I am an assistant professor in the School of Social Work.
And I also am working on this project at the Comprehensive
Cancer Center.
I have quite a team of people that work with me, some of which
are sitting over there in the audience.
And I have doctoral students, master students,
and then community partners.
because I feel like I think I'm gthat we have the ideathis,
about the disparities.
one thing and that is the Wisconsin Comprehensive Cancer
Control Plan, because it is that plan that really brought
this particular project that I'm going to talk about
to fruition.
pretty much discussed the need I think that we have
to approach cancer health for modisparities.r ways
And we've certainly had some
When we started this project, when we thought about how do we
address disparities;
since we're academicians; hwe're not in the community.ly
How do we make that link? And that's where we came up
with the model that I'm going to talk to you about today,
which we refer to as
We felt like the model needed Pto be one where somehows.
we could bridge from
out into the communities. I know from having worked in
communities for 20 years, that there is strengths
in communities, and that often
And that it's really important they're not recognized.
that it would recognize, and that a model would do just that,
and not as the academicians seegoing in to help people,rs
but rather working together and bringing both our strengths
and expertise.
that I'm going to talk about And so this is a model
We're working in nine diverse communities across Wisconsin.
It's a model that we're looking to see and testing
to see if it's replicable.
cultures? Is it sensitive to the culture
and the climate of each community?
And does it adopt a holistic
That is, not just focusing on the physical aspects of cancer,
but also the psychosocial and the spiritual.
I've done hospice work
in working with people who are for years, and what I found
psychosocial is so crucial. dyiThat's not to sayhat
that the physical is not. It is, but I think that
sometimes the psychosocial
And so that's what we really and the spiritual get lost.
an integral part of this model. wanSo, we're using CBPR, was
Community Based Participatory Research.
This has different principles.
we're really working Each one of these principles,
So, we truly want the partnership that we've
talked about, and we want it
We want there to be a joint involvement in the process,
so it's not us doing the work,
addressing these disparities. As I said before, partners
do contribute expertise.
in ownership. And I'm going to talk about
how we do that. And we increase understanding
of the issue, not just in the communities.
The communities pretty well know
It's really us going in and understanding what the issue is
in the community. And then a key component
is capacity building. And that is the outcome
of this model, we hope. That it builds capacity not only
for the community to address
the academic partners, our disparities, but also for
with communities to address capacitthe disparities.n-hand
And then this balance between research and action,
and that's very critical to me. When I do research,
it's applied research.
information, I want to see I don't just want to gather
And it's a critical component of social work.
So, here is the model.
each one of these stats. I'm going to go through
show you that this is the model But Iitself, steps 1-8.ickly
And all along these steps-- and I'll mention this--
we're training and mentoring
And we find that they're also training and mentoring us,
so it truly is a back and forth relationship.
So, the key part to this
And that's really crucial. is the partnership building.
talking with them, Meeting with communities,
We've had people tell us that's not enough.
come out to the community. you know, researchers never
But you know, it's too far They call us, they email us.
to a tribe, you know. People want to do the research,
but they don't want to make the trip.
They don't want to
We make that effort. really see the community.
communities. We go out to all of our
The community, they define And we do that regularly.
So when we meet with the boundaries.
in a community who wants an organization or a group
that community defines to work with our project,
In some, it may be-- what community means to them.
about each one. But it could be that they define
the community by zip code.
by a county. It could be that they define it
they see as their community, It's their definition of what
the project. and where they want to focus
of Understanding We always do a Memorandum
We sit down and together with our communities.
responsibilities, so that we both understand
what it is
It's a partnership agreement. that wWe each sign it.ther.
And that's the basis
In addition, our project gives for our work together.
These are grant funds. funds to the community.
the communities, but we don't give them a budget.
We don't say, "You must spend it on this."
Communities know what to do with the money.
And it's their money
So, we give them the money. I'll talk about the different
steps, and the money
But truly, we give it to them, at the different steps.
in terms of the project. and they use it as they see fit,
actively engage in the project, Tas well as I said my teamrs
is made up of students. It is really important
that we build capacity
And I think Dr. Underwood did a great job of explaining
that really, it's students. I mean, if we can really begin
to really train our young pre-professionals, and it's
not just the community, but also the students here at
the university that I work with,
work with pre-professionals as well out in the communities.
Now, our communities. We're working with nine what's
termed "medically underserved communities" in the state
of Wisconsin. One is the Sankofa Project.
Actually, Dr. Underwood is on the board of the Sankofa Project
under the American Cancer Society.
And it's African Americans, really at a community level,
addressing cancer health
Wisconsin Coalition and Mutual disparities.
Hmong population. And let me say on Sankofa,
they define their community as three zip codes.
So we're working in those three zip codes.
The Hmong community defined it as the state.
The clans are so, they said that there is really no way
to say this is our community, because the clans
work so closely together. Latino Health Council
of Dane County. Dane County is their community.
Gerald Ignace Health Center of Milwaukee.
This is an urban American-Indian
They define theirs as anyone health center.
receive services and those who who walks in the door to
But they can be enrolled are enrolled tribal members.
Scenic Bluffs Community Health Clinics.
Cashton is west Wisconsin,
We're working in two counties athere: Vernon and Monroe..
So that's the rule. And these are the new
communities, though they're no longer new, because they've
actually already finished one of the big assessments.
That is Lac Courte Oreilles Band.
And that's northwest Wisconsin. Bad River, Red Cliff.
Those are both tribes at the tip of Wisconsin.
And the 16th Street Community,
in Milwaukee. that's aAnd they serve,th center
about 95% of their population are Latino.
And they define theirs
And the reservations, it's the reservation itself.
And then we're working
not necessarily on the model. wWe're really working on,
partnership building. And we've had some.
I'll hopefully have time
because we've actually had to say a little about that,
and gone out to the community. some discussions
Care at the Cancer Center Dr. Jiwent out with us.liative
The Bishop invited people from the district,
and we sat in the Bishop's house
of cancer disparity, and discussed the issues
So, we're slowly kind of and what they felt they needed.
So step one is the partnership building.
I can't say enough about that.
it's all throughout. And it's not just step one,
to develop that partnership. It's really continuing
in all the communities Step two has been completed
And this one is the assessing of community readiness.
So here what we've done,
two assessments. is we're doing, actually,
at the individual level, Rather than just assessing
at the community level. So, we interview.
We have the community choose their leaders
that they want us to interview. And we interview those leaders
regarding resources, leadership,
culture in terms of values the climate,
It's to get an idea of how and beliefs regarding cancer.
what strengths and the leaders see what resources,
in the community context what challenges they have
And then those leaders are to deal with cancer.
in the community. interviewWe train themfessionals
on interviewing skills. And they actually conduct
the interviews themselves.
interviewed, then we analyze After the leaders have been
back to the community. the data and then report it
We give it back to the leaders We ask the community leaders.
to read through it and ask the leaders
their words accurately. Because we know we're notd
members of the community, so it's very easy for us
to make a mistake.
So, the community readiness, I've already mentioned this.
in terms of the qualitative, it does do,
The leaders give us lots it really is very rich.
when we get to the intervention of infphase of this model.elp us
But I just wanted to say also,
with this and you can actually there is a scoring that goes
to address cancer health score a community's readiness
All the way from a community disparities.
of no awareness at all, all the way to a high level
of community ownership. The score in and of itself
is a score. But it does give you an idea
of where a community is.
is higher up, in terms of stabilization,
well you don't want to go in
You know, some communities-- just with pamphlets.
community in particular Wthat is really doing a lot.ne
Sankofa, and actually we have two communities.
And so it's really important
going on in the community, to understand what's already
but we build on. so that we don't replicate,
in terms of the update. Now,The nine communities.lly,
We've got the professionals out there.
They're trained.
the interviews. And we, at this point, have gone
back to two of the communities
But we are still analyzing with the results.
But what we found is that tbasically, the communities.
are scoring lower on their level of readiness,
except for the two
And cultural beliefs and values play a critical role,
and that any intervention that we develop
will have to take that component
We also know that we're going to into consideration.
with interventions. It can't just be a standard,
"We're going to bring in
and we're going to do this." this program
community and hopefully bring in not just the community,
but the resources in the community,
the local businesses, etc.
community actively working, Peas well as peoplethe
in the Cancer Center, etc., who want to go out
and do programs.
those connections? How do we make
assessment. StIt's called, "Assessingal
the Quality of Cancer Care."
And this, we actually interview people who have had cancer,
who currently have cancer,
be receiving treatment, and people who are dying of cancer.
And we, in addition have
because as previously noted nowabout lung cancer in somervey
of our communities, particularly
we have yet to be able the tribes up north,
lung cancer, because people die so quickly from lung cancer.
So, in order to capture the information about people
who have died from lung cancer, we have the caregiver survey.
And what this survey does,
the contextual piece so we have kind of
assessment. frWe kind of have an ideaess
of what the leadership is in cancer, the resources, etc.
Now what we want to do
who are actually is we want to hear from people
in this community with taking this journey
And you know what have been ththe things that have gonee.
really well for them? What have been challenges?
And so that is where
and we really look at across the cancer journey.
As I said before, all the way from screening,
diagnosis, treatment, to those people who die.
And we assess areas.
because we didn't just want It'sto have quantitative.thod,
We really wanted to have
just to tell their story. theWe gather informationple
in all of these areas.
I basically mentioned the caregiver survey.
But we've had to develop
We have "A", instruments.
asked of all respondents. It captures basic demographic
information that would be the same across for anyone.
But we had to develop, then,
"A" kind of tells the interviewer where to go next.
Survey "B" is the one that asks questions about
whether you are currently receiving treatment.
Survey "C" is for those people
but for whatever reason, they've who have cancer,
And survey "D", they are not never received treatment.
but have in the past. currWe now have translatedent,
the surveys into Hmong
The next thing and into Spanish.
of the referral sources. is the development
process but I think it's a This has become a very integral
When we go into a community, key component of this model.
how do we get referrals, we ask the leaders about,
Where would we get them from? tAn example is our.
rural community.
we're working with And our rural community
St. Joseph's Hospital, Gunderson Lutheran,
Vernon Memorial Hospice, Vernon Memorial Hospital,
It's a community-based Hope, which is an organization.
And then the Community Health Center of Scenic Bluffs.
Referrals are coming
These are competing healthcare from all of those sources.
set down at the table to do this systems that have come together,
cuts across is they want to deal because the one thing that
Same thing Sankofa. wiThe same thing has happened..
We're working with multiple healthcare systems.
And we even found a hospice where 25% of their patients
are African-American. And that's very rare.
So the communities are really pulling together.
And I think that's one of things
effective about this model that we're seeing that's really
even if you're competing is getting people,
how can we work together. So, again with the AQCC,
kind of our update. We have the five communities.
Already, we've gotten our IRB approvals.
We're out in three communities
assessment. So, Sankofa community,
the rural community and Latino Health Council community.
So, we've moved to that.
That's as far as we've gotten Nowat this point.s.
But our next steps are
this individual data. We'll take that data,
again, we'll go back
We'll ask the communities, to the communities.
to different respondents. We'll randomly selectk
respondents to go back to and make sure that what we have
interpreted of the qualitative
But that data will be compiled. It'll take it back the leaders
again of the community. And then, once that data
has been approved, we'll combine
contextual data. that with the community
at the table with our community partners, and whoever they want
to bring to the table,
And the priorities and then set priorities.
based on what we've collected. will be set by the community
developed, implemented Then, an intervention will be
And with that, I don't know that our team
will do the intervention. I think that what we're seeing
is that there is so much going
They already have programs on already in these communities.
They have people who are very involved, very knowledgeable.
And I know that there have been so many people from this campus
who have contacted me saying, you know, "If a community would
like to do this, I have this
I will go in. graI will do it no cost.ct.
I would like to work
I just don't know how wito approach them.s.
I don't have the connection." So we're hoping that in
setting these priorities
that what we can do then and developing the intervention
between additional partners. is create more bridges
And this is not anything And that's really our hope.
We don't see it as, okay short-term.
but rather then what we hope when we're done we're done,
relationships with the is that we will have good enough
that we can continue to do it communitin other areas.partners,
Because I truly believe the only way we're going
to eliminate disparities
The reason I really got into is if we all work together.
in the south, of seeing what this research is that first-hand
That's where I was born, poverty, what racism can do.
My father was Potowatomie. that's where I was raised.
of American Indians what happens I've seen in terms
and what people are not given. in terms of healthcare,
and it's very important. That touches really close to me,
are working on disparities, And I finmy students,eople who
the people in the communities.
captured that piece of it. I thought Dr. Underwood really
and that we need to-- if we're ever going to bridge
racism and discrimination that lead to disparities,
then we also have to bridge these different institutions,
the competing partners. We need to make those bridges
as well.
will be how we eventually eliminate disparities.
So, quickly to conclude,
that I think disparities-- I just want to say
they're scientific, or medical, or economic challenge.
They're really an ethical challenge, you know.
So being raised American Indian I always have a hard time
with even the idea
because how do you own land? of immigration,
a country and who can't. How do you say who can come into
look on a map with the borders, The wathat's not the way.es you
That's very frustrating.
racism, and these It leethical challengesion,
that we need to address.
We've got to stop just It's a long-term commitment.
and coming back out. going in, doing our research,
And, you know, working with the communities is a first step.
I just want to thank again. None of my research team
could be here today, because
But I would say that my students they are working.
the students that we're working with in the communities
are wonderful.
They're doing interviews. ThThey've helped uss.
construct the surveys.
but it's those pre-professionals It's not just my students,
I also wish could be here today because they've really done
an amazing job. Thank you.
( applause )
covering in the next >> A sense of what I will be
We're going to focus 25 minutes, or so.
disparities. specifically on mental health
trends, trends in the state I'm goingof Wisconsin.t national
I will talk very briefly about
to begin to address these issues my research as an attempt
And then I will end by providing some practical
recommendations as to how we can go about addressing these
issues which I like to call a road map.
As I begin, I'd like to quote from the former Surgeon General
David Satcher in his
on mental health and culture, grounrace, and ethnicity.using
He stated that, "Health disparities exist for racial
and ethnic minorities, and as a result, mental illnesses have
a greater impact on the overall health, as well as the
productivity of racial
I'm very visual, and so I assume that everybody else
is very visual. So I wanted to present
just a visual image of what health disparities look like.
And this was a cartoon that I retrieved off of the Internet.
So, you can see that health is
At the bottom of the staircase conceptualized as a staircase.
At the top of the staircase, we have minority groups.
Now, I want us to be mindful we have white individuals.
simplistic, because it doesn't that this model is very
socio-economic status. take into consideration
not all white individuals are at the top of the staircase
because of these issues.
several systemic issues Along that are implicatedcan see
in health disparities.
closer to home by talking about an experience I had with a woman
on a public bus in Madison
really hones in on mental health that I think in a lot of ways
The slide is a little busy, dso I'm going to walk you
through this slide. I was on my way to work
several years ago.
I sat next to an I was a student at the time,
on the bus. The woman immediately started
a conversation with me. She said, "What are you
studying?"
counseling psychology." She then said "Good, is there
an area in psychology that
in?" you're particularly interested
particularly interested in And I responded, "Yes, I'm
The woman responded, "That's cultural issues in counseling."
like you to study that stuff." good, we really need people
a conversation with me and And then she launched into
tell you what happened to me started saying, "Girl, let me
She was standing, and I think her hand went on her hip,
and she was kind of rocking back
She said, "Sometimes I have to temood swings, you know.ence.
When the weather gets cold, I sometimes get depressed,
and I'm unhappy, you know.
is related Part of my unhappiness
living in a white city. Anyway, I decided to tell
my doctor about my mood swings. He recommended counseling.
At first I did not want to go,
folks think about counseling. bePlus, I didn't want anyonek
to think I was crazy. Well, finally I got the courage
to go to counseling.
During the first 30 minutes, I thought it might be helpful.
I need to see a psychiatrist the counselor tells me
What's wrong with that damn forcounselor?n.
He didn't even spend any time getting to know me.
He immediately started
I just needed somebody to talk talking about medication.
about medication. Well, girl, I never went back
to see his..."
Now I'm going to focus And you can finish the sentence.
And again using information from the Surgeon General's
report, he stated that, "Racial and ethnic minorities
have less access to and availability to
mental health care, and they
mental health services." tend to receive poor quality
was published recently, it was actually a physician
paper in the Annals of
Internal two years ago. was published
that even after adjusting for insurance status and income,
racial and ethnic minorities
to healthcare, and lower quality tend to have less access
And as I focus on national healthcare than whites.
disparities, I'm going to tfocus on three areas.h
I'm going to focus on:
to mental health services, accessibility or access
services, and quality of care. availability of mental health
slide, the major barrier And as you can see from the
In this country today we have 45 million Americans who do.
not have health insurance, and
make up almost 20%, in thAmerican Indians 24%,ricans
Asian Americans 16.8% or 17%
the highest group 32.7%, Latinos make up
and Caucasians 11.3%. I think we can all agree
that these numbers are high even for Caucasian individuals.
We find that there are
among this population higthat are uninsured.ment
We know that most people
through their employer. These individuals also have
low-paying jobs, in which they are unable to afford
health insurance. And also because of immigration
status as well, for the Latino
Now there are public health programs for individuals that
are poor or live in a certain level of the poverty line, but
the issue with those programs is that the enrollment process
is pretty complicated.
first language, then you have Ansome added complications inour
trying to access those services,
of limited knowledge but then there is also the issue
In addition to these factors, we about those programs.
and as we think about also hamental illness. stigma,
And in the African-American community, and in other
minority communities, I would say even in Caucasian
communities as well,
have a mental illness problem, when we hear that people
That's the language we thinkthat we use."crazy."
And so seeking mental health
a confirmation services is simply
Then there is also the issue that you are indeed "crazy."
We know that in the minority of spirituality.
of these individuals community that high numbers
The problem with religious are using religious coping.
seeking treatment. coping is that it then delays
do seek treatment, And so when these individuals
that they're dealing with are quite severe at that point.
And then there is the issue of availability of services.
And availability is dependent on area of residence.
We know that a large number of African-Americans live
in rural south, where they have limited access
to mental health services.
are living reservations Americwith limitedagain,
mental health services. This is also an issue for
poor white individuals that are also living in rural communities
and have limited access to mental health services.
Now, interestingly, mental health providers
are concentrated in urban areas,
numbers of minorities anliving in urban areas,ge
they tend to concentrate
we don't have mental health in services available.ere
So we've got some interesting dynamics going on there.
Then, we also have
accept Medicaid pror Medical Assistance.ot
And I actually had a private
And my co-workers, very well practice here in Madison.
"Earlise, be careful about intentioned said to me
clients you have how many Medical Assistance
they require more time." on your case load because
They certainly require And that is indeed the case.
I had a client that I worked more time.
at different times of the day with, Iand nightt calls
regarding pretty severe issues
within the home. that was happening
community mental health centers our very own Dane County
Mental Health Center
to low-income individuals. that provide services
at the mental health center. Well, there is a long wait list
the wait list is anywhere Ibetween 8-11 months.w
And we know that when these individuals call for services,
they're needing services right away.
In fact, they're needing it yesterday, maybe a month before.
So having to wait 8-11 months before you get your
first appointment is really unacceptable.
Quality of care.
colleagues, they found that Solder African-Americans who-
were diagnosed with depression
not to receive anti-depressant were twice as likely
compared to white individuals. medications
report, he also indicated that, In"African-Americans compared's
to Caucasians, were less likely to receive anti-depressants
when first diagnosed
And in a study that was withrecently conducted bylem."
Malphy and colleagues, they found that African-Americans
are more likely to be prescribed
and less safe tricyclic anti-depressant medications
while Caucasians
to receive newer, safer, were significantly more likely
And there is some recent and more tolerable SSRIs.
indicating that African-Americans experience
high rates of side effects
medication, but yet they on tricyclic anti-depressant
that medication. are being prescribed
population in quality of care. Looking at the Latino
by Skellar and colleagues, In a study conducted
were 50% less likely to receive either a diagnosis of depression
or anti-depressant medication compared to Caucasians.
Another study conducted by Sleet found that Caucasian
physicians were more likely to provide information
about anti-depressants
compared to Latino patients. to Caucasian patients
by Barovski and colleagues In another study that was done
services, they found that Latinos and African-Americans
were less likely to be detected of having major depression
compared to Caucasians. And as you've noticed,
I haven't really talked much
or Pacific Islanders about Asian-American
And that is because we don't and Native Americans.
studies focusing on care have large epidemiological
to be able to provide and any sort of informationions
about these groups, so certainly an area of concern.
Now, I'd like to bring the
and focus on Wisconsin, our Badger State if you will.
The information that I'm
by the Wisconsin going to present was compiled
the information that I'm Minority Health Program, and
based on inpatient care. going to present is primarily
health services for racial With regards to seeking mental
a low rate of seeking outpatient and ethnic minorities, there is
but there is a high rate mental health services,
The data that I'm going to present is based on
inpatient care. So if you look at the--
You were right Tracy, that did get cut off there.
If you can look on the Y-axis,
is age-adjusted depression what I'm trying to say there
per 100,000 persons. hospitalization rates
the bottom here on the X-axis, And then if you look on
racial and cultural groups. So looking at the rate for
inpatient care for depression among these populations,
you find that American Indian females have the highest rate
of inpatient care for depression,
followed closely by African-American women.
Now as you look at this data
Caucasian population, you see significant differences here.
And the issue with the
is even more critical Amewhen you think aboution
the size of the American Indian population
in the state of Wisconsin.
population, which works out to about 45,000 individuals.
I'm sorry about that being
It shows up on my screen cut off at the end there.
bear with me just fine, so if you'll kind of
is age-adjusted hospitalization andrates per 100,000 persons.xis
Now we're looking at rates
for Schizophrenia. of inpatient care
disparities here. AgaIf you look at theuge
African-American population,
males are hospitalized you find that African-American
compared to white individuals, at a higher rate
There is some new research at a rate of almost four times.
that Schizophrenia coming out indicating
may be over-diagnosed, in African-American males
that African-American males who may be presenting with
symptoms that meet the criteria for a mood disorder,
for example, depression or bipolar disorder,
are instead being diagnosed with Schizophrenia.
And then, they are receiving
When you look at the numbers inpatient care.
the numbers look the same fas the Caucasian population,h
again, it still is an issue of concern when you think about
the size of the American Indian population
in the state of Wisconsin.
we find the same kinds Looking at bipolar disorder,
African-American men and women of disparities, again, between
We also have the same issue here with Caucasian men and women.
population. And just when you think it
couldn't get any worse, well it does.
When you look at the rates
for alcohol and drug use. So, if you look here in the
middle, you see the data for
and again huge disparities the American Indian population
to Caucasian individuals, almost five times the rate.s
You have the same issue going on
African-American population here whenas well,k at the
almost three times the rates. I'd like to shift gears
a little bit and focus on my research to give you a sense
on how my research makes an attempt to address these issues
here in the state of Wisconsin. My dissertation which was
published two years ago in the Journal of
Counseling Psychology examined African-American
clients engaging in counseling
mental health agency. This was a qualitative study,
I had a sample
that were actually receiving of 13 African-American clients
They were able to talk counseling services at the time.
at the time. about their own experiences
going into all of the details, Without spending too much time
What we found was that these I will just present the results.
they engaged in an ongoing clients reported that
they assessed several factors. assessing process, and
match in terms of race. They aThey also assessedrapist
their own safety in counseling, how comfortable they felt
disclosing personal information in counseling,
as well as concerns about how that information
could be used against them. We had folks that were involved
in the legal system,
there about confidentiality. and so there were some concerns
about counselor effectiveness. They were also concerned
of connecting with me as an African-American client.
Do they have experience working with racial
and ethnic minority clients.
"You know, I need a therapist Onto treat me as a persone,
and not based on the information
Interestingly, they then used this assessment data to monitor
and manage the amount of self-disclosing
that they engaged in. And so as you can imagine
when they felt unsafe,
Or, they disclosed they didn't disclose very much.
It also informed decisions on a very superficial level.
in therapy. And we did have folks that
talked about leaving therapy
of a mismatch, if you will. Then we also had individuals
that were involved with the legal system that wanted to
leave therapy, but they couldn't
to be there. because they were mandated
was they engaged, again, in a very superficial disclosing so
they stayed very surface level. And another study that
I recently published, this was
that was published in the Journal of the Nationalreview
Medical Association.
in a few minutes The reference will come up
in getting further details. In this systematic review, we
examined differential treatment effects for depression in racial
and ethnic minority women.
and so we reviewed randomized Tclinical trials that focused
on depression interventions.
able to locate ten randomized Uclinical trials that had a
representative sample of racial and ethnic minority women.
What we did find though in reviewing those ten studies
is that these women seemed
or what we're calling toa collaborative care model.ce,
It seemed to provide
Now, the components that optimal clinical benefit.
includes: having culturally competent clinicians who were
trained to work with ethnic and racial minorities.
They were open to the use of medication, but in this
particular model that we looked at, there were also trained
nurses who were providing ongoing follow up assessments,
as well as support for treatment
of side effects that may occur adherence to address any issues
supporting them in continuing forthe treatment in the way as
that it was prescribed. They were open to individual
and group counseling. They need to be educated about
depression, so that they have a sense of causal factors,
about triggers, and about treatment options as well.
And with that information they then wanted the opportunity
to choose a treatment of their choice.
Case management was also
Outreach to minority individuals important.
that included childcare as weand transportation,rvices
so that they can
Okay, another publication that is actually in press.
I focused on recruiting older African-American women
to participate in mental health research.
And based on my own experiences doing this type of research,
as well as what is
what is actually missing in the literature and
to develop a model. iNow it is important to notee
that this model of recruitment
minority populations, as well. can be useful with all
to go through the entire model, but the core piece that Ie
would like you to keep in mind, looking in the middle here,
is that as we try to recruit
and ethnic minorities to participate in our research,
we need to have a culturally
such that we need to be aware of our biases that we bring
to this research. And we need to have knowledge
of the populations
as well as skill and strategies to work with that population.
And most important, we also need to establish
community partnerships, and we
long before we design need to hthe research.tnerships
And the rest of it is sort of the usual research process.
And then one final study
African-American women's beliefs focusing on examining
and ways of coping. This study is currently
on the review.
because of the issue of stigma And we designed this study
mental health services. This was a mixed method
design study. We had a sample
of 185 African-American women that were all recruited
here in Dane County.
age groups, as you can see. I am only going to present
the quantitative results. We found that the women
believed that there are several factors that can cause
mental illness, including family
as well as racism. and social problems,
mental illness is cyclical, has serious negative consequences
and can be controlled by treatment
and personal motivation.
included praying. They were open to seeking
medical and mental healthcare,
to counseling, again but they were more open
the side effects of medication. becaWe found interestinglyout
low levels of perceived stigma. And we also found some
interesting age differences.
to use religious coping Oldand to seek treatmentkely
compared to younger and middle aged women.
As I wrap up in the four
I would like to leave you minutwith some practicalining,
recommendations in terms of addressing these issues,
which I like to call a roadmap. I will focus
on those four areas.
we certainly need to include With regards to research,
in a meaningful way. racial and ethnic minorities
mandates, but we need to include I know that NIH has various
to health benefits, as well as them in a way that is relevant
We need to partner with racial in a culturally relevant way.
to increase recruitment, and ethnic minority communities
community advisory boards and by partnering with these groups
to conduct community-based
We also need to collaborate with racial and ethnic minority
researchers as well as students.
very early in their career. We need to build a culturally
diverse research team.
I believe that each department With regards to education,
a required course focusing in school needs to have
and diversity in healthcare. on cultural issues
schools and departments that I know that there are some
which I think is very important. use an integrated approach,
to have both. We also need to create research
and clinical practicum
have the opportunity to be and rotation so that students
And in terms of our own development as professionals,
as well, we need to seek out
knowledge about these issues. Clinical practice, we certainly
need to have more culturally
as well as services. competent clinicians,
state-of-the-art medication We and psychotherapies, anded,
recognize if there is a conflict
minorities participating because we don't have enough
but it certainly is an area for improvement here.
Collaborative care model
Patient-centered care, so that that I mentioned earlier.
to be involved in their care. patieWe need to partnerunity
with religious and folk healers,
they're going first, because we know that's where
We also need to focus on so we need to catch them there.
That includes location, hours, access related issues.
And with regards to service, sliding scale fee, etc.
because when we think about I the tenure process, we knowsue
that service is sort of at the bottom.
But if we're serious
we need to include service about reaching this population,
Serve on boards in the community as well.
and ethnic minorities. that are serving racial
some of the cultural events in our community as well.d
As I end in my 50 seconds remaining, just the take home
message here. If you don't remember anything
else, I hope you remember this. Disparities in mental health
care exist and is affecting the overall health status
of racial and ethnic minorities,
in rural communities. aHealth disparities can bels
eliminated, and we all have a role to play in eliminating
health disparities. I certainly encourage you
to use the information that is being presented here today
and let us all work together
( applause to eliminate health disparities.
)