Coronavirus Trauma and African Americans’ Mental Health: Seizing Opportunities for Transformational Change

The COVID-19 pandemic is a natural disaster of historic proportions with widespread and profound psychological sequelae. African Americans fall ill and die more than whites from COVID and more survivors and loved ones face psychological risk. African Americans also experience greater personal, social, and financial stress even when not personally touched by COVID illness, and they are again vulnerable as COVID diminishes African American community’s capacity for mutual support. Enactment of the American Rescue Act of 2021 can moderate if not eliminate African Americans’ greater adversity and greater psychological challenge; other provisions can move the mental health treatment system beyond its previous failure to reach African Americans as it constructively responds to the crisis that COVID presents. From outreach through trusted community actors and institutions for meeting African Americans’ needs of varying intensity and duration, and by providing a spectrum of evidence supported interventions—culturally adapted as needed—newfound success can mark a turning point toward new approaches and lasting success

Mainstreaming Mental Health Care in 42 Countries.

Abstract-Global consensus and national policies have emphasized deinstitutionalization, or a shift in providing mental health care from institutional to community settings. Yet, psychiatric hospitals and asylums receive the majority of mental health funding in many countries, at odds with research evidence that suggests that services should be delivered in the community. Our aim is to investigate the norms, actors, and strategies that influence the uptake of deinstitutionalization internationally. Our study is informed by prior literature on management and implementation science. The success and failure of mental health care operations depend on identifying and overcoming challenges related to implementing innovations within national contexts. We surveyed 78 experts spanning 42 countries on their knowledge and experiences in expanding community-based mental health care and/or downsizing institution-based care. We also asked them about the contexts in which said methods were implemented in a country. We found that mental health care, whether it is provided in institutions or in the community, does not seem to be standardized across countries. Our analysis also showed that moving deinstitutionalization forward requires meaningful engagement of three types of actors: government officials, health care professionals, and local experts. Progress toward deinstitutionalization depends on the partnerships formed among these actors and with diverse stakeholders, which have the potential to garner resources and to scale-up pilot projects. In conclusion, different countries have adapted deinstitutionalization in ways to meet idiosyncratic situations and population needs. More attention should be given to the management and implementation strategies that are used to augment treatment and preventive services

Ethnic Differences in Children’s Entry into Public Mental Health Care via Emergency Mental Health Services

For children and youth making a mental health crisis visit, we investigated ethnic disparities in whether the children and youth were currently in treatment or whether this crisis visit was an entry or reentry point into mental health treatment. We gathered Medicaid claims for mental health services provided to 20,110 public-sector clients ages 17 and younger and divided them into foster care and non-foster care subsamples. We then employed logistic regression to analyze our data with sociodemographic and clinical controls. Among children and youth who were not placed in foster care, African Americans, Latinos, and Asian Americans were significantly less likely than Caucasians to have received mental health care during the three months preceding a crisis visit. Disparities among children and youth in foster care were not statistically significant. Ethnic minority children and youth were more likely than Caucasians to use emergency care as an entry or reentry point into the mental health treatment, thereby exhibiting a crisis-oriented pattern of care

Did Medicaid Expansion Close African American-white Health Care Disparities Nationwide? A Scoping Review

Objectives: To investigate the impact of the Affordable Care Act’s (ACA) Medicaid expansion on African Americanwhite disparities in health coverage, access to healthcare, receipt of treatment, and health outcomes. Design: A search of research reports, following the PRISMA-ScR guidelines, identified twenty-six national studies investigating changes in health care disparities between African American and white non-disabled, non-elderly adults before and after ACA Medicaid expansion, comparing states that did and did not expand Medicaid. Analysis examined research design and findings. Results: Whether Medicaid eligibility expansion reduced African American-white health coverage disparities remains an open question: Absolute disparities in coverage appear to have declined in expansion states, although exceptions have been reported. African American disparities in health access, treatment, or health outcomes showed little evidence of change for the general population. Conclusions: Future research addressing key weaknesses in existing research may help to uncover sources of continuing disparities and clarify the impact of future Medicaid expansion on African American health care disparities

Qualitative evaluation of mental health services for clients with limited English proficiency

BACKGROUND: To meet federal requirements under Title VI of the Civil Rights Act, the state of California instituted policies requiring that comprehensive mental health services in native languages be made available to limited English proficiency (LEP) populations when concentrations exceed “threshold” levels. METHODS: This paper builds on promising results from quantitative evaluations by reporting on qualitative interviews with Latino and Vietnamese LEP clients in mental health services (N = 20) to examine the awareness, impact, and implications of these threshold language policies. RESULTS: Results suggest that, while individuals are often not aware of the policies themselves, the language-related services they receive that are prompted by the policies are critical to treatment initiation and retention. Results also convey the complexities of using interpreters for sensitive psychological topics, and suggest that, for LEP individuals seeking mental health treatment, providers who speak their native languages are generally preferred. CONCLUSIONS: Access to language-appropriate services seems to be an important part of why LEP populations seek mental health treatment. However, there are multiple variables that factor into the usage and usefulness of such services

Proceedings of the 3rd Biennial Conference of the Society for Implementation Research Collaboration (SIRC) 2015: advancing efficient methodologies through community partnerships and team science

It is well documented that the majority of adults, children and families in need of evidence-based behavioral health interventionsi do not receive them [1, 2] and that few robust empirically supported methods for implementing evidence-based practices (EBPs) exist. The Society for Implementation Research Collaboration (SIRC) represents a burgeoning effort to advance the innovation and rigor of implementation research and is uniquely focused on bringing together researchers and stakeholders committed to evaluating the implementation of complex evidence-based behavioral health interventions. Through its diverse activities and membership, SIRC aims to foster the promise of implementation research to better serve the behavioral health needs of the population by identifying rigorous, relevant, and efficient strategies that successfully transfer scientific evidence to clinical knowledge for use in real world settings [3]. SIRC began as a National Institute of Mental Health (NIMH)-funded conference series in 2010 (previously titled the “Seattle Implementation Research Conference”; $150,000 USD for 3 conferences in 2011, 2013, and 2015) with the recognition that there were multiple researchers and stakeholdersi working in parallel on innovative implementation science projects in behavioral health, but that formal channels for communicating and collaborating with one another were relatively unavailable. There was a significant need for a forum within which implementation researchers and stakeholders could learn from one another, refine approaches to science and practice, and develop an implementation research agenda using common measures, methods, and research principles to improve both the frequency and quality with which behavioral health treatment implementation is evaluated. SIRC’s membership growth is a testament to this identified need with more than 1000 members from 2011 to the present.ii SIRC’s primary objectives are to: (1) foster communication and collaboration across diverse groups, including implementation researchers, intermediariesi, as well as community stakeholders (SIRC uses the term “EBP champions” for these groups) – and to do so across multiple career levels (e.g., students, early career faculty, established investigators); and (2) enhance and disseminate rigorous measures and methodologies for implementing EBPs and evaluating EBP implementation efforts. These objectives are well aligned with Glasgow and colleagues’ [4] five core tenets deemed critical for advancing implementation science: collaboration, efficiency and speed, rigor and relevance, improved capacity, and cumulative knowledge. SIRC advances these objectives and tenets through in-person conferences, which bring together multidisciplinary implementation researchers and those implementing evidence-based behavioral health interventions in the community to share their work and create professional connections and collaborations