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Health Equity ECHOSession 3
Wednesday, April 21st, 2021
11:30am-1:00pm ET
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Disclaimer
The views, opinions, and content expressed in this presentation do not
necessarily reflect the views, opinions, or policies of the Center for
Mental Health Services (CMHS), the Substance Abuse and Mental
Health Services Administration (SAMHSA), or the U.S. Department of
Health and Human Services (HHS).
www.samhsa.gov
Introductions
Pierluigi Mancini, PhD,President, Multicultural
Development Institute, Inc.
Maura Gaswirth, LICSWDirector, Training and
Technical Assistance, Center of Excellence for Integrated Health Solutions, National
Council for Behavioral Health
Aaron Williams, MA,Integrated Care Consultant
Center of Excellence for Integrated Health Solutions,
National Council for Behavioral Health
Introductions
Terence Fitzgerald, PhD, Ed.M., MSW
Clinical Associate Professor, Department of Children Youth & Families, USC
Suzanne Dworak-Peck School of Social Work, University of
Southern California
Amelia Roeschlein, DSW, MA, LMFTConsultant, Trauma Informed Services
National Council for Behavioral Health
Linda Henderson-Smith, PhD, LPC
Director, Children and Trauma-Informed Services, National
Council for Behavioral Health
Safe Space Guidelines
•
Moment to Arrive
Impact of Bias, Racism and Trauma on Behavioral Health Disparities: Strategies to Improve Outcomes
and Engagement in Care
Aaron Williams, MA
Sr. Director of Training and Technical Assistance
National Council for Behavioral Health
Today’s Presenter
By the end of this session, participants will:
• Understand context and data around health disparities and treatment gaps in mental healthcare and substance use disorder treatment among racial and ethnic groups
• Be familiar with health inequities, and barriers to accessing care for racial and ethnic groups
• Understand historical trauma, racism, bias, and stigma in relation to addiction service delivery among racial and ethnic groups
• Identify organizational strategies for decreasing trauma, racism, bias, and stigma in addiction service delivery
Learning Objectives
Mental Illness and Substance Use Disorders in America
Mental Health and SUD: Huge Treatment Gaps
• Nearly 72,000 Americans died from drug overdoses in 2019, according to provisional data released by the Centers for Disease Control and Prevention.
• Estimated number of drug overdose deaths in 2020 range from 81,000 to 90,000, the highest number of overdose deaths ever recorded in a 12-month period.
https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html; https://www.washingtonpost.com/politics/2021/04/07/health-202-overdose-deaths-may-have-topped-90000-2020/; https://www.commonwealthfund.org/blog/2021/spike-drug-overdose-deaths-during-covid-19-pandemic-and-policy-options-move-forward
Drug Overdose Rates
Opioid Overdose Deaths Among Black People 1999-2019 (KFF)
Opioid Overdose Deaths Among Hispanic/Latino People 1999-2019
(KFF)
“Differences in the incidence, mortality, and burden of
disease and other adverse health conditions that exist among special population
groups in the United States”
“Differences in health that are not only unnecessary and
avoidable, but, in addition, are considered unfair and
unjust”
Disparities in Health: Definition
Health disparities are connected to a social context that includes individual, socioeconomic, and political factors which determine health outcomes
Historically social policy has contributed to health disparities
Factors may include housing, neighborhood, access to work and educational opportunities, individual lifestyle (age, gender), socioeconomic status, and access
to health care
Evidence shows that health disparities among particular racial and ethnic groups have multiple causes that need to be addressed on multiple levels
Health Disparities: The Context
Health Inequities arise when certain
populations are made vulnerable to illness or disease, often through
the inequitable distribution of
protections and supports
Jones, CP 2002National Academies of Sciences, Engineering, and Medicine. 2017
Health Inequities
Social Determinants of Health
• Racism is a system of structuring opportunity and assigning value based on phenotype (“race”), that:
• unfairly disadvantages some individuals and communities
• unfairly advantages other individuals and communities •
• undermines realization of the full potential of the whole society through the waste of human resources.
• It is a system (consisting of structures, policies, practices, and norms) that structures opportunity and assigns value based on phenotype, or the way people look. It unfairly disadvantages some individuals and communities.
Jones, CP 2002
Health Inequities and Racism
Racial oppression• Internalized Devaluation
• “…oblivious to this infection but emotionally reactive to its effects”• “I am bad and unworthy”• “Profoundly devalued youth become hypervigilant about gaining respect… To some of these
youth, death is preferable to disrespect.”
• Assaulted Sense of Self• “…the culmination of recurring experiences with internalized devaluation.”
• Internalized Voicelessness▪ “…results from and fuels internalized devaluation and an assaulted sense of self… it impairs
the ability to advocate for oneself.”
• The Wound of Rage• “It is virtually impossible to be the depository of perpetual negative and debilitating
messages and have one’s sense of self assaulted without experiencing rage. ....It is distinguishable from anger, which is an emotion connected to immediate experiences.”
• The Case of a Nobody• “…sense of hopelessness, despair, and rage are the by-products of chronic and repeated
experiences of being systematically devalued and having [one’s] sense of self assaulted.”Healing the Hidden Wounds of Racial Trauma, Kenneth V HardyJournal: Reclaiming Children and Youth, Spring 2013 (vol 22, number 1) pg. 24-29
To You
Implicit Bias & Automatic Associations
Genocides Slavery Pandemics Massacres
Prohibition/destruction of
cultural practices
Discrimination/Systemic prejudice
Forced relocation
Intergenerational/Historical Traumatic Events
An attribute, behavior, or condition, that is socially discrediting
Stigma
Real World Implications
• Black patients were 70% less likely to receive a prescription for buprenorphine at their visit when controlling for payment method, sex and age
• This study demonstrates that buprenorphine treatment is concentrated among white persons and those with private insurance or use self-pay.
Lagisetty 2019
Inequities in Addiction Treatment
Kilaru 2020
Black patients were half as likely to obtain treatment following overdose compared with non-Hispanic white patients even when privately insured.
Inequities in Addiction Treatment (cont’d)
Use of Medications in Pregnant Women of Color
In a cohort study of 5247 women with opioid use disorderwho delivered a live infant, black non-Hispanic andHispanic women with opioid use disorder weresignificantly less likely to use any medication fortreatment and were less likely to consistently usemedication for treatment during pregnancy comparedwith white non-Hispanic women with opioid use disorder.
National Overview of Medication-Assisted Treatment forAmerican Indians and Alaska Natives With Substance UseDisorders
2017 study found “Low rates of MAT implementationsuggest racial disparities in access to MAT among AI/ANs,a population with historically high rates of substance usedisorders. Study findings also highlight the important roleof treatment culture and organizational fit in theimplementation of MAT in treatment programs servingAI/AN populations. Results also speak to the importanceof adapting existing EBTs in a culturally competent way tobest serve the needs of the AI/AN community.”
Buprenorphine Treatment Divide byRace/Ethnicity and Payment
2019 study demonstrates that buprenorphinetreatment is concentrated among whitepersons and those with private insurance oruse self-pay.
Association of Racial/Ethnic SegregationWith Treatment Capacity for Opioid UseDisorder in US Counties
2020 study suggests that the racial/ethniccomposition of a community was associatedwith which medications residents would likelybe able to access when seeking treatment foropioid use disorder. Reforms to existingregulations governing the provisions of thesemedications are needed to ensure that bothmedications are equally accessible to all.
Use of Medications for Addiction Treatment: Racial Disparities
Despite relatively uniform rates of substance use among racial and ethnic populations, there is a disproportionate rate of drug
arrests for Black Americans.
ACLU Tale of Two Countries 2020
Rates of Black and White Marijuana Possession Arrests per 100k People
Inequities in Rates of Incarceration
Inequities in Rates of Incarceration (cont’d)
• Negative representations, stereotyping and stigma
• Intergenerational substance use and polysubstance use
• Fear of legal consequences
• Misperceptions and faulty explanations about addiction and opioids.
• Lack of culturally responsive and respectful care
• Discrimination and trauma
The Opioid Use disorder crisis among African Americans: An urgent issue
https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-05-02-001_508%20Final.pdf
Source: The Social Determinants of Mental Health. Michael T. Compton, M.D., M.P.H., and Ruth S. Shim, M.D., M.P.H., Focus Vol. 13, No. 4, Fall 2015
Challenges to Prevention, Treatment, and Recovery for African Americans
• Negative representations, stereotyping and stigma
• Intergenerational substance use and polysubstance use
• Fear of legal consequences/Immigration issues
• Language barriers
• Lack of culturally responsive and respectful care.
• Heterogeneity of the Hispanic/Latino population
The Opioid Use disorder crisis and the Hispanic/Latino population: An urgent issue
https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-05-02-002.pdf
Source: The Social Determinants of Mental Health. Michael T. Compton, M.D., M.P.H., and Ruth S. Shim, M.D., M.P.H., Focus Vol. 13, No. 4, Fall 2015
Challenges to Prevention, Treatment, and Recovery for Hispanic/Latino
People
Implement
Implement a comprehensive, holistic approach
Involve
Involve the community and develop multisectoral, diverse community partnerships
Increase
Increase culturally relevant public awareness
Employ
Employ culturally specific engagement strategies
Create
Create a culturally relevant and diverse workforce
Strategies to Address Opioid Misuse and OUD in Black/African American
Communities
• Implement a comprehensive, holistic approach
• Create culturally tailored public awareness campaigns in native languages
• Form diverse partnerships
• Utilize schools
• Leverage faith-based organizations
• Build a bilingual, culturally aware and respectful workforce
• Develop culturally and linguistically appropriate prevention and treatment
• Link to primary care
The Opioid Use disorder crisis and the Hispanic/Latino population: An urgent issue
https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-05-02-002.pdf
Strategies to Address Opioid Misuse and OUD in Hispanic/Latino
Communities
Header
Essential Ingredients for Sustained
Recovery:
▪ Safe and affordable housing
▪ Employment and job readiness
▪ Education and vocational skills
▪ Life and recovery skills
▪ Parenting and family skills
▪ Health and wellness
▪ Recovery support networks
▪ Community and civic engagement
Creating and Reinforcing Recovery Capital
This Photo by Unknown Author is licensed under CC BY-SA
Case PresentationMark Salazar, President & CEO, Mental Health Association of San Francisco
The Mental Health Association has a 24/7 Peer run warmline that is a non-emergency resource for anyone in Californiaseeking mental and emotional support. We have over 80 counselors and a total of 98 Warm Line staff that respond to8,000 to nearly 13,000 calls/chats a month. We are concerned with how overnight shifts can be taking a toll on ourstaff’s wellness (physical-mental, life-work balance). In addition, our overnight shift is disproportionately staffed byBIPOC counselors and coordinators. This is not unique to MHASF-- this trend is consistent in overnight work. Overnightcounselors work uniquely challenging hours and face a greater degree of physical and emotional strain than daytimeshifts, and while they receive a pay differential for working overnight and have access to individual and groupsupervision during overnight shifts, this shift can and does lead to burnout for counselors.
Part of the challenge in addressing this is that the overnight position and daytime position are distinct roles, withdifferent applications on our website. Every applicant selects the shift (daytime, evening, overnight) that they would liketo apply for. This is to say, we are not "assigning" BIPOC folks to that shift, but we do have many BIPOC folks specificallyapplying for that role. We are seeking strategies to best support our overnight staff, while simultaneously looking forways to improve our recruitment/hiring processes that result in more diverse applicant pools across 24-hour shift work.
• What are some strategies we can implement to increase support for individuals working overnight shifts?• How do we begin to address the systemic issue of a larger majority of White staff members during the daytime and
overnight staff being a majority BIPOC individuals?• Are there tools and processes to use in recruitment that encourages and results in more diverse applicant pools
across 24-hour shift work?
Open Discussion
Discussion Conclusion
Health Equity ECHO Listserv Update
Resources
• Health Equity and Racial Justice Webpage• National Council’s Cultural Humility Scale• TI-ROC Climate of Equity Assessment• The Opioid Use disorder crisis among African Americans: An urgent issue
- SAMHSA
• The Opioid Use disorder crisis and the Hispanic/Latino population: An urgent issue – SAMHSA
• Providers Clinical Support
• Medication Assisted Recovery (Indian Health Service)
• Opioid Response Network
• Racial Equity Tools
• Racial Equity Readiness Assessment – Race Forward
Upcoming CoE Events:
CoE Webinar: Oral Health and Behavioral Health: Framework for Coordination &
Integration and Success Stories
Register here for Webinar on April 27, 3-4:30pm ET
Interested in an individual consultation with the CoE experts on integrated care?
Contact us through this form here!
Looking for free trainings and credits?
Check out integrated health trainings from Relias here
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CoE Office Hour: Strategies to Support Wellbeing and Retention of BIPOC Staff
Register here for Office Hour on April 22, 3-4pm ET
Thank You
Questions?
Email [email protected]
SAMHSA’s Mission is to reduce the impact of substance abuse and mental illness on America’s communities.
www.samhsa.gov
1-877-SAMHSA-7 (1-877-726-4727) 1-800-487-4889 (TDD)
