Clinician Factors Related to Outcome Differences Between Black and White Patients at CMHCs

Abstract

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 multi-cultural 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.

Racial/ethnic disparities in client unilateral termination: The role of therapists’ cultural comfort

“…Additionally, Hayes et al (2014) replicated these findings in a study of 36 therapists and 228 clients at a university training clinic; however, they examined racial/ethnic disparities in client-reported changes in psychological distress (i.e., Outcome Questionnaire-45; Lambert et al, 1996) as a result of treatment. Larrison et al (2011) also replicated these results in a community mental health sample of 551 clients and 62 therapists. They found that approximately 20% of therapists had better treatment outcomes (i.e., reduction in psychological distress based on the Behavioral and Symptom Identification Scale-24; Eisen, Dill, & Grob, 1994) with their White clients as compared to their Black clients.…”

“…Building upon this literature, researchers have also found therapists to be one of the primary sources of racial/ethnic disparities in mental health treatment outcomes (Hayes, Owen, & Bieschke, 2014;Imel et al, 2011;Larrison, Schoppelrey, Hack-Ritzo, & Korr, 2011;Owen, Imel, Adelson, & Rodolfa, 2012). That is, racial/ethnic disparities emerge primarily when the differential outcomes between REM and White clients within therapist caseloads are examined.…”

Cultural Competence in the Treatment of Addictions: Theory, Practice and Evidence

“…Clinicians are one of the primary sources of racial/ethnic disparities in mental health treatment outcome (Hayes, Owen, & Bieschke, 2015;Imel et al, 2011;Larrison, Schoppelrey, Hack-Ritzo, & Korr, 2011;Owen, Imel, Adelson, & Rodolfa, 2012). Owen et al (2015) argue that racial/ethnic disparities emerge mainly when differential outcomes between CALD and mainstream clients within therapist caseloads are examined.…”

Racial Differences in Mental Health Recovery among Veterans with Serious Mental Illness

“…Audio recordings of consumer-provider encounters for depression treatment found that providers engaged in less rapport building communication with black consumers and, despite no differences in patient symptomatology levels, providers were less likely to perceive black consumers as experiencing significant emotional distress [25]. Studies of mental health providers have documented inconsistent treatment outcomes between black and white consumers based on provider cultural competence [26, 27]. Researchers have attempted to address this issue by identifying provider behaviors that contributes to disparities [28], as well as cataloging culturally unique interaction patterns and communication behaviors to inform culturally sensitive care [29, 30].…”