Client Race Research Articles

Race and the Local Politics of Punishment in the New World of Welfare

To illuminate how race affects the usage of punitive tools in policy implementation settings, we analyze sanctions imposed for noncompliant client behavior under welfare reform. Drawing on a model of racial classification and policy choice, we test four hypotheses regarding client race, local context, and sanctioning. Based on longitudinal and cross-sectional multilevel analyses of individual-level administrative data, we find that race plays a significant role in shaping sanction implementation. Its effects, however, are highly contingent on client characteristics, local political contexts, and the degree to which state governments devolve policy control to local officials.

The roles of law, client race and program visibility in shaping police interference with the operation of US syringe exchange programs.

To determine the comparative levels of and associations between policing interference and characteristics of US syringe exchange programs (SEPs). Cross-sectional. A national survey of US SEPs. A total of 111 program managers (representing 59% of all US SEPs). Program manager self-report. With overall interference profiles ranging from systematic to totally interference-free, 43% of respondents reported at least monthly client harassment, 31% at least monthly unauthorized confiscation of clients' syringes, 12% at least monthly client arrest en route to or from SEP and 26% uninvited police appearances at program sites at least every 6 months. In multivariate modeling, legal status of SEP, jurisdiction's syringe regulation environment and affiliation with health department were not associated with frequency of police interference. Programs serving predominantly injection drug users (IDUs) of color were 3.56 times more likely to report frequent client arrest en route to or from SEP and 3.92 times more likely to report unauthorized syringe confiscation. Those serving more than three sites were 3.96 times more likely to report client harassment, while stationary operation was protective against uninvited police appearances. The majority (56%) reported not documenting adverse police events; those who did were 2.92 times more likely to report unauthorized syringe confiscation from clients. Findings highlight limitations of the impact of legal reforms on aligning police activities with SEP operations. Systematic adverse event surveillance and evidence-based structural interventions are needed to maximize the benefits of public health prevention targeting IDUs and other criminalized populations. SEPs that report no adverse events may represent programs already working in harmony with law enforcement agencies, a priority highlighted in US Centers for Disease Control's new SEP guidelines. The significance of mechanisms translating criminal justice disparities into health disparities is discussed.

Sexual Health Counselor Preferences of African American and European American Women: A Brief Report

African American women (n = 42) and European American women (n = 46) were queried regarding their comfort level discussing various sexual health topics with hypothetical counselors who were varied by race (African American vs. European American) or counseling value (culturally sensitive vs. knowledgeable). Contrary to hypotheses, European American participants were more comfortable with the knowledgeable African American counselor and the culturally sensitive European American counselor, while African American women showed no preference. Implications are discussed for improving sexual health counseling services for African American and European American women with consideration of client sexual attitude and race of counselor in order to reduce disparities in sexual health.

Disproportionate Diagnosis of Mental Disorders Among African American Versus European American Clients: Implications for Counseling Theory, Research, and Practice

Research generated by the professions of psychiatry and psychology reveals that African Americans are more often diagnosed with specific mental disorders (e.g., psychotic disorders) compared with European Americans. No research to date, however, has investigated whether professional counselors make differential diagnoses according to client race. This study (N = 1,648) found that counselors diagnosed African Americans with psychotic and childhood disorders at a disproportionately high rate. Implications for counseling theory and practice are discussed.

Differences in Mental Health Counselors’ Diagnoses Based on Client Race: An Investigation of Adjustment, Childhood, and Substance-Related Disorders

This study of mental health counselors' diagnoses of African-American and Euro-American clients (N=899) found that African-Americans were diagnosed disproportionately more often with disruptive behavior disorders whereas Euro-Americans were diagnosed more often with less severe adjustment disorders. These findings mirror those of researchers from other mental health professions considering different mental disorders. Implications for mental health counseling practice and future research are discussed, and pathways to account for the phenomenon are proposed.

Race and Hospital Diagnoses of Schizophrenia and Mood Disorders

Overdiagnosis or misdiagnosis of schizophrenia among African American clients is a longstanding and critical disparity in mental health services. Overdiagnosis of schizophrenia is detrimental because it increases the potential for treatment with the wrong medications. Inadequate assessment of mood disorders, co-occurring substance abuse, and client characteristics are three factors believed to be associated with the overdiagnosis of schizophrenia. This article examines the relationships among demographic characteristics, co-occurring substance abuse, and admission diagnoses of schizophrenia and mood disorder for clients admitted to state psychiatric hospitals in Indiana. Data were obtained from the state management information system for a sample of 2,404 clients. The sample comprised white clients (80.5 percent) and African American clients (19.5 percent). All but a few of the clients were involuntarily hospitalized, and more than half of them had a diagnosis of schizophrenia. African American clients were less frequently diagnosed with bipolar and major depressive disorders and more frequently diagnosed with schizophrenia than were white clients. After controlling for the influence of other demographic variables, client race was the strongest predictor of admission diagnoses of schizophrenia. Implications for social work practice in the field of mental health and mental health services research are discussed.

The Impact of Client Race on Clinician Detection of Eating Disorders

Eating disorders are thought to occur less among African-American women than among women of other ethnic groups. Ninety-one clinicians read 1 of 3 passages (differing only with regards to the girl’s race: African-American, Caucasian, or Hispanic) describing disturbed eating patterns of a fictional character named Mary. Participants were then asked to indicate if they thought Mary had a problem and to rate her anxiety, depression, and eating disorder symptoms based upon the passage they had read. The results suggest that clinicians may have race-based stereotypes about eating disorders that could impede their detection of symptoms in African-American girls.

Attrition After Intake at a University Counseling Center: Relationship Among Client Race, Problem Type, and Time on a Waiting List

The present study examined the relationship between attrition after intake and the length of time that clients spent on a waiting list by client race and problem type. Participants were 1,461 clients who completed an initial intake evaluation at a large, Mid-Atlantic counseling center over a 6-year period. Fullfactorial hierarchical logistic regression analyses revealed that African American clients were less likely to return for counseling than were European American clients, regardless of the problem type. ********** A Challenge all too familiar for staff at university counseling centers is meeting the demand for services in an appropriate and timely fashion. Because the demand for services may outweigh available staff resources, certain administrative procedures, such as the creation of a client waiting list, may become necessary (Anderson, Hogg, & Magoon, 1987). Reports from the College and University Counseling Centers Data Bank (Magoon, 2001) and other research (e.g., Clack, Stone, & Thurman, 1984) indicate the pervasiveness of waiting list procedures. Although the reality is that waiting lists are pervasive, particularly at large university counseling centers, concerns remain regarding the adverse impact of waiting lists. The potential adverse impact of waiting lists may be particularly poignant for members of racial and ethic minorities, who may view this administrative procedure as a form of institutional racism (Ridley, 1995). Previous research on waiting list attrition has failed to examine the possible influences of racial differences. For example, Anderson et al. (1987) found no significant difference in waiting list attrition between those who had a long wait and those who had a short wait between intake and the first session. However, a limitation of this study was that group differences were examined only between those who had a long wait for services and those who had a short wait for services. In describing the demographic data of the participants, it was simply stated that the groups did not differ appreciably with regard to racial and ethnic makeup (Anderson et al., 1987). Thus, any racial difference in waiting list attrition is not known. The present study was designed to begin to fill that void in the literature. Waiting List Research: An Overview The efficacy and appropriateness of waiting lists have long been areas of inquiry. Early research on waiting lists has suggested increased dissatisfaction among clients who had to wait for services (Levy, 1963; Sinnett & Danskin, 1967). Some findings suggest that clients' dissatisfaction with being on a waiting list is related to failure to return for services (i.e., attrition), especially for those individuals rated as more psychologically dysfunctional by the intake interviewer (e.g., Whittemore, 1985). However, other scholars contend that the waiting list itself is not problematic, citing that dissatisfaction is more related to clients' perception of whether something is being done to address their concerns (Shueman, Gelso, Mindus, Hunt, & Stevenson, 1980). For example, Obetz, Farber, and Rosenstein (1997) found that students who perceived that they had waited longer were less likely to believe their needs were met by the counseling center; however, no relationship between actual length of wait and satisfaction with counseling was found. A prevailing theme in the literature is that length of time on a waiting list is not a significant factor in client attrition after intake for the majority of clients, regardless of the types of problems (e.g., emotional or vocational) with which clients present (Anderson et al., 1987; Archer, 1981, 1984; Krauskopf, Baumgardner, & Mandracchia, 1981; May, 1990; Obetz et al., 1997). In fact, research suggests that most clients do not report negative reactions or effects from being on waiting lists (Archer, 1984). For example, May found that for clients not needing immediate intervention, the majority (63%) of those who failed to follow through with services stated they either no longer needed counseling or were undecided about pursuing counseling. …

Race, Color-Blind Racial Attitudes, and Judgments About Mental Health: A Shifting Standards Perspective.

A fictitious counseling center intake report was given to a sample of 158 White graduate students in counseling and clinical psychology to examine the impact of reported client race (Black or White) on perceptions of clients' symptom severity. As predicted by the shifting standards model of social judgment (M. Biernat, M. Manis, & T. E. Nelson, 1991), participants judged the Black target to be significantly less symptomatic than the White target. After controlling for social desirability (measured as motivation to respond without prejudice; E. A. Plant & P. G. Devine, 1998), a significant interaction effect showed that color-blind racial attitudes (H. A. Neville, R. L. Lilly, G. Duran, R. M. Lee, & L. Browne, 2000) were positively related to symptom perception for the Black target but not the White target. The shift in assessment (rating the Black target more favorably than an identical White target) was more evident for participants with lower levels of color-blind attitudes. Implications for counseling and future research are discussed.

Effect of Therapist Color-Blindness on Empathy and Attributions in Cross-Cultural Counseling.

Empathy and attributions of client responsibility for the cause of and solution to a problem were examined for 247 psychologists who were identified as having low, moderate, and high color-blind racial attitudes. Participants responded to 1 of 4 vignettes that controlled for client race (i.e., African American, European American) and client attributions regarding the cause (i.e., depression, discrimination) of a problem. Analyses revealed that the therapists’ level of color-blindness was directly related to their capacity for empathy and also to their attributions of responsibility for the solution to the problem with an African American client but not with a European American client. No relationship was found between therapist color-blindness and attributions of responsibility for cause of the problem. Implications of these results for counseling practice, training, and research are discussed.

Effects of Client Race on Clinical Judgment of Practicing European American Vocational Rehabilitation Counselors

This Web-based study investigated the effects of client race on the clinical judgment of practicing European American vocational rehabilitation counselors, specifically, whether participants demonstrated bias in their general evaluation, perceptions of psychopathology, and estimates of the educational and vocational potential of African American clients. Participants reviewed case materials depicting either an African American or a European American client and rendered judgments (a) once after minimal initial information was provided, when initial impressions could be more vulnerable to racial stereotypes, and (b) once after subsequent information was provided, facilitating more definitive judgments. African American clients were judged more negatively than European American clients, and these differences persisted after reviewing subsequent information. Implications for treatment planning are discussed.

Counselors' Multicultural Competencies and Vocational Rehabilitation Outcomes in the Context of Counselor—Client Racial Similarity and Difference

This investigation explored the relationship between rehabilitation counselors' multicultural competency and vocational rehabilitation (VR) outcomes in the context of counselor—client racial similarity and difference for individuals with disabilities who were served in a large northeastern state VR agency. The results demonstrated significant main effects as well as complex interaction effects among client race, counselor race, and counselor multicultural competency in relation to rehabilitation rate and vocational training rate. Thus, clients from different racial groups experienced different outcomes in the VR process in this agency as a function of the counselors' race and multicultural competency. The current findings are discussed in relation to previous studies of VR service equity for persons with disabilities from underrepresented groups, and recommendations for future research are provided.

Effects of Client Race on Clinical Judgment of African American Undergraduate Students in Rehabilitation

Two randomly assigned groups of African American undergraduate students in rehabilitation services were asked to review case materials of a client who was portrayed as African American to one group and as European American to the other. Participants rated the client in terms of their clinical impressions and estimates of future potential. In Rosenthal and Berven's (1999) similar study, European American students rated the European American client as having higher educational and employment potential than the African American client. In our study, African American students rated the African American client as having higher educational potential than the European American client. In addition, across all four of the other independent measures (general evaluation, psychopathology—conduct, psychopathology—substance abuse, and vocational potential), African American participants demonstrated no bias against the African American client or the European American client. The differential findings of these two studies and their implications for education and future research are discussed.

Relationship of referral source, race, and wait time on preintake attrition.

This study assessed whether referral source, client race, and wait time contributed to the preintake dropout rates in a large urban community mental health center in the northwestern United States. The data were collectedfrom archival records maintained by the mental health agency's intake department. A total of 1,105 participants were documented over a 2-year period spanning 2000 and 2001. The results indicated that individuals who referred themselves for services were more likely to attend an initial intake appointment than those who were referred by others. Conversely, neither race nor wait time was significantly related to preintake attrition. Implications for psychologists are discussed.

Effects of Client Race‐Ethnicity on Perceptions of Counselor Trainees: Study 1 and Study 2

The authors investigated the impact that racial stereotypes have on counselor trainees' perceptions of the attributes and behaviors of ethnically diverse male clients. Two studies were conducted in which participants were counselor trainees (Study 1, N = 58; Study 2, N = 75) who received a case study in which a male student sought counseling for problems affecting his school work. No differences were revealed in Study 1. In Study 2, counselor perceptions of client attributes differed across client race–ethnicity. The results are discussed in terms of their implications for training counselors, particularly regarding multicultural courses and workshops.

Predictors of observer ratings of multicultural counseling competence in Black, Latino, and White American trainees.

Using transcribed intake sessions of 52 counselor-client dyads, this study explored the relative contributions of (a) counselor and client race or ethnicity, (b) counselor-client racial or ethnic match, (c) previous academic training in multicultural counseling, and (d) self-reported multicultural counseling competence to observer ratings of trainees' multicultural counseling competence. Results revealed that (a) Black American and Latino American counselor trainees were rated as more multiculturally competent than their White American peers, and (b) prior multicultural training was positively predictive of observer-rated multicultural counseling competence. Implications of the findings for counselor training and practice are presented.

Clinical Judgment and Bias Due to Client Race or Ethnicity: An Overview with Implications for Rehabilitation Counselors

Rehabilitation counselors are responsible for determining eligibility of clients for services, assessing rehabilitation needs, and developing service plans to meet those needs. Patterns of inequitable treatment of minorities have been documented in all major junctures of the vocational rehabilitation process. This article provides an overview of clinical judgment and discusses stereotypes and prejudice due to client race or ethnicity as potential sources of bias within the rehabilitation counseling process. Implications for rehabilitation counselors are discussed and specific bias reduction strategies are provided.

World Wide Web Accessible Resources Related to Research on Social Work Practice

The World Wide Web offers resources related to research on social work practice, arranged in categories from the general to social work specific. Included are World Wide Web sites for general indexes, reference sources, search procedures, government resources, journals, measurement, psychology, other social sciences, social work professional issues, social work client issues, race and culture, and social work education.

Race, Gender, and Housing Inequality: An Exploration of the Correlates of Low-Quality Housing Among Clients Diagnosed with Severe and Persistent Mental Illness

This paper explores the relationship of race and gender to housing quality among clients diagnosed with severe mental illness. More specifically, it asks: "How do a client's race and gender affect her/his odds of living in a "low-quality" housing arrangement?" A low-quality arrangement is defined as one which is time-limited and/or physically unsafe. The analysis draws upon clinical, demographic, and housing data for 517 African American and White consumers of publicly-funded mental health services in King County, Washington. Multivariate logistic regression is the primary analytic strategy used. Controlling for certain clinical/behavioral and economic/ecological factors, race/gender category is found to affect significantly the odds of experiencing low-quality housing.

Effect of Client Race and Depression on Evaluations by White Therapists

This study examined the effect of client race and depression level on global and interpersonal evaluations by white therapists. Sixty-two white therapists (23 male, 39 female), with at least Master's level training and/or 3 years of experience in individual psychotherapy, viewed a 3-minute segment of a scripted videotaped interaction between a “client” and “therapist.” The “client” was either a black or white female, enacting a depressed or nondepressed role. Each therapist viewed only one of the four conditions. As predicted, therapists held more negative evaluations of depressed versus nondepressed clients, and the combination of being black and depressed led to the most negative evaluations. Unexpectedly, black nondepressed clients were not rated more negatively than white nondepressed clients. Results are discussed in terms of possible explanations for the findings and their implications for therapy outcome.