Addressing Clinician Bias to Improve Equitable Implementation of Evidence-Based Practice

项目摘要 尽管几十年的研究认识到不平等，但儿童心理健康的差异仍然存在。黑人和拉丁裔 青少年（BLY）继续获得较低的数量和质量所需的心理保健相比，非 西班牙裔白色青年。即使在福利、青年和保健服务与国家保健服务之间的机会差距缩小的情况下， 青少年，如在学校（青少年获得精神保健的最常见环境），治疗 差距依然存在。医疗保健提供者的隐性偏见已被确定为这些差异的贡献者 通过对患者-临床医生关系的负面影响和高质量证据的不公平交付- 基于实践（EBP）。任何EBP的实施都有加剧现有健康差距的风险 由于不公平的访问，交付，或干预的好处。临床医生的偏见可能是一个关键的， 任何EBP实施的未解决决定因素。虽然一些隐含的偏见干预， 医疗保健提供者正在兴起，研究很少包括心理健康专业人员。在先前 NIMH资助的项目，我们的研究团队迭代开发了一个简短的（~45分钟），互动的在线虚拟 内隐偏见减少和中立化培训（VIBRANT）为学校心理健康临床医生。在一个小 在一项概念验证研究中，学校心理健康临床医生发现VIBRANT是高度可用的，适当的， 可接受的，并且在其临床实践中实施是可行的。完成VIBRANT培训后， 临床医生表现出显着的改善，内隐偏见的知识，并呈下降趋势， (as通过内隐联想测试测量）超过14周。此外，减少最多的临床医生 在隐性偏见中，也报告了与年轻患者的最强联盟。鉴于这些有希望的发现， 目前的研究旨在进行一项试点随机混合3型有效性实施试验， VIBRANT-促进公平采用、渗透、忠实和持续的实施策略 有80名学校心理健康临床医生。一个高度可学习、高效和可扩展的EBP， 特别适合教育部门的是基于测量的护理（MBC）-系统收集 患者报告的进展数据，为临床决策提供信息。该研究旨在评估 VIBRANT的可行性，以促进公平采用，渗透，忠实，和维持MBC， 为MBC提供经过验证的、简短的、交互式的在线培训。我们还将研究VIBRANT对近端 变化机制包括临床医生的内隐偏见以及远端青年心理健康结果（即， 症状和功能）与160 BLY。最后，我们将评估未来大规模研究的可行性 功效试验

Project Abstract Pediatric mental health disparities persist despite decades of research recognizing inequities. Black and Latinx youth (BLY) continue to receive lower quantity and quality of needed mental healthcare compared to non- Hispanic White (NHW) youth. Even in settings where access disparities are reduced between BLY and NHW youth, such as in schools (the most common setting in which youth access mental healthcare), treatment disparities persist. Healthcare providers’ implicit bias has been identified as a contributor to these disparities via negative impacts on the patient-clinician relationship and inequitable delivery of high-quality evidence- based practices (EBP). The implementation of any EBP runs the risk of worsening existing health disparities due to inequitable access, delivery, or benefit of the intervention. Clinician bias can be a critical and unaddressed determinant of implementation for any EBP. Although some implicit bias interventions for healthcare providers are emerging, studies have rarely included mental health professionals. In a previously NIMH funded project, our research team iteratively developed a brief (~45 minutes), interactive online Virtual Implicit Bias Reduction and Neutralization Training (VIBRANT) for school mental health clinicians. In a small proof-of-concept study, school mental health clinicians found VIBRANT to be highly usable, appropriate, acceptable, and feasible to implement in their clinical practice. After completing the VIBRANT training, clinicians demonstrated notable improvements in implicit bias knowledge, and a downward trend in implicit bias (as measured by the Implicit Association Test) over 14 weeks. Moreover, clinicians with the greatest reductions in implicit bias also reported the strongest alliance with their youth patients. Given these promising findings, the current study aims to conduct a pilot randomized Hybrid Type 3 Effectiveness Implementation Trial of VIBRANT—an implementation strategy for promoting equitable adoption, penetration, fidelity, and sustainment of EBPs—with 80 school mental health clinicians. One highly learnable, efficient, and scalable EBP that is particularly well-suited for the education sector is Measurement-Base Care (MBC)—the systematic collection of patient-reported progress data to inform clinical decision-making. The proposed study aims to evaluate VIBRANT’s feasibility to promote equitable adoption, penetration, fidelity, and sustainment of MBC, with a validated, brief, interactive online training for MBC. We will also examine VIBRANT’s impact on proximal mechanisms of change including clinicians’ implicit bias as well as distal youth mental health outcomes (i.e., symptoms and functioning) with 160 BLYs. Finally, we will evaluate research feasibility of a future large-scale efficacy trial.