Ethnoracial status, intersectionality with gender, and psychotherapy utilization, retention, and outcomes.

Abstract

Objective: Psychotherapy access, utilization, retention, and effectiveness require continued improvement, especially for groups for whom availability and outcomes may be currently suboptimal, including ethnoracial minorities. Further, ethnoracial status’ intersectionality with other identity variables (e.g., gender) may relate to structural barriers to care and effectiveness of care, an area in need of further research. Method: The Florida State University Psychology Clinic, a low-cost population-facing treatment center, has routinely collected clinically relevant information on all consenting clients, including severity of clinical presentation at intake and over time, number of therapy sessions attended and of no-shows, premature termination, demographics, etc. A large sample of clients (N = 2,076; 57% women; 67.9% non-Hispanic White) on whom we collected and entered at least some data, though missing data were common, has accrued. We conducted chi-square tests to examine treatment utilization gaps, analysis of variance to measure differences in intake severity, and analysis of covariance to measure differences in treatment effectiveness. Results: Based on the percentages of ethnoracial minority groups with mental disorders in the broader local community, we are falling short in outreach to Black clients, and when we do engage them, we retain them suboptimally. Once well engaged, however, results across groups suggest few differences in outcomes by ethnoracial status, gender, or their intersection. Ethnoracial match was associated with more sessions attended in Black people. Conclusions: Psychotherapy effectiveness has the potential to be optimized for everyone, and a promising direction in this regard is the case conceptualization of a cultural formulation interview and cultural humility mindset.

Intent and impact: Connecting multicultural and social justice counselor training to community client experiences

“…With approximately half of the sample participants unable to pay monetary fees for their counseling sessions, the social justice component of the CCERC model has a demonstrated impact of providing services to community members with limited financial resources. Notably, the sample is mostly White American, heterosexual, women, also reflective of other training clinics (Joiner et al., 2022), revealing the multicultural component of the model is relatively less impactful in reaching Black, Indigenous, and People of Color (BIPOC) communities. Black residents make up 29% of the city where the CENTER is located, for example, while just 20% of participants identified as Black (U.S. Census Bureau, 2023).…”

Cost-inclusive research on health psychology interventions: Why, how, and what next.

“…If more wealthy patients use more expensive health services, and these are reduced by an HPI by a similar proportion as less expensive health services used by less wealthy patients, HPIs might be incentivized to prefer wealthier patients and those with higher income potential. These preferences, although obviously wrong, could maintain and exacerbate inequalities in access to and engagement in HPIs and inequities in wealth and income (Joiner et al, 2022). One might hope that costs of an intervention, which typically include the monetary value of patient time devoted to the intervention, would increase in direct proportion to potentially higher service cost-savings and patient earnings following effective intervention: time of higher-income patients in treatment would contribute to higher intervention costs for those patients.…”

Barriers to Mental Health Treatment in United States College Students of Color

“…Predisposing characteristics have also been referred to as attitudinal barriers, while enabling characteristics have been conceptualized in relation to structural barriers. 8 These factors work together to determine treatment seeking. For example, whereas individuals may perceive a strong need for treatment, they may lack the requisite knowledge in terms of where to locate available services.…”