One in five youth under age 18 in the United States have been diagnosed with a mental or behavioral health condition, a rate that has accelerated following the COVID-19 pandemic. Associated increases in suicide and emergency department visits resulted in the declaration of a national emergency. Despite the urgency of this crisis, half of these youth do not receive treatment from a behavioral health professional, with certain populations at higher risk for disparities in both access to care and health-related outcomes. This blog will explore how the MAP system, one of the products offered at PracticeWise, can equip providers to deliver evidence-informed care that promotes equity for youth with behavioral or mental health conditions, including those who are most vulnerable.
Who is most vulnerable
Healthcare disparities, also referred to as health inequities, are the differences in access to, availability of, or use of services between groups. Populations that experience behavioral health disparities include racial and ethnic minority groups, families with lower socioeconomic status (SES) and/or lower levels of education, underserved rural communities, sexual and gender minority groups and families with limited English proficiency. Youth diagnosed with autism spectrum or developmental disorders and those who are involved in the child welfare or juvenile justice systems are also vulnerable to experiencing behavioral health care inequities. The mechanisms that cause and maintain inequities (i.e., societal, organizational, individual) are complex and beyond the scope of this blog. Let’s focus instead on how you as a provider can promote the provision of equitable care for youth with behavioral/mental health conditions.
What equitable care is
Behavioral health care that incorporates cultural humility, accessibility, and treatment tailored to the unique needs of a family enhances equity. Acknowledging that there are a variety of systemic factors that contribute to equitable care on a macro level (e.g., policy development, insurance coverage, and social climate), individual providers can ask themselves a few questions to consider whether the care they are providing promotes equity:
- What personal biases do I need to acknowledge?
- Is there evidence to support the treatment plan?
- How is the treatment plan tailored to the family’s needs?
- In what ways does the treatment plan enhance accessibility for the family (e.g., telehealth, school-based)?
- How is the youth responding to the treatment? Are there barriers, and how can I adapt the treatment plan to address these?
How MAP supports the planning of equitable care
MAP stands for Managing and Adapting Practice and is a toolkit that helps providers select, build, organize, and implement behavioral health treatment based on the most up-to-date research. PracticeWise offers MAP as a solution for addressing disparities and promoting equitable behavioral health care at the provider level.
For example, let’s say you are providing care for “Mara,” a 15-year-old Hispanic female teen with anxiety who is hesitant to engage in behavioral health care. Using one of the MAP Process Guides (i.e., visual framework to guide decision making), The EBS Systems Services Model orients you to the various sources of information that can inform Mara’s collaborative treatment plan, including (1) local information on youth like Mara accessing services in your healthcare system, (2) theoretical explanations about how anxiety develops and manifests in teen girls, (3) Mara’s personal history, including cultural beliefs and expectations about behavioral health conditions and care, and (4) the treatment outcome literature for anxiety (i.e., what works).
Using PWEBS, the research database that contains almost 2,000 peer-reviewed papers and more than 3,400 protocols, you can peruse the scope of evidence for the treatment of anxiety. Searching by youth population (e.g., race/ethnicity, gender, age) and setting (e.g., school-based, hospital) narrows the results to the evidence base that is inclusive of Mara’s specific situation. For example, a quick search of PWEBS reveals there are 21 papers and 25 protocols on anxiety that include 15-year-old Hispanic females. Perhaps you want to go one step further and see which protocols have specifically integrated cultural rituals or behaviors (i.e., the practice of Cultural Training). The PWEBS summary also shows you which practices are most commonly incorporated across these 25 protocols, such as Exposure, Cognitive, and Psychoeducation for the youth and the caregiver.
With these various sources of information, you can develop an evidence-informed care plan tailored to Mara and her specific needs across the phases of treatment (i.e., Connect, Cultivate, and Consolidate) using another MAP Process Guide, the Treatment Planner.
How MAP supports the implementation of equitable care
A third MAP Process Guide, Embracing Diversity, prompts you to reflect on how you might adapt services to meet Mara’s specific needs. For example, if her family, like others in your area, is hesitant to engage in behavioral health services due to a cultural belief that Mara should be strong enough to cope with family support alone or fears related to her parents’ citizenship status, you can consider adapting the setting (i.e., telehealth), requesting an interpreter to provide psychoeducation about anxiety and the beneficial treatments to her family in their native language, and using shared language (e.g., Mara’s labels for presentation of her anxiety symptoms are “butterflies” and “nerves”).
Using a fourth MAP Process Guide, the Session Planner, you can select practices from your Treatment Planner to plan a single encounter with Mara. If after providing psychoeducation and establishing rapport, you plan to use exposure in the next session, you can go to the MAP library of Practice Guides (PGs) and find a 2-page, step-by-step instructions on how to deliver exposure. However, you may decide that given Mara’s family’s reticence with engaging in care, it would be helpful to first promote family engagement (Engagement with Caregiver PG) and reduce barriers (Accessibility Promotion PG) before diving into the Exposure PG.
You are now engaging in evidence-informed practice tailored to Mara’s family’s needs. But, how do you know that treatment is working? MAP also provides a user-friendly tool to track progress, practice, and other events. The Clinical Dashboard is a resource that helps providers track treatment progress, practices, and other events over the course of care. This makes it easier to see what has been done in treatment and how a youth is progressing over time. For example, you may have selected to use an anxiety severity rating to monitor Mara’s anxiety symptoms over time. Perhaps, in collaboration with Mara, you define anxiety severity as “how heavy the butterflies are.”
In Summary
The MAP system supports the planning and implementation of equitable behavioral health care through individualized decision-making, ongoing monitoring, and the flexibility to adapt care across the treatment course based on a family’s needs at any given time.
Resources
- Learn more about the MAP system
- Browse the On-Demand library for courses
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About the Author
Janelle Wagner, Ph.D., serves on the Professional Development Team as an Associate Trainer and Senior Consultant for PracticeWise. Learn more about Dr. Wagner on the PracticeWise team page.
