Objective: Mental health disparities between racial/ethnic minorities (REM) and White individuals are well documented. These disparities extend into psychotherapy and have been observed among clients receiving care at university/college counseling centers. However, less is known about if campus RE composition affects outcomes from psychotherapy for REM and White clients. Method: This study examined psychotherapy outcomes from 16,011 clients who engaged in services at 33 university/college counseling centers. Each of these clients completed the Behavioral Health Measure as a of part routine practice. Campus RE composition was coded from publicly available data. Results: The results demonstrated that White clients had better therapy outcomes than REM clients when they were at campuses where there were more White students. For universities 1 SD below the mean percentage of White students, the average difference in therapy outcomes for White and REM clients was Cohen's d = .21 (with White students experiencing more improvement); however, for universities 1 SD above the mean, the between group outcome disparity was greater (Cohen's d = .38). Conclusion: Therapists and higher education professionals should consider environmental impacts on counseling services. Implications for higher education, counseling centers, and mental health disparities are provided. Public Significance StatementThe demographic composition of universities and colleges contributes to racial/ethnic disparities in psychotherapy outcomes. Providers and administrators should not only examine contextual factors on campuses, but also consider how to better support the students who comprise their unique campus communities.

Health psychology research emphasizes biological and positivist methods, giving less attention to the multifaceted sociocultural and political forces at play in health processes and outcomes. In this article, we present a new sociostructural approach for working toward racial equity in health psychology research, consistent with public psychology goals. This new approach uses the multicultural orientation framework (MCO) to guide health psychologists to consider the sociocultural and political history of their work, systems of oppression and privilege embedded in health research, and a path toward using research to achieve social change, antiracism, and health equity. We identify MCO as a tool for health psychology researchers to engage in ongoing self-reflection, cultivate cultural humility, and act upon opportunities to examine cultural factors at each step of the research process. After describing the MCO’s components of cultural humility, cultural opportunities, and cultural comfort, we introduce questions that researchers can use to guide self-reflexivity and the implementation of MCO into health psychology research focused on racial equity. Specifically, we present the issue of Black women’s perinatal health to embody the importance of applying MCO to health disparities research. We then walk through how to apply MCO in health research study development, data collection, and data dissemination. As we outline how to apply MCO to promote antiracist health research, we aim to enact social change consistent with the public psychology goals of building and fostering strong community relationships that inform social policy.

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The practice of routine outcome monitoring (ROM) has grown in popularity and become a fixture in feedback-supported clinical practice and research. However, if the interpretation of an ROM measure changes over time, treatment outcome scores may be inaccurate and produce erroneous or misguided interpretations of client progress and therapist efficacy. The current study examined whether factorial invariance held when using the Behavioral Health Measure (BHM-20) longitudinally in a clinical sample (n ϭ 12,467). Using multidimensional item response theory-based models for the investigation of the BHM-20 factor structure, at a single time point and then longitudinally. Based on the original factor structure of the BHM-20 a unidimensional model, a three-factor orthogonal model, and a three-factor correlated model were fit to the data, indicating poor model fit with the proposed three-factor or unidimensional models. Next, using exploratory factor analysis and subsequent multidimensional item response theory procedures, a new 4-factor (General Distress, Life Functioning, Anxiety, and Alcohol/ Drug Use) model was proposed with improved model-fit statistics. Finally, when testing the longitudinal invariance of the BHM-17 over 10 sessions of treatment, it was found to be fully consistent. The current study proposes the use of a 17-item, 4-factor model for a new understanding of the BHM-17. Implications for use in ROM and limitations are discussed. Public Significance StatementThe current study suggests that instruments used in ROM, specifically the BHM-20, may not be accurate in measuring client outcomes longitudinally. This is problematic because it means that client feedback data collected in session about their experience in therapy is not accurate. The current study offers a refined version of the BHM-20 called the BHM-17, which can be used longitudinally with improved accuracy.

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