Family First: The Development of an Evidence‐Based Family Intervention for Increasing Participation in Psychiatric Clinical Care and Research in Depressed African American Adolescents

Abstract

Researchers have documented health disparities for African American and other youth of color in the area of mental health. In accordance with calls for the development of innovative methods for use in reducing these disparities, the purpose of this article is to describe the development of an evidence-based intervention targeting the use of psychiatric clinical care by African American families. The authors summarize current research in the areas of perceived and demonstrated bias in the provision of mental health services, the significance of the problem of low African American participation in psychiatric clinical research and care, and evidence-based approaches to conducting family-oriented research to address adolescent mental illness in this population. This discussion is followed by a description of the development of an intervention to improve familial treatment engagement and plans to test the intervention. The article is provided as a foundation for carefully defined plans to address the unmet mental health needs of depressed African American adolescents within a culturally relevant familial context. Recent research suggests that African American and other adolescents of color face grave disparities compared with their White counterparts in the burden experienced by mental illness and in the appropriateness of indicated behavioral and pharmacological treatments for psychiatric illnesses (Breland-Noble, 2004; U.S. Department of Health and Human Services, 2001). Specifically, recent research indicates that African American youth with mental health and behavioral problems in the foster care system, and therapeutic foster care specifically, have a greater likelihood of involvement with the juvenile justice sector and in-home counseling and crisis services. Further, recent research suggests that African American youth are Keywords

Referral and Resource Use Patterns for Psychiatric-Related Visits to Pediatric Emergency Departments

“…Studies have documented health disparities for African Americans in mental healthYrelated services and interventions. 18 African American families across socioeconomic strata make less use of traditional mental health services than white families 19 and may only seek care for their children in mental health crises. In addition to parent referrals, law enforcement and school officials also contributed to the ED referral base, which may reflect the zero tolerance policy of many school districts and, again, the lack of timely access to mental health care for children in crisis.…”

Clinical research in adolescents: challenges and opportunities using obesity as a model

“…49 Traditional clinical research fails to appeal to adolescents' interests, generally does not use age-appropriate modes of communication, and is unlikely to tap into peercondoned behaviours and activities. 44,50 Studies that involve more adolescent-friendly protocols, including internet and SMS facilities, are starting to appear in the literature with some encouraging results , although to date the adolescent obesity literature is sparse. [51][52][53][54][55][56] Much clinical research relies on hospital and health-care networks.…”

“…Consequently, a focus on health is a low priority for adolescents, unless they perceive that its value or impact will be immediate. 44 Second, adolescents are a difficult group to engage in health research. They are not driven by current morbidity, as are adults, and they are not always willing volunteers.…”

“…[43][44][45] Recruitment and retention, consent and confidentiality and the additional roles of parents and guardians are important considerations. To achieve meaningful results, the challenge of achieving adequate numbers is well recognized for paediatric and adolescent obesity studies.…”

Treatment‐Seeking Disparity Between African Americans and Whites: Attitudes Toward Treatment, Coping Resources, and Racism

“…This treatment-seeking disparity is often explained through an emphasis on African Americans' attitudes toward mental health service, coping resources in the African American community, and forms of racial bias in mental health care (Breland-Noble, Bell, & Nicolas, 2006;Snowden, 2003). Much of the research on the treatment-seeking disparity does not emphasize subtle forms of racism in mental health treatment.…”