Racial Disparities in Adolescent Mental Health Treatment: The Role of Paraprofessionals
Black families may turn to volunteer mentoring programs rather than psychological professionals when their adolescents are experiencing mental health challenges.
Researchers have documented long-standing disparities in mental health services among racial minority youth. In particular, Black youth are significantly less likely than White youth to receive services from mental health professionals, despite similar levels of psychopathology. There are a range of practical barriers contributing to these disparities, including those related to availability of professionals, insurance and affordability, transportation, and parents’ work schedules. Additionally, cultural barriers may further discourage Black families from seeking out mental health services, including stigma of mental health diagnosis and treatment, the under-representation of clinicians of color, and the historical provision of culturally insensitive assessment and treatment.
A recent study sheds further light on this racial disparity in mental health services utilization. In a large, nationally representative survey, caregivers were asked to rate adolescents’ mental health symptoms, perceived need for professional psychological services (i.e., psychotherapy) and paraprofessional services (i.e., mentoring programs like Big Brother Big Sister) for their adolescent, and actual utilization of these services within the past year.
The authors’ primary goal was to examine differences in caregivers’ perceived need for and reported utilization of services for Black and White youth. After holding levels of psychopathology constant, White caregivers perceived a greater need for professional psychological services than Black caregivers, while Black caregivers perceived a greater need for paraprofessional services, such as mentoring. In other words, if their adolescents presented with the same levels of symptoms, White caregivers were more likely to see a need for professional intervention, while Black caregivers were more likely to see a need for informal or paraprofessional services.
These results add another layer of discussion to the documented racial disparities in attitudes toward and use of mental health services. According to these findings, Black caregivers were not simply less likely to perceive a need for professional services; rather, they seemed to find informal services like mentoring more appealing or helpful. The study’s authors provide several potential explanations for these racial differences, including cultural stigma related to mental health treatment among minority groups, limited knowledge and availability professional services, and lack of cultural sensitivity among mental health professionals.
Are these findings consistent with program data from mentoring programs? Another recent study, which surveyed 26 different mentoring programs across the country, provides further evidence that racial minority families are more likely than White families to seek out or be referred to mentoring services when facing adolescent mental health challenges. Strikingly, the authors of this report found that over two thirds of adolescents in mentoring programs were racial minorities, and that 43% of youth in these programs were Black, figures that are out of proportion compared to the general population, of which approximately 15% are Black. The majority of youth in mentoring programs were experiencing clinically significant social, behavioral, and/or psychological difficulties at rates two to three times national averages, but only about a quarter were receiving concurrent services from mental health professionals.
Together, these studies suggest that mentoring programs are serving youth with significant mental health difficulties. Further, due to practical and cultural barriers, Black and other racial minority families may be more likely to seek out mentoring rather than professional psychological services. This is not inherently problematic, given research that shows paraprofessional can be as effective as professionals at delivering evidence-based interventions. However, it is problematic if mentoring programs do not prepare and train mentors to work with mentees with acute symptoms and to deliver evidence-based interventions. Indeed, research suggests that most mentors report that their primary activities with their mentee consist of “just hanging out” rather than more targeted problem-solving and skill-building. Further, the majority of volunteer mentors report feeling overwhelmed by their mentees’ needs and a perceived inability to help. It is therefore not surprising that, overall, mentoring programs have weak effects on youth’s psychological and behavioral outcomes.
For mentoring programs to effectively serve adolescents with high levels of psychological and behavioral difficulties and diverse cultural backgrounds, it is important that they adequately prepare and train mentors to identify and target these problems with evidence-based, culturally sensitive interventions. Public health organizations are increasingly embracing task-shifting to address disparities in access to health care. Under this model, the direct delivery of services, traditionally conducted by professionals, is “task-shifted” to paraprofessional providers who are more widely available, while highly trained professionals take on a training and supervisory role. The millions of adults who volunteer as mentors each year may be a viable workforce of task-shifted paraprofessionals. However, to fulfill this role, it is important that mentors be trained in specific, evidence-based interventions for adolescent mental health challenges (e.g., cognitive-behavioral therapy) and supervised by professional experts. Currently, the predominant philosophy of mentoring is to prioritize fun and relationship-building over structured treatments, but the fact that mentoring programs have consistently yielded much smaller effects than other youth-focused prevention efforts suggest that these nonspecific interventions may not be calibrated to the acuity of symptoms with which youth are presenting. To better serve the diverse youth and families seeking their services, mentoring programs must embrace more specific, targeted interventions and develop program infrastructures that connect professional and paraprofessionals providers through training and supervision.
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Matthew Hagler is currently studying clinical psychology at the University of Massachusetts Boston with Dr. Jean Rhodes. His research focuses on adult-youth relationships and youth mentoring interventions.