This R34 project examines the organizational factors that influence disparities in treatment outcomes for African American clients receiving services from community mental health agencies (CMHAs) in rural areas. The limited available research about disparities in mental health treatment outcomes has focused on either staff level or client level factors, in isolation from the [organizational] context. The present study [builds upon two preliminary studies to examine the interaction among factors at all three levels (client, staff, and organization) that may influence treatment outcomes. The proposed study will include] clients and staff at 13 sites in the southern portion of the Upper Mississippi River Basin (UMRB), [which] has one of the highest concentrations of African Americans living in a rural setting outside the deep South. In the first phase [of the two phase sequential mixed methods model, data will be collected from staff and clients regarding their perceptions of the organizational climate as well as selected demographic and control variables (e.g., client gender and diagnosis, staff education and burnout). The outcome, change over time in client symptoms, will be measured using a repeated measure design consisting of a baseline and two follow-up measures. A four-level hierarchical model will be fitted to estimate the relative contributions of each level (client, staff, and organization) to explaining differences in the pattern of change between African American and white clients.] [In] the second phase, [key organizational level factors] identified in the first phase will be examined [from a multiplicity of viewpoints using focus groups with agency and community stakeholders and through] an expert panel to gain an in-depth understanding of how organizational climate influences treatment outcomes. The specific aims of the project are to: 1) [Build on the findings from the case and pilot studies to further our understanding of the relative contributions of organizational-, staff-, and client-level factors to disparities in outcomes among African American clients receiving services at CMHAs;] and 2) [Articulate an organizational-level intervention to assist CMHAs in reducing outcome disparities between African American and white clients by impacting specific organizational- and staff-level factors that are both empirically related to outcome disparities and amenable to change.] The research to test the effectiveness of the intervention will be proposed as an R01. [unreadable] [unreadable] [unreadable] [unreadable] [unreadable]
NIH ExPorter
NIH ExPorter