Mapping Interventions to Reduce Mental Health Services Disparities among Transgender and Nonbinary Adults

制定干预措施以减少跨性别和非二元成年人之间的心理健康服务差异

• 批准号: 10351271
• 负责人: Aaron S Breslow
• 金额: $ 15.86万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-12-15 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10351271
• 关键词: Address; Administrator; Adult; Advocate; Award; Behavioral; Caring; Characteristics; Clinic; Clinical Data; Clinical Skills; Collaborations; Data; Data Analyses; Databases; Discrimination; Electronic Health Record; Exclusion; Exhibits; Face; Future; Goals; Health; Health Personnel; Health Services Accessibility; Health Services Research; Healthcare; Healthcare Systems; Hospitals; Improve Access; Individual; Intervention; Interview; Investigation; Learning; Life; Maps; Measures; Medical; Medical center; Mental Health; Mental Health Services; Mental disorders; Methods; National Institute of Mental Health; New York City; Outcome; Patients; Persons; Policies; Politics; Population; Population Heterogeneity; Prothrombin; Provider; Psychological Stress; Reporting; Research; Research Personnel; Resources; Risk; Sampling; Savings; Service delivery model; Services; Site; Strategic Planning; Suicide attempt; Surveys; System; Time; Training; United States; Visit; advanced system; behavioral health; care delivery; care outcomes; cisgender; cohort; contextual factors; data integration; disparity reduction; gender minority; health care delivery; health care disparity; health care service; improved; improved outcome; innovation; insurance claims; intervention mapping; medically necessary care; minority stress; novel; outreach; scale up; social; social determinants; social health determinants; transgender

PROJECT SUMMARY/ABSTRACT. Despite strides in social and political protections for transgender and nonbinary (i.e., transgender) people, transgender populations continue to face crisis-level rates of mental health concerns. Recent national surveys show that transgender people face also continue to face a burden of unmet need within healthcare systems, reporting elevated rates of mental healthcare avoidance of and exclusion from often life-saving services. This is often a result of discrimination from healthcare providers. Many hospital systems are unequipped to support transgender people seeking mental healthcare. As such, efforts to engage transgender individuals have not made significant dents in improving access to care and reducing psychological stress. One particular site of risk and opportunity for intervention is the Bronx, NY, a New York City borough containing the nation’s poorest congressional district and an epicenter of the ongoing health concerns for TNB people. The current project aims to data from a large group of patients at Montefiore Medical Center, a hospital system with over 3 million visits per year, to measure and address mental healthcare disparities. This study targets mental healthcare disparities using patients’ medical charts as well as interview data with transgender advocates and stakeholders. For Aim 1 (Year 1), we will analyze the extent to which transgender people receive fewer and/or worse quality mental health services at a large hospital site. We will do so by measuring differences between a large sample of 9,968 transgender adults with an even larger sample of 49,840 non-transgender adults. For Aim 2 (Year 2), we will meet with three groups of 36 stakeholders to contextualize why service disparities exist and strategies to address them. The first group will be composed of transgender people connected to mental health services. The second will be transgender people who are not connected to mental health services. The third will be hospital staff and administrators who specialize in transgender-affirming care. For Aim 3 (Years 3-4), we will integrate both types of data ( together and create a map to shift the ways mental health services are provided to improve transgender-affirming care. This award was developed with the goal of identifying barriers to and enablers of comprehensive TNB care, in order to measure and reduce mental healthcare disparities for diverse, resilient adult transgender populations.

项目总结/摘要。 尽管在社会和政治保护跨性别和非二元（即，transgender）people， 变性人群体继续面临心理健康问题的危机水平。最近的国家调查 表明跨性别者也继续面临着医疗保健系统中未满足需求的负担， 报告说，精神卫生保健回避和排斥往往挽救生命的服务的比率上升。这 往往是医疗服务提供者歧视的结果。 许多医院系统没有能力支持寻求精神保健的变性人。因此，在本发明的一个方面， 让变性人参与的努力在改善获得护理方面没有取得重大进展， 减轻心理压力。一个特殊的风险和干预机会的地点是纽约州的布朗克斯， 纽约市的自治市，包括全国最贫穷的国会选区和正在进行的 TNB人群的健康问题。目前的项目旨在从蒙特菲奥里的一大群患者中收集数据 医疗中心，一个每年有超过300万人次就诊的医院系统， 医疗差距。这项研究的目标是精神卫生保健的差距，使用病人的医疗图表以及 与跨性别倡导者和利益相关者的访谈数据。 对于目标1（第1年），我们将分析跨性别者获得更少和/或更差的程度 在大型医院提供优质的心理健康服务。我们将通过测量一个大的 9,968名跨性别成年人的样本与49,840名非跨性别成年人的样本。 对于目标2（第2年），我们将与三组36名利益相关者会面，以了解为什么要提供服务 存在着差距，并制定了解决这些差距的战略。第一组将由变性人组成 与心理健康服务有关第二种是与精神疾病无关的变性人。 保健服务第三个将是专门从事跨性别肯定护理的医院工作人员和管理人员。 对于目标3（第3-4年），我们将整合这两种类型的数据（并创建一个地图， 提供心理健康服务，以改善对变性人的肯定护理。该奖项是与 目标是确定全面的TNB护理的障碍和促进因素，以衡量和减少精神疾病， 不同的，有弹性的成年变性人群体的医疗保健差异。