Advanced Center for Mental Health Disparities

Background of the Advanced Disparities Center
Projects and Pilots
Funding Acknowledgement
List of Advanced Center Investigators
List of Advanced Center Publications

The Advanced Disparities Center was established to increase the understanding of the factors affecting mental health service disparities in Latinos and other minorities and generating research and knowledge to eliminate them.

Projects & Pilots
Project 1: Improving Clinical Assessment of Diagnosis for Ethnic and Racial Minorities. The Patient Provider Encounter Study integrates a cultural anthropological approach with statistics and psychiatric epidemiology to enhance clinicians’ diagnostic formulations concerning their Latino and Black patients. The goal is to use a mixed method approach to help the clinician, at the initial assessment in a psychiatric setting, make a determination regarding whether a new Latino or Black patient has a serious mental or substance abuse disorder.

Project 2: Identifying and Addressing Health Care Disparities Among Severely Mentally Ill Latinos and Black persons. This research program aims to generate new evidence on service use and quality of care for housed or homeless severely mentally ill Latino and Black persons, and generate specific recommendations aimed at better meeting treatment needs and narrowing observed disparities. Analyses focus on two data sets: Access to Community Care and Effective Services and Support (ACCESS) quasi-experimental program, and Florida Medicaid claims data for the period 1994-2006.

Pilot 1: Ethnic Differences in Perceived Impairment and Need for Care. This pilot investigates whether there are cultural differences between non-Latino white, Latino, and island Puerto Rican providers and parents in their assessments of vignettes of youth impairment, the severity of the behaviors, and the need for mental health treatment. The goal is to assess whether differential behaviors and severity thresholds relate to mental health service disparities for Latino youth.

Pilot 2: Dialogue with the Latino Community and Healthcare System Stakeholders for Identifying Quality Improvements. The focus of this pilot is on understanding the experience of health care reform in Massachusetts for Latino consumers who were previously funded by the uncompensated care pool. We will explore the processes for integrating community knowledge and expertise about Latino mental health needs in a safety net health care system in order to develop quality improvement projects and interventions that will improve services and reduce mental health service disparities.

Funding Acknowledgement
The Advanced Center is supported by NIMH Research Grant # 1 P50 MHO 73469 funded by the National Institute of Mental Health.

Advanced Center Investigators
Executive Committee (alphabetical order)
Margarita Alegría, Ph.D., Center for Multicultural Mental Health Research at Cambridge Health Alliance/Harvard Medical School
Glorisa Canino, Ph.D., University of Puerto Rico
Marcela Horvitz-Lennon, M.D., M.P.H , University of Pittsburgh
Sheri Lapatin, M.I.A., Associate Director of Center for Multicultural Mental Health Research at Cambridge Health Alliance/Harvard Medical School
Thomas McGuire, Ph.D., Harvard Medical School

Key Investigators (alphabetical order)
Nicholas Carson, Ph.D.,
Center for Multicultural Mental Health Research at Cambridge Health Alliance/Harvard Medical School
Pinka Chatterji, Ph.D., Department of Economics, University at Albany, the State University of New York
Ligia Chavez, Ph.D., University of Puerto Rico
Naihua Duan, Ph.D., Department of Biostatistics and Psychiatry at Columbia University, New York State Psychiatric Institute
Tara Earl, Ph.D., Center for Multicultural Mental Health Research at Cambridge Health Alliance/ Harvard Medical School
Lisa Fortuna, M.D., M.P.H, University of Massachusetts Medical School
Richard Frank, Ph.D., Harvard Medical School
Peter Guarnaccia, Ph.D., Rutgers University
Arlene Katz, Ed.D., Harvard Medical School
Norah Mulvaney-Day, Ph.D., Center for Multicultural Mental Health Research at Cambridge Health Alliance/ Harvard Medical School
Ora Nakash, Ph.D., Center for Multicultural Mental Health Research at Cambridge Health Alliance/ Harvard Medical School
Sharon-Lise Normand, Ph.D., Harvard Medical School
Robert Roberts, Ph.D., University of Texas
Patrick Shrout, Ph.D., New York University

Advisory Board
Junius Gonzales, M.D., M.B.A., University of South Florida
Cynthia Garcia-Coll,Ph.D., Brown University
Kim Hopper, Ph.D., Columbia University
Sayra Pinto, Twin Cities Latino Coalition
Maria Jose Carrasco, M.P.A. National Alliance on Mental Illness

Project Manager
Anne Valentine, M.P.H. Center for Multicultural Mental Health Research at Cambridge Health Alliance


Advanced Center Publications

In Press Documents

Polo, A., & Alegría, M. (in press) “Psychiatric Disorders and Mental Health Service Use Profile of Latino Men in the United States.” In M. Aguirre-Molina, L. Borrell & W. Vega (Eds.), Health Issues of Latino Males: A Social and Structural Approach. Piscataway, NJ: Rutgers University Press.

Published Documents


Carson, N, Katz, N, Gao, N, Alegria, M. (2010). Assessment of Physical Illness by Mental Health Clinicians During Intake Visits. Psychiatric Services, 61:32-37, January 2010.


Horvitz-Lennon, M, Reynolds, S., Wolbert, R., Witheridge, T. F.(2009) The Role of Assertive Community Treatment in the Treatment of People with Borderline Personality Disorder. American Journal of Psychiatric Rehabilitation, 12 (3), 261-277

Alegria, M., Sribney, W., Perez, D., Laderman, M., Keefe, K. (2009). The Role of Patient Activation on Patient-Provider Communication and Quality of Care for US and Foreign born Latino Patients. Journal of General Internal Medicine, 24(Suppl 3), 534-541.

Cook, B, Lin, J, Guo, J & Alegria, M. (2009). Pathways and Correlates Connecting Exposure to the US and Latino Mental Health. American Journal of Public Health, 99 (12), 2247-2254.

Alegria, M. (2009). The Challenge of Acculturation Measures: What are we missing? A commentary on Thomson & Hoffman-Goetz. Social Science & Medicine, 69(7): 996-998.

Canino, G & Alegria, M. (2009). Understanding Psychopathology Among the Adult and Child Latino Population: From the United States and Puerto Rico: An Epidemiologic Perspective. In J.Grau, M. Azmitia, N. Cabrera, G. Carlo, J. Chahin & F.A. Villarruel (Eds.), Handbook of U.S. Latino Psychology: Developmental and Community-Based Perspectives. Thousand Oaks, CA: SAGE.

Fortuna, L, Porche, M, Alegria, M. (2009). A Qualitative Study of Clinicians' Use of the Cultural Formulation Model in Assessing Posttraumatic Stress Disorder. Transcultural Psychiatry, 46: 429-450.

Horvitz-Lennon, M., T. McGuire, M. Alegria, and R. G. Frank. (2009). Racial and Ethnic Disparities in the Treatment of a Medicaid Population with Schizophrenia. Health Services Research, Publish Ahead of Print:10.1111/j.475-6773.2009.01041.

Horvitz-Lennon, M, Frank, R, Thompson, W, Baik, S, Alegria, M, Rosenbeck, R & Normand, S-L. (2009). Investigation of Racial and Ethnic Disparities in Service Utilization Among Homeless Adults with Severe Mental Illnesses. Psychiatric Services, 60(8): 1032-1038.

Alegría, M., Canino, G., & Pescosolido, B. (2009) “A Socio-Cultural Framework for Mental Health and Substance Abuse Service Disparities.” In B. J. Sadock, V. A. Sadock & P. Ruiz (Eds.), Comprehensive Textbook of Psychiatry. Baltimore: Wolters Kluwer Health, Lippincott Williams & Wilkins.

Nakash, O., Rosen, D., Alegria, M. (2009). The Culturally Sensitive Evaluation. In P. Ruiz and A. Primm (Eds)., Disparities in Psychiatric Care: Clinical and Cross-Cultural Perspectives. Bethesda: Wolters Kluwer Lippincott Williams and Wilkins.

Alegría, M., Woo, M., Takeuchi, D., Jackson, J. (2009) “Ethnic and Racial Groups - Specific Considerations.” In P. Ruiz, A. Primm (Eds.), Disparities in Psychiatric Care: Clinical and Cross-Cultural Perspectives. Lippincott Williams & Wilkins.

Fullerton, C. A., McGuire, T. G., Feng, Z., Mor, V., & Grabowski, D. C. (2009). Trends in Mental Health Admissions to Nursing Homes, 1999-2005. Psychiatric Services, 60(7), 965.

Alegría, M, Chatterji, P, Wells, K, Cao, Z, Chen, C, Takeuchi, D, Jackson, J and Meng, X-L. (2009) “Disparity in Access to and Quality of Depression Treatment among Racial and Ethnic Minorities”Psychiatric Services, 59(11)1264-1272.

Alegría, M. (2009). “Training for Research in Mental Health and HIV/AIDS Among Racial and Ethnic Minority Populations: Meeting the Needs of New Investigators.” American Journal of Public Health, 99(S1), S26-S30

Nakash, O., Dargouth, S., Oddo, V., Gao, S., Alegría, M. (2009) “Patient initiation of information: Exploration of its role during the mental-health intake.” Patient Education and Counseling, 75(2), 220-226.

Katz, A., & Alegría, M. (2009). “The Clinical Encounter as Local Moral World: Shifts of Assumptions and Transformation in Relational Context.” Social Science & Medicine, 66(7), 1238-1246.

Cook, B., McGuire, T. & S. Zvuekas. (2009) “Measuring Trends in Racial/Ethnic Health Care Disparities,” Medical Care Research and Review, 66(1), 23-48.

Cook, B., McGuire, T., Meara, E. & Zaslavsky, A. (2009) Adjusting for Health Status in Non-Linear Models of Health Care Disparities Health Services and Outcomes Research Methodology, 9(1), 1-21.


Miranda, J. McGuire, T., Williams, D., and Wang, P. (2008) “Mental Health in the Context of Health Disparities,” American Journal of Psychiatry. (165): 1102-1108.

Alegria, M., Nakash, O., Lapatin, S., Oddo, V., Gao, S., Lin, J., Normand, SL. (2008). How Missing Information in Diagnosis Can Lead to Disparities in the Clinical Encounter. Journal of Public Health Management & Practice. 14(6) Supplement:S26-S35.

Canino G, Alegría M. (2008). Psychiatric Diagnosis - Is it Universal or Relative to Culture? Journal of Child Psychology and Psychiatry. 49(3): 237-250.

Duan, N., Meng, X.-L., Lin, J. Y., Chen, C.-n., Alegría, M. 2008. Disparities in
Defining Disparities: Statistical Conceptual Frameworks
. Statistics in Medicine. 27(20): 3941-3956.

McGuire, T. and Miranda, J. (2008). New Evidence Regarding Racial and Ethnic Disparities in Mental Health Care: Policy Implications. Health Affairs 27(2): 393-403.


Alegría M, Shrout PE, Woo M, Guarnaccia P, Sribney W, Vila D, Polo A, Cao Z, Mulvaney
Day N, Torres M, & Canino G. (2007). Understanding differences in past year psychiatric
disorders for Latinos living in the US
. Social Science and Medicine. 65: 214-230.

Chatterji, P., Alegría , M., Lu, M., & Takeuchi, D. (2007).Psychiatric disorders and labor market outcomes: evidence from the National Latino and Asian American Study. Health Economics, 16(10): 1069-1090.

Cook, B., T.G. McGuire, J. Miranda. 2007. Measuring Trends in Mental Health Care Disparities, 2000-2004. Psychiatric Services. 58(12): 1533-1540.

Hodgkin, D., Volpe-Vartanian, J., & Alegría, M. (2007) Discontinuation of Antidepressant Medication Among Latinos in the US. The Journal of Behavioral Health Services & Research. 34(3): 329-342.

Pippins-Rodriguez, J., Alegría, M., & Haas, J. (2007) Association between language proficiency and the quality of primary care among a national sample of insured Latinos. Medical Care. 45(11):1020-1025.

Vega, W., Karno, M., Alegría, M., Alvidrez, J., Bernal, G., Escamilla, M., et al. (2007). Research Issues for Improving Treatment of U.S. Hispanics With Persistent Mental Disorders. Psychiatric Services, 58(3): 385-394.