Strengthening Social Impact Among Older Adults through a Cultural Competency Framework for Collaborative Research

Background and Purpose: About 20% of people ages 65 years or older experience some mental health issues. Persons of color are at greater risk for under-diagnosis, misdiagnosis, and under-treatment than other groups. Preparing practitioners with cultural competence is one way to address barriers to care and build capacity to meet historically underserved communities' needs. Evidence-based frameworks and approaches are necessary, as illuminated during the COVID-19 pandemic, which revealed a range of health disparities that are pervasive among culturally and racially diverse older adults. Closing gaps in health disparities requires attention to diverse populations. The purpose of this study is to explore a mental health care intervention to facilitate access to and utilization of care using a cultural competency framework with older adults living with health and mental health disorders.

Methods: A social worker-led, team approach to intervening with culturally diverse individuals was developed, implemented, and evaluated to determine an effective intervention strategy for residents in senior housing communities. A team of mental healthcare providers (MSW, APRN, MD) made weekly home visits to assess, refer, and provide mental health services to community-dwelling older adults. Outreach services were offered in senior housing communities. Access to residents was supported by staff and building managers. Because many of the older adults in the community were Latino and Spanish-speaking, we recruited and enrolled Spanish-speaking providers to provide services. Trainees received intensive 3-week training before contacting clients to engage in outreach services. Important health services tasks and responsibilities such as brokering and advocating with appropriate primary care and specialty practitioners (e.g., social work, nursing, psychiatry) were key. Case management responsibilities included assisting with scheduling appointments, monitoring follow-through of appointments, and referrals based on assessment of needs. Psychosocial assessments conducted by trainees were essential to the success of this mental health outreach program. Of the trainees, 86% were women, 33% African American, and 67% were Latino. Phase one of this intervention was a three-year, ongoing community outreach program. Data collection included mixed methods with a brief survey to gather demographic and health data of older adults. Qualitative data was collected through face-to-face interviews in either English or Spanish and lasted approximately 90 minutes. Interviews were recorded and conducted in the community or at home for convenience and as preferred by the older adult.

Results: Community-based mental health services were provided to racial/ethnically diverse older adults (women = 80% African American = 45%, Latino = 50% and White = 5%). The results of 50 interviews are reported for this preliminary, qualitative descriptive study. Analysis revealed two salient themes: culturally competent providers are preferred and diversity matters in providing mental health services. These findings have implications for workforce development, training, and continuing education of mental health interventionists.

Conclusions and Implications: Participants express their preferences for culturally concordant care accessible within their communities. Focusing on historically marginalized populations is essential to create greater access to health and mental health services across racial, ethnic, and cultural groups.