Cultures of Care: Exploring Inequalities in Mental Health Services Among Mexican American Youth

Practice/Policy Question: How well suited are the practices of mainstream adolescent psychiatry to the needs and expectations of Mexican American adolescents who seek mental health care? More specifically, how do the cultural affiliations and structural position of these youth affect the quality of care they receive? And how can standard treatment practices be most effectively adjusted to account for the influence of social and cultural factors? Background: Research investigating mental health disparities among adolescents of Mexican descent in the US has linked higher rates of psychological distress and low utilization of mental health services to inequalities related to ethnicity, immigrant origins, and economic status of these youth. While this research is crucial for informing efforts to improve mental health outcomes among Mexican American adolescents, research investigating how these axes of inequality affect the quality of care experienced by youth who do receive mental health services represents an equally critical, yet relatively neglected, area for addressing these disparities. Evidence suggests that cultural and ethnic background can affect quality of care in mental health settings in ways that directly affect patient engagement and clinical outcomes. This research will contribute to building a body of evidence concerning particular ethnic and cultural factors that affect Mexican American youth engagement and outcomes in mental health care. This work will ultimately allow us to intervene in larger cycles of disadvantage in which many Mexican American adolescents are caught, by reducing inequality at the point of contact with institutions of mental health care. Research Aims or Questions: This study aims to investigate the backgrounds, perspectives, and experiences of Mexican American youth in outpatient psychiatric treatment, with a particular focus on learning how structural position and cultural affiliations influence experiences of, and responses to, psychological distress and clinical treatment. In addition, we aim to characterize clinical models and practices and clinician attitudes, particularly in relation to culture and ethnicity. Our ultimate aim is to use empirical findings to work collaboratively with clinicians and youth patients, on the development of a guide or model for adapting clinical practices—what we are calling an “evidence-based quality of care improvement model.” Setting and Participants: This research focuses specifically on the clinical setting, as a point of entry into larger cycles of disadvantage for Mexican American youth. The study includes a diverse set of participants within the clinical setting, including youth patients (n=100), their parents (n=100-200) and clinicians (n=10). Adolescent participants are youth between the ages of 12-18, who self- identify as Mexican American and are currently in treatment at an outpatient psychiatry clinic in a large urban center. The study will also include youth who have recently discontinued treatment. Intervention: There is no formal intervention proposed as part of the project, but one of the key study goals is to develop a model for intervention. Using study findings and meta-data, we propose to collaborate with clinicians, youth patients, and parents to isolate key methods and content for inclusion in a model for adapting clinical practices to improve quality of care. Research Methods: The proposed research uses both ethnographic and quantitative methods to examine how culture/ethnicity matter to Mexican Ameri