Nolan Zane

Ethnic‐specific mental health services: Evaluation of the parallel approach for Asian‐American clients

Little research has addressed whether ethnic-specific, parallel services would eliminate outcome inequities for ethnic minorities while at the same time not creating any for White clients. This study examined parallel services for Asian-American outpatients with respect to client characteristics, types of services utilized, and service effectiveness. The oft-mentioned heterogeneity of the Asian-American clientele was affirmed. Numerous Asian–White and inter-Asian differences were found in terms of demographic and clinical characteristics. There was little evidence of differential care provided to Whites and Asians as reflected in the types of services received. With respect to service effectiveness, few significant ethnic group differences were found in premature termination, early termination, treatment duration, or clinical outcome. These results were found even when the effects of certain demographic and clinical variables (that have tended to covary with ethnicity) were controlled. The notable exception involved Southeast Asian clients who were more likely to terminate early in treatment compared with other Asian groups and received significantly less individual therapy, the most intensive and expensive type of treatment, than White clients. The findings strongly suggest that for most Asian-American groups equitable care and service effectiveness can be achieved through the use of ethnic-specific services. However, even within the parallel configuration, further service modifications and innovations may be needed to better address the mental health needs of Southeast Asian refugee communities.

Treatment outcomes of Asian‐ and White‐American clients in outpatient therapy

This study was the first to examine extensively the outcomes of Asian-American clients in mental health treatment. The research evaluated the short-term effects of outpatient individual psychotherapy. The focus on shortterm outcome was particularly appropriate in view of earlier utilization studies that have consistently found higher premature termination rates and shorter treatment stays for Asian clients relative to White clients. The study used multiple outcome criteria from two different sources: Client self-reports of symptomatology and satisfaction with services and therapist evaluations of client symptomatology and adjustment. To better interpret ethnic effects, client and therapist variables (e.g., social class and pretreatment adjustment) that often have been confounded with ethnicity were accounted for in a multiple regression design. Results indicated poorer short-term treatment outcomes for Asian-American clients. Asian clients were less satisfied than White clients on all five satisfaction indices and reported greater depression, hostility, and anxiety after four sessions of treatment. No ethnic differences were found on the therapist-rated outcome measures, but there was a tendency for therapists to evaluate Asian clients as having lower levels of psychosocial functioning than White clients after short-term treatment. The findings underscore the need for culturally responsive therapies because Asian-American clients are experiencing worse outcomes, and these outcomes cannot be attributed to cultural differences between Asian and White clients that exist prior to treatment.

Examining the effects of ethnic‐specific services: An analysis of cost‐utilization and treatment outcome for Asian American clients

Ethnic-specific mental health services have developed to meet the unique cultural and linguistic needs of the ethnic client. It has been assumed that this type of service configuration provides more accessible, culturally-responsive mental health care, which in turn, encourages utilization and enhances outcomes. Previous studies have found that ethnic-specific services (ESS) increase utilization of mental health services, but there has only been inconsistent evidence that ESS results in better outcomes. This study compared patterns of the cost-utilization and outcomes of Asian American outpatients using ESS to those Asians using mainstream services. Consistent with earlier studies, cost-utilization for ESS Asian clients was higher than that for mainstream Asian clients. Better treatment outcome was found for ESS clients compared to their mainstream counterparts, even after controlling for certain demographics, pretreatment severity, diagnosis, and type of reimbursement. Moreover, there was a significant relationship between cost-utilization and outcome for ESS clients, whereas for mainstream clients, this relationship was not significant. The findings strongly suggest that mental health services with an ethnic-specific focus provide more effective and efficient care for at least one ethnic minority group. Implications for the delivery of culturally-competent mental health services are discussed.

Differential responses to trauma: Migration-related discriminants of post-traumatic stress disorder among Southeast Asian refugees

This study examined possible differentiating experiences between Post-Traumatic Stress Disorder (PTSD) and non-PTSD refugees, after matching them on certain demographic characteristics and exposure to trauma. Previous research on predictors of PTSD usually has not controlled for differences in trauma exposure between the comparison groups. By examining individuals who have had similar traumatic histories, this study more clearly identified some factors implicated in the development of PTSD among Southeast Asians. To increase comparability with previous PTSD research, all events were assessed with reference to three time frames involving premigration, migration, and postmigration periods. The role of anger reactions was also examined in view of previous findings from the veteranbased PTSD research. Finally, this study ascertained the influence of acculturation and cultural identity orientation because these variables often have been implicated in the adjustment of Asian Americans. Results from the present study indicate that respondents with PTSD appeared to experience and express much more anger and were more dependent on public assistance. They were also less engaged in maintaining their cultural traditions and ties. However, more life changes and a trend toward more separations and reunifications with family members were evidenced for those without PTSD. The implications of these findings in developing community intervention strategies for Southeast Asian refugees who have experienced trauma are discussed.