Final Report

Jeffrey G. Reitz, Ph.D.
November 30, 1995

* This report was prepared as a joint project of the Multicultural Coalition for Access to Family Services, Toronto, and the Ontario Ministry of Community and Social Services.

Table of Contents         Executive Summary
Chapter | 1 | 2 | 3 | 4 | 5 | 6 | 7 |      Bibliography | A-B | C-I | J-O | P-Z |

This review of nearly 400 publications from Canada, the US, Britain and Australia has identified a large number of studies supporting the conclusion that very often, recent immigrant groups experience low rates of utilization of many important social and health services, despite evidence of significant need. The barriers most often identified include those related to language, lack of information about services, cultural patterns of help-seeking, lack of cultural sensitivity by service providers, financial barriers, and lack of service availability.

The specific barriers to service delivery identified in the research varies according to type of service, the nature of the service delivery itself (which varies from one location to another), and minority group.

Among the most significant information gaps are the following:

* lack of information on different minority group utilization rates for different services; there are few surveys across minority group particularly for human and family services.

* lack of systematic information on group needs; inference of barriers from utilization rates depends on needs assessments

* the relative importance of specific barriers to specific services in specific groups is poorly assessed; studies often either rely on the opinions of service providers, or focus on a specific barrier.

The best studies most closely related to the human and family services fields are studies of minority group access to mental health services. In the human and family services field, service delivery is less standardized, and there are fewer organizational and financial resources to support extensive research.

Practitioner training programs increasingly emphasize the problem of cultural sensitivity and service barriers, reflecting both an awareness of needs and a judgement that this awareness is insufficient in the field. However, no formal assessment of practitioner awareness has been conducted.

A large number of innovations have been proposed, some have been implemented, and a few have been evaluated in formal research. Evaluation of impact includes both impacts on utilization, and impacts on client well-being; the evidence suggests more effects on the former. Innovations designed to enable mainstream agencies to overcome information barriers, and language barriers would appear to be warranted, but there are not evaluations of their impact.

"Ethnic match" which ensures that members of minority groups have the opportunity to be served by members of their own group appears to have impacts on utilization. "Ethno-specific" agencies take a variety of forms. Evidence, the best being from the US (mainly in New York and California), suggests that ethno-specific agencies have significant benefits effects in boosting utilization. Evidence on impacts on client well-being are mixed. Many specific features of models for ethno-specific agencies have not been evaluated fully (e.g. forms of inter-agency cooperation).

Some findings apply across minority ethno-racial groups; some do not. The reluctance to seek professional help for mental health problems seems to characterize most groups. However the reasons vary markedly among Asian, Hispanics and black groups. Problems vary according to economic and occupational position, and immigration background, including refugee status.

Bibliography with Selected Annotations

Access Action Council 1991. Aging in a Multicultural Society: Creating Opportunities for Action. Toronto: Access Action Council.

Achata, Carolyn W. 1993. "Immunization of Mexican Migrant Farm Worker's Children, on Site at a Day Care Center in a Rural Tennessee County: Three Successful Summers," Journal of Health & Social Policy, 4(4):89-101.

There are barriers to health care for this migrant population due to cultural differences, communication barriers. These were overcome in part by arranging to use day care centre attendance. This is a form of outreach.

Adams, Anne Currin and Elfriede G. Schlesinger 1988. "Group Approach to Training Ethnic-Sensitive Practitioners," in Jacobs, C. and D.D. Bowles (eds.) Ethnicity and Race: Critical Concepts in Social Work. Silver Spring, MD: National Association of Social Workers, Inc., 204-216.

Adler, Nancy J. 1983. "Organizational Development in a Multicultural Environment," The Journal of Applied Behavioral Science, 19(3):349-365.

Agard, Ralph 1987. Access To The Social Assistance Service Delivery Systems. A Brief to the Social Assistance Review Committee. Toronto: Ontario Ministry of Community and Social Services.

Agenda 1992. "Lack of Insurance and Underinsurance: Biggest Barriers to Hispanic Health Care," National Council of La Raza, Agenda, 11(1):1-3.

Ahmed, Shama 1982. "Some Approaches to Recruitment and In-Service Training for Multiracial Social Work," in Cheetham, Juliet (ed.) Social Work and Ethnicity. London: George Allen & Unwin, 197-207.

____________, Juliet Cheetham, and John Small (eds.) 1986. Social Work with Black Children and their Families London: B.T. Batsford.

Collection of brief articles recounting experiences with black children in social service settings, also minority women in women’s shelters (refuges), and young black offenders. Introduction by Cheetham lists evidence of barriers in access to ‘welfare services’ experienced by blacks in Britain. Cheetham mentions Asian mothers not helped by ante-natal services, day care to employed black mothers is of poor quality, black children in care with less chance than white children of reunion with parents, and local authorities often insensitive to diverse cultural groups. Various articles provide qualitative case material on differential treatment or differential minority needs not met. For example, an article by Asrat-Girma, "Afro-Caribbean Children in Day Care," reports experiences of mothers with negative treatment by child care workers, often based on negative stereotypes of black culture, or negative judgements of practices stemming from cultural differences.

Ahmed, Waqar I.U. 1992. "The Maligned Healer: The 'Hakim' and Western Medicine," New Community, 18(4):521-536.

Akbari, Ather H. 1989. "The Benefits of Immigrants to Canada: Evidence on Tax and Public Services," Canadian Public Policy - Analyse de Politiques, 15(4):424-435.

Examines the net balance of taxes paid and public services used by immigrants and native born in Canada, based on the 1981 Canadian census public use sample. Public services include education, health services, and transfer payments (Family allowances, unemployment insurance, Canada/Quebec Pension Plan, Old Age Security, Guaranteed Income Supplements, and other federal and provincial transfers). Even after 35 years in Canada, immigrants are a net benefit to non-immigrants. Note that immigrant use of services is not compared to the use of services by non-immigrants.

Akutsu, Phillip, Lonnie R. Snowden and Kurt C. Organista 1995. "Referral Patterns at Ethnic-Specific and Mainstream Programs," Journal of Counselling Psychology, in press.

This study examined the referral patterns of 1095 African, 2168 Asian, 1385 Hispanic, and 2273 White Americans (aged 18 and older) in a public mental health system to determine if group differences in help-seeking and referral patterns were related to participation at ethnic-specific versus mainstream programs. Results indicate that: (1) ethnic minorities at both mainstream and ethnic-specific programs were more likely than Whites to have been referred by natural help-giving and lay referral sources (e.g. family/friends, health services, social services) and (2) ethnic minorities at ethnic-specific programs were more likely than ethnic minorities at mainstream programs to have been referred by natural help-giving and lay referral sources if they were Asian and Hispanic Americans and self-referred if they were African American.

Allmen, Eva 1990. "Counselling and settlement: the current and future role of mainstream and settlement services." in Yelaya, Shankar A. (ed.), 1990, Proceedings of The Settlement and Integration of New Immigrants to Canada Conference. February 17-19, 1988, Waterloo, Ontario: Faculty of Social Work and Centre for Social Welfare Studies, Wilfrid Laurier University, pp. 199-221.

Allodi, F. 1978. "The utilization of mental health services by immigrant Canadians," Canada's Mental Health, 26(2):7-9.

Anderson, Joan M. 1985. "Ethnicity and Illness Experience: Ideological Structures and the Health Care Delivery System," Social Sciences and Medicine, 22(11):1277-1283.

Andersen, Ronald, Sandra Zelman Lewis, Aida L. Gaichello, Lu Ann Aday and Grace Chiu 1981. "Access to Medical Care among the Hispanic Population of the Southwestern United States," Journal of Health and Social Behavior, 22 (March):78-89.

Andrulis, Dennis P. 1977. "Ethnicity as a Variable in the Utilization and Referral Patterns of a Comprehensive Mental Health Center," Journal of Community Psychology, 5:231-237.

A fifty percent sample of the 1972 population of terminated cases at a comprehensive mental health center was examined for utilization patterns of Black, Mexican-American and Anglo clients. Significant differences by ethnicity were found for referral source, diagnosis, discharge, and referral need. However, clients under 18, especially Mexican-Americans, displayed consistent variation among the variables considered.

Armitage, Andrew 1975. Social Welfare in Canada: Ideals, Realities and Future Paths. Toronto: McClelland and Stewart.

Asamoah, Yvonne, Alejandro Garcia, Carmen Ortiz Hendricks and Joel Walker 1991. "What We Call Ourselves: Implications for Resources, Policy, and Practice," Journal of Multicultural Social Work, 1(1):7-22.

Association of Directors of Social Services and Commission on Racial Equality 1978. Multi-Racial Britain: The Social Services Response. London: Commission for Racial Equality.

A systematic review of department policies, the work of a joint working party of the Association of Directors of Social Services and the Commission for Racial Equality.

Atkinson, Donald R. and Ruth H. Gim 1989. "Asian-American Cultural Identity and Attitudes Toward Mental Health Services," Journal of Counselling Psychology, 36(2):209-212.

Among 557 Asian American students, acculturation leads to greater receptivity to professional mental health care.

Austin, David M. 1985. "A Prefatory Essay on the Future Administration of Human Services," Journal of Applied Behavioral Science, 21(4):351-364.

Australia, National Multicultural Advisory Council 1995. Towards and Beyond 2000, a report of the National Multicultural Advisory Council, (vols. 1 and 2). Canberra: Australian Government Publishing Service.

Australia, Office of Multicultural Affairs 1992. Access and Equity Evaluation Summary. Canberra: Australian Government Publishing Service.

Australia, Office of Multicultural Affairs, Department of the Prime Minister and Cabinet 1990. Multicultural Policies and Programs. Canberra: Australian Government Publishing Service.

_________________________________________________________________________ 1991. Making it Happen - Access and Equity at Work around Australia. Canberra: Australian Government Publishing Service.

_________________________________________________________________________ 1992. Access & Equity - Evaluation Summary. Canberra: Australian Government Publishing Service.

_________________________________________________________________________ 1994. Annual Report: Access & Equity. Canberra: Australian Government Publishing Service.

Baker, Michael and Dwayne Benjamin 1994. "The Receipt of Transfer Payments by Immigrants to Canada." Journal of Human Resources.

_______________________________ 1995. "Labor Market Outcomes and the Participation of Immigrant Women in Canadian Transfer Programs." Pp. 209-242 in Diminishing Returns: The Economics of Canada's Recent Immigration Policy, edited by Don DeVoretz, Toronto: C.D. Howe Institute.

Bamford, Terry 1990. The Future of Social Work. Basingstoke: Macmillan Publishing Company.

Criticisms of the "cultural sensitivity" approach are made, 52-55.

Bane, Mary Jo and David T. Ellwood 1994. Welfare Realities: From Rhetoric to Reform. Cambridge, MA: Harvard University Press.

Barrilleaux, Charles J. and Mark E. Miller 1992. "Decisions without Consequences: Cost Control and Access in State Medicaid Programs," Journal of Health Politics, Policy and Law, 17(1):97-118.

Beiser, Morton, Kuldip Gill and R. Gary Edwards 1993. "Mental health care in Canada: Is it accessible and equal?" Canada's Mental Health, 41(2):2-7.

This literature review examines the ways in which barriers such as unrecognized need, gender, age, socioeconomic position, ethno cultural status and availability of service affect mental health care in a country that assures universal health coverage for all Canadians.

Beller, Andrea H. and John W. Graham 1986. "Child Support Awards: Differentials and Trends by Race and Marital Status," Demography, 23(2):231-245.

Berger, Ruth 1989. "Promoting Minority Access to the Profession," Social Work, 34(4):346-349.

A study presents an overview of the factors that have emerged as significant for the recruitment of minorities into social work and raises the challenge of their retention in social work schools and within the profession. Research has suggested that for the majority of BSW graduates, the aspiration to achieve an MSW was nurtured or instilled during the undergraduate experience. At both the BSW and the MSW level, groups of minority students can be identified as potential candidates for social work and strategies should be developed for their recruitment. At the undergraduate level, potential candidates include high school and high school equivalency graduates, community and junior college graduates, college seniors, and employees in social welfare organizations who have high school diplomas or associate degrees. Sources of candidates for recruitment to graduate schools of social work have been colleges and social agencies, but enrollments have been decreasing in recent years. Strategies being attempted to increase enrollments include establishing minority student caucuses in graduate schools and holding open house functions targeted to minorities. Research is needed to explore factors relating to the retention of minorities in social work educational programs and in the profession.

Bergin, Betty 1988. Equality is the Issue: A Study of Minority Ethnic Group Access to Health and Social Services in Ottawa-Carleton. Ottawa: Social Planning Council of Ottawa-Carleton.

___________ 1992. Immigrants' Access to Social Services: Summaries and Analysis of Selected Reports. Ottawa: Multiculturalism and Citizenship Canada (Citizenship and Community Participation).

Bernard, Heneman, Gisèle Legault, Sylvie Gravel, Sylvie Fortin and Elena Alvarado 1994. Adaptation of services to new immigrant families. Montréal: Public Health Department in association with the School of Social Work, University of Montréal.

A sample of 297 recent immigrants with at least one pre-school child and living in areas served by one of three "Local Community Services Centres," and 94 medical and social practitioners serving immigrants in these areas. Asked about three areas of service: health problems, social problems (job, financial, housing, discrimination, immigrant status), and cultural problems (boredom, child care, men-women relations, domestic violence). (There is some overlap between the cultural and social areas in the examples given.) There were important and very large differences between the parents and the practitioners in the identification of priority problems, in the perceptions of access barriers, and in the perceptions of reasons for the barriers. "Families report problems in accessing services in 16% of cases in the health sector, 29% in the social sector, and 32% in the cultural sector, whereas practitioners assume that such problems exist in 79%, 72%, and 59% of cases respectively." The authors of this study say that the practitioners seem to have accepted the results of various studies, implying that they may not be right. Or, it may be that the families are not aware of services, and therefore do not perceive barriers.

Blau, Francine D. 1984. "The Use of Transfer Payments by Immigrants," Industrial and Labor Relations Review, 37(2):222-239.

Examines transfer payments to immigrants and natives in the US using the 1976 Survey of Income and Education. Transfers include welfare (public assistance, AFDC, and supplemental security income), and social insurance payments (social security, railroad retirement, veteran’s payments, unemployment compensation, and workers’ compensation). Immigrants use transfers more, mainly because they are older. After age and other factors are held constant, immigrant families use less welfare, and only slightly more social insurance. Welfare payments were 59 per cent lower than among comparable native-born families with male heads, and 57 per cent lower than comparable families with female heads. For recent immigrants, lack of knowledge of English reduces total transfers because of lower probability of participating in social insurance programs.

Blendon, Robert J., Linda H. Aiken, Howard E. Freeman and Christopher R. Corey 1989. "Access to Medical Care for Black and White Americans: A Matter of Continuing Concern," Journal of the American Medical Association, 261(2):278-281.

Blum, Esther 1986. "Ethnically-Sensitive Field Instruction: A Necessity in a Multicultural Society," in Bogo, M. and E. Vayda (eds.) The Practice of Field Instruction in Social Work: Theory and Process. Toronto: University of Toronto Press, 89-94.

Bollini, P. 1992. "Health Policies for Immigrant Populations in the 1990s: A Comparative Study in Seven Receiving Countries," International Migration, special issue, 30:103-113.

Borjas, George J. 1993. "National origin and immigrant welfare recipiency," Journal of Public Economics, 50(3):325-344.

A theoretical and empirical analysis of differences in welfare recipiency among the national origin groups that make up the immigrant population in the US is presented. The model is implemented empirically using detailed data on immigrant welfare utilization by country of origin from the US Census of 1980. The effects of source-country characteristics on immigrant welfare recipiency are estimated to test implications of the model. I think that this is very interesting for delivery because familiarity with the system negates delivery by "special interest group."

______________ 1994a Immigration and Welfare, 1970-1990. Cambridge, MA: National Bureau of Economic Research.

______________ 1994b "The economics of immigration," Journal of Economic Literature, 32(4):1667-1717.

The new immigration may have adverse fiscal impact because recent waves participate in welfare programs more intensively than earlier waves.

______________ and Stephen J. Trejo 1991. "Immigrant Participation in the Welfare System," Industrial and Labor Relations Review, 44(2):195-211.

Examines the use of public assistance income (Aid to Families with Dependent Children, General Assistance and Supplemental Security Income (Old-Age Assistance, Aid to the Blind and Aid to the Permanently and Totally Disabled) using the 1970 and 1980 public use census microdata samples. Finds that the use of welfare is higher for more recent immigrants, and for immigrants who have been in the country longer. The latter is referred to as an "assimilation effect." There is a lot of variation among origins groups. There is no attempt to control for eligibility, because the author’s are concerned with the welfare burden, not with welfare under-utilization as a social problem.

Bridgman, Gail 1993. The Place of Mainstream and Ethno-Racial Agencies in the Delivery of Family Services to Ethno-Racial Canadians. Master of Social Work Thesis submitted to the Faculty of Graduate Studies, Graduate Program in Social Work, York University.

A study of five mainstream and five ethno-specific agencies in the Toronto area. The ethno-specific agencies were members of the Multicultural Coalition for Access to Family Services. "Our findings confirm on the one hand, that mainstream agencies have been slow to respond to cultural diversity. On the other hand, ethno-racial family service agencies were found to be providing culturally-sensitive and linguistically appropriate, accessible services to ethno-racial clients. There appears to have been little improvement in co-ordination and co-operation between the two sectors despite growing service demands and decreased financial resources.

British Columbia, Community Panel Family and Children's Services Legislation Review 1992. Report of the Aboriginal Committee, Liberating Our Children Liberating Our Nations. Ministry of Social Services, Province of British Columbia.

Table of Contents         Executive Summary
Chapter | 1 | 2 | 3 | 4 | 5 | 6 | 7 |      Bibliography | A-B | C-I | J-O | P-Z |

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