ETHNIC MATCHING AND USE OF MENTAL HEALTH SERVICES

这项研究解决了种族匹配的心理健康客户与 实践者和这种匹配的关系，以利用 公共部门的心理健康服务。 文献中包含了许多 种族匹配的研究，但很少有足够的范围，严谨， 与真实的实践世界中的服务系统相关， 可靠的知识基础。 在评估种族匹配影响的方法中， 学习会在几个方面比其他方面更好。 具体而言，它将： (1)评估基于种族的匹配，以及两种不匹配（配对 一个少数民族客户与一个白色从业者;配对一个少数民族客户 与来自客户以外的少数群体的从业人员）; (2)考虑种族的强度（匹配会话的比例） 匹配;（3）区分基于种族的匹配和基于语言的匹配 匹配;（4）在从业者层面区分匹配 和程序或子程序;（5）同时考虑三个主要的 与白人沿着的少数民族群体，（6）侧重于特定类型的利用 以及以费用较低的服务替代的可能性 对于更昂贵的。 匹配的这些方面将在 以客户和临床医生为大样本的研究设计，以及 指定基于理论的多变量利用率模型。 本研究的数据将取自精神健康账单信息 系统（MHBIS）在圣克拉拉县，以及城市和县的圣 加州的弗朗西斯科。 客户、临床医生和项目信息 将来自1987-1988财政年度的这些相同的管理 信息系统。 这些来源将提供大规模的数据， 少数族裔和白色客户的非重复样本。 具体研究几个问题：（1）什么是关系 门诊医生和客户的种族匹配（匹配与不匹配 与白色从业者或与少数民族从业者不匹配），以： 利用特定类型的服务（门诊，病例管理， 医院、急诊室、上锁的、住宅）;以费用较低的 更昂贵的服务形式，以及终止时的状态（成功与 撤回/单方面解除vs.其他）？ 的关系是什么 门诊语言匹配这些结果？ 是什么关系 门诊计划匹配（分配到以种族为重点的计划与 #21453;，这些成果？ (2)两者之间的关系如何 匹配类型和这些结果受易感因素调整的影响 变量（客户性别、年龄、婚姻状况、教育、就业）， 访问变量（客户收入，保险范围;临床医生性别，年龄， 专业地位、培训年限）和需求（GAS评级和DSM III-R 诊断）？ 研究结果将对政策制定者、理论家和 从业者 决策者将获得客观信息， 考虑少数族裔利用的收益和损失， 强调各种类型的匹配。 理论家可以了解真实的 匹配的世界意义，因为他们试图了解心理健康， 跨文化背景 临床医生可以更好地评估他们的优势， 作为精神卫生服务提供者， 继续教育的机会，并作出决定， 他们的工作量的组成。

This study addresses ethnic matching of mental health clients with practitioners and the relationship of such matching to utilization of mental health services in the public sector. The literature contains many studies of ethnic matching, but few of sufficient scope, rigor, and relevance to service systems in the real world of practice to provide a reliable foundation of knowledge. In its approach to evaluation of the impact of ethnic matching, the present study will improve in several respects upon others. Specifically, it will: (1) evaluate ethnic-based matching, and two kinds of mismatching (pairing of an ethnic client with a white practitioner; pairing an ethnic client with a practitioner from a minority group other than that of the client); (2) consider the intensity (proportion of matched sessions) of ethnic matching; (3) distinguish between ethnic-based matching and language-based matching; (4) distinguish between matching at the level of the practitioner and the program or subprogram; and (5) simultaneously consider three major ethnic groups along with whites, (6) focus on utilization of specific types of services, and the possibility of substitution of less costly services for more costly ones. These aspects of matching will be addressed in a research design that features large samples of clients and clinicians, and specifies a theory-based multivariate model of utilization. Data for the study will be taken from the Mental Health Billing Information System (MHBIS) in use in Santa Clara County, and the City and County of San Francisco, California. Information on clients, clinicians, and programs will come from fiscal year 1987-1988 from these identical management information systems. these sources will provide data on large nonduplicated samples of minority and white clients. Several specific questions will be studied: (1) What is the relationship of ethnic matching of outpatient clinician and client (match vs. mismatch with white practitioner or mismatch with minority practitioner) to: utilization of specific types of services (outpatients, case management, hospital, emergency, locked, residential); substitution of less costly for more costly forms of service, and status at termination (successful vs. withdrew/unilaterally discharged vs. other)? What is the relationship of outpatient linguistic matching to these outcomes? What is the relationship of outpatient program matching (assignment to ethnic-focused program vs. other program) to these outcomes? (2) How is the relationship between each type of matching and these outcomes affected by adjustment for predisposing variables (client gender, age, marital status, education, employment), access variables (client income, insurance coverage; clinician gender, age, professional status, years training), and need (GAS rating and DSM III-R diagnosis)? Results from the study will be of use to policymakers, theorists, and practitioners. Policymakers will gain objective information as they consider gains and losses in minority utilization that result from an emphasis on various types of matching. Theorists can learn about the real world implications of matching as they seek to understand mental health in crosscultural context. Clinicians can better evaluate their strengths and weaknesses as providers of mental health service in considering opportunities for continuing education and making decisions about composition of their caseloads.