Anyone who has ever worked in retail is familiar with the mystery shopper. An individual poses as a regular shopper to ascertain the ‘real’ customer experience for the retailer. Dani Adams, PhD, an NIMH T32 Postdoctoral Fellow at the Brown School’s Center for Mental Health Services Research (CMHSR), utilized this unique methodology for her dissertation research which examined the real-world accessibility of mental health services for youth at safety-net health agencies such as federally qualified health centers and community mental health centers. She took a special interest in kids and adolescents enrolled in Medicaid.
For her dissertation, Adams will receive the American Public Health Association’s 2022 Kenneth Lutterman Award for Best Student Paper for her outstanding work as a student researcher in the field of mental health services. The award is in recognition of her dissertation paper titled “Assessing Real-World Access to Trauma-Specific Outpatient Health services for Adolescents: A Mystery Shopper Study.”
For her research, Adams hired three racially and ethnically diverse women to pose as mothers and call agencies throughout the Chicago area to schedule real appointments for their pseudo-adolescent child who had recently witnessed a traumatic event. The study participants made over 450 calls involving nearly 230 agencies throughout Cook County, Illinois. Each agency was called twice – once using a script where the parent reported having Medicaid, and once using a script where the parent reported having private insurance.
“Using this methodology, we were able to get a more accurate sense of what access to care actually looks like for these families,” she said. “The situation is pretty stark. The big caveat to the results is that access was terrible for everyone regardless of insurance type. Only 17% of pseudo-mothers could schedule an appointment, with the primary reasons for denials being administrative burdens and lack of capacity.”
Further research results indicated racial and ethnic discrimination likely played a role in scheduling challenges.
“One of the biggest findings of the study is that the Black and Latina callers were 18% more likely to be denied an appointment than the white caller. That’s a statistically significant number and it’s extremely concerning. We know that there are existing racial disparities in mental health outcomes. For me, this kind of points to one potential reason for that. If it’s harder for Black and brown families to schedule appointments, then it’s harder for them to engage in and access mental health services.”
Adams believes one key to improving the process of accessing mental health services for youth, lies with the frontline personnel – the receptionist and the scheduler.
“That’s where my research is leading,” she said. “They are a missing piece in strengthening the mental health system. They are often overlooked in the process. They’re underfunded and undertrained.”
He totally shifted my trajectory
Originally from South Dakota, Adams called Chicago home until this summer when she made the move to the Brown School where she is doing her postdoc at the CMHSR with Professor Leopoldo J. Cabassa and Associate Professor Byron Powell. While new to the Brown School, it turns out Adams’ connections to the institution were forged almost a decade ago.
Powell has been Adams’ mentor for several years since meeting in 2015 when both were at the University of Pennsylvania. Powell was a postdoc, and Adams was working there as a clinical research coordinator with Rinad Beidas. In fact, it was Powell’s encouragement that set Adams on the path to social work.
“He’s been hugely influential in my life. He totally shifted my trajectory,” she said. “I was thinking of going into clinical psychology, and he was like, ‘You think about systems, you think about policy, you should really be going into social work, not clinical psych. So, I took his advice.’”
Her connections to the Brown School don’t stop there. Adams partnered with a Brown School doctoral student, Nancy Jacquelyn Pérez-Flores, on her dissertation study. Pérez-Flores learned about the opportunity to be a voice actress for Adams’ study through the Collaborative for Community Wellness, a mental health advocacy group in Chicago for which they were both members. Adams hired Pérez-Flores to be a voice actress for the study and has continued collaborating with her on the submission of the study for publication.
Adams will attend the annual APHA meeting this month in Boston to present her research findings and accept her award. She calls this recognition a huge honor and a validation of her work as important, policy-relevant, innovative, and rigorous.
Seriousness aside, she adds: “It just means so much, ‘because, y’all, doing a dissertation is a struggle.”