Building Infrastructure for Community Capacity in Accelerating Integrated Care

项目总结 尽管来自种族/民族和语言少数群体的个人构成了相当大的-而且还在不断增长- 在美国人口中，他们比非拉丁裔人对精神卫生保健的需求更大 白色的。这些群体的成员在Medicaid中有大量代表，Medicaid是覆盖范围最广的最大保险公司 脆弱的个体。尽管《平价医疗法案》扩大了医疗补助的资格，但迄今为止的研究 没有发现扩张缩小了白人和白人之间在心理健康治疗方面的差距 少数族裔。专家们发现，缺乏具有文化能力的双语/双文化心理健康 供应商是维持这些差距的一个因素。类似的挑战也一直存在 通过社区培训解决面临严重劳动力限制的低收入国家的问题 卫生工作者(CHW)，他们来自他们服务的社区，并表现出希望 在国际上作为精神健康服务提供者。然而，在美国，他们通常还没有担任过这一角色 护理服务系统。以州医疗补助为基础的责任护理组织(ACO)正在大规模形成 通过基于团队的方法提供护理协调的数字，越来越多的证据表明 这一战略可以极大地惠及资源匮乏的人口。然而，许多ACO还没有成立 将心理健康服务纳入其网络，尽管观察到满足心理健康需求之间存在联系 和改善身体健康。建设工作人员提供这些所需服务的能力将有助于ACOS 实施循证心理健康干预，改善被分配人员的整体幸福感 病人。因此，我们提议的协作R01将在两个阶段发展ACO-学术-社区伙伴关系 在ACO发展的不同阶段，人口统计上的不同状态，并测试一个模型，该模型训练CHW 在诊所/医生组织和以社区为基础的组织中担任精神健康提供者 与北卡罗来纳州和马萨诸塞州的指挥官有关。这一努力应该会扩大ACO基础设施，并 年，增加低收入种族/族裔和语言少数群体获得精神卫生保健的机会并提高其质量 资源贫乏的社区。如果成功，我们将与ACO站点合作伙伴一起评估实施情况 采用、保真度、维护和探索实施流程的结果(促进者和情景 因素)作为在不同诊所、CBO和ACO网络中实施的潜在调解人。

PROJECT SUMMARY Although individuals from racial/ethnic and linguistic minority groups make up a considerable—and growing— proportion of the US population, they experience greater unmet need for mental health care than non-Latino Whites. Members of these groups are heavily represented in Medicaid, the largest insurer covering the most vulnerable individuals. And although the Affordable Care Act expanded Medicaid eligibility, research to date has not found that expansions have decreased the gap in mental health treatment between Whites and racial/ethnic minorities. Experts have identified a lack of culturally competent, bilingual/bicultural mental health providers as a factor contributing to the maintenance of these disparities. Similar challenges have been addressed in lower-income countries facing severe workforce constraints through the training of community health workers (CHWs), who originate from the communities they serve and have shown promise internationally as mental health service providers. However, they have not yet typically served in this role in US care delivery systems. State Medicaid-based accountable care organizations (ACOs) are forming in large numbers to provide care coordination via team-based approaches, with accumulating evidence suggesting that this strategy can greatly benefit resource-poor populations. However, many ACOs have not yet incorporated mental health services into their networks, despite the observed link between addressing mental health needs and improving physical health. Building staff capacity to provide these needed services would help ACOs implement evidence-based mental health interventions and improve the overall well-being of their assigned patients. Thus, our proposed collaborative R01 will develop ACO-academic-community partnerships in two demographically different states at different stages of ACO development and test a model that trains CHWs to serve as mental health providers within clinics/physician's organization and community-based organizations linked to ACOs in North Carolina and Massachusetts. This effort should expand ACO infrastructures and increase access to and quality of mental health care for low-income racial/ethnic and linguistic minorities in resource-poor communities. If successful, we will work with our ACO site partners to assess implementation outcomes of adoption, fidelity, maintenance, and explore implementation processes (facilitators and contextual factors) as potential mediators of implementation within diverse clinics, CBOs, and ACO networks.