Historic Redlining and Contemporary Behavioral Health Workforce Disparities

Erikson, Clese; Dent, Randl B; Park, Yoon Hong; Luo, Qian

doi:10.1001/jamanetworkopen.2022.9494

Cited by 13 publications

(4 citation statements)

References 4 publications

(16 reference statements)

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“…the need for innovative, evidence-based solutions (Alegría et al, 2016). Issues related to poor access to care (Agency for Healthcare Research and Quality, 2015), including workforce shortages (Erikson et al, 2022;Jackson and Gracia, 2014;Kaiser Family Foundation, 2022), stigma (Quartana et al, 2014;Rao, Feinglass, and Corrigan, 2007), and concerns around trust and privacy (Campbell and Long, 2014;Hwang et al, 2008), have contributed to disparities in care and potentially poorer outcomes for racial and ethnic minority patients in both the civilian and military contexts. Poor outcomes in BH care have spillover impacts on other aspects of health and well-being, including negative impacts on physical health, well-being, and military readiness and retention (Hepner, Roth, et al, 2021).…”

Section: Prioritize Racial and Ethnic Equity In Behavioral Health Carementioning

confidence: 99%

Improving Behavioral Health Care in the Military Health System: Challenges, Promising Strategies, and Research Directions

2023

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nsuring that service members have timely access to high-quality behavioral health (BH) care is a priority for the U.S. Department of Defense (DoD) and essential to ensuring the health and readiness of the force. The Military Health System (MHS) provides health care to service members, their dependents, and military retirees, and the Defense Health Agency (DHA) oversees health care delivery. To support the MHS in its mission, in this paper, we highlight opportunities to improve the quality, access, and equity of BH care delivery.Military health care is delivered in two ways: as direct care provided at military treatment facilities (MTFs) and as private-sector care provided by TRICAREcontracted civilian health care facilities and providers in the community. 1 Privatesector care extends access to care for patients who are unable to access timely care or specific specialty care from an MTF. Active-duty service members receive most of their care from MTFs, whereas their dependents and other beneficiaries receive most of their care from private-sector providers (Bond and Schwab, 2019;Tanielian and Farmer, 2019). In fiscal year (FY) 2021, private-sector care accounted

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Section: Prioritize Racial and Ethnic Equity In Behavioral Health Carementioning

confidence: 99%

Improving Behavioral Health Care in the Military Health System: Challenges, Promising Strategies, and Research Directions

2023

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“…The laws and policies that enacted residential racial segregation and the subsequent community disinvestment have had one of the most persistent effects on the health of racially minoritized populations. Current measures of community vulnerability, such as the area deprivation index (ADI) and the social vulnerability index (SVI), are tightly associated with historical residential segregation, and these measures of community vulnerability have been associated with inequities in healthcare delivery (e.g., availability of mental health services) 6 and health outcomes (e.g., COVID‐19 incidence and mortality) 7 . In this issue, McGee‐Avila et al examined the location of cancer treatment among adults diagnosed with breast, colorectal, or invasive cervical cancer and found significant differences in geospatial patterns of cancer treatment by race/ethnicity, insurance type, and area‐level factors, even after controlling for sociodemographic factors and tumor characteristics 8 .…”

Section: Structural Inequitiesmentioning

confidence: 99%

The RWJF Health Policy Research Scholars: Interdisciplinary leaders advancing health equity

Peek

Goheer

Saha

2023

Health Services Research

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“…Problems with access to mental healthcare past and present are well documented across the US, and are especially pronounced within minoritized and underserved populations [8][9][10][11][12][13]. One key and increasingly common approach to understanding these inequities is through the study of social determinants of health (SDOH), which focus on how the various circumstances in which people live affect their health and wellbeing [14,15].…”

Section: Introductionmentioning

confidence: 99%

Equity in Digital Mental Health Interventions: Where to Next? (Preprint)

Robinson,

Flom,

Forman-Hoffman

et al. 2024

Preprint

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UNSTRUCTURED Healthcare technologies have the ability to bridge or hinder equitable care. Advocates of digital mental health interventions (DMHIs) report that such technologies are poised to reduce the documented gross health care inequities that have plagued generations of people seeking care. This is due to a multitude of factors such as their potential to revolutionize access, mitigate logistical barriers to in-person mental health care, and leverage patient inputs to formulate tailored, responsive, and personalized experiences. While we agree with the potential of DMHIs to advance health equity, we articulate several steps essential to mobilize and sustain meaningful forward progression in this endeavor, reflecting on decades of research and learnings drawn from multiple fields of expertise and real world experience. First, DMHI manufacturers must build diversity, equity, inclusion, and belonging (DEIB) processes into the full spectrum of product evolution itself (e.g., product design, evidence generation) as well as into the fabric of internal company practices (e.g., talent recruitment, communication principles, and advisory boards). Next, awareness of the DEIB efforts – or lack thereof – in DMHI research trials is needed to refine and optimize future study design for inclusivity as well as proactively address potential barriers to doing so. Trials should incorporate thoughtful, inclusive and creative approaches to recruitment, enrollment and measurement of social-determinants of health and self identity, as well as a prioritization of planned and exploratory analyses examining outcomes across various groups of people. Third, mental health care advocacy, research funding policies, and local and federal legislation can advance these pursuits, with directives from the US Preventive Services Task Force, National Institutes of Health, Food and Drug Administration applied as poignant examples. For products with artificial intelligence/machine learning (AI/ML), maintaining a "human in the loop" as well as pre-specified and adaptive analytic frameworks to monitor and remediate potential algorithmic bias can reduce the risk for increasing inequity. Last, but certainly not least, is a call for partnership and transparency within and across ecosystems (academic, industry, payer, provider, regulatory agencies, value based care organizations) to reliably build health equity into real-world DMHI product deployments and evidence generation strategies. All these considerations should also extend into the context of an equity-informed commercial strategy for DMHI manufacturers and healthcare organizations alike. The potential to advance health equity in innovation with DMHI is apparent. We advocate the field's thoughtful and evergreen advancement in inclusivity, thereby redefining the mental health care experience for this generation and those to come.

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Historic Redlining and Contemporary Behavioral Health Workforce Disparities

Cited by 13 publications

References 4 publications

Improving Behavioral Health Care in the Military Health System: Challenges, Promising Strategies, and Research Directions

Improving Behavioral Health Care in the Military Health System: Challenges, Promising Strategies, and Research Directions

The RWJF Health Policy Research Scholars: Interdisciplinary leaders advancing health equity

Equity in Digital Mental Health Interventions: Where to Next? (Preprint)

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