Session: Promising Intervention Targets to Advance Culturally Responsive Mental Health Care: Relational Mechanisms, Structural Barriers, and Telemental Health (Society for Social Work and Research 31st Annual Conference)

Despite decades of attention to mental health disparities, racial and ethnic minority populations continue to face inequities in both access to care and the quality of treatment received. These disparities arise from intersecting structural barriers—such as workforce shortages, language discordance, and insurance limitations—and relational dynamics within therapy, including cultural misalignment and challenges in building effective cross-cultural therapeutic relationships. They are further compounded by a workforce that does not reflect the racial, cultural, and linguistic diversity of the populations it serves and is unevenly distributed, leaving many communities with limited access to culturally responsive providers. Addressing these gaps requires identifying scalable, mechanism-focused intervention targets that operate across both therapeutic processes and systems of care. This symposium brings together complementary lines of research that examine promising targets at the relational and structural levels, including innovative models of clinician training and expansion of telemental health, to advance more equitable and culturally responsive mental health services.

The first two presentations examine two core relational mechanisms that are promising targets for intervention to improve the cultural responsiveness of psychotherapy to racial and ethnic minorities. The first presentation uses a unique matched pairs design involving 146 racially concordant or discordant therapy dyads to explore variability in cognitive match and its relationship to multicultural therapy process and outcomes. Results demonstrate that although BIPOC patients report greater distress related to their presenting concerns than White patients at intake, White therapists are less attuned and underestimate BIPOC patient distress related to their presenting problems, with significant implications for treatment outcome. The second paper discusses a second relational mechanism, the cross-racial therapeutic alliance, and presents a qualitative evaluation of Cross-Racial Alliance-Focused Training (CR-AFT), delivered as part of a clinical trial involving 8 White therapists and 40 Asian American clients. Therapists indicate that CR-AFT supervision enhances their ability to build cross-racial therapeutic alliances, while highlighting the need for refinements in the approach to improve usability and integration in practice.

Whereas the first two presentations examined dyadic therapy processes shaping treatment experiences of racial and ethnic minority patients, the third and fourth examine structural factors shaping the mental health help-seeking behaviors, treatment experiences, and service gaps in care delivery to other underserved populations. The third presentation presents qualitative interviews with immigrants with limited English proficiency who have sought and utilized language-concordant telemental health services to develop and empirically ground the Network Episode Model for Immigrants (NEM-IM). This work extends existing help-seeking theory to account for how migration experiences, acculturation, and digital and transnational social networks shape telemental health use among LEP immigrants. The fourth and final presentation extends the session's focus on racial inequities in care by shifting attention to the supply side, examining whether the private practice workforce in Alaska is structured in ways that can actually serve Indigenous and low-income populations. Analysis of web-scraped Psychology Today profiles demonstrate that geographic remoteness, provider market composition, and insurance barriers converge to limit access for the communities most in need.