The System of Care Mental Health Service Experience: Differences in Perceptions between African American and Caucasian Youth and its Impact on Service Use and the Relationship between Receipt of Services and Emotional and Behavioral Symptoms

Abstract

Racial disparities in adolescent mental health services remain an unrelenting public health problem. The purpose of this study was to understand the differential system of care service utilization patterns and associated symptoms among African American and Caucasian adolescents with serious emotional disturbances (N = 655; M age = 13.7, 60% Caucasian, 63% male). The primary objectives were to: (1) explore differences in perceptions of mental health service experiences at 6-months by race; (2) examine race as a moderator between perceptions of service experiences and receipt of services between 6 and 12 months; and (3) explore mental health symptoms at 12 months as a function of race. Mental health symptoms for a subsample of youth (N = 548) with elevated symptoms were also examined. A secondary data analysis using data from the Comprehensive Community Mental Health Services for Children and Their Families Program (CMHI) and generalized estimating equation (GEE) analyses indicated that (1) African American and Caucasian adolescents did not differ in their overall perceptions of their service experience, (2) race did not moderate perceptions and receipt of services, and (3) race moderated the relationship between receipt of family therapy and externalizing symptoms. The results also showed that use of individual therapy was predicted by race (Caucasian) and greater emotional/behavioral symptoms at baseline, while group therapy was predicated by gender (male) and greater functional impairment at baseline. Adolescents' perceived social support from adults (not peers) predicted fewer internalizing symptoms, and Caucasian adolescents experienced fewer externalizing symptoms. The examination of mental health symptoms for the subsample revealed that race did not moderate receipt of services and symptoms. Instead, perceived social support from adults (not peers) predicted fewer internalizing symptoms, and clinician-client racial match predicted fewer externalizing symptoms. The findings suggest that African American and Caucasian adolescents share similar perceptions of their service experience, yet disparities in service use and symptomatology persist. Further, youth with perceived social support and a clinician-client racial match experience fewer mental health symptoms. Practitioners should assess adolescent's perceived social support upon receipt of treatment, discuss clinician preferences, and explore opportunities to engage African American families in family therapy.