Assessing and Addressing Implicit Organizational Bias to Tackle Mental Health Disparities

项目摘要/摘要 在美国，少数民族之间的心理健康差距已经达到了危机的程度。虽然 少数民族更有可能经历精神疾病，如抑郁症和相关的社会问题 健康的决定因素，如贫困和歧视，他们就不太可能寻求帮助，获得帮助，或 接受优质的心理健康服务。纠正这种差距和改善参与度的努力往往 专注于添加新服务或改变提供商特征，包括他们可能存在的隐含偏见 在不知不觉中坚持住了。然而，最近的科学审查表明，文化和结构性障碍 根植于心理健康组织本身的是持续坚持的一个重要因素 心理健康方面的差距。虽然实现科学提高了我们对关系的认识 在组织因素和循证实践的采纳之间，相对较少的 与心理健康差距有关的组织问题的实证研究。研究中的这一差距 这可能部分是由于在组织一级相对缺乏可操作的不平等概念。 基于我们的研究，我们已经概念化了差距的一个关键组织机制--我们 术语隐含的组织偏见(IOB)-或关于以下方面的潜规则、信念和期望 客户理想的行为方式和/或与心理健康系统互动的方式，以获得最佳利益 来自可用的服务(例如，客户应该是口头的，公开承认问题，接受服务，积极主动， 以个人为导向)。这些首选的组织规范可能与少数民族的规范冲突 患者，导致不协调、次优或折衷护理的可能性更高。计划中的职业 发展奖寻求将关于隐性偏见的大量证据从关注个人扩展到 本组织通过两个阶段的参与性混合方法研究，其目的是：1) 系统地运作，并开发一种工具来评估隐性组织偏见及其 与少数民族社区文化的一致性；2)检查心理测量学 IOB的属性测量和测试我们的概念模型中概述的关联路径。 虽然我在患者和社区层面的精神健康差异研究方面有丰富的经验，但这 K的目的是发展我在以下方面的技能：1)内隐偏见研究、组织理论和实施 科学；2)概念图和评估的发展；3)先进的混合方法和量化 研究。我已经建立了一个全面的指导和培训计划，涉及国家和 在差异、隐性偏见和组织研究方面处于国际领先地位。我的导师们，结合一个 耶鲁大学世界级的培训环境，将指引我走向独立的目标 心理健康差异多层次影响的调查员，具有设计和实施方面的专业知识 严谨、务实的研究，旨在改善少数民族的参与度、护理和临床结果。

PROJECT SUMMARY/ABSTRACT Mental health disparities among ethnic minorities have reached crisis proportions in the United States. Although ethnic minorities are more likely to experience mental illnesses such as depression and associated social determinants of health like poverty and discrimination, they are less likely to seek help from, have access to, or receive quality mental health services. Efforts to redress such disparities and improve engagement have often focused on adding new services or altering provider characteristics, including the implicit biases they may unknowingly hold. However, recent scientific reviews suggest that cultural and structural barriers deeply embedded in the underlying mental health organization itself are a significant factor in the continued persistence of mental health disparities. While implementation science has advanced our knowledge of the relationship between organizational factors and the uptake of evidence-based practices, there has been comparatively little empirical research on organizational issues as they pertain to mental health disparities. This gap in research may be due, in part, to the relative lack of operationalized constructs of disparity at the organizational level. Based on our research, we have conceptualized a key organizational mechanism of disparities—which we term Implicit Organizational Bias (IOB)—or, the unspoken norms, beliefs, and expectations about the way clients should ideally behave and/or interact with the mental health system to gain optimal benefit from available services (e.g., a client should be verbal, openly admit a problem, accept services, be proactive, be individually-oriented). These preferred organizational norms may conflict with the norms of ethnic minority patients, leading to a higher likelihood of incongruent, suboptimal, or compromised care. The proposed career development award seeks to extend the substantial evidence on implicit bias beyond its focus on individuals to the level of the organization through two phases of participatory, mixed methods research that aim: 1) To systematically operationalize, and develop a tool to assess, Implicit Organizational Bias and its congruence with the culture of ethnic minority communities; and 2) To examine the psychometric properties of the IOB measure and test the pathways of association outlined in our conceptual model. While I have extensive experience in mental health disparities research at the patient and community levels, this K is intended to develop my skillset in: 1) implicit bias research, organizational theory, and implementation science; 2) concept mapping and assessment development, and 3) advanced mixed methods and quantitative research. I have established a comprehensive mentoring and training program involving national and international leaders in disparities, implicit bias, and organizational research. My mentors, in combination with a world-class training environment at Yale University, will guide me towards my goal of becoming an independent investigator of multi-level influences on mental health disparities, with expertise in designing and conducting rigorous, pragmatic research aimed at improving engagement, care, and clinical outcomes for ethnic minorities.