Brown Waller 3rd Annual Caribbean Conference by HC120831073519


									      Caribbean-born Adults Living
           in the United States:
The State of Mental Health and Substance
     Abuse Research and Treatment

     Alliances for Quality Education

                 Rhonda Waller, PhD
    Director of Training and Technical Assistance
                   Nakia Brown, PhD
        Director of Research and Evaluation
           Nycal Anthony -Townsend, MHS
                  President and CEO
Alliances for Quality Education (AQE)

 Specializes in building the capacity of
 academic, governmental and non-profit
 organizations to better serve their
 constituencies. Our mission is to improve the
 educational and health status of underserved
 people by expanding the capacity of the
 organizations and communities that serve

1. Identify gaps in mental health (MH) substance
   abuse (SA) research and treatment for Caribbean-
   born adults living in the United States

2. Provide recommendations to enhance the quality of
   data collected on Caribbean-born populations to
   identify and address their MH/SA needs

• Race and ethnicity are treated as
  separate concepts in the United
  States (US)

• Caribbean-born populations living
  in the US are included as “Black”
  unless they indicate otherwise
    US Census Definition
• Native-born:
  – Born in the US or one of it’s
     • Includes Puerto Rico, US Virgin
       Islands, Guam, & American Samoa
• Foreign-born:
  – Any other country or territory
     • Includes Caribbean islands/countries
       2010 Census
Race & Ethnicity Categories
• White: origins in Europe, Middle East, or North Africa

• Black/African American/Negro: origins in any African
  racial group

• Native Hawaiian/Other Pacific Islander : Hawaii,
  Guam (a US Territory), or Samoa

• Hispanic or Latino: Origins in Cuba, Mexico, Puerto
  Rico (US Territory), South or Central America
  regardless of race

• Other: “Some other race” or “two or more races”
 Health Care Use Reporting:
 Race & Ethnicity Categories
• Henry J. Kaiser Family Foundation (2009)
  National Report on Race, Ethnicity, and
  Healthcare Identifiers:
   – African American, non-Latino
   – Latino
   – White, non-Latino

• Alliance for Health Reform’s (2006): Racial
  and Ethnic Disparities in Health Care
   • White, African American, Latino, and other racial
     and ethnic minorities
“Blacks” in the United States

*does not include Cuba or the Dominican Republic
Source: U.S. Census Bureau, 2007 American Community Survey
Top 10 Metropolitan Areas of Residence for
        the Caribbean-born in US

                       (N=2.95 million) *
•   New York City/Long Island/North New Jersey (42%)
•   FL: Miami/Ft. Lauderdale (30%)
•   MA: Boston/Worcester/Lawrence (4%)
•   FL: West Palm Beach/Boca Raton (3%)
•   Washington, DC/Baltimore, MD (2%)
•   FL: Orlando (2%)
•   CA: Los Angeles/Riverside/Orange County (2%)
•   FL: Tampa/St. Petersburg/Clearwater, FL (2%)
•   Philadelphia, PA-Wilmington DE, Atlantic City, NJ (2%)
•   GA: Atlanta (1%)
    *includes Cuba and the Dominican Republic
    Source: US Census Bureau, Census 2000, Migration Policy Institute.
Caribbean-born Population by
    Country of Birth, 2000
       (n=2.9 million)
     Mental Health (MH):
    Caribbean-born Adults

• Small sample size of “Blacks”
  prevents within group comparison

• Most studies conducted in the
  United Kingdom (not the US)
       MH Research Findings

• Higher rates of depression and aggression
  among Caribbean-born (Cohen et al., 1997)

• Caribbean Blacks > US-born Blacks in
  psychological stress (Williams 2000)

• Caribbean Blacks < US-born Blacks in
  reported rates of ‘heavy’ drinking (Dawson 1998)

• Similar MH help-seeking behaviors
  (Woodard et al., 2008)
National Survey of American Life

•   2001-2003
•   University of Michigan
•   One of 3 NIMH-funded surveys
•   Used DSM-IV criterion
     NSAL Findings: MH

• Similar Overall Prevalence Rates
• By Gender  (Williams et al., 2007)

  – Men: Caribbean > US Blacks
  – Women: Caribbean < US Blacks
• MH Service Use Rates                 (Jackson et al., 2007)

  – US Blacks > Caribbean
Substance Abuse Research:
  Caribbean-born Adults

• Limited US published research

• Caribbean-born < US Blacks
  (Williams et al., 2007)

• Women: Caribbean-born < US Blacks
   (Broman et al., 2008 )
Number of MH/SA Facilities
                   ( within a 5-mile Radius)

   Boroughs                     MH Tx             SA Tx

      Bronx                       95               76

    Brooklyn                      68               86

   Manhattan                      117              144

     Queens                       35               43

MH Locator --
SA Locator --
   National Registry of Evidence-Based
    Programs and Practices (NREPP)

• Purpose
   – Connect public with intervention developers to
     help implement approaches

• Evidence-Based Interventions (EBIs)
   –   Positive behavioral outcomes
   –   Experimental/quasi-experimental design
   –   Peer-reviewed publication
   –   Public use-ready
     NREPP Search Criterion
   Current State of Affairs

• Limited MH/SA Research

• No US-based MH/SA EBIs for
  Caribbean-born populations

• Lack of EBI evaluation on
  Caribbean-born populations
    Fundamental Issue

Caribbean-born populations
that we are discussing traverse
multiple categories, but may
not adequately captured in any.
 Standards for Federal Data
   on Race and Ethnicity

• Race and Ethnicity

• Immigration Status (optional)
  – Cuba and Dominican Republic
     • CPS, NHIS, and NHANES
       Points to Consider

• Heterogeneity among “Blacks”

• Heterogeneity among Caribbean-born

• Variation in MH/SA risk profiles

• Impact of culture and contextual
  factors on treatment outcomes
      Points of Emphasis

• Important to understand health
  disparities in the US not just in terms
  of race/ethnicity, but also by culture,
  language, etc.

• In US, there exists axes of diversity
  not only among native-born, but also
  among foreign-born
         MH/SA Research

• Increase self-select identification
• Engage stakeholders to inform data
• Use qualitative data collection to
  enhance research quantitative findings
• Conduct longitudinal studies
        MH/SA Services

• Use data to develop or modify
• Evaluate EBIs for their
• Include stakeholders in EBI
        Thank You
           Rhonda R. Waller, Ph.D.
Director of Training and Technical Assistance

           Nakia C. Brown, Ph.D.
    Director of Research and Evaluation

    Alliances for Quality Education, Inc.
     1101 Mercantile Lane, Suite 104
             Largo, MD 20774
            Fax: (301) 583-8422

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