Racial and Ethnic Disparities in Systems of Care: A Look at the

National Evaluation Data

May 19, 2005

Phyllis Gyamfi, Ph.D. & Bhuvana Sukumar, Ph.D.

ORC Macro

Referral Patterns by Race and Ethnicity

6.5%4.6%

7.9%

14.8%

7.2%

27.3%

73.4%

26.9%

19.3%

8.0%

27.7%

18.2%

61.7%

51.5%54.5%

2.0%5.0% 5.0% 6.0%

4.0%

9.9%

1.1%

14.2% 12.7%

8.0%

4.0% 3.0%6.0% 6.0%

61.1%57.7%

81.1%

36.3%

0%

20%

40%

60%

80%

100%

JuvenileJustice

School Mental Health PhysicalHealth

Child Welfare SubstanceAbuse

American Indian BlackWhite Asian

Hispanic Native Hawaiian

(n = 1,899) (n = 2,223) (n = 3,851) (n = 162) (n = 1,446) (n =11)

Most Prevalent Diagnoses by Racial/Ethnic Group

African American

(n = 2,435

American Indian

(n = 314)

Asian

(n = 50)

Hispanic (n = 1,070)

Multi-racial

(n = 347)

Native Hawaiian

(n = 41)

White

(n = 5,021)

Other

(n = 83)

ADHD/

Disruptive Behavior

(64.0%)

ADHD/

Disruptive Behavior

(46.2%)

ADHD/

Disruptive Behavior

(46.0%)

ADHD/

Disruptive Behavior

(55.2%)

ADHD/

Disruptive Behavior

(57.1%)

ADHD/

Disruptive Behavior

(51.2%)

ADHD/

Disruptive Behavior

(56.0%)

ADHD/

Disruptive Behavior

(53.0%)

Mood Disorder

(21.5%)

Adjustment Disorder

(25.2%)

Mood Disorder

(36.0%)

Mood Disorder

(26.2%)

Mood Disorder

(24.8%)

Mood Disorder

(26.8%)

Mood Disorder

(27.2%)

Mood Disorder

(31.3%)

Adjustment

Disorder

(10.8%)

Mood Disorder

(21.0%)

PTSD

(10.0%)

Adjustment

Disorder

(12.3%)

Adjustment Disorder

(13.8%)

Adjustment Disorder

(12.2%)

Adjustment

Disorder

(11.0%)

PTSD

(10.8%)

PTSD

(3.7%)

PTSD

(7.6%)

Adjustment Disorder

(8.0%)

PTSD

(6.3%)

PTSD

(4.3%)

PTSD

(9.8%)

PTSD

(5.8%)

Adjustment Disorder

(4.8%)

Types of Services Used by Racial and Ethnic Groups*

Services American Indian

Asian African American

Native Hawaiian

Hispanic White

Crisis Stabilization 19.8%

(n = 126)

17.6%

(n = 17)

16.3%

(n = 823)

38.5%

(n = 13)

19.7%

(n = 446)

22.0%

(n = 2,189)

Family Therapy 35.7%

(n = 126)

29.4%

(n = 17)

33.7%

(n = 820)

23.1%

(n = 13)

44.0%

(n = 443)

39.0%

(n = 2,194)

Individual Therapy 79.2%

(n = 125)

82.4%

(n = 17)

70.7%

(n = 817)

69.2%

(n = 13)

75.2%

(n = 443)

80.5%

(n = 2,197)

Medication Monitoring

34.1%

(n = 126)

82.4%

(n = 17)

60.5%

(n = 820)

76.9%

(n = 13)

60.7%

(n = 448)

68.4%

(n = 2,195)

Case Management 62.4%

(n = 125)

94.1%

(n = 17)

77.2%

(n = 821)

76.9%

(n = 13)

73.8%

(n = 442)

78.6%

(n = 2,189)

Behavioral Therapeutic Aide

15.1%

(n = 126)

18.8%

(n = 16)

17.7%

(n = 820)

30.8%

(n = 13)

13.0%

(n = 446)

20.1%

(n = 2,191)

Transportation 19.8%

(n = 126)

41.2%

(n = 17)

29.6%

(n = 820)

30.8%

(n = 13)

27.8%

(n = 446)

20.1%

(n = 2,183)

*All Chi-Square tests were significant (p < .01)

Improvement in Total CAFAS* Score by Racial/Ethnic Groups**

109.5103.8

113.4101.094.0 95.491.6

101.0

89.099.0

88.582.9 81.0

92.788.3

0

40

80

120

160

200

240

AmericanIndian

Asian Black Hispanic White

Intake

6 Months

12 Months

Ave

rage

Sco

re

(n = 52) (n = 10) (n = 531) (n = 288) (n = 1,415)

*Between-group effect: F = 2.1, df = 4/2,291, p > .05 (NS). *Within-group effect: F = 3.7, df = 4/2,291, p < .05.**Only children who had CAFAS impairment scores at Intake, 6 months and 12 months were included in this analysis

.

Reliable Change in Total Problem Behaviors by Race and Ethnicity (Intake to 12 Months)

45.7%43.4%43.6%

8.3%

54.3%

46.5%

32.9%

40.6%

66.7%

43.1%

7.8%12.9%

25.0%

15.8% 13.5%

0%

20%

40%

60%

80%

100%

AmericanIndian

Asian Black Hispanic White

Per

cent

ImprovedRemained StableNeeds Improvement

(n = 70)

(n = 12) (n = 596) (n = 318) (n = 1,594)

Diversity of Governing Bodies and Program Staff in Urban and Rural Systems of Care in 2003a

25%

90%

25%

60%

100% 100%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Perc

ent

Urban Rural: Non-American Indian Rural: American Indian

a Sample size (n) refers to number of system-of-care communities.b At least 26% of children served are non-White and at least 26% of governing body members are non-White.c At least 26% of children served are non-White and at least 26% of system-of-care staff are non-White.

(n = 8) (n = 9) (n = 3) (n = 10) (n = 10) (n = 5)

Diverse Governing Bodyb Diverse Staffc

Implementing Accessible Services

Domain Indicators

Infrastructure

Put mechanisms in place to minimize financial barriers

Ensure that all services in the array have sufficient capacity to serve all who need them

Maximize the accessibility of the service array

Service Delivery

Conduct outreach to the intended target population

Ensure that the process to enter services is not complicated for families

Minimize the length of time between referral and receipt of services

Offer service planning, provision, and case review meetings at flexible times

Offer service planning, provision, and case review meetings at a variety of convenient locations

Provide transportation assistance

Make services financially accessible to families

Minimize wait times to receive services (e.g., limit wait lists)