The Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Mental Health Services (CMHS) has undertaken a major initiative to eliminate disparities in mental health care. This effort includes a focus on racial and ethnic groups in addition to disparities created by gender, gender expression, sexual orientation, disability, religion, socio-economic status, geography (e.g., rural, remote and frontier services), language, immigration status and family composition. The overall goal of the Initiative is to develop and implement strategies that will facilitate the elimination of disparities across the life span. The EMHD Initiative includes a number of projects and activities as outlined below that have been conducted in collaboration with the Human Resources Research Organization (HumRRO) and AFYA, Inc.:
AFYA, Incorportated in collaboration with the National Alliance of Multi-Ethnic Behavioral Health Associations (NAMBHA)
One of the primary tasks associated with the EMHD Initiative is the development of the website - http://www.endmentalhealthdisparities.org. The website is designed to serve as the locus for information associated with the entire Initiative, thus users may access a variety of documents and resources including meeting minutes related to the EMHD Initiative; materials associated with the SAMHSA NNED Initiative; the Training of Trainers Project; research studies; funding and job announcements; events in the field and other information related to mental health disparities. The website serves as an outlet for posting information about efforts involving cultural and linguistic competence and strategies to reduce and eliminate health disparities. Space is provided for interested groups to communicate in a private forum. Members can offer and receive feedback from constituents utilizing the site. The website is geared toward Federal, state and community parties, as well as others interested in the elimination of mental health disparities.
The External Workgroup provides input and guidance into the activities of CMHS and SAMHSA and works to ensure that continuity and collaboration exists between them and the NNED Steering Committee. The Workgroup also contributes direction on how to reduce duplication of efforts in the field. The members of this workgroup are representatives of national, state and local organizations; family members; youth and consumers. Particular emphasis is placed on ensuring adequate representation of racial and ethnic groups within the body of the Workgroup. The External Workgroup is composed of three committees that collaborate to eliminate mental health disparities in the areas of Policy, Consumer Empowerment, and Workforce Development. The third meeting of the External Workgroup was held April 6-7, 2010 at SAMHSA.
AFYA, Inc. in collaboration with the National Latino Behavioral Health Association (NLBHA)
The following activities are included in this endeavor:
The National Latino Behavioral Health Association (NLBHA) is working to form and develop a National Latino Consumer Network to address the issue of lack of consumer involvement within the behavioral health care system at the service delivery and policy making levels.
On September 22, 2009, the NLBHA, in partnership with the Latino Behavioral Health Institute (LBHI), convened a symposium focusing on a nationwide action aimed at influencing national behavioral health policy, eliminating disparities in access to services, and improving the quality of services and treatment outcomes for Latino populations.
The symposium entitled “Tenemos Voz: Family and Consumer Voice in Behavioral Health” brought together a group of Latino consumers to establish an operating structure and work plan for the consumer driven initiative Tenemos Voz to improve the delivery and quality of care for Latinos across the country.
Regular monthly meetings continue with consumers representing key states across the country where consumer needs may not have been addressed in terms of access to culturally and linguistically competent services that are most likely to benefit Latino consumers in the long run. NLBHA has facilitated Tenemos Voz New Mexico following through with a nationwide action-oriented advocacy agenda. The toolkit under development will support consumer groups organizing to meet goals they wish to accomplish.
AFYA, Inc. in collaboration with First Nations Behavioral Health Association (FNBHA)
The preliminary mission of the First Nations Behavioral Health Association (FNBHA) Consumer Initiative is to garner the voices and stories of consumers to better inform families, communities and providers of the “real” story in this day and age.
FNBHA assembled a steering committee of community grass root organization members to address outreach and engagement of youth and adult consumers and their families in Indian Country, in an effort to bring those voices to the table.
The 2-day round table meeting convened in May 2010, provided American Indian and Alaska Native (AI/AN) consumer/recovery/family organizations and leaders the opportunity to formulate a strategic plan for the establishment of a sustainable consumer driven network that can help shape the service delivery system for AI/AN communities. The round table meeting addressed:
• Identification of current consumer needs and existing strengths and resources within the communities;
• Understanding the importance of tradition and spirituality in the context of each respective community; and
• Bringing about a sense of “being seen, understood, respected, and heard” by families, communities and providers.
This community-based initiative builds on existing programs, with communities assuming ownership and the investments necessary to sustain the consumer lead movement. Ongoing monthly meetings are held with AI/AN consumers (adults, youth, and families) representing the various behavioral health and related organizations to follow through with the collaborative action-oriented agenda that emerged from the round-table meeting.
AFYA, Inc. in collaboration with the National Leadership Council on African American Behavioral Health, Inc. (NLC)
The National Leadership Council on African American Behavioral Health, Inc. (NLC) is working to develop and implement a structured engagement program that uses focus groups to gather, sift, and share information from African American professionals, consumers, and family members regarding their knowledge and perceptions of mental illness and available treatment. NLC conceptualizes this approach as culturally competent marketing (Davis, 2008) designed to increase mental health literacy, help seeking behavior, self-advocacy, and consumer involvement over time.
NLC conducted a review of literature and community resources on best practices and practice based evidence for behavioral health treatment and services for the African American community, including the role of self help practices like consumer run peer support services and family support services. NLC then shared an analysis of the information with focus group participants in Washington, DC; Austin, Texas; Los Angeles, California; Columbus, Ohio and Hartford, Connecticut. These regional groups comprised of representatives from African American consumer peer groups and organizations, family support groups, community constituents (i.e., churches, social organizations, etc.), and provider organizations discussed best practices in treatment, services interventions and community supports that work best for African American populations.
NLC’s work with the regional focus groups is expected to result in the development and dissemination of four products to assist African American consumers and families to sustain consumer operated services and family support groups; to increase their voice in advocacy planning, and implementation of services and programs; and to provide recommendations for workable services and educational products:
(1) A database on African American Consumer run peer services, family support groups and provider organizations in the African American community;
(2) A written practices report on best practices in the literature and practice based evidence services identified through the environmental scan and focus group input as effective practices in the African American communities;
(3) Four educational webinars on topics identified through the regional focus groups; and
(4) A how-to-manual on developing and sustaining African American consumer operated peer groups/organizations and family groups based on the information collected through the focus groups.
AFYA, Inc. in collaboration with the National Asian American Pacific Islander Mental Health Association (NAAPIMHA)
The National Asian American Pacific Islander Mental Health Association (NAAPIMHA) is working to develop a statewide AANHPI Consumer Network in California that will help Asian American, Native Hawaiian and Pacific Islander (AANHPI) consumers focus on addressing mental health issues in the various AANHPI communities. Approximately thirty five percent of AANHPIs live in California making it the perfect place to build the AANHPI consumer movement. Lessons learned from this project can serve as a template to be eventually used to develop a national consumer voice.
NAAPIMHA will convene four meetings: two statewide, face to face meetings of consumers comprising a Steering Committee; and two additional local meetings, open to all consumers, designed to strengthen the local network. The series of meetings will help develop the infrastructure for a statewide AANHPI consumer network. Having a two tiered process is expected to help develop leadership among consumers who have already shown leadership or have the potential while still providing an opportunity for any consumer to participate in the network.
NAAPIMHA will work with community based organizations to identify individuals for both the Steering Committee and the network in general. Working with community based organizations also brings the agencies into the fold and strengthens the network of providers who work in collaboration with consumers as a way of improving services. Telecommunication approaches are used to maintain communication between the various stakeholders.
HumRRO in collaboration with The University of California/Davis and the Institute for Scientific Analysis
The following activities were part of this completed task:
A national conference was held March 13-14, 2008 in Bethesda, MD
A report on the conceptual problems in identifying and accounting for cultural variables that may mitigate the effectiveness of evidence-based psychological interventions was developed
A report on measurement approaches that can enhance the sensitivity of research in assessing impact and outcomes of evidence-based psychological interventions when applied to ethnic minority populations was produced
A package of articles, reports, and other materials that focuses on ethno-cultural issues in evidence-based practice research was posted on the EMHD website
HumRRO in collaboration with Emory University Department of Medicine, Division of Geriatrics
The following activities are part of this task:
Conduct a literature search on the topic
Develop an article on the current state of research on mental health disparities in older adults
Construct a set of recommendations to guide a research agenda on mental health disparities in the elderly
Develop a state-of-the-art article that explores the use of information technology (IT - computers and the Internet) to increase mental health literacy in diverse older adults
HumRRO in collaboration with Vanguard Communications
Over the past several years, numerous experts across SAMHSA, CMHS and the mental health field have weighed in on effective strategies for eliminating mental health care disparities. A critical step in improving the system is to apply what is known about evidence based and promising practices to a comprehensive social marketing plan that, when implemented, can transform mental health services delivery beginning at the grassroots level.
The following activities were part of this completed project:
Develop a matrix of existing resources and efforts related to the EMHD Project(Environmental Scan)
Construct a social marketing plan for the EMHD Project
Develop a set of adjunctive materials that are consistent with a situational analysis and a resulting marketing plan
HumRRO in collaboration with Sebastian Lantos, LLC
This task has involved several activities to promote the use of translation and interpretation services and provide training and information to enhance the capacity of interpreters and translators working in mental health settings across the life span.
The following activities are part of this endeavor:
The translation of products and materials developed by the EMHD Project
The provision of interpretation sessions at selected meetings, workshops and conference calls to meet the linguistic needs of the participants
The execution of workshops on " Language Interpreting Guidelines" at conferences
Four "Webinars" have been held on the use of interpreting services in mental health settings
AFYA, Inc. in collaboration with HumRRO and Georgetown University
The purpose of this project is to convene a Policy Summit that furthers the impact of EMHD Initiative by leading efforts to design and implement policy supporting the elimination of mental health disparities with particular focus on cultural and linguistic competence. Planning is underway for the Second Policy Summit on the Elimination of Mental Health Disparities which will be held in the late spring of 2011.
Six state delegations of seven persons each will be selected to participate in the two and one half day Policy Summit
The event is designed to facilitate states' development and implementation of policies that will address the elimination of mental health disparities
The target population will be racial and ethnic groups, special populations and people living in rural areas
Delegations will participate in work sessions to develop action plans that they will implement upon their return home
Delegation membership must include meaningful consumer participation and family participation as defined by family members and consumers
The delegations will include individuals who are strategically positioned to significantly influence efforts to address this issue in their respective states
Members of Policy Summit's delegations will be selected based on: demonstrated need of the delegation's community for furthering policy development supporting equity in mental health service/support delivery (Community self-assessment); level of readiness and commitment of delegation participants to facilitating change; and ability to collaborate with grass-roots organizations.
HumRRO in collaboration with the National Latino Behavioral Health Association (NLBHA)
The result of this effort will be an alternate and supplemental means of measuring community-defined evidence in Latino behavioral health agencies and/or projects, and the establishment of a framework for other racial and ethnic groups to demonstrate the validity of their community-defined evidence-based practices.
The following activities are part of this venture:
Develop a directory of community based programs that provides exemplary behavioral health services to Latino communities
Construct a brief or monograph for individuals in the field and other interested parties that will summarize an inventory of culturally based practices that successfully serve Latino populations
Compose a brief or monograph that outlines the meaning of "Community Defined Evidence"- why it is important, and how the concept relates to evidence-based practice and practice-based evidence
In collaboration with AFYA, Inc.
The purpose of this project is to follow up on the findings identified through the recent self-assessment conducted by CMHS as an approach to enhance organizational knowledge, skills and commitment in the area of cultural competence and mental health disparities.
• Increase CMHS-wide understanding of “Culture,” “Cultural and Linguistic Competence,” and “Diversity,” and how these are operationalized.
• Offer on-going learning opportunities that demonstrate effective practices (e.g., evidence based practices, etc.), including: Presentations, developmental assignments, workshops, conferences and seminars.
EMHD’s Cultural and Linguistic Competence Liaison to the Child, Adolescent and Family Branch at CMHS is working with EMHD Internal Workgroup members to determine strategies and lead the implementation of activities designed to promote cultural and linguistic competence as a natural way of doing business.
AFYA Inc., in collaboration with Georgetown University
AFYA Inc., in collaboration with Georgetown UniversityThe Center or Mental Health Services is sponsoring the second Leadership Academy to Address Disparities in Mental Health Care. The intensive learning experience prepares leaders to assume the challenges in the mental health field by working to not only enhance their skills, but more importantly, to create a vision and commitment for their own personal leadership journey.
Participants will learn the “ten characteristics” of becoming a transformational leader, and building on an understanding of the different leadership styles will embrace the concept of leadership being everyone’s business. No matter where participants are in the organizational chart or what their role is, as each participant enhances his/her ability to demonstrate leadership, especially leadership to address disparities in service delivery, we move closer to achieving our vision of eliminating mental health disparities.
HumRRO in collaboration with the Homelessness Resource Center (HRC)
To increase awareness among service providers who interact with youth who are homeless and LGBT, HRC will create three videos on providing culturally competent care to this population. The videos will be accessible via the HRC website and will be linked to best practices and culturally competent tools in the field for working with LGBT youth.
The following activities are part of this project:
Create an LGBT youth sponsored topic page that describes the videos and provides links to each video
Develop three final videos with graphics and soundtracks
HumRRO in collaboration with the National Council for Community Behavioral Healthcare (National Council)
The National Council coordinates the Primary Care-Mental Health Collaborative Care Project, which helps community mental health centers (CMHCs) create a mutually beneficial relationship with community health centers (CHCs) in their community. During this process, organizations are expected to increase referrals from primary care, create a structure that ensures collaborative care for shared patients, and increase clients' access to primary care services. HumRRO, in conjunction with CMHS, the National Network to Eliminate Disparities (NNED) and the National Council will convene a cohort of this project in an Initial Learning Session. This session will focus specifically on providers working in and with traditionally undeserved communities.
This project will employ a Learning Collaborative model, in which primary care and specialty mental health teams from the selected sites will convene in an initial Learning Session. During this session, the participants will receive clinical education materials and training, review the project outcome metrics, and plan their initial approach to achieving the goals. This initial Learning Session will be scheduled for two days in Baltimore, MD during 2009. A plan for next steps will be developed from the Initial Learning Session.
In collaboration with AFYA, Inc.
CMHS engages representatives of diverse communities to provide guidance in developing strategies to reduce mental health disparities across the nation. To this end, one-day meetings were held with representatives from NAMBHA and its affiliates (FNBHA, NLBHA, NAAPIMHA and NLC) on April 21, 2008 and on April 7, 2009 at SAMHSA to assist CMHS in identifying priorities and establishing activities focused on diverse populations.
AFYA, Inc. in Collaboration with Mental Health America (MHA)
In Phase 1 of the initiative, MHA utilized its successful multi-state meeting format to bring focused state delegations together to develop strategies that will promote utilization of services and/or new models of care for and by minority populations.
In Phase 2, State teams are to implement innovative models/pilot projects in their target area and target populations, using the action planning steps and resources from the multi-state meeting. MHA provided technical assistance to the State teams, following the multi-state meeting in March 2008, to support the development and implementation of community action plans/projects in order to receive follow-up grants to support their local efforts.
AFYA, Inc. in Collaboration with the Western Interstate Commission for Higher Education (WICHE)
The WICHE Mental Health Program (MHP) prepared a policy overview focused broadly on rural mental health disparities. This review was based upon a thorough literature review of health and mental health scholarly research and policy publications, and other documents available, which provided a thorough background for understanding the issues relating to mental health disparities in rural America. WICHE MHP performed the following activities as part of the endeavor:
examined and prepared a knowledge synthesis of this information and data,
conducted two (2) rural policy focus groups with broadly representative rural stakeholder groups to share the knowledge synthesis and gather additional information and input,
identified examples of national, regional, state, and local initiatives that appear to effectively seek to mitigate and/or improve rural mental health disparities, and
prepared a comprehensive written policy white paper on their literature review, knowledge synthesis, focus group input, and environmental scan of promising practices/initiatives.