title: Aftercare engagement: A review of the literature through the lens of disparities.
abstract: While prior research has well documented racial and ethnic disparities in mental health care broadly, significantly less attention has been given to possible disparities existing in the transition to aftercare. Grounded in Klinkenberg and Calsyn's (1996) framework, we review current research on aftercare, identify commonalities between the prior and current reviews, and highlight gaps for future research. We focus on variables pertinent to our understanding of racial/ethnic disparities. Articles were retrieved via PsycINFO, PubMed, PsycARTICLES, and Google Scholar. We targeted those written in English and conducted in the United States after 1996 that examined aftercare and disparities-related variables. Accumulating evidence across the 18 studies that we reviewed suggests that disparities exist in aftercare engagement. We found clear support for significant racial/ethnic effects on aftercare engagement, such that racial/ethnic minorities are typically more vulnerable to disengagement than Whites. In addition, we found modest support for the association between aftercare engagement and other individual- and community-level variables, including sex, insurance status, prior outpatient treatment, and residence in an urban versus rural setting. Moreover, extant qualitative research has identified barriers to aftercare engagement including stigma, low mental health literacy, and negative attitudes toward treatment. Finally, systems-level variables including assertive outreach efforts and reduced length of time on waitlists were identified as consistent predictors of engagement. Suggestions for future research and clinical implications are explored. (PsycINFO Database Record
authors.affiliation: Department of Psychology, Clark University.
authors.forename: Kristen
authors.identifier: 0000-0003-3427-6817
authors.initials: K
authors.lastname: Keefe
authors.affiliation: Department of Psychology, Clark University.
authors.forename: Esteban V
authors.identifier: 0000-0001-7811-4233
authors.initials: EV
authors.lastname: Cardemil
authors.affiliation: Department of Psychology, Clark University.
authors.forename: Matthew
authors.identifier: 0000-0002-8268-7429
authors.initials: M
authors.lastname: Thompson
mesh_terms: D000359:Aftercare / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D012959:Socioeconomic Factors