Reaching Out to Diverse Populations: Opportunities and Challenges

by Practice Research and Policy Staff and Communications Staff

July 12, 2007 — With the growing diversity of the U.S. population, practitioners are increasingly called on to make their services more widely available in racially and ethnically diverse localities.

There is growing demand for practitioners to provide culturally appropriate assessment, treatment and preventive services. Practitioners need to be attuned to the high risk of mental health disorders such as depression among certain ethnic and cultural groups. Additional practice opportunities reflect the likelihood that some members of these groups face challenges in adjusting to unfamiliar communities and cultural norms. Chronic stressors may include the experiences of racism and acculturation by minority and immigrant populations.

According to the U.S. Census Bureau, Hispanics comprise the largest minority group in the country (approximately 40 million, or 13.7 percent of the total U.S. population) and have the highest population growth rate. Meanwhile, the millions of Americans of Asian descent speak dozens of languages and dialects. According to the 1999 U.S. Surgeon General's Report on Mental Health, more than 35 percent of the U.S. population who identify themselves as Asian Americans or Pacific Islanders live in households where individuals older than 13 have limited proficiency in English.

Studies suggest lower overall rates of treatment for mental disorders among racial and ethnic minorities. These groups have lower aggregate education and income levels than non-minorities. Researchers have associated this disparity with a higher likelihood of individuals not receiving any mental health services, as well as receiving less adequate treatment than other mental health patients.
In today's health care marketplace, providing services to specific populations and building a niche practice can help a psychologist remain competitive. Gaining experience in providing services to members of certain communities can help a psychologist become recognized as an expert in working with particular populations. Many practitioners also find it very gratifying that, beyond growing their practice, they are providing a valuable service by meeting community needs for mental health and health services.

This article addresses opportunities and challenges for practitioners in reaching out to build community connections and offering professional services to diverse ethnic and racial groups.

Learn About Cultural Values and Related Factors That Affect Demand for Your Services

Developing an awareness of cultural values — such as reliance on family support systems, collective decision making, spirituality and respect for peers — is paramount in reaching out to diverse populations. The ability to understand and respect a prospective client's belief system is crucial.

Cultural factors shape perceptions of illness as well as the process of seeking help for emotional difficulties and other health-related issues. Cultural values that may inhibit help seeking include encouragement to deal with emotional distress on one's own. Some groups affirm that family members rather than "outsiders" have a duty to care for a family member who needs help.

The following factors may have a bearing on demand for and delivery of your services:
  • Members of certain cultural backgrounds are likely to respond better when positive terms like "happiness" and "well being" are used rather than terms that relate to pathology or problems.

  • Some prospective clients may prefer practitioners of the same gender.

  • Be mindful of topics that may elicit highly sensitive reactions, for example, an individual's history of sexual activity.

  • Ensure that the office environment, including artwork and the arrangement of furniture, is respectful of cultural beliefs and values.

Identify Community Needs and How Best to Reach Prospective Clients

Identifying community characteristics and needs is an important early step in planning your outreach to ethnically and racially diverse populations.

Contact local government agencies and business associations to find out what demographic data they can provide for the geographic area you serve. In addition to these sources, local schools know of new arrivals in the community. Further, your colleagues and other health care professionals may have valuable insights about local subgroups that are not well integrated into the health care system.

Visiting local community centers and gathering spots such as ethnic grocery stores, schools that teach in native languages other than English and sports groups for the population(s) that you wish to reach can help you become familiar with a particular culture.

Seeking the assistance of community leaders in assessing community needs is essential. To begin building professional relationships, one should first ask for help from community leaders in understanding a culture. Learn some basics about Buddhism, for example, if a substantial number of potential clients practice Buddhism. Become aware of relevant community resources for referrals to ancillary support services.

Religious institutions, schools and cultural facilities can help you identify community leaders who can provide insights into needs of a population subgroup. Some of these institutions may themselves offer programs such as stress management, thereby giving you possible cues about educational activities that may resonate with particular groups. Psychologists in turn can perform a valuable service by providing information to community leaders about unmet community mental health needs.

Practitioners may find that community members have developed support systems, such as family networks, to cope with mental health needs. Mental health care may be a novelty, and providers may be met with suspicion, especially if traditions dictate that personal problems should not be shared outside of the immediate family. On the other hand, many members of diverse groups do value mental health services and would be willing to access services from a trusted provider.

When initiating outreach to diverse community groups, remember that you are the newcomer. You are trying to build a relationship with a new group and help prospective clients understand how your professional services can be beneficial. This process takes time.

Pinpoint Potential Obstacles to Accessing Services

The potential barriers to accessing services from a licensed psychologist can be formidable for members of ethnic and cultural minority groups. In addition to language barriers, other potential obstacles include:
  • Cultural stigma associated with seeking professional help and concerns about confidentiality

  • Lack of knowledge about available services, which may be particularly problematic among immigrant groups. Further, some immigrants may believe that mental health facilities are places where people are taken involuntarily in times of crisis. Such a misperception can aggravate the already wide disparity between need for mental health services and the availability of these services.

  • Limited or no insurance coverage or other means of paying for services

  • Reliance on nonprofessional sources of support, especially family members and friends

  • Use of alternative sources of help such as herbalists and spiritual leaders

  • Male gender (women are generally more open to the possibility of accessing professional services)

Cultivate Opportunities for Community Outreach

Making community connections offers psychologists an opportunity to learn more about unmet needs and local market trends while diversifying their practices. One highly visible way for psychologists to get involved with target communities for their services is to speak to local groups in a variety of settings - businesses, schools, nursing homes, places of worship and community organizations. Where language could be a barrier, practitioners may wish to ask community members to serve as translators when giving presentations. This gesture can help strengthen relations with the target community.

The APA public education campaign offers materials to members for use in community outreach activities. APA members can access information for consumers about "mind-body health," resilience and the warning signs of violence by visiting the Public Education Campaign section of APA practice. (See the final section of this article for information about additional tools that can help practitioners make community connections.)

Some psychologists have found it helpful for community outreach to participate in health fairs and screening days for depression, anxiety and other disorders sponsored by health facilities, government agencies and professional organizations.

Community mental health centers may offer programs that focus on topics such as parenting skills whose appeal may cut across racial and ethnic lines. Hospitals in some large cities have health clinics targeted to certain ethnic groups that may not have trained and experienced mental health staff. Look for opportunities to partner with representatives of such facilities and to suggest ways that you can help address unmet community needs.

When it comes to delivering professional services, it is important to assess the impact of language differences as well as reliance on family members in help seeking. The fact that many immigrants do not speak English as a primary or even secondary language has profound implications for the prospect of building strong client-therapist relationships that rely on verbal communication.

Given the importance of family members in minority and immigrant populations, it may be appropriate for the psychologist to consider using a family systems approach to treatment, including encouraging family members to attend psychotherapy sessions as appropriate. Yet it is important for practitioners also to be aware of the substantial body of professional literature that discourages the use of family members as translators during ongoing psychotherapy.

Psychologists are well trained to help immigrants and their families deal with acculturative stress and the ongoing process of blending values and experiences from their country of origin with their experience of living in the U.S. Some recent immigrants have been affected by a history of direct or vicarious trauma in their country of origin. Practitioners also can play a valuable role in helping immigrants deal with difficulties in adapting to unfamiliar customs and other new experiences that can affect their adjustment. Additional immigrant family challenges ripe for professional help include intergenerational conflicts stemming, for example, from differing ideas about acceptable cultural norms.

It may become easier to build bridges to diverse communities once you have a foundation in place. A study of help seeking for depression among Korean immigrants to the U.S. found that a past positive experience with mental health services by participants served to facilitate help seeking.

Tools for Making Community Connections

Members should be aware of tools from APA and the APA Practice Organization that can assist practitioners with establishing and building community connections. As already noted in this article, APA members have access to "toolkits" of information for consumers about mind-body health, resilience and warning signs of violence. Visit the Public Education Campaign section of APA practice.

In addition, the Psychologist Locator at the APA Help Center is an online resource that helps consumers find quality psychological services in their local communities. APA members who pay the Practice Assessment are eligible for inclusion in this service. The Locator Service allows licensed psychologists to include detailed information about their practice, including areas of expertise and languages spoken. Visit APA practice for additional details about participating in the Psychologist Locator.

During the spring of 2007, the APA public education campaign launched a new Spanish-language website. The consumer-oriented site, which mirrors the APA Help Center, offers information about a variety of psychological and emotional health issues pertaining to work, family, relationships, schools and disasters. Practitioners have found the material on these sites useful for a variety of community outreach activities, including participation in health fairs and other local events.

The APA Practice Organization gratefully acknowledges Melba Vasquez, PhD, a practicing psychologist in Austin, Texas, for her contributions to this article.