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Health Services Organization

by: Mr. Granville Champlin

Health Services Organization HLT SER 100

Mr. Granville Champlin
GPA 3.71


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Class Notes
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This 64 page Class Notes was uploaded by Mr. Granville Champlin on Friday September 4, 2015. The Class Notes belongs to HLT SER 100 at University of California - Los Angeles taught by Staff in Fall. Since its upload, it has received 91 views. For similar materials see /class/177322/hlt-ser-100-university-of-california-los-angeles in Health and Human Services at University of California - Los Angeles.

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Date Created: 09/04/15
Mental Health and Ethnic Minorities A Supplement to Mental Health A Report of the Surgeon General Why ethnic minorities Growing awareness of disparities in health care 0 Initial Report had scant coverage 0 Growing population Immigration to the US 1924 Immigration Act national origins system 2 of foreignborn in 1890 0 Until 1960 majority of all legal immigrants were from Europe and Canada 0 1965 Immigration Act 20000 from each country in Eastern Hemisphere Ethnic Minorities in US 12 African American 12 LatinoHispanic American 4 Asian American 07 American IndianAlaskan Native Growing and More Diverse 30 of population 0 In 50 years 57 of under 18 0 Immigration now worldwide What is race Racism Indirect effects through stress segregation poorer education 0 Direct effects through inequitable distribution of medical resources Legally sanctioned discrimination and exclusion of ethnic minorities is the rule rather than the exception for much of the history of this country Poverw of Ethnic Minorities 8 of White Americans 0 12 of Asian Americans Pacific Islanders 0 25 of BlackAfrican Americans 0 25 of Hispanic Americans 0 26 of American IndiansAlaskan Natives Culture Counts Risk factors protective factors family involvementsubstance abuseetc Diagnostic factors idioms of distress culture bound syndromes Intervention factors likelihood of quality care environmental supporttolerance Need for Care Psychiatric diagnoses in community 0 Symptoms of distress Culture bound syndromes 0 Presence in vulnerable groups Vulnerable groups Homeless 35 times higher rates of disorder than general community Incarcerated rates of serious mental illness 23 times greater than community 0 Children in foster care are 8 times more likely to experience hospitalization than children in AFDC families Vulnerable groups Continue Exposure to trauma 20 years after the war Vietnam theater veterans 5 times more likely to have current PTSD than Vietnam era veterans for women 9 times as likely Alcoholdrug abuse 2 to 3 times more likely to have anxiety or depression Mental Health Care Availability of care 0 Access to care 0 Use of care 0 Quality of care African Americans Historical Context 50100 million kidnapped into slavery 1661 legalized slavery 1865 slavery abolished 1954 Brown v Board of Education 1964 Civil Rights Act Whites attitudes still most negative African Americans today 55 live in South 0 large inner city urban populations 0 38 children in twoparent families 0 high school graduates similar to whites not only less income less wealth poorer health status Need for Mental Health Care Community rates ECA similar except older males with cognitive impairment NCS similar with lower rates of depression Vulnerable Populations Homeless 40 African American Incarcerated nearly 50 of all prisoners in state and federal jurisdictions are black 0 Foster care 45 of the children in foster care are African American Exposure to violence More exposure in the community for youth and adults 0 More exposure of African Americans in Vietnam than whites Summary of Need for Care African Americans in the community are similar to white Americans despite poverty 0 African Americans are overrepresented in vulnerable groups Availability of Care African American care givers are rare 2 of psychiatrists 2 of psychologists 4 of social workers 0 Availability of care in rural areas is limited Access to care Health insurance 56 private health insurance 21 public health insurance 23 uninsured 15times rate of whites Utilization of Care ECA odds of African American with disorder receiving care about 12 that of whites NCS 15 with a mood disorder get help 0 African Americans with insurance less likely to get care than whites with insurance Appropriateness of Care Mood disorders overdiagnosed as schizophrenic Less likely to receive care for appropriate care for depression 0 Receive high doses of anti psychotics African Americans Summar Those in the community well but highly overrepresented in vulnerable groups Poorer availability access and use of care Poorer quality care when received American IndiansAlaskan atIves Historical Context European contact in 17th Century exposure to disease 1820 Indian Removal Act onto reservations 1887 Dawes Severalty Act allotted land to Indians lost surplus lands 1900 s only 5 of original population survived Historical Context Continued 1924 Congress granted citizenship 1934 Indian Reorganization Act civilizing and teaching Christianity boarding schools 0 1950 s withdrew most support 0 1970 s began tribal authority 0 1978 granted religious freedom American IndiansAN Toda 1 in 5 lives on reservation numbers grew substantially during the 1970 s 0 42 in rural areas 0 66 under 25 have completed high school crossover effect c 27 female headed household 17 nation poorer health although improving Need for Mental Health Care No available community study 0 National telephone survey higher rating of poor mental health CDC Suicide rates 15 times national Vulnerable Groups Homeless 8 of US homeless Incarcerated about 4 AlcoholDrugs 27 of men and 13 women have alcohol related deaths 0 Fetal Alcohol Syndrome 297 1000 vs 009 whites Vulnerable Groups Cont Exposure to Violence rate of violent victimization over twice that in the nation as a whole Northern Plains youth 61 exposed to violence 0 Children in Foster Care Prior to 1978 2530 children removed from families Summary of Need for Care Rates in the community are unknown but factors such as suicide rates suggest high rates of mental disorders are likely Homelessness incarceration exposure to violence and substance abuse major concerns Availability of Care 0003 of physicians American Indian or Alaskan Natives 29 psychiatrists in US are American Indian or Alaskan Native Access to Mental Health Care Only half of American IndiansAlaskan Natives have employer based insurance 0 25 have Medicaid Only 1 in 5 live near an IHS facility 0 More than 13 have no usual source of medical care Use of Mental Health Care Very little data available on use of services findings are inconsistent Children more likely to receive care in juvenile justice than mental health system Quality of Care Almost nothing is known regarding the quality of care of for American Indians and Alaskan Natives Little is known about rates of disorder or use of care 0 Of particular concern is exposure to violence and substance use and abuse in this population Asian Americans Historical context Early immigrants Chinese Filipino and Japanese 1882 Chinese Exclusion Act 1924 banned all immigrants from Asia except diplomats and students 1952 Asians first eligible for citizenship Historical Context Cont 1965 waves of Asians from China Philippines South Korea and India 0 Southeast Asian refugees from Vietnam Laos and Cambodia 0 19801990 Asian population in US nearly doubled 23 of Asians in US not born here Asian Americans Today Largest share of every Asian American group lives in California 0 35 of Hmong live in Minnesota and Wisconsin 0 Children more likely to live with both parents than any other group 0 Higher incomes overall with some impoverished groups Asian Americans Today Even among impoverished Hmongs rates of attendance at college for those under 25 is similar to white population 0 Health status of Asian Americans generally better than white Americans Need for Mental Health Care One study of Chinese Americans in LA current rates of depression 34 vs 10 in white Americans Followup at 18 months those who speak English more likely to become depressed than those who do not speak English Suicide rates 7 vs 13 in whites Culture Bound Syndromes Neurasthenia 7 of Chinese Americans living in LA more than half no DSM disorder Vulnerable Groups Southeast Asian refugees have high rates of trauma exposure Cambodians highest level of trauma exposure followed by Lao and Vietnamese Southeast Asian refugee children have high rates of PTSD and depression 48 of children surviving Pol Pot regime have current PTSD and 41 depression Availability of Care Approximately half the ratio of providers as are available for white Americans 0 No data on language of providers but nearly half of Asian Americans are not fluent in English Access to Care 21 of Asian Americans lack insurance 34 of Koreans 20 Chinese Filipinos Among low income Asians 13 have Medicaid compared with 24 of low income whites Use of Services Virtually every study finds that Asian Americans use less services than do any other group Asians who do use care are often more disturbed than whites who use care Quality of Care Asian Americans stay in care longer if care is ethnic specific 0 Little is known about quality of care received by Asian Americans Summary of Asian Americans Little is known about mental health of diverse Asian groups 0 Overall indicators are good for Asian Americans 0 Asian Americans who do not care rarely use mental health services 0 Southeast Asian refugees are at high risk for disorder Historical Context for Latinos Many Mexicans became citizens when territories from Texas to California became part of the US The instability of the Mexican Revolution early 1900 s brought many Mexicans to the US migration has continued from Mexico at a steady pace Historical Context for Latinos Puerto Ricans began to immigrate in 946 displacement of agricultural workers in the Caribbean Cubans influx when Batista government was overthrown by Fidel Castro in 1959 largely professionals others have continued to come with fewer resources Historical Context Latinos Since 1970 s many Central Americans have come fleeing civil wars in their homelands Citizenship 100 Puerto Ricans 51 Cubans 15 Mexican Americans Latinos in the US Today Largest in the Southwest 0 Only 14 households one person 30 white and black 0 20 single parents 9 Whites 1996 57 of Hispanics ages 18 24 completed high school Nearly half of all foreignborn Latinos drop out of high school Health of Hispanics Latinos have lower infant mortality than do white Americans 0 Similar socioeconomic to African Americans but less then 12 infant mortality rate 0 Health indicators for Puerto Ricans worse than for other Latinos Need for Care Mexican Americans come to the US with significantly lower rates of mental disorders than do white Americans o 25 of Mexican immigrants have a disorders as compared with 48 of Mexican Americans born in the US Rates increase after 13 years in US Need for Care continued Rates are similar for most other Latino groups although there is some indication that Puerto Ricans in New York have high rates of depression Latino youth and children show more evidence of disorder than do adults Culture Bound Syndromes Ataque de nervios screaming uncontrollably attacks of crying trembling and becoming verbally or physically aggressive found in 14 of Puerto Rican population Vulnerable groups Incarcerated Approximately 9 of Hispanics are incarcerated as compared with 3 whites Hispanic men are 4 times more likely to be in prison during their lives than white men 0 Exposed to trauma Central American at high risk for exposure to trauma Vulnerable Groups cont Substance abuse Latino males who are US born are at somewhat higher risk for substance abuse than are white men Summary of Need Latinos come to the US with low rates of mental disorders 0 Rates increase over time Latino youth appear to be at increased risk for disorders Latinos are overrepresented among incarcerated and those exposed to violence Availability of Care Only 22 of Latinos speak English well 0 Ratio of mental health workers to population Latinos 29100000 Whites 173 100000 Access to Care 37 of Latinos are uninsured nearly double the rate of white Americans 0 Only 43 have workplace coverage compared with 73 of white Americans 0 18 have Medicaid Utilization of Care Latinos are less likely to use care than are white Americans Latinos with mental disorders are less likely to use care than are white Americans 0 Less acculturated Latinos who need care are less likely to seek care than are more acculturated Latinos who seek care Quality of Care Latinos with bipolar disorder are more likely to be misdiagnosed as schizophrenic as compared with whites Nationally Latinos who do receive care are less likely to receive guideline concordant mental health care than are white Americans Summary of Latinos Latinos have increasing rates of disorders through time living in the US Latino youth have low rates of graduation from high school and high rates of mental disorders Latinos are less likely to receive any care or appropriate care than are white Americans


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