1、Higher risk of being misdiagnosedLess likely than whites to receive evidence based TxLess likely to receive proper medication when first diagnosedHealth Care SystemOperation of Health Care SystemCultural and linguisticrequirementsStructure of incentives toservice LatinosWork force diversityDesign of
2、 services for LatinosProvider OrganizationLevel of Institutional RacismProvider burdenOrganizational climateProcess of CareAccess totreatment forLatinosQuality of careonce in treatmentfor LatinosDifferential treatmentservice outcomesFunctioningBurder of illnessQuality of LifeThe Socio-Cultural Frame
3、work of Service Disparities (SCFSD)Vega WA, et al. Gaps in service utilization by Mexican Americans with mental health problems. Am J Psychiatry 1999;156:928-34.Health CarePoliciesRegulations atstate andfederal levelMarket forcesHealth Care SystemOperation of Health Care SystemCultural and linguisti
4、crequirementsStructure of incentives toservice LatinosWork force diversityDesign of services for LatinosProvider OrganizationLevel of Institutional RacismProvider burdenOrganizational climateProcess of CareAccess totreatment forLatinosQuality of careonce in treatmentfor LatinosDifferential treatment
5、service outcomesFunctioningBurder of illnessQuality of LifeThe Socio-Cultural Framework of Service Disparities (SCFSD)Ruiz P. Issues in the psychiatric care of Hispanics. Psychiatric Services 1997;48:539-40.Health CarePoliciesRegulations atstate andfederal levelMarket forcesHealth Care SystemOperati
6、on of Health Care SystemCultural and linguisticrequirementsStructure of incentives toservice LatinosWork force diversityDesign of services for LatinosProvider OrganizationLevel of Institutional RacismProvider burdenOrganizational climateProcess of CareAccess totreatment forLatinosQuality of careonce
7、 in treatmentfor LatinosDifferential treatmentservice outcomesFunctioningBurder of illnessQuality of LifeChangingsocio-contextual,cultural,andpolitical forcesThe Socio-Cultural Framework of Service Disparities (SCFSD)Logit Model for Received Active Tx (TANF/AFDC Sample (N=17,772) for those w New Dep
8、ressionHealth CarePoliciesRegulations atstate andfederal levelMarket forcesHealth Care SystemOperation of Health Care SystemCultural and linguisticrequirementsStructure of incentives toservice LatinosWork force diversityDesign of services for LatinosProvider OrganizationLevel of Institutional Racism
9、Provider burdenOrganizational climateProcess of CareAccess totreatment forLatinosQuality of careonce in treatmentfor LatinosDifferential treatmentservice outcomesFunctioningBurder of illnessQuality of LifeCommunity SystemOperation of CommunitySystemCommunity perceptionsof servicesSocial capitalLevel
10、 of communitymistrust in health careprovidersLevel of cohesionChangingsocio-contextual,cultural,andpolitical forcesThe Socio-Cultural Framework of Service Disparities (SCFSD)Health CarePoliciesRegulations atstate andfederal levelMarket forcesHealth Care SystemOperation of Health Care SystemCultural
11、and linguisticrequirementsStructure of incentives toservice LatinosWork force diversityDesign of services for LatinosProvider OrganizationLevel of Institutional RacismProvider burdenOrganizational climateProvider/ClinicianStereotypingTreatment, uncertaintyand stereotyping ofLatinosAttitudes towards
12、LatinosClinicians sex, ethnicity/race, and trainingProcess of CareAccess totreatment forLatinosQuality of careonce in treatmentfor LatinosDifferential treatmentservice outcomesFunctioningBurder of illnessQuality of LifeCommunity SystemOperation of CommunitySystemCommunity perceptionsof servicesSocia
13、l capitalLevel of communitymistrust in health careprovidersLevel of cohesionChangingsocio-contextual,cultural,andpolitical forcesThe Socio-Cultural Framework of Service Disparities (SCFSD)Health CarePoliciesRegulations atstate andfederal levelMarket forcesHealth Care SystemOperation of Health Care S
14、ystemCultural and linguisticrequirementsStructure of incentives toservice LatinosWork force diversityDesign of services for LatinosProvider OrganizationLevel of Institutional RacismProvider burdenOrganizational climateProvider/ClinicianStereotypingTreatment, uncertaintyand stereotyping ofLatinosAtti
15、tudes towards LatinosClinicians sex, ethnicity/race, and trainingProcess of CareAccess totreatment forLatinosQuality of careonce in treatmentfor LatinosDifferential treatmentservice outcomesFunctioningBurder of illnessQuality of LifeCommunity SystemOperation of CommunitySystemCommunity perceptionsof
16、 servicesSocial capitalLevel of communitymistrust in health careprovidersLevel of cohesionFamily/Friend/Lay SectorCaregivers recognition ofmental health problemsor inhibiting help seekingPercieved effectivenessof mental health systemMental health literacyPatientSex, race/ethnicityProblem recognitionMigration historyTreatment historyLevel of needSeverity of symptomsChangingsocio-contextual,cultural,andpolitical forcesThe Socio-Cultural Framework of Service Disparities (SCFSD)
