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Equity in Clinical Pathways: Public Health Approaches to Address Mental Health Disparities in Immigrant Children / Stacey L Bevan.
- Format:
- Book
- Thesis/Dissertation
- Author/Creator:
- Bevan, Stacey L., author.
- Language:
- English
- Subjects (All):
- Nursing.
- Education.
- Public health.
- Mental health.
- Pediatrics.
- Nursing--Penn dissertations.
- Penn dissertations--Nursing.
- Local Subjects:
- Nursing.
- Education.
- Public health.
- Mental health.
- Pediatrics.
- Nursing--Penn dissertations.
- Penn dissertations--Nursing.
- Physical Description:
- 1 online resource (162 pages)
- Contained In:
- Dissertations Abstracts International 85-12B.
- Place of Publication:
- [Philadelphia, Pennsylvania] : University of Pennsylvania, 2022.
- Ann Arbor : ProQuest Dissertations & Theses, 2024
- Language Note:
- English
- Summary:
- Despite increased health-harming exposures associated with poor child development outcomes, immigrant children consistently receive medical diagnoses and access treatment at lower rates than native-born peers. Critics of behavioral and cultural protective explanations for this pattern, known as the immigrant health paradox, suggest structural disadvantage drives artificially low diagnostic prevalence. This study tested if adverse exposures related to immigration are associated with child health concerns and access to the clinical pathway for mental health services. This study aims to 1) describe parent concerns for child health across clusters of immigration-related exposures, 2) understand the relationship between parent concerns and screening tools routinely used in primary care, and 3) test mediating associations across the clinical pathway for mental health. This study uses survey data and developmental assessments from n = 935 Latinx immigrant families of children between 9 and 60 months recruited at community sites in Philadelphia. I use hierarchical cluster analysis, adjusted regression models, and structural equational modeling to evaluate the study aims. The sample clustered into two groups based on high and low exposures related to immigrant health, such as xenophobia, fear of deportation, and poor economic integration, which predicted parent concerns for child health. Parent concerns were positively and moderately correlated to screening results, with stronger agreement for child behavior than development. In the clinical pathway, screening results partially mediated the association between parent concerns, diagnosis, and service access, with proportionally larger direct associations. Results support modifications to clinical practices that identify, diagnose, and provide early child behavior and development services. This study suggests that diagnostic and treatment disparities are sensitive to improvements in medical systems, social policies, and legal protections that promote equitable health for immigrant children.
- Notes:
- Source: Dissertations Abstracts International, Volume: 85-12, Section: B.
- Advisors: Pinto-Martin, Jennifer; Committee members: Liu, Jianghong; Souders, Margaret; Gonzales, Roberto; Harris, Jasmine.
- Department: Nursing.
- Ph.D. University of Pennsylvania 2024.
- Local Notes:
- School code: 0175
- ISBN:
- 9798382830391
- Access Restriction:
- Restricted for use by site license.
- This item is not available from ProQuest Dissertations & Theses.
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