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: 10540324
• 负责人: Aaron S Breslow
• 金额: $ 15.89万
• 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/10540324
• 关键词: Address; Administrator; Adult; Advocate; Award; Behavioral; Caring; Characteristics; Clinic; Clinical Data; Clinical Skills; Collaborations; Data; Data Analyses; Databases; Discrimination; Disparity; Electronic Health Record; Exclusion; Exhibits; Face; Future; Goals; Health; Health Personnel; Health Services Accessibility; Health Services Research; Healthcare; Healthcare Systems; Hospitals; Improve Access; Individual; Inequity; 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; Procedures; Provider; Psychological Stress; Reporting; Research; Research Personnel; Resources; Risk; Sampling; 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 stress; health care delivery; health care disparity; health care service; improved; improved outcome; innovation; insurance claims; intervention mapping; medically necessary care; minority stress; nonbinary; novel; outreach; resilience; 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.

项目摘要/摘要。 尽管在对变性人和非双性人(即变性人)的社会和政治保护方面取得了很大进展， 变性人继续面临心理健康问题的危机率。最近的全国性调查 显示变性人面临医疗系统内未得到满足需求的负担， 报告称，精神卫生保健回避和排除往往是挽救生命的服务的比率上升。这 通常是由于医疗保健提供者的歧视造成的。 许多医院系统没有设备来支持寻求精神保健的变性人。因此， 争取跨性别者参与的努力在改善获得护理和 减轻心理压力。一个特别的风险和干预机会地点是纽约州布朗克斯市 纽约市拥有美国最贫穷的国会选区，也是正在进行的 TNB人群的健康问题。目前的项目旨在从蒙特菲奥雷的一大群患者那里获得数据 医疗中心，一个每年有300多万人次就诊的医院系统，用于测量和解决精神疾病 医疗保健方面的差距。这项研究针对精神卫生保健方面的差异，使用患者的病历以及 采访变性人倡导者和利益相关者的数据。 对于目标1(1年级)，我们将分析变性人收到的更少和/或更差的程度 一家大型医院提供优质的心理健康服务。我们将通过测量一个较大的 对9968名变性人成年人进行抽样，对49840名非变性人成年人进行更大规模的抽样。 对于目标2(第2年)，我们将与36个利益相关者组成的三个小组会面，以说明服务的背景 差距是存在的，解决这些差距的战略是。第一组将由变性人组成 与心理健康服务有关。第二类是与心理无关的跨性别者 医疗服务。第三位将是医院工作人员和管理人员，他们专门从事变性人肯定护理。 对于目标3(3-4年)，我们将整合这两种类型的数据(在一起并创建地图以改变方式 提供精神健康服务，以改善对变性人的肯定护理。这一奖项是与 确定全面TNB护理的障碍和推动者的目标，以衡量和减少精神负担 不同的、有弹性的成年变性人群体的医疗保健差距。