ETHNIC MATCHING AND USE OF MENTAL HEALTH SERVICES

这项研究探讨了心理健康服务对象的种族匹配 从业者以及这种匹配与利用的关系 公共部门的精神卫生服务。这部文献包含了许多 关于种族匹配的研究，但很少有足够的范围、严谨和 与实践的真实世界中的服务系统相关，以提供 可靠的知识基础。 在评估种族匹配的影响方面，目前 学习将在几个方面比其他方面有所改进。具体地说，它将： (1)评估基于种族的匹配，以及两种不匹配(配对 一个种族客户和一个白人从业者；配对一个种族客户 与客户以外的少数群体的从业者)； (2)考虑民族会议的强度(匹配会议的比例) 匹配；(3)区分种族匹配和语言匹配 匹配；(4)区分从业者层面的匹配 和方案或子方案；以及(5)同时考虑三大 民族与白人一起，(6)注重特定类型的利用 以及替代成本较低的服务的可能性 买更贵的。匹配的这些方面将在 以大样本客户和临床医生为特色的研究设计，以及 指定基于理论的多变量利用率模型。 这项研究的数据将来自精神健康账单信息 系统(MHBIS)在圣克拉拉县以及圣克拉拉市和县使用 加利福尼亚州，弗朗西斯科。有关客户、临床医生和项目的信息 将从1987-1988财年起来自这些相同的管理层 信息系统。这些来源将提供大量的数据 少数族裔和白人客户的非复制样本。 将研究几个具体问题：(1)什么是关系 门诊医生和来访者的种族匹配(匹配与不匹配 与白人从业者或与少数族裔从业者不匹配)以： 利用特定类型的服务(门诊、病例管理、 医院、急诊、锁定、住宅区)；以成本较低的 更昂贵的服务形式和终止时的状态(成功与 撤回/单方面解除与其他)？是什么关系？ 门诊语言与这些结果匹配吗？这是什么关系？ 门诊计划匹配的比例(分配给以种族为重点的计划与 其他计划)对这些结果的影响？(2)两者之间的关系如何 匹配类型和这些结果受倾向调整的影响 变量(客户性别、年龄、婚姻状况、教育、就业)、 获取变量(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(气体等级和DSM III-R 诊断)？ 研究结果将对政策制定者、理论家和 从业者。政策制定者将获得客观信息，因为他们 考虑少数股利用的得失，这是由于 注重多种类型的匹配。理论家可以了解真实的 配对对世界的影响，因为他们试图了解 跨文化背景。临床医生可以更好地评估他们的实力和 作为精神卫生服务提供者在考虑中的弱点 继续教育的机会和作出关于 他们案件数量的构成。

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.