Integrated specialty mental health care among older minorities improves access but not outcomes: results of the PRISMe study

Abstract

While providing services in primary care results in better access to and use of these services, accessing these services is not enough for assuring adequate clinical outcomes.

Recruitment and Retention of Ethnic Minority Elders into Clinical Research

“…Despite the challenges inherent in conducting clinical research with ethnic minority elders, some trials have 19 Similarly, other studies have effectively recruited diverse groups of ethnic minority elders into caregiver research by establishing strong connections within the target community. [20][21][22] In an excellent example of minority recruitment strategies, the Sacramento Area Latino Study of Aging successfully recruited 1789 Northern-Californian Latinos with a mean age of 70.6 years to study the prevalence of mild cognitive impairment and/or dementia of various types.…”

“…The 2003 National Assessment of Adult Literacy studied prose, document, and quantitative tasks in 19,200 Americans and found 14% at the below basic level, 22% at the basic level, 53% at the intermediate level, and less than 12% at the proficient level. 14 Hispanics represented 41% of the "below basic" level (the simplest, most concrete skills such as locating easily identifiable information and following written instructions such as what is ok to drink before a medical test) compared with 9% White, 13% Asian/Pacific Islander, 24% Black, and 25% American Indian/Alaska Native.…”

Barriers and Facilitators of Hispanic Older Adult Mental Health Service Utilization in the USA

“…Hispanic elders, caregivers, and mental healthcare workers have identified the lack of mental health clinics in Hispanic neighborhoods as a barrier to accessing care (Barrio et al, 2008). One study revealed that when mental health and substance abuse treatment were integrated into a primary care setting, Hispanic older adults with depression, anxiety, and/or alcohol misuse were 3.6 times more likely to utilize mental health services compared to if the services were offered in a specialty mental health setting, regardless of whether case managers were available to connect them with community services (Areán et al, 2008). This is consistent with research findings on the Hispanic community that they are more likely to use services located within a familiar setting (Ojeda & McGuire, 2006).…”

“…Studies with a cross-sectional design are unable to establish cause-and-effect relationships between barriers and mental health service use. Two studies identified possible limitations related to their intervention; one study's intervention was not designed specifically for ethnic minorities (Areán et al, 2005), and the other revealed inconsistent intervention implementation among its sites (Areán et al, 2008). Furthermore, the Hispanic sample in one of those studies consisted of only participants who spoke English (Areán et al, 2005).…”

Behavioral health coaching for rural veterans with diabetes and depression: a patient randomized effectiveness implementation trial

“…In response, researchers and clinicians have tried to increase the availability of providers and behavioral health services. For example, training non-mental health clinicians to provide basic mental health services has been shown to improve the provision of mental health care in primary care settings (e.g., Areán et al [16]). Other modifications include the use of telephone-based mental health care, which eases travel burden on patients, and, in some contexts, appears to perform as well as face-to-face care, with lower attrition rates [17].…”