Peter Gamache, Ph.D. Peter Gamache, Ph.D. candidatecandidate

MBA/MPH MBA/MPH

Reducing Disparities among Reducing Disparities among Youth in Transition to Youth in Transition to

Adulthood Adulthood Georgetown Technical Assistance CenterGeorgetown Technical Assistance Center

IntroductionIntroduction

Learning Learning communitycommunity

Peer resource Peer resource networknetwork

Source of SupportSource of Support

Peter Gamache, Ph.D. candidate, MBA, MLA, MPH, RNPeter Gamache, Ph.D. candidate, MBA, MLA, MPH, RNCell # 813-817-5100 | Email: peter.gamache@gmail.com Cell # 813-817-5100 | Email: peter.gamache@gmail.com Website: petergamache.comWebsite: petergamache.com

Gaps Within & Across Systems. . .for addressing, monitoring, and evaluating unequal access, availability, and utilization.

Child System

Special education

Child welfare

Juvenile Justice

Child mental health

Adult system

Criminal justice

Adult mental health

Housing

Vocational rehabilitation

Substance abuse

18 – 21

years

Birth Death

Intersections and Multiplier Effects

According to the NIMH (2006), 1 out of 10 children age 18 and younger suffer from a mental disorder.

Children in particular are at greater risk of having mental health problems when socio-political factors, environmental factors, or distressing events occur in their lives or surroundings (Friedman, Callejas, Nesman, Mowery, & Gamache,

2006).

According to SAMHSA, these factors include harmful stress, discrimination, poverty, trauma, and exposure to violence or physical abuse (DHHS, 2003).

Intersections and Multiplier Effects

Insurance Hispanic children: 21.1% uninsured Black children: 13% Asian children: 9.4% Non-Hispanic White children: 7.6% All children: 11.6 percent uninsured (Urban

Institute, 2004).

Mental Health Access The percentage of African Americans

receiving needed mental health care is only half that of non-Hispanic Whites(Surgeon General Report, 1999).

Employment Black unemployment was 14.8 percent in 2009,

compared to 8.5 percent for Whites. Hispanic unemployment was 12.1 percent (Urban League, 2010).

Unemployed males, ages 16-29 = 19.5% African American, 7.9% White; 8% Hispanic; 7.8% Asian (Kaiser Family Foundation, 2006).

Reasons: Mental health disparities contributing to gaining/maintaining employment.

Postsecondary Education White youth are nearly twice as likely as

Hispanic youth beginning at community colleges to finish a bachelor’s degree; 81 percent of Whites complete a bachelor’s degree compared to 57 percent of Latinos (Fry, 2004).

Intersections and Multiplier Effects

Criminal Involvement African-American youth are six

times more likely than White youth to be incarcerated. Latino youth are three times more likely (Annie E. Casey

Foundation).

Alcohol/Substance Abuse % of high school students who

drank for the first time before age 13 = 18.1% White, 24.9% Black, 27.1% Hispanic (CDC Youth Risk Behavior Surveillance, 2010).

Intersections and Multiplier Effects

Transition to Independence Process (TIP) System

Employment Engages in employment exploration & experience.Education Explores career options (e.g., interviewing people in

careers, library explorations and web searches on careers, visiting community trade schools & colleges).

Living Situation Improves stability in housing location (e.g., planned

moves vs. evictions and fleeing to avoid rent).Personal Effectiveness & Wellbeing Accesses/uses preventative and necessary

medical/dental services.Community-life Functioning Attends or volunteers with community organizations,

activities, support groups, spiritual supports.

Examples

Assets-based ApproachAssets-based Approach Biological NeedsBiological Needs Psychological NeedsPsychological Needs Social NeedsSocial Needs

Human CapitalHuman Capital Social CapitalSocial Capital Cultural CapitalCultural Capital

Physical Mental

Emotional

Transition to Independence Process (TIP) System

Employment Human Capital

Technical skills development Volunteering Job shadowing Practicum Apprenticeships

Social Capital Professional networking

Cultural Capital Current events Destinations

Example:

Next Steps

• If disparities are to be reduced, service providers must acknowledge experiences of racism and discrimination within health and mental health systems at the interpersonal and intrapersonal levels, and such incidents require targeted attention at the organizational and systems levels.

• Discrimination and racism should be considered in all program planning and research efforts.

References• Annie E. Casey Foundation. Retrieved from

http://www.aecf.org/upload/publicationfiles/fact_sheet5.pdf• Centers for Disease Control and Prevention. (2010, June).

Youth risk behavior surveillance system. Retrieved from http://www.cdc.gov/HealthyYouth/yrbs/index.htm

• Clark, H. B., & Unruh, D. K. (2009). Transition of youth & young adults with emotional or behavioral difficulties: An evidence-supported handbook. Baltimore, MD: Paul H. Brookes Publishing.

• Department of Health and Human Services (2003). Glossary of terms: Child and adolescent mental health. Retrieved from http://www.mentalhealth. samhsa.gov/publications/allpubs/CA-0005/default.asp

• Friedman, L., Callejas, L., Nesman, T., Mowery, D., & Gamache, P. (2006). Research with African American populations. Retrieved from http://rtckids.fmhi.usf.edu/rtcpubs/CulturalCompetence/services/CultCompServices.pdf

References• Fry, R. (2004). Latino youth finishing college: The role of

selective pathways. Washington, DC: Pew Charitable Trusts. Retrieved from http://www.pewtrusts.org/uploadedFiles/wwwpewtrustsorg/News/Press_Releases/Hispanics_in_America/pew_hispanic_college062304.pdf

• Kaiser Family Foundation. (2006). Race, ethnicity, & health care. Retrieved from http://www.kff.org/minorityhealth/upload/7541.pdf

• National Institute of Mental Health (2006). Child and adolescent mental health. Retrieved from http://www.nimh.nih.gov/healthinformation/childmenu.cfm

• Surgeon General Report. (1999). African Americans. Use of mental health services. Retrieved from http://mentalhealth.samhsa.gov/cre/fact1.asp

• Urban Institute. (2010). Children without health insurance. Retrieved from http://www.urban.org/pressroom/childrenwithout.cfm

• Urban League. (2010). State of Black America report. New York: Author. Retrieved from http://www.nul.org/estore/content/2010-state-black-america-report