Despite similar prevalence of all childhood severe and persistent mental illness except depression, there are pronounced racial disparities in use of mental health services. A variety of factors related to racism and stigma, family and illness characteristics, and service system attributes are likely to account for these disparities, but prior research on AA children is limited in these areas. We want to shift the field from simple enumeration and description of these disparities to interventions that offer culturally-sensitive ways of helping African-American families to access timely and appropriate care for their children with these illnesses. We have drawn on available evidence, results from initial focus groups conducted by our group, and our extensive clinical work with AA families dealing with early onset schizophrenia, severe affective disorders and autism to inform the initial stage of intervention design. We propose to develop an intervention to enhance knowledge and motivation to seek timely and appropriate care as well as the know-how to navigate services by means of the following specific aims: (1) To refine the'content of the proposed intervention by identifying factors that AA families feel have compromised or facilitated their use of mental health services for their children with SPMI using focus group methods;by determining the relative population prevalence and impact of these factors using a large sample survey of AA families (N= 300);and by assessing participant satisfaction with topics covered and materials employed in this intervention using postintervention evaluations. (2) To refine the structure of the proposed intervention based on interim findings, and (3) To conduct a small randomized pilot trial of the proposed intervention to estimate key parameters for the design of an adequately powered rigorous efficacy study by assessing its feasibility in terms of recruitment, completion rates, and proportion of sessions attended;by determining the most appropriate and sensitive outcome measures from possible measures including amount and/or type of mental health care received, knowledge about illnesses, knowledge about the mental health care system, strength of perception that mental health care is beneficial and desirable, self-efficacy ratings, and caregiver stress;and by estimating the effect size of the intervention compared to the control condition and associated confidence limits of key outcomes. We see this independent research project as the foundational component of a long term research agenda focused upon AA families and mental health services. The immediate next step associated with this project would be the submission of an R01 application to test the cost-efficacy of the family psychosocial intervention piloted in this study. We believe we have the vision, research capacity, and commitment to develop a sustainable research program focused on lessening disparities in mental health service use by AA families and their children.
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