1 - (SYM 11) Understanding the Treatment Needs of Black Americans Receiving Coordinated Specialty Care

Background: Black Americans are 2.4 times more likely to be diagnosed with schizophrenia than their white counterparts, and after diagnosis experience worse outcomes than their white counterparts in inpatient and nonspecialized care settings. Coordinated specialty care attenuates but does not eliminate disparities. Cultural adaptations to first-episode psychosis (FEP) care may improve outcomes for Black clients. The current study consists of two projects aimed to identify recommendations to improve care for Black Americans with FEP and their family members.

Methods: Study 1 was a qualitative study, in which interviews and focus groups were used to gather data from 30 stakeholders in four CSC clinics in North Carolina: 16 Black clients, 5 family members, and 21 providers. Participants were asked about their positive and negative experiences with CSC treatment, with an emphasis on how being Black affected their experience. Data were analyzed using thematic analysis. The second complementary study was a systematic review, of US-based studies that tested culturally tailored mental health treatments for Black individuals. Specific cultural adaptations, acceptability and feasibility, and risk of bias were evaluated.

Results: In the qualitative study, several barriers to recovery were identified: discrimination within and outside of the Black community, socioeconomic barriers, challenges with psychoeducation and coordination of care, mistrust of the medical system, ineffectiveness of treatment for cannabis use, and difficulty connecting with non-Black providers. The systematic literature review yielded a total of 20 studies. Common cultural adaptations included (a) employing Black providers; (b) representing black experiences in therapeutic materials; (c) culturally-tailored psychoeducation; (d) proactive engagement strategies; (d) communal healing from racism through groups; (e) building racial pride; and (f) including religion and spirituality.

Conclusions: Based on the above findings, we recommend: (a) increasing partnerships between clinics and Black community organizations; (b) starting Black-only family support groups; (c) building the workforce providers and staff by investing early in the pipeline (e.g., connecting with local psychology training programs); (d) increasing accessibility and flexibility of services (e.g., home visits, community connections); (e) engaging in outreach to the Black community; and (f) training clinicians on best practice treatments for cannabis use.