Chinese American Students' Use of School Based Mental Health Services: Cultural and Contextual Influences

Background:

School based health centers are an increasingly popular strategy to reduce unmet need for mental health treatment. This trend is evident in San Francisco, where a local initiative established “Wellness Centers” at every high school. Since their inception, however, Chinese American youth have been underrepresented in the population served, though their aggregate levels of need are similar to students from other racial and ethnic groups. To explain this phenomenon, theorists have identified potential contextual and cultural influences on youths' help-seeking, but there has been insufficient empirical investigation of these ideas (Cauce et al., 2002). This exploratory study considers Chinese American youths' perceptions of Wellness services, understandings of need, norms around help-seeking, and utilization of alternative coping strategies.

Methods:

The first stage of the study involved exploratory, descriptive analysis of a questionnaire administered to 2,587 randomly selected high school students (77% response rate). The second phase of data collection entailed interviews and gender-specific focus groups with 52 Chinese American students at three schools, purposively selected to be representative of different types of schools in the district in terms of size, racial/ethnic composition and academic achievement. Interview and focus group questions were created with the aim of generating greater understanding of the survey findings and theories of help seeking for youth of color. After entering the transcripts into NVivo, an inductive and deductive coding approach was employed; preliminary codes were generated from a literature review and additional codes were added as transcriptions were reviewed and debriefed by two members of the research team. To improve rigor, transcripts were reviewed for disconfirming evidence and competing interpretations.

Results:

Analysis of the survey data revealed that Chinese American youth had different perspectives about service use than students of different racial or ethnic backgrounds. Compared to their peers, a higher proportion of Chinese American youth believed that youth should be able to deal with problems on their own (14% vs. 9%). They more often viewed the Wellness Centers as places for students in trouble (34% vs. 28%) and reported lower rates of comfort with accessing services when upset or stressed (40% vs. 50%). Major themes from the focus groups included the use of culturally sanctioned coping strategies, associating service use with having a problem, reluctance to share personal difficulties because of parental expectations, and mistrust of providers.

Conclusions:

These findings support theories of contextual and cultural influences on help-seeking and add to our understanding of why Chinese American youth are underrepresented in school based mental health services. This study suggests that school based practitioners may increase service utilization on the part of Chinese American youth by focusing on relationship building through informal, but targeted, outreach strategies that create opportunities for youth to get to know and trust service providers. Additional implications for outreach and education are discussed.