Academic journal article Journal of Mental Health Counseling

Asian American Mental Health Clients: Effects of Ethnic Match and Age on Global Assessment and Visitation

Academic journal article Journal of Mental Health Counseling

Asian American Mental Health Clients: Effects of Ethnic Match and Age on Global Assessment and Visitation

Article excerpt

Effects of client-counselor ethnic match (i.e., match, no match) and client age group (child, adult) on counselor-evaluated Global Assessment of Function (GAF) and visitation were investigated. The sample consisted of 253 Asian-American outpatient clients (24.9% children 75.1% adults) of a community mental health center. Unadjusted results indicated that ethnically matched clients had more positive GAF evaluations and more clinic visits than nonmatched clients. When adjusted for eight covariates, results showed ethnically matched clients continued to show higher levels of visitation. Analysis of separate diagnostic categories showed that ethnically matched mood-disorder clients had higher levels of visitation. Conversely, nonethnically matched anxiety disorder clients showed higher GAF evaluations than their ethnically matched counterparts. Implications are discussed.

Many books, book chapters, and articles have been published on Asian-American mental health, but there is still a dearth of adequate empirical studies (Serafica, 1999; Sue & Morishima, 1982). Ethnicity has proven difficult to define, research samples are inadequately described, external validity has been underemphasized, and the adequacy of assessment methods and clinical diagnostic categories have been questioned in repeated critiques of ethnic minority research methodology (e.g., Alvidrez, Azocar, & Miranda, 1996; Cauce, Coronado, & Watson, 1998; Dana, 2000; Okazaki & Sue, 1995; Sue, 1999). More specifically for Asian-American research, Kurasaki, Sue, Chun, and Gee (2000) call for a new generation of research that goes beyond the descriptive level of identifying ethnic differences in counseling outcomes. Research that systematically examines the responsiveness of the mental health system to multicultural populations is now needed. Such research must not only acknowledge historic deficiencies in methodology but also should stem from the development and application of relevant models to systematically investigate the entire process of access and treatment for mental health problems.

A next step described by Kurasaki et al. (2000) is to identify cultural elements in the treatment process that affect treatment outcomes. As a preliminary undertaking in this direction, Zane, Enomoto, and Chun (1994) examined short-term outpatient treatment outcomes for 20 Asian Americans and 65 White Americans using client and counselor variables often confounded with ethnicity in a multiple regression design. These authors found poorer outcomes, less satisfaction, and increased symptomatology for Asian-American clients that could not be accounted for by cultural differences and were attributed to an absence of culturally responsive therapy.

The ethnic responsiveness hypothesis (i.e., the expectation of the beneficial effects of client-counselor ethnicity, language, and gender match variables upon clinical outcomes) has received sufficient support--from improved treatment outcomes as a consequence of matching clients and counselors and from services provided in culture-specific mental health settings--to warrant systematic research in greater depth (Sue, Fujino, Hu, & Takeuchi, 1991; Takeuchi & Uehara, 1996; Yeh, Eastman, & Cheung, 1994). Matching clients and clinicians for ethnicity can now be contextualized into a matrix of other relevant cultural elements to provide the necessary depth for increased understanding of the processes and outcomes of mental health services to ethnic populations.

The identification of these additional elements affecting ethnic responsiveness has been accomplished using a MANCOVA model with covariates for age, gender, marital status, Medi-Cal, (i.e., state insurance), education, citizenship, primary language, trauma, referral source, language match, gender match, and diagnosis (Gamst, Dana, Der-Karabetian, & Kramer, 2000). Using 4,554 adult clients from four major ethnic groups, this study specified some of the conditions under which matching was effective and necessary or of equivocal relevance for each ethnic group in this diverse Southern California outpatient population. …

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