This study is a response to the research on Expressed Emotion (EE) which focuses mostly on the negative aspects of family relations (e.g. criticism) and their relationship to relapse; and little attention is paid to positive family factors such as warmth. Recent research has shown a link between warmth and positive mental health outcomes (Bertrando et al.1992, Ivonavic et al. 1994). In a recent study examining the role of family factors and the course of schizophrenia, Lopez and colleagues (1998) found that family warmth protects against relapse for Mexican-Americans with schizophrenia. These preliminary findings suggest the importance of family warmth and support further investigation of warmth and prosocial family functioning, particularly among Mexican origin samples. Thus, an objective of the proposed study is to examine warmth in Mexican origin families, as well as other Hispanic origin families. While positive family factors such as warmth have been linked to favorable mental health outcomes in schizophrenia, it is yet unclear as to what about warmth matters that is related to favorable outcomes in schizophrenia. The specific aims of the research are to examine positive family functioning and its relationship to course of illness and to use other family assessment procedures besides interviews, such as observation of family interactions, in order to gain a better understanding of what family members do to be supportive of their ill relative with schizophrenia.
This is a 3 Phase binational pilot project directed towards assessing available mental health services, providing tools to community residents for the early detection and treatment of a mental illness, and assessing community residents’ use of available mental health services. Phase I consists of two aims: 1) assessing the available mental health services within a high density Latino community of 2500 to 5000 habitants between the ages of 18 and 60 within the cities of San Fernando in Los Angeles County, Puebla, Mexico, and Ciudad Juarez, Mexico; and 2) conducting a widespread educational campaign about serious mental illness and treatment within these same communities. The purposes of Phase II are 1) to develop a bank of names and contact information of community residents with relatives who may suffer from serious mental illness and 2) to identify a community-based sample of family caregivers and their ill relatives and to assess their use of mental health services and the role of the family in caring for their ill relative. Due to a growing interest in the project outside of the San Fernando Valley, Phase III then is to carry out the community education campaign and its evaluation in other parts of Mexico and the United States, such as Tijuana, Baja California, San Diego, and Nashville.
This 2 Phase study is looking to further build up a conceptual model of cultural competence developed by our research group called “Shifting Cultural Lenses.” In order to do so, Phase I consists of operationalizing the model. More specifically, the intent is to create a treatment manual and training protocol. Evaluation of the model will take place in Phase II. . The two specific aims regarding PHASE II include: 1) applying the training protocol to a small cohort of clinicians and assessing whether the training leads to increases in the clinicians’ level of cultural competence in the treatment of mental health patients; and 2) assessing whether the training results in improvements in patients’ retention in treatment, their satisfaction with treatment, and in their clinical functioning. Validation of this model and its training protocol has the potential to improve the mental health care for ethnic and racial minority group members. If successful, the training protocol can be used to train clinicians to provide culturally competent mental health care, which is one strategy that can help reduce disparities in mental health care for minority group members.
The study of culture, ethnicity, and race in American psychology. American Psychologist, 48, 629-637. (1993_Betancourt__Lopez.pdf)
Cultural psychopathology: Uncovering the social World of mental illness. Annual Review of Psychology, 51, 571-598. (2000_Lopez_Guarnaccia.pdf)
Reflections on the Surgeon General’s report on mental health: Culture, race, and ethnicity. Culture, Medicine and Psychiatry, 27, 419-434. (2003_Lopez.pdf)