The overall goal of the proposed application continues to be the examination of the help seeking process for mental health services of poor Puerto Ricans. However reform in the organization of the public health care system in Puerto Rico with the adoption of privatized managed health care provides a unique opportunity to examine how variations in the health care system might impact the process of seeking care for mental health problems. The two major aims of the proposed study are: 1) to determine the impact of managed care on help seeking for ental health problems among poor Puerto Ricans. Specifically, we will examine if there are changes in the probability of use, patterns of provider and continuity and extent of treatment under managed and non-managed health care; and 2) to identify the factors that predict changes over time in the use of services, provider patterns, and continuity and extent of treatment for a mental health problem (help-seeking). Special emphasis will be placed examining of predictors of help-seeking vary for individuals under managed and non- managed care. Our study population consists of an islandwide community- based sample of 3,507 adults previously interviewed over two data collection periods one year apart. Health care reform in Puerto Rico is being implement stepwise, by taking one region at a time. Throughout most of 1996, puerto Rico will virtually have one half of the island under reform (under managed care) while in the remaining half, health services for the indigent will continue to be provided through public facilities (without managed care). This allows us the unique opportunity to use our earlier collected data as a baseline, and to study the influence of managed mental health care relative to help-seeking in a pre/post quasi- experimental control group design. This study design will permit comparisons of the help-seeking process between individuals living in regions with and without managed health care, as well as, comparisons of the same individual's help seeking behavior before and after health care reform. To examine specific hypotheses the analyses encompass the use of multivariate logit or multinomial regressions and a variety of random- effects regression models that make full use of the longitudinal aspects of the data. The results of the study will provide information of relevance for health service planners and providers.
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