WAQP Week 6 Assignment

Rubric Standard | Complete > Does the prospectus contain all the required elements? Refer to the annotated outline to see the required parts of the Dissertation Prospectus document.

Note. Please complete following the directions provided, using the stem sentences, and referring to the examples in the appendix.

Title

Racial/Ethnic Minority Adults’ Experiences with Barriers to Mental Health Care Access and Utilization

Supporting Literature

The first step in developing your prospectus is to search the literature related to the general area you want to investigate (see social problem below). In your review of recent, empirical literature, what keywords did you search and in what databases?

The keywords and databases searched included The key words searched and the databases used included racial/ethnic disparities, mental health care access, mental health service utilization, structural barriers, cultural barriers, technological barriers, African American OR Black, Hispanic OR Latino, Asian American, combined with Boolean operators (AND/OR) mental health treatment disparities. Only articles published between 2021 and 2026 that were peer reviewed and empirical were included. PubMed, PsycINFO, Google Scholar, Web of Science and CINAHL were the main databases used for searches. Other searches were made in multi-disciplinary databases, including SAGE Journals and the JSTOR, to find social science views.

Provide at least 10 brief summaries of recent, scholarly (peer-reviewed) articles that support/justify a current and relevant problem in your discipline or professional field. Source(s) supporting your framework should be included. Include the complete, APA reference entry, followed by (a) an in-text citation; (b) what was studied; (c) what was found; and (d) why this research is important in relation to your study. This evidence provides the justification for your research problem.

Breslau, J., Han, B., Levin, J. S., Lai, J., & Yu, H. (2024). Are disparities in mental health care for Medicaid beneficiaries lower in managed care? Healthcare, 12(1), 100734.  https://doi.org/10.1016/j.hjdsi.2024.100734

(a) Breslau et al. (2024); (b) used Medicaid claims data to evaluate the trends of racial/ethnic disparities in mental health service use; (c) identified large and persistent disparities among Black and Hispanic beneficiaries despite insurance coverage, highlighting structural and cultural barriers; (d) relevant to my study because they found that disparities in mental health care access persist despite insurance coverage, which emphasizes structural and cultural barriers.

Cook, B. L., Rastegar, J., & Patel, N. (2024). Social risk factors and racial and ethnic disparities in health care resource utilization among Medicare advantage beneficiaries with psychiatric disorders.  Medical Care Research and Review,  81(3), 209-222. https://doi.org/10.1177/10775587231222583

(a) Cook et al. (2024); (b) This study examined the intersection of social risk factors (e.g., housing instability, food insecurity) and racial/ethnic disparities in mental health service utilization using large-scale claims and survey data; (c) found that even after accounting for social risks, Black and Hispanic adults had significantly lower utilization rates than White adults; (d) this research is important to my study because it highlights how structural social determinants compound racial/ethnic disparities, supporting the need to examine multifaceted barriers.

Elliott, T. R., Choi, K. R., Elmore, J. G., & Dudovitz, R. (2024). Racial and ethnic disparities in receipt of pediatric mental health care.  Academic Pediatrics,  24(6), 987-994. https://doi.org/10.1016/j.acap.2024.01.024

(a) Elliott et al. (2024); (b) This study examined racial and ethnic disparities in the receipt of mental health services among a nationally representative sample of U.S. children aged 5 to 17 years using data from the National Health Interview Survey; (c) found that Black and Hispanic children were significantly less likely to receive mental health treatment compared to White children, even after controlling for socioeconomic and health-related factors; (d) this research is important to my study because it demonstrates the persistence of racial and ethnic disparities in pediatric mental health care access, thereby supporting the need for qualitative exploration of the structural, cultural, and technological barriers experienced by racial and ethnic minority populations across age groups.

Green, J. G., McLaughlin, K. A., Fillbrunn, M., Fukuda, M., Jackson, J. S., Kessler, R. C., Sadikova, E., Sampson, N. A., Vilsaint, C., Williams, D. R., Cruz-Gonzalez, M., & Alegría, M. (2020). Barriers to mental health service use and predictors of treatment drop out: Racial/Ethnic variation in a population-based study. Administration and Policy in Mental Health and Mental Health Services Research, 47(4), 606-616.  https://doi.org/10.1007/s10488-020-01021-6

(a) Green et al. (2020) b) Studied nationally representative survey data from the United States related to adults with mental illnesses and explored the factors of perceived need, barriers to treatment and dropout; c) Discovered that racial and ethnic minorities had lower chances of recognizing their need for treatment or accessing services and higher rates of dropout in comparison to white adults, with different kinds of barriers involved (structural, attitudinal, cultural, etc.); d) Relevant to my paper since it presents information about structural, cultural and other barriers causing disparities in mental healthcare utilization by racial and ethnic minorities.

Koroma, M. I., Inungu, J. N., Adu-Serwaah, M., Sultana, S., Younis, M. Z., & Iheduru-Anderson, K. (2025). Disparities in adult mental health service utilization in the United States: A cross-sectional study.  Electronic Journal of General Medicine,  22(5). https://doi.org/10.29333/ejgm/16747

(a) Koroma (2025); (b) This cross-sectional study examined factors associated with mental health service utilization among U.S. adults using national survey data; (c) found that White adults had the highest service utilization rate (28.3%), compared to Black (17.6%), Hispanic (16.1%), and Asian (10.3%) adults, with significant racial/ethnic disparities persisting even after controlling for predisposing, enabling, and need-based factors; (d) this research strengthens the justification for my study by providing recent evidence of the ongoing racial and ethnic disparities in mental health service utilization and highlighting the need to qualitatively explore the structural, cultural, and technological barriers contributing to these inequities

Ma, Y., Ramos, C., Wen, H., & Cummings, J. R. (2025). Racial and ethnic differences in mental health service use among adolescents.  JAMA Network Open,  8(6), e2516612. doi:10.1001/jamanetworkopen.2025.16612

(a) Ma et al. (2025); (b) This cross-sectional study examined racial/ethnic differences in mental health service utilization (visits, medications, telemental health) among 23,541 U.S. adolescents using national survey data; (c) found that racial/ethnic minority adolescents (Black, Hispanic, Asian) were significantly less likely to receive any mental health visits, outpatient care, or telemental health services compared to White adolescents; (d) this research is important to my study because it documents persistent post-pandemic disparities in access and utilization among youth, highlighting the need to examine structural, cultural, and technological barriers affecting minority populations.

McCleary-Gaddy, A. T., & James, D. (2024). Dehumanization, attitudes toward seeking professional psychological care, and mental health among African American women.  Cultural Diversity & Ethnic Minority Psychology,  30(1), 166. https://psycnet.apa.org/doi/10.1037/cdp0000554

(a) McCleary-Gaddy & James (2024); (b) This study examined how cultural identity, discrimination, and dehumanization influence mental health treatment-seeking behaviors among African American women; (c) found that experiences of dehumanization and discrimination were associated with less favorable attitudes toward seeking professional psychological care, while mistrust of providers and the lack of culturally responsive mental health environments served as significant barriers to treatment-seeking; (d) this is relevant to my study because it highlights cultural barriers central to racial/ethnic disparities in mental health care access and utilization.

Pervez, R., & Anjum, N. (2023). Systemic barriers and interventions in healthcare for underserved communities: An exploration of health disparities.  Insights-Journal of Life and Social Sciences,  1(2), 19-24. https://orcid.org/0009-0004-0747-3369

(a) Pervez & Anjum (2023); (b) looked at the structural and institutional barriers that impact access to healthcare for populations that are underserved; (c) found that logistical, institutional and systemic inequities are significant factors that contribute to interrupted care; (d) relevant because this gives evidence for the structural inequities that I will examine in the mental health context.

Rodgers, C. R., Flores, M. W., Bassey, O., Augenblick, J. M., & Lê Cook, B. (2022). Racial/ethnic disparity trends in children’s mental health care access and expenditures from 2010-2017: Disparities remain despite sweeping policy reform.  Journal of the American Academy of Child & Adolescent Psychiatry,  61(7), 915-925. https://doi.org/10.1016/j.jaac.2021.09.420

(a) Rodgers et al. (2022); (b) This study analyzed national trends in children’s mental health care access and expenditures using data from the Medical Expenditure Panel Survey (MEPS) from 2010 to 2017; (c) found that despite national policy reforms, disparities persisted and widened for Black youth compared to White youth, with Black children showing decreasing or stagnant mental health service use and lower expenditures over time; (d) this research is important to my study because it highlights the persistence of long-term racial/ethnic disparities in mental health care access from childhood into adolescence, underscoring the need to examine underlying structural, cultural, and technological barriers.

Van Doren, N., Zhu, Y., Vázquez, M. M., Shah, J., Grammer, A. C., Fitzsimmons-Craft, E. E., Eisenberg, D., Wilfley, D. E., Taylor, C. B., & Newman, M. G. (2024). Racial and Ethnic Disparities in Barriers to Mental Health Treatment Among U.S. College Students. Psychiatric Services, 75(9), 839-846.  https://doi.org/10.1176/appi.ps.20230185

(a) Van Doren et al. (2024); (b) This study examined racial and ethnic differences in barriers to mental health treatment using a national sample of U.S. college students who were not currently in psychotherapy; (c) found significant disparities, with Black and Hispanic/Latina students reporting more financial and time-related barriers, while also showing greater willingness to seek treatment compared to White students; (d) this research is important to my study because it highlights structural and cultural barriers to mental health care access among racial and ethnic minority young adults and underscores the need for qualitative exploration of lived experiences with these interconnected barriers.

Rubric Standard | Justified > Is evidence presented that this problem is significant to the discipline and/or professional field? The prospectus should provide relevant statistics and evidence, documentable discrepancies, and other scholarly facts that point to the significance and urgency of the problem.

Problem

What was the social problem that prompted you to search the literature to find out more? Write in complete sentences using a scholarly tone.

The situation or issue that prompted me to search the literature is the issue of disparities in terms of race and ethnicity regarding access and use of mental health services amongst people under the criminal justice system in the United States. In the area of mental health needs, racial and ethnic minorities, specifically Blacks and Hispanics, tend to show similar or even higher rates than their White peers but show lower levels of utilization of services. Such disparity tends to be quite pronounced when speaking about forensic psychology practice which includes court-mandated competence assessment, mental health diversion program, correctional institutions, and re-entry programs. According to national statistics, for instance, while 50% of White adults with fair/poor self-rated mental health report service utilization, the numbers for Black adults with fair/poor self-rated mental health and Hispanic adults with fair/poor self-rated mental health are 39% and 36% respectively.

There is evidence of overrepresentation of racial and ethnic minorities in the criminal justice system, and there are known roles of the mental health services in reducing recidivism, helping restore mental competence, and ensuring a proper re-entry into the community. However, there is a lack of qualitative literature on experiences of racial and ethnic minorities as clients of forensic mental health. There is little information available about barriers to mental health services for such population and decisions they make when facing the issue of obtaining mental health services in forensic setting.

Now that you have read and summarized some of the recent literature to understand your problem, and given what other researchers are exploring, what meaningful gap have you identified that your study will address? (What have others not yet explored about this problem that you will contribute with your study?)

Although researchers have investigated this issue, the topic has not been explored in this way: in terms of the absence of a comprehensive and integrated qualitative analysis of structural, cultural, and technological barriers and their interrelated impact on the lived experience of racial and ethnic minorities in the context of forensic mental health.

While the existing literature shows racial and ethnic disparities in access to and use of mental health services both among the general population and among justice-involved individuals, most of the studies focused either on particular barriers or used quantitative methods of research. For example, structural barriers such as systemic racism, low availability of services, overrepresentation of minorities in the criminal justice system were studied separately from cultural barriers such as stigma, mistrust, preference for informal sources of support and from technological barriers such as limited digital literacy and lack of access to telehealth services.

Little research has been conducted on the intersection of these barriers and the process of navigating forensic mental health settings by racial and ethnic minority justice-involved adults. Forensic mental health settings can include competency evaluation and competency restoration, forensic mental health diversion, jail- or prison-based mental health services, re-entry services. This gap needs to be addressed because it has significant implications for addressing recidivism and supporting forensic mental health practice and policy.

Based on all of the above information (social problem, literature review, gap), in one sentence, what is your research problem ?

The specific research problem that will be addressed through this study is the absence of an integrated perspective on the processes of experiencing, perceiving, and navigating the interconnected barriers – structural, cultural, and technological – in accessing and utilizing mental health services by racial and ethnic minorities who have become justice-involved adults in the context of forensic psychology, including competency evaluations, diversion programs, and re-entry services.

The problem statement formulates the phenomenological gap without making any assumptions about causality and remains closely connected to the formulated social problem and literature gap.

Rubric Standard | Meaningful > Has a meaningful problem and gap in the research literature been identified? In other words, is addressing this problem the logical next step, given the previous exploratory and confirmatory research (or lack thereof) on this topic? It is not acceptable to simply replicate previous research for a Ph.D. degree.

Rubric Standard | Original > Does this project have potential to make an original contribution? The problem must be an authentic "puzzle" that needs solving, not merely a topic that the researcher finds interesting. Addressing the problem should result in an original contribution to the field or discipline.

Purpose

To address your stated research problem, what is the purpose of your study? Will you describe, compare, explore, examine, etc.? Complete the purpose sentence below and be sure to clarify your variables/concepts of interest.

The purpose of this Qualitative study is to examine the personal experiences and perceptions of adult members of racial and ethnic minorities involved in the criminal justice system as they relate to barriers associated with structure, culture, and technology that impact their access to and use of mental health services in forensic psychology settings.

Phenomenology offers a holistic view that takes into account the barriers and their effect on decision-making process regarding the utilization of mental health services among other aspects.

Framework (Conceptual or Theoretical)

What theory(ies) and/or concept(s) support (frame) your study and who are the original authors? Provide an in-text citation with your response, and the complete APA reference entry with summary in the Supporting Literature section.

The theories and/or concepts that ground this study include the concept of intersectionality, which forms the main theoretical basis of the research (Crenshaw, 1989) and Andersen's Behavioral Model of Health Services Use as a supplementary theory (Andersen, 1995).

In this case, intersectionality is a general framework of the study, which implies a multifaceted and interconnected nature of various systems of oppression such as race, ethnicity, justice involvement, and socio-economic status, and their role in shaping lived experiences of racial and ethnic minority adults accessing forensic mental health services. It involves an appreciation of complexity of reality of the study participants that should go beyond one-dimensional analyses of disparity in access and use of health services. On the other hand, Andersen's Behavioral Model helps organize the analysis of various barriers to access and use of health services within predisposing, enabling, and need factors, which at the same time leaves room for integration into the study.

How do these theories and/or concepts relate to your research problem, purpose, and the nature of your study?

The logical connections between the framework presented and the nature of my study include :Andersen's Behavioral Model of Health Service Utilization (Andersen, 1995) serves as a useful tool for analyzing the predisposing, enabling, and need variables that affect the use of forensic mental health services. The intersectionality theory (Crenshaw, 1989) works in conjunction with this model by focusing on the overlapping of certain identities (race, ethnicity, gender, and justice involvement) and the barriers and marginalized experiences arising from them.

The theories assist in qualitatively analyzing disparities in the use of forensic mental health services by racial/ethnic minority adults involved with the justice system. These theoretical frameworks help in accomplishing the objective of the research project by going beyond one dimension.

Rubric Standard | Grounded > Is the problem framed to enable the researcher to either build upon or counter the previously published findings on the topic? For most fields, grounding involves articulating the problem within the context of a theoretical base or conceptual framework. Although many approaches can ground a study in the scientific literature, the essential requirement is that the problem is framed such that the new findings will have implications for the previous findings.

Research Question(s) and Hypotheses (if applicable)

List the question(s) that you plan to use to address the research problem. Your question(s) must align with your study purpose and include the variables and/or concepts and how they will be examined.

What are the real-life experiences of justice-involved adults who belong to ethnic/racial minorities concerning the structural, cultural, and technological barriers impacting their access to and utilization of forensic mental health services in the U.S?

This qualitative research question is directly linked to the purpose of the study in terms of examining the experiences of participants from the intersectional perspective and Andersen's Behavioral Model. Specifically, this research focuses on the ways in which these interlocking identities affect predisposing, enabling, and need variables in the framework of forensic psychology. No hypotheses will be stated due to the exploratory nature of the qualitative study.

Nature of the Study

What systematic approach/method and research design do you plan to use to address your research question(s)?

To address the research questions in this Qualitative study, the specific research design will include The specific research design will be a basic qualitative design with semi-structured interviews that will investigate the lived experiences of racial/ethnic minority adults facing structural, cultural, and technological barriers to mental health care access and utilization for the purpose of addressing the research questions identified in this qualitative study.

Reference entry for the work on which this research design is based:

Tisdell, E. J., Merriam, S. B., & Stuckey-Peyrot, H. L. (2025).  Qualitative research: A guide to design and implementation. John Wiley & Sons.

For your planned research design, what type of data will you need and what data collection instruments will provide it?

For my planned research design, I will need My proposed research design involves gathering primary qualitative data with semi-structured interviews with adults of racial and ethnic minority backgrounds with barriers to mental health care services. A semi-structured interview guide developed by the researcher will be the main data collection tool.

What data sources and analysis do you plan to use to answer your research question(s)?

The sources of data are going to involve purposive sampling of 12–15 racial and ethnic minorities (Black, Hispanic, and Asians) who are justice involved and have experienced challenges in access and use of forensic mental health services. The challenges will be established through self-report at screening time involving forensic evaluation, non-compliance with court-ordered treatment, or documented difficulties with access to community-based forensic mental health services. Audio-recorded interviews will be conducted to collect the data.

Thematic analysis, following the six-step process as presented by Braun & Clarke (2006), is going to be used: (a) Familiarisation with the data; (b) Generating initial codes; (c) Searching for themes; (d) Reviewing themes; (e) Defining and naming themes; (f) Producing the report.

This approach will be consistent with the qualitative research design and the frameworks of the intersectionality and Andersen's models.

Reference Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.  https://doi.org/10.1191/1478088706qp063oa

What limitations, challenges, and/or barriers might you need to address while conducting this study (e.g., access to participants, access to data, requirements for storing data, separation of roles or other ethical considerations, instrumentation fees, etc.)?

There are several potential difficulties that can arise in the process of conducting this study. First, it is likely to encounter problems in recruiting 12-15 racial and ethnic minorities who have been in contact with the justice system since their history of distrust in relation to research and medical practice combined with the social stigma of being a part of both the mental health and justice systems is expected to make access difficult.

Ethical considerations are particularly important in this context. They involve proper handling of the power dynamic between researcher and participant with a justice background, protection of the voluntary nature of participation without coercing anyone, confidentiality in relation to the sensitive nature of both mental health and legal status, and reduction of emotional stress experienced during the interview. There are several extra measures that will be taken, including the use of trauma-informed interviewing techniques, appropriate informed consent procedures, and safe storage of data (encrypted audio recording and anonymized transcripts).

Rubric Standard | Feasible > Can a systematic method of inquiry be used to address the problem; and does the approach have the potential to address the problem while considering potential risks and burdens placed on research participants? The tentative methodology demonstrates that the researcher has considered the options for inquiry and has selected an approach that has potential to address the problem.

Significance

How will your study address the meaningful, discipline-specific issue that you identified and therefore contribute to your field, discipline, professional practice, etc. contributing to positive social change?

This study is significant in that it tackles an important problem that forensic psychologists face – the continuing racial and ethnic disparities in service use for mental disorders among people in contact with the criminal justice system. In this study, by analyzing the effect of structural, cultural, and technological barriers on the service use among racial/ethnic minority adults, the researchers will get unique information about how the combination of these barriers impacts the access to and involvement in the provision of forensic mental health services.

The results of the analysis will be useful for forensic psychology as the information obtained from the study can help forensic professionals create practices that would take into account predisposing cultural barriers, enabling barriers (including those related to technology use) and intersecting identities to provide services better to racial/ethnic minorities.

Specifically, the results of the research will help forensic psychologists to understand better how the predisposing cultural barriers, the barriers that make accessing and using services possible (enabling barriers), including technological barriers, and other aspects of clients' identity can affect service use in areas such as correctional mental health treatment, court mandated evaluations/interventions, competency restoration, reentry, and risk assessment procedures. The knowledge can be used to create policies and protocols to improve the situation and address the over-representation of racial and ethnic minorities in the criminal justice system.

The study promotes social change as the findings of the study will make forensic mental health care more fair and efficient.

Rubric Standard | Impact > Does this project have potential to affect positive social change? As described in the Significance section, the anticipated findings have potential to support the mission of Walden University to promote positive social change.

Rubric Standard | Objective > Is the topic approached in an objective manner? The framing of the problem should not reveal bias or present a foregone conclusion. Even if the researcher has a strong opinion on the expected findings, the researcher must maximize scholarly objectivity by framing the problem in the context of a systematic inquiry that permits multiple possible conclusions.

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