Access and utilization of mental health care have receive significant attention for the last two decades. While some dimensions and clusters of variables have been explored of variables have been explored, the psychological dimensions beyond the traditional continuum of psychological well-being/distress of users and non-users have been conspicuously under-explored. The present research program redresses this state of affairs by focusing on specific psychological dimensions while attending to the more traditional variables, such as predisposing characteristics, enabling factors, and need. Specifically, knowledge, values, beliefs, and attitudes help by contrasting ethnic groups with respect to the most typical mental health care service, psychotherapy, are systematically researched. Moreover, these psychological dimensions are viewed in the cultural matrices in which they acquired. The pivotal theoretical framework of this research program integrates two sources. The framework operationalizes the behavioral model of access to care while redressing its limitations by adding the conceptual model of social representation. The latter does justice to the psychological and cultural dimensions underplayed in the prior model. The first phase of the program will pilot test the instruments and procedures to be used on a sample of psychotherapy users of a university outpatient psychotherapy clinic. The second phase will pilot test the bilingual (English/Spanish) instruments and procedures in a small sample of the intended population, while gathering information on the decision- making process from individual interviews and focus groups. The third phase of the research will examine the decision-making process used by clients scheduled for their first visit to outpatient mental health clinics. Caucasian participants will be accessing a generic outpatient psychotherapy clinic, and Latino/a participants will be accessing a clinic located in a Latino neighborhood that caters to the immediate community. The clinic is staffed by bilingual, culturally competent therapists. Participants will be assessed on a range of dimensions including demographics, social factors, knowledge, values, beliefs, and attitudes toward psychotherapy, enabling resources and perceived need. The Latino/a and Caucasian users will be interviewed in their preferred language (English or Spanish), and information will be obtained on the variables described above through semi-structured interviews and administration of standardized instruments. Qualitative data will be analyzed through consensual qualitative research methodology, and quantitative data through comparison to normative samples and other traditional methods. The fourth phase will examine the same variables in Caucasians and Latino/as who are not receiving services. Sixty-four subjects will be assessed in each group in phases 3 and 4, and the data will be analyzed in an ethnicity by treatment-no treatment design. In the fifth phase, the clinical records of participants in phase 3 will be reviewed to assess the outcomes of the treatment received. This phase seeks to distinguish dropouts from completers of psychotherapy by relating their decision to terminate or stay in treatment to their knowledge, values, beliefs, and attitudes toward psychotherapy at the beginning of treatment, with relevant demographic variables controlled statistically.
