Integrated Care Pathways for Black Persons With Traumatic Brain Injury: A Critical Transdisciplinary Scoping Review of the Clinical Care Journey

Abstract

Objectives: This novel critical transdisciplinary scoping review examined the literature on integrated care pathways that consider Black people living with traumatic brain injury (TBI). The objectives were to (a) summarize the extent, nature, and range of literature on care pathways that consider Black populations, (b) summarize how Blackness, race, and racism are conceptualized in the literature, (c) determine how Black people come to access care pathways, and (d) identify how care pathways in research consider the mechanism of injury and implications for human occupation. Methods: Six databases were searched systematically identifying 178 articles after removing duplicates. In total, 43 articles on integrated care within the context of Black persons with TBI were included. Narrative synthesis was conducted to analyze the data and was presented as descriptive statistics and as a narrative to tell a story. Findings: All studies were based in the United States where 81% reported racial and ethnic disparities across the care continuum primarily using race as a biological construct. Sex, gender, and race are used as demographic variables where statistical data were stratified in only 9% of studies. Black patients are primarily denied access to care, experience lower rates of protocol treatments, poor quality of care, and lack access to rehabilitation. Racial health disparities are disconnected from racism and are displayed as symptoms of a problem that remains unnamed. Conclusion: The findings illustrate how racism becomes institutionalized in research on TBI care pathways, demonstrating the need to incorporate the voices of Black people, transcend disciplinary boundaries, and adopt an anti-racist lens to research.

A systematic review on integrated care for traumatic brain injury, mental health, and substance use

“…As noted by strategic approach 1.4, programs for underserved or marginalized populations must be available to address health equity and guarantee universal access to quality healthcare. Additional work focusing on the experiences of underserved, marginalized, or racialized communities, such as the recent critical transdisciplinary scoping review mapping integrated care pathways for Black people experiencing TBI [ 112 ], are needed to ensure integrated care adequately and effectively addresses the needs of these communities.…”

Exploring the Relationships Between Rehabilitation and Survivors of Intimate Partner Violence: A Scoping Review

“…Very few of the included studies reported on race or ethnicity among study participants and none of the included articles discussed the potential impacts of racism, racialization, or culture, either among survivors or rehabilitation professionals. A recent scoping review investigating integrated care pathways for Black persons reported differential access to and lower quality rehabilitation care for Black people than white people in several included studies ( Omar et al, 2023 ). The authors of studies included in the review discussed systemic inequalities, racial prejudices, and biases as contributors to this differential access, factors that Omar et al (2023) note describe anti-Black racism.…”

“…A recent scoping review investigating integrated care pathways for Black persons reported differential access to and lower quality rehabilitation care for Black people than white people in several included studies ( Omar et al, 2023 ). The authors of studies included in the review discussed systemic inequalities, racial prejudices, and biases as contributors to this differential access, factors that Omar et al (2023) note describe anti-Black racism. Recognizing, naming, and understanding the impacts of anti-Black, anti-Indigenous, and other forms of racism on IPV survivors seeking rehabilitation are critical to dismantling systems of oppression and providing equitable care.…”