Building Infrastructure for Community Capacity in Accelerating Integrated Care

项目摘要 虽然来自种族/民族和语言少数群体的个人构成了一个可持续的-而且越来越多的- 在美国人口中，他们比非拉丁裔人更需要精神卫生保健 白人这些群体的成员在医疗补助计划中占有很大比例，医疗补助计划是最大的保险公司， 脆弱的个体。尽管《平价医疗法案》扩大了医疗补助的资格， 并没有发现扩张缩小了白人和黑人之间在心理健康治疗方面的差距， 种族/少数民族。专家们发现，缺乏文化能力，双语/双文化心理健康 供应商是造成这些差异的一个因素。类似的挑战已经 在劳动力严重不足的低收入国家， 卫生工作者（CHW），他们来自他们所服务的社区， 作为国际精神卫生服务提供者。然而，在美国， 护理提供系统。以国家医疗补助为基础的责任护理组织（ACO）正在大量形成 通过基于团队的方法提供护理协调的人数，越来越多的证据表明， 这一战略可使资源贫乏的人口大大受益。然而，许多ACO尚未纳入 精神卫生服务纳入其网络，尽管观察到解决精神卫生需求 和改善身体健康。培养员工提供这些所需服务的能力将有助于ACO 实施以证据为基础的心理健康干预措施，并改善其分配的整体福祉 患者因此，我们提议的合作R 01将在两个方面发展ACO-学术界-社区伙伴关系 人口统计学上不同的州在不同的ACO发展阶段，并测试一个模型，培训CHW， 在诊所/医生组织和社区组织中担任心理健康提供者 与北卡罗来纳州和马萨诸塞州的助理犯罪组织有关这一努力应扩大ACO基础设施， 提高低收入种族/族裔和语言少数群体获得精神保健的机会和质量， 资源贫乏的社区。如果成功，我们将与ACO现场合作伙伴一起评估实施情况 采用、忠实、维护的结果，并探索实施过程（促进者和环境 因素）作为不同诊所、社区组织和ACO网络内实施的潜在媒介。

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.