Assessing and Addressing Implicit Organizational Bias to Tackle Mental Health Disparities

评估和解决隐性组织偏见以解决心理健康差异

• 批准号: 10192277
• 负责人: Miraj U. Desai
• 金额: $ 13.03万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-07 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10192277
• 关键词: Address; American; Assessment tool; Attention; Belief; COVID-19; Caring; Characteristics; Client; Clinic; Clinical; Collaborations; Communities; Community Health; Conflict (Psychology); Country; Data; Development; Discrimination; Elements; Empirical Research; Environment; Epidemic; Evidence based practice; Future; Goals; Health system; Healthcare; Healthcare Systems; High Prevalence; Individual; International; Journals; K-Series Research Career Programs; Knowledge; Lead; Light; Measures; Mediating; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentors; Methodology; Methods; Modeling; Outcome; Pathway interactions; Patients; Perception; Phase; Poverty; Process; Property; Provider; Psychologist; Psychometrics; Public Health; Publishing; Quality of Care; Research; Research Methodology; Research Personnel; Science; Services; Social Environment; Source; Structure; System; Testing; Training; Training Programs; United States; United States Substance Abuse and Mental Health Services Administration; Universities; base; behavioral health; care preference; comparative; concept mapping; design; effective intervention; ethnic minority population; expectation; experience; global health; health disparity; health economics; health equity; health organization; help-seeking behavior; implementation science; implicit bias; improved; innovation; mental health organization; minority communities; mortality; organizational structure; pandemic disease; population health; psychologic; psychosocial; racial and ethnic disparities; service delivery; social culture; social health determinants; social organization; suicidal risk; theories; therapy design; tool; uptake; vision science

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.

项目概要/摘要 在美国，少数族裔之间的心理健康差异已达到危机程度。 少数族裔更有可能患上精神疾病，例如抑郁症和相关的社会问题 由于贫穷和歧视等健康决定因素，他们不太可能寻求帮助、获得帮助或获得帮助 接受优质的心理健康服务往往是纠正这种差异和提高参与度的努力。 专注于添加新服务或改变提供商特征，包括它们可能存在的隐性偏见 然而，最近的科学评论表明，文化和结构性障碍在不知不觉中仍然存在。 根植于潜在的心理健康组织本身是持续坚持的一个重要因素 虽然实施科学提高了我们对这种关系的认识。 组织因素与循证实践的采用之间的差异相对较小 对与心理健康差异有关的组织问题进行实证研究。 部分原因可能是组织层面相对缺乏可操作的差异结构。 根据我们的研究，我们概念化了差异的关键组织机制——我们将其 术语“隐性组织偏见”(IOB)——或者，关于组织的不言而喻的规范、信念和期望 客户应以理想的方式表现和/或与心理健康系统互动以获得最佳利益 从可用的服务中（例如，客户应该口头承认问题，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族裔的规范相冲突。 患者，导致护理不一致、次优或受损的可能性更高。 发展奖旨在将隐性偏见的实质性证据扩展到个人之外 通过参与式混合方法研究的两个阶段来提高组织水平，其目的是： 1) 系统地实施并开发一种工具来评估隐性组织偏见及其影响 与少数民族社区文化的一致性；以及 2) 检查心理测量 IOB 的属性测量并测试我们概念模型中概述的关联路径。 虽然我在患者和社区层面的心理健康差异研究方面拥有丰富的经验，但这 K 旨在发展我在以下方面的技能：1）隐性偏见研究、组织理论和实施 科学；2) 概念图和评估开发，以及 3) 先进的混合方法和定量方法 我制定了一项涉及国家和地区的全面指导和培训计划。 我的导师在差异、隐性偏见和组织研究方面处于国际领先地位。 耶鲁大学世界一流的培训环境将引导我实现成为一名独立的人的目标 对心理健康差异的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族裔的参与、护理和临床结果。