental group were associated with a subsequent substantiated allegation indicating substance exposure at birth. Cox proportional hazards modeling indicates that women in the experimental group were significantly less likely to be associated with a new substance exposed birth. CONCLUSIONS: The use of recovery coaches in child welfare significantly decreases the risk of substance exposure at birth. Integrated and comprehensive approaches are necessary for addressing the complex and co-occurring needs of families involved with child protection.

Income barriers faced by individuals in receipt of Temporary Assistance for Needy Families (TANF).

Research surrounding welfare to work programs suggests a number of potential factors that mediate welfare dependency ranging from a person's degree of employment barriers to their psychological well-being. This study explores how employment barriers, health barriers, background barriers, human capital barriers, and psychological well-being of individuals in receipt of TANF are related to earned income. Findings indicate that employment barriers, background barriers, human capital, and perceived locus of control are significant factors in determining welfare recipients' future earned income. Other barriers including physical health and psychological well-being such as depression, happiness, life satisfaction and optimism were not strong predictors of earned income.