Behavioral Health Disparities

1. Behavioral Health Disparities Lorraine Moya Salas, PhD Bianca Altamirano, MSW

2. Health Disparities • Those challenged by poverty experience the poorest health. • Racial and ethnic minorities experience poorer health relative to national averages from birth to death • Higher infant mortality • Higher rates of disease and disability • Shortened life expectancy

3. Health Disparities Health inequalities are a result of both socioeconomic advantage and race/ethnicity independently and in combination.

4. The Philadelphia Negro, 1899 “One thing of course we must expect to find, and that is a much higher death rate at present among Negroes than among whites. This is one measure of the difference in their social advancement…” ~ W. B. DuBois~

5. Health status is a reflection of a myriad of factor including personal choices, historic disadvantage and persistent social inequalities.

6. Public Health Models • Conditions that foster disparities: “Social determinants of health are life-enhancing resources such as food supply, housing, economic, and social relationships, transportation, education, and health care whose distribution across populations effectively determines length and quality of life.”

7. Social Determinants

8. Whole-Stream Approach Upstream determinants – change policies and environmental conditions to promote health. Downstream determinants – interventions

9. Behavioral Health Disparities • Behavioral health disorders are comparable across racial and ethnic groups yet ethnic and racial groups are more adversely impacted by their conditions.

10. Behavioral Health Disparities American Indians have a heightened risk for PTSD and alcohol dependence. Higher rates of schizophrenia in the African American community. Latino/African American youth have higher rates of PTSD. Higher rates of psychological symptoms

11. Roots of disparities • Social determinants influence the onset and progression of health and mental health conditions. • Environment plays a larger role in the onset of conditions • Progression of conditions are impacted more so by access and quality of care.

12. Holistic Health Physical health and mental health are interconnected. Emphasis of interventions may differ but to achieve health – “a state of complete physical, mental, and social well-being and not merely the absence of disease” we must attend to social determinants within and outside health care systems.

13. Resiliency Paradigm Resilience - successful adaptation despite threatening circumstances, wellness in spite of significant risk.

14. Mental Health Outcomes Risk Factors Protective Factors • Poverty • Community disorganization/violence • Inadequate schools • Trauma - racism • Low birth weight • Genetic vulnerability • Family conflict • Maternal mental disorder • Dysfunctional childrearing environment • Chronic health conditions • Hope/optimism • Social competence • Support family relationships • Parental structure/monitoring • Caring schools • Availability of resources • Social norms • Sense of community • Spirituality/Religion • Bicultural orientation

15. Racism

16. CIHDR Model

17. Lack of Access to Quality Care • Underutilization of services • Socioeconomics (lack health insurance, geographic factors) • Provider bias • Communication barriers • Lack of diversity among providers • Distrust, stigma, alternative health practices

18. Effective/Promising Interventions Comprehensive community interventions Community Health Workers/Promotoras Integrated Care/Collaborative Care Models Culturally tailored evidenced-based interventions

19. Comprehensive Community Interventions Effective in changing environmental conditions that are linked to chronic physical and mental health conditions Limited research on effectiveness of specific community interventions. Best available evidence

20. Action Model (Adapted from Healthy People 2020)

21. Place Matters http://www.youtube.com/user/interculturalvideo?blend=4&ob=5#p/u/3/y1SeLM2crUs

22. Promotoras/Community Health Workers “Lay members of communities who work either for pay or as volunteers in association with the local health care system in both urban and rural environments and usually share ethnicity, language, socioeconomic status, and life experiences with the community they serve.”

23. Impact Improve health care access/utilization, increase health knowledge, and the health status of people of color. Play a role in changing community conditions.

24. Integrative Care • “The systematic coordination of physical and behavioral health services” • Co-location • Coordination • Engage consumers in the treatment process • Evidence-based guidelines

25. The Chronic Care Model

26. Culturally adapted evidence-based interventions • Both empirically supported treatments and culturally adapted interventions are effective. • Preference findings, engagement, and retention. • Cultural considerations • Historical trauma • Acculturation

27. Key Learnings Whole-stream interventions Holistic health Evidence based practice and culturally adapted/culturally supported interventions

28. Comments or Questions