eSolutions: Integrated Care for Minority Populations
eSolutions is a monthly e-newsletter bringing you practical solutions and resources on primary and behavioral healthcare integration from across the United States.
In This Issue:
Feature Article: Integrated Care for Racial & Ethnic Minorities
Quick Tips: Strengthen the Provider-Client Relationship through Cultural Understanding
Grantee Spotlight: Montrose Counseling Center
Teresa Chapa, PhD, MPA, senior policy advisor, mental health, U.S. Department of Health & Human Services, Office of Minority Health
When navigating our fragmented and complex healthcare system, racial and ethnic minorities and persons with limited English proficiency often seek behavioral health assistance through their primary care providers.
The Office of Minority Health (OMH) first examined the role of integrated care in 2004 to find solutions for improving access, engagement and utilization of mental health services by minority populations by writing a position brief that included the research and guidance of national experts in the fields of health, mental health, substance use and addiction, integrated health care, and cultural and linguistic competency. Since then, the field has gained significant momentum.
OMH developed its initiatives and programs in integrated care with the goal of improving the health and behavioral health status of racial and ethnic minority and limited English proficiency populations by highlighting and promoting models that provide efficient and seamless coordination of access, quality and delivery of care. Our goals and objectives are centered on promoting health equity while building on innovation and leadership, working collaboratively across the U.S. Department of Health and Human Services and with other federal and non-federal partners, leveraging dollars and bridging gaps. Along with our partners, OMH hopes these new models of integrated care can be implemented to improve the overall quality of care for our underserved communities.
Strategies aimed at eliminating behavioral health disparities include:
- Increase knowledge and implementation of integrated primary and behavioral healthcare models that serve racial and ethnic minority communities and those with limited English proficiency.
- Promote best, promising and evidence-based practices that are culturally and linguistically appropriate.
- Support efforts to build a multidisciplinary, diverse, knowledgeable, bilingual and culturally competent workforce and leadership for integrated care.
- Improve health and behavioral healthcare by addressing the role of social determinants of health.
- Improve information dissemination strategies through learning collaboratives.
Examples of OMH’s integrated care and workforce development projects include:
- Integrated Care for Asian American, Native Hawaiian & Pacific Islander Communities: A Blueprint for Action Summit (August 2011) and A Blueprint for Action. Consensus Statements and Recommendations (2012).
- Eliminating Behavioral Health Disparities through the Integration of Behavioral Health and Primary Care Services for Racial and Ethnic Minority populations: Establishing Models for Improving Clinical Outcomes. Hogg Foundation for Mental Health. Consensus meeting: Nov. 2011. Consensus paper: Jan. 2012. Final rollout: February 7, 2012. Review of the literature due May 2012.
- Mobilizing Social Work as a Resource for Eliminating Behavioral Health Disparities: a Disparities Curriculum Infusion Project, National Association of Deans and Directors of Schools of Social Work. Literature Review. Due April 2012.
- Dialogue and Strategies for Effective Holistic Health for African Americans-Blacks: Addressing the Integration of Mental Health, Substance Abuse and Primary Care (2010) and Pathways to Integrated Health Care, Strategies for African American Communities and Organizations: consensus statements and recommendations (2011).
- Movilizándonos por Nuestro Futuro: Strategic Development of a Mental Health Workforce for Latinos Consensus meeting (2009), and consensus statements and recommendations (2010); the Alliance for Latino Behavioral Health Workforce Development (2010), a leadership driven steering committee dedicated to implementing recommendations and actions steps of Movilizándonos and workforce overall.
For more information on OHM’s efforts related to integrated care for racial and ethnic minority populations, contact Teresa Chapa, PhD, MPA, senior policy advisor, mental health, U.S. Department of Health and Human Services, Office of Minority Health, at 240-453-6904 or firstname.lastname@example.org.
Contact CIHS for technical assistance around health disparities and visit www.integration.samhsa.gov for resources on the integrated health workforce and cultural competency. For extensive information on diversity, visit the National Network to Eliminate Disparities in Behavioral Health (NNED).
Clinicians working in integrated care settings have the best of intentions. They strive for better client engagement, better patient-provider relationships and better health and behavioral health outcomes. However, lack of cultural understanding and sensitivity are vital to engaging and caring for members of cultural, ethnic and racial groups in the care they need to achieve recovery and improved health. Below are several tips that a healthcare professional can implement today to help build stronger, more culturally competent relationships with clients of all minority populations.
- Recognize that culture is a defining characteristic for some clients, and in such, their cultural identity may be at the root of their presenting health problem.
- Alternatively, do not assume that culture is a defining characteristic of all clients. If your client views himself or herself outside the context of any cultural identity, you should too.
- Do not assure any client that you “understand.” Rather than try to prove how much you know about a client’s culture, demonstrate your willingness to learn from the client.
- Treat each client as an individual, not as a member of a group. People seek and need treatment, not cultures. Accept the level of importance culture takes up in a client’s life and don’t assume that all the characteristics you have learned are dominant in his or her culture.
- Do not assume you have an advantage with clients of the same culture as you. Your own feelings about your culture may be as much of a hindrance as a help. The feeling that you “have it right” may lead you to unknowingly force your preferences on your clients.
- Remember that human beings are more alike than different. Do not overlook obvious interpretations of behavioral health and health symptoms by only interpreting a client’s actions in context of their culture.
- Accept that we all relate to others within the context of our own set of values, knowledge and experiences. In that vein, assume that you have biases and beliefs that may hinder optimal provider-client relationships. Draw upon your own expertise at the same time you honor and acknowledge each client’s expertise. As an integrated healthcare provider, you are the expert on strategies of health behavior change and treatment and services. Each of your clients is the expert on his or her own culture and the place it holds in his or her life and healthcare.
Contact CIHS for technical assistance on culturally competent care in integrated care settings.
CIHS provides training and technical assistance to the Substance Abuse and Mental Health Services Administration’s Primary and Behavioral Health Care Integration (PBHCI) grantees. Each issue of eSolutions profiles a grantee’s work.
Empowering Houston’s GLBT Community to Live Healthier Lives
For more than 30 years, Houston’s Montrose Counseling Center has served as a model behavioral health program for addressing unique needs of the GLBT community. Founded during an era when the typical service provider either ignored GLBT issues or attempted to change or “cure” individuals, Montrose aimed to provide a safe place that affirms individuals as they are when they present for services. Their mission is to “empower our community, primarily gay, lesbian, bisexual, and transgender individuals and their families, to enjoy healthier and more fulfilling lives by providing culturally affirming and affordable behavioral health and prevention services.”
This innovative organization has led the way in creating awareness of the needs that were unmet for this affinity group, and offering solutions that are making a difference in the lives of many. They have becoming involved in virtually all of the Houston initiatives for special populations: coalitions focusing on homelessness, mental health, substance abuse, sexual assault, HIV/AIDS, etc. Their involvement has increased their awareness of the community services available for Montrose clients. However, even more importantly, their ongoing presence has served to desensitize the community and allow a better understanding of what the GLBT community is about.
Montrose touches the lives of about 13,000 people each year. They have grown from a small 13 employee, $385K organization to their present 85 employee, $5.5M enterprise. This growth is largely a result of their unwavering attempt to meet their clients’ needs when no other community options were available. As a result, in addition to counseling, intensive outpatient and clinical case management services for mental health and substance abuse, they are able to provide prevention services, support groups, HIV/AIDS services, housing, domestic violence services, education, and street outreach distributing condoms and bleach kits.
In some of their more pioneering efforts, Montrose has been awarded federal grants enabling their expansion to address additional unmet needs that were identified within the GLBT affinity group. They are one of 64 recipients of the SAMHSA Primary and Behavioral Healthcare Integration grants to address the health disparities among the people they serve. They provide another much needed service funded by another SAMHSA grant: SPRY (Seniors Preparing for Rainbow Years) addresses the needs of the aging gay community through peer outreach.
For more information on Montrose Counseling Center, visit www.montrosecounselingcenter.org or SPRY www.spryhouston.org.
AHRQ Releases Latest National Healthcare Disparities Report
The latest National Healthcare Disparities Report released by the Agency for Healthcare Research and Quality shows that access to healthcare did not improve for most racial and ethnic groups between 2002 and 2008, the years leading up to enactment of the Affordable Care Act.
SAMHSA’s Office of Behavioral Health Equity Has a New Website
SAMHSA’s Office of Behavioral Health Equity has a new website. The website features a resources sections, news archives, the NNED and populations of focus — American Indian/Alaska Native; Asian American, Native Hawaiian and Pacific Islander; Black or African American; Hispanic/Latino; Lesbian, Gay, Bisexual, & Transgender.
A Look into Physician Prescribing Patterns of Innovative Antidepressants
Published in the International Journal of Psychiatry in Medicine, Physician Prescribing Patterns of Innovative Antidepressants in the United States: The Case of MDD Patients 1993-2007 found strong links between sociological factors (e.g., race and ethnicity) and physicians' antidepressant prescribing patterns. Namely, the authors noted, “Possible health disparities and gaps between optimal and suboptimal healthcare for patient mental health caused by systematic differences in sociological factors need to be mitigated.”
New Study: Socioeconomic Position Could Predict Depression among African Americans
A recent study published by Social Psychiatry and Psychiatric Epidemiology found that multiple measures of socioeconomic position such as income, unemployment and marital status can be important predictors of depression among African Americans.
New MAT Online Course for Treatment Providers Working with Special Populations
A new ATTC online course is designed to enhance treatment professionals’ general knowledge of medication-assisted treatment (MAT) and improve providers’ skills related to reaching and educating identified special populations about MAT.
New MAT Website Goes Live
The ATTC Network’s new MAT website will help healthcare professional increase outreach, access and retention in MAT, especially for specific minority populations. On the site, you can enroll in self-paced online course on MAT, access MAT materials to use with clients and learn more about MAT and how to increase outreach and engagement of African American, Asian/Pacific Islander, Hispanic/Latino(a) and Native American/Alaska Native populations.
SAMHSA to Award Peer-Run Social Marketing Programs
SAMHSA is accepting applications for the “Wellness Initiative’s Million Hearts Social Marketing Programs for Peer-Run Recovery Community Organization Awards.” Twenty awards of $15,000 each will enable client- and peer-recovery community organizations to conduct social marketing activities to increase awareness about the importance of prevention and management of cardiovascular disease and stroke among adults with behavioral health challenges and the providers that serve them. Applications are due on May 14 by 5 p.m. EDT.
Open Minds Explains Medical Home vs. Health Home Article
An Open Minds article outlines the difference between health and medical homes.
Adults Experiencing Mental Illness Have Higher Rates of Certain Chronic Physical Illnesses
A new SAMHSA report shows that adults who had a mental illness in the past year have higher rates of certain physical illnesses than those not experiencing mental illness. According to a SAMHSA report, adults aged 18 and older who had any mental illness, serious mental illness or major depressive episodes in the past year had increased rates of high blood pressure, asthma, diabetes, heart disease and stroke.
Kaiser Family Foundation’s Monthly Update on Health Disparities
This free, monthly update from the Kaiser Family Foundation synthesizes news coverage related to health and health care issues affecting underserved and racial and ethnic communities. The update also summarizes recent journal articles and other research developments in the field.
SAMHSA Newsletter Addresses Alcohol and Drug Abuse in Indian Country
SAMHSA, in collaboration with the Office of Justice Programs and other organizations, has released the first issue of its new quarterly newsletter, Prevention and Recovery. This publication highlights successful practices and stories related to alcohol and drug abuse in Indian Country.
New SAMHSA Publication Talks Science
SAMHSA’s Research to Practice: How Advancements in Science Are Helping People with Mental and Substance Use Disorders highlights examples of substance abuse and mental health research findings that impact practice across diverse topics. Explores how clinicians contribute to science and how technology implementation supports enhanced decision-making and integrated care.
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Our free technical assistance services can help primary and behavioral healthcare providers find integrated health solutions that work. To contact CIHS, visit www.integration.samhsa.gov, e-mail Integration@thenationalcouncil.org, or call 202.684.7457.
SAMHSA–HRSA Center for Integrated Health Solutions
Director: Kathy Reynolds; Deputy Directors: Laura Galbreath and Larry Fricks; eSolutions Editor: Heather Cobb
The SAMHSA-HRSA Center for Integrated Health Solutions, operated by the National Council for Community Behavioral Healthcare under a cooperative agreement from the U.S. Department of Health and Human Services, is funded jointly by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration. The CIHS promotes the development of integrated primary and behavioral healthcare services to better address the needs of people with mental health and substance use conditions, whether seen in specialty behavioral health or primary care settings.