Despite similar prevalence of all childhood severe and persistent mental illness except depression, there arepronounced racial disparities in use of mental health services. A variety of factors related to racism andstigma, family and illness characteristics, and service system attributes are likely to account for thesedisparities, but prior research on AA children is limited in these areas. We want to shift the field from simpleenumeration and description of these disparities to interventions that offer culturally-sensitive ways of helpingAfrican-American families to access timely and appropriate care for their children with these illnesses. Wehave drawn on available evidence, results from initial focus groups conducted by our group, and ourextensive clinical work with AA families dealing with early onset schizophrenia, severe affective disordersand autism to inform the initial stage of intervention design. We propose to develop an intervention toenhance knowledge and motivation to seek timely and appropriate care as well as the know-how to navigateservices by means of the following specific aims: (1) To refine the'content of the proposed intervention byidentifying factors that AA families feel have compromised or facilitated their use of mental health servicesfor their children with SPMI using focus group methods; by determining the relative population prevalenceand impact of these factors using a large sample survey of AA families (N= 300); and by assessingparticipant satisfaction with topics covered and materials employed in this intervention using postinterventionevaluations. (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 forthe design of an adequately powered rigorous efficacy study by assessing its feasibility in terms ofrecruitment, completion rates, and proportion of sessions attended; by determining the most appropriate andsensitive outcome measures from possible measures including amount and/or type of mental health carereceived, knowledge about illnesses, knowledge about the mental health care system, strength of perceptionthat mental health care is beneficial and desirable, self-efficacy ratings, and caregiver stress; and byestimating the effect size of the intervention compared to the control condition and associated confidencelimits of key outcomes. We see this independent research project as the foundational component of a longterm research agenda focused upon AA families and mental health services. The immediate next stepassociated with this project would be the submission of an R01 application to test the cost-efficacy of thefamily psychosocial intervention piloted in this study. We believe we have the vision, research capacity, andcommitment to develop a sustainable research program focused on lessening disparities in mental healthservice use by AA families and their children.
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