Caribbean-born Adults Living in the United States:

The State of Mental Health and Substance Abuse Research and Treatment

Alliances for Quality Education

Rhonda Waller, PhDDirector of Training and Technical Assistance

Nakia Brown, PhD Director of Research and Evaluation

Nycal Anthony -Townsend, MHS President and CEO

Alliances for Quality Education (AQE)

Specializes in building the capacity of academic, governmental and non-profit organizations to better serve their constituencies. Our mission is to improve the educational and health status of underserved people by expanding the capacity of the organizations and communities that serve them.

Purpose

1. Identify gaps in mental health (MH) substance abuse (SA) research and treatment for Caribbean-born adults living in the United States

2. Provide recommendations to enhance the quality of data collected on Caribbean-born populations to identify and address their MH/SA needs

Rationale

• Race and ethnicity are treated as separate concepts in the United States (US)

• Caribbean-born populations living in the US are included as “Black” unless they indicate otherwise

US Census Definition

• Native-born:– Born in the US or one of it’s

territories• Includes Puerto Rico, US Virgin

Islands, Guam, & American Samoa

• Foreign-born:– Any other country or territory

• Includes Caribbean islands/countries

2010 CensusRace & Ethnicity Categories

• White: origins in Europe, Middle East, or North Africa

• Black/African American/Negro: origins in any African racial group

• Native Hawaiian/Other Pacific Islander : Hawaii, Guam (a US Territory), or Samoa

• Hispanic or Latino: Origins in Cuba, Mexico, Puerto Rico (US Territory), South or Central America regardless of race

• Other: “Some other race” or “two or more races”

Health Care Use Reporting: Race & Ethnicity Categories

• Henry J. Kaiser Family Foundation (2009) National Report on Race, Ethnicity, and Healthcare Identifiers:– African American, non-Latino– Latino– White, non-Latino

• Alliance for Health Reform’s (2006): Racial and Ethnic Disparities in Health Care Identifiers:• White, African American, Latino, and other racial

and ethnic minorities

“Blacks” in the United States

*does not include Cuba or the Dominican RepublicSource: U.S. Census Bureau, 2007 American Community Survey

Top 10 Metropolitan Areas of Residence for the Caribbean-born in US

(N=2.95 million) *

• New York City/Long Island/North New Jersey (42%)

• FL: Miami/Ft. Lauderdale (30%)

• MA: Boston/Worcester/Lawrence (4%)

• FL: West Palm Beach/Boca Raton (3%)

• Washington, DC/Baltimore, MD (2%)

• FL: Orlando (2%)

• CA: Los Angeles/Riverside/Orange County (2%)

• FL: Tampa/St. Petersburg/Clearwater, FL (2%)

• Philadelphia, PA-Wilmington DE, Atlantic City, NJ (2%)• GA: Atlanta (1%)

*includes Cuba and the Dominican RepublicSource: US Census Bureau, Census 2000, Migration Policy Institute.

Caribbean-born Population by Country of Birth, 2000

(n=2.9 million)

Mental Health (MH): Caribbean-born Adults

• Small sample size of “Blacks” prevents within group comparison

• Most studies conducted in the United Kingdom (not the US)

MH Research Findings

• Higher rates of depression and aggression among Caribbean-born (Cohen et al., 1997)

• Caribbean Blacks > US-born Blacks in psychological stress (Williams 2000)

• Caribbean Blacks < US-born Blacks in reported rates of ‘heavy’ drinking (Dawson 1998)

• Similar MH help-seeking behaviors (Woodard et al., 2008)

National Survey of American Life (NSAL)

• 2001-2003

• University of Michigan

• One of 3 NIMH-funded surveys

• Used DSM-IV criterion

NSAL Findings: MH

• Similar Overall Prevalence Rates• By Gender (Williams et al., 2007)

– Men: Caribbean > US Blacks– Women: Caribbean < US Blacks

• MH Service Use Rates (Jackson et al., 2007)

– US Blacks > Caribbean

Substance Abuse Research: Caribbean-born Adults

• Limited US published research

• Caribbean-born < US Blacks (Williams et al., 2007)

• Women: Caribbean-born < US Blacks(Broman et al., 2008 )

Number of MH/SA Facilities ( within a 5-mile Radius)

Boroughs MH Tx SA Tx

Bronx 95 76

Brooklyn 68 86

Manhattan 117 144

Queens 35 43

MH Locator -- http://store.samhsa.gov/mhlocatorSA Locator -- http://findtreatment.samhsa.gov/

National Registry of Evidence-Based Programs and Practices (NREPP)

• Purpose– Connect public with intervention developers to

help implement approaches

• Evidence-Based Interventions (EBIs) Requirements – Positive behavioral outcomes – Experimental/quasi-experimental design – Peer-reviewed publication– Public use-ready

NREPP Search Criterion

http://www.nrepp.samhsa.gov/

Current State of Affairs

• Limited MH/SA Research

• No US-based MH/SA EBIs for Caribbean-born populations

• Lack of EBI evaluation on Caribbean-born populations

Fundamental Issue

Caribbean-born populations that we are discussing traverse multiple categories, but may not adequately captured in any.

Standards for Federal Data on Race and Ethnicity

• Race and Ethnicity

• Immigration Status (optional)– Cuba and Dominican Republic

• CPS, NHIS, and NHANES

Points to Consider

• Heterogeneity among “Blacks”

• Heterogeneity among Caribbean-born

• Variation in MH/SA risk profiles

• Impact of culture and contextual factors on treatment outcomes

Points of Emphasis

• Important to understand health disparities in the US not just in terms of race/ethnicity, but also by culture, language, etc.

• In US, there exists axes of diversity not only among native-born, but also among foreign-born

Recommendations: MH/SA Research

• Increase self-select identification categories

• Engage stakeholders to inform data collection

• Use qualitative data collection to enhance research quantitative findings

• Conduct longitudinal studies

Recommendations: MH/SA Services

• Use data to develop or modify MH/SA EBIs

• Evaluate EBIs for their effectiveness

• Include stakeholders in EBI development

Thank You

Rhonda R. Waller, Ph.D.Director of Training and Technical Assistance

rwaller@aqe-inc.com

Nakia C. Brown, Ph.D.Director of Research and Evaluation

nbrown@aqe-inc.com

Alliances for Quality Education, Inc.1101 Mercantile Lane, Suite 104

Largo, MD 20774 Fax: (301) 583-8422

www.aqe-inc.com