Department of Community Medicine and Population Health

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Browsing Department of Community Medicine and Population Health by Subject "CARE"

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    Geographic and Racial-Ethnic Differences in Satisfaction With and Perceived Benefits of Mental Health Services
    (American Psychiatric Publishing, 2014) Kim, Giyeon; Parton, Jason M.; Ford, Katy-Lauren; Bryant, Ami N.; Shim, Ruth S.; Parmelee, Patricia; University of Alabama Tuscaloosa; Morehouse School of Medicine
    Objective: This study examined whether racial-ethnic differences in satisfaction with and perceived benefits from mental health services vary by geographic region among U.S. adults. Methods: Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES), selected samples consisted of 2,160 adults age 18 and older from diverse racial-ethnic groups (Asian, black, Hispanic/Latino, and white) who had used mental health services in the past 12 months. Generalized linear model analysis was conducted for the United States as a whole and separately by geographic region (Northeast, South, Midwest, and West) after adjustment for covariates. Results: In the national sample, no significant main effects of race-ethnicity and geographic region were found in either satisfaction with or perceived benefits from mental health services. In the stratified analyses for geographic regions, however, significant racial-ethnic differences were observed in the West; blacks in the West were significantly more likely to report higher satisfaction and perceived benefits, whereas Hispanics/Latinos in the West were significantly less likely to do so. Conclusions: The findings suggest that there are regional variations of racial-ethnic differences in satisfaction with and perceived benefits from mental health services among U.S. adults and that addressing needs of Hispanics/Latinos in the West may help reduce racial-ethnic disparities in mental health care. Clinical and policy implications are discussed.
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    A Prospective Study of the Associations Among Housing Status and Costs of Services in a Homeless Population
    (American Psychiatric Publishing, 2015) Fuehrlein, Brian S.; Cowell, Alexander J.; Pollio, David; Cupps, Lori; Balfour, Margaret E.; North, Carol S.; University of Texas Southwestern Medical Center Dallas; US Department of Veterans Affairs; Veterans Health Administration (VHA); VA North Texas Health Care System; Research Triangle Institute; University of Alabama Tuscaloosa; Washington University (WUSTL)
    Objective: The complex needs of homeless populations result in use of a wide range of services and high costs for housing programs and psychiatric and general medical care. Allocation of resources often is not congruent with assessed needs. A series of cost-congruence hypotheses was developed to test assumptions that needs are associated with resources provided for appropriate services in homeless populations. Methods: Individuals (N=255) who were homeless were followed for two years and were categorized by housing status over time (consistently housed, housed late, lost housing, or consistently homeless). Detailed information about the individuals was obtained at baseline, and follow-up data were collected one and two years later. Extensive data about the costs of services provided by type (medical, psychiatric, substance abuse, and homeless maintenance and amelioration) were derived from 23 agencies, and service use information was collected from the agencies and by self-report. Multiple regression models were used to test the hypotheses. Results: Medical, psychiatric, and homeless maintenance costs varied by housing status. Serious mental illness predicted costs for psychiatric services, as expected, but also costs for substance abuse services and acute behavioral health care and total costs. Alcohol use disorders predicted substance abuse service costs. Conclusions: This study followed a homeless cohort prospectively and provided estimates of costs of service use derived from a large number of agencies. This research increases the understanding of patterns of service use in a homeless population and informs the provision of services appropriate to the complex needs of this difficult-to-serve population.
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    Racial Anxiety among Medical Residents: Institutional Implications of Social Accountability
    (Johns Hopkins University Press, 2019) Bradley, Lilanta Joy; Clem, Jennifer; Godsil, Rachel; MacFarlane, Jessica; Foster, Pamela Payne; University of Alabama Tuscaloosa; Rutgers State University Newark
    As the U.S. population becomes more racially diverse, physicians need to have cultural skills for optimal health outcomes; however, the literature is sparse for cultural skill application of medical trainees. This paper focuses on Family Medicine residents' perceptions of racial anxiety and their preparedness to manage cross-racial interactions. Of the 24 respondents, the majority were female. The ethnicities of respondents were 16 non-Hispanic White, five African American, and three Native American. Most participants demonstrated good general knowledge and/or self-efficacy on racial anxiety, but produced lower scores in workplace skills and actions related to racial anxiety. Thus, physician training programs should incorporate more skill development around racial anxiety. More research is needed to examine how medical schools approach multicultural education as a method of disrupting health disparities to reflect trends of social accountability and social justice.