Relative effect of clinicians on outcome disparities for racial and ethnic minority clients receiving outpatient mental health services

Objectives - The theoretical underpinnings of the clinician effect research suggest that some of the disparities experienced by racial and ethnic minority clients receiving outpatient mental health services may be explained at the clinician level. We examine whether outcome disparities exist among a group of adult clients experiencing a serious mental illness and what effect, if any, their clinicians have on the occurrence of disparities.

Methods – The study utilized a naturalistic sample of 808 clients nested within 143 clinicians at 13 community mental health agencies. Outcomes were measured three times using the BASIS-24, an indicator of symptomology and functioning. Data were analyzed using hierarchical linear modeling (HLM) with repeated measures of the BASIS-24 at level 1, client demographic, psychiatric, and service factors at level 2, and clinician demographics, training, and perceptions of work environment at level 3. The analysis controlled for clients' diagnosis, age, gender, services, and employment status.

Results –There were no overall outcome disparities between minority and white clients; however, there was significant variability between clinicians in the occurrence of disparities. This means that some clinicians had substantial outcome disparities between their minority and white clients, while other clinicians had no disparities. Clinician-level predictors of outcome disparities included level of cultural competency, level of supervisory support, and perceived clarity of the agency's rules and goals.

Conclusions – Some clinicians appear to magnify outcome disparities for racial and ethnic minority clients, while others minimize it. Organizational and professional training factors seem to contribute to clinicians' likelihood of creating outcome disparities.