Enhancing Structural Competency in School-Based Health Centers to Address LGBTQ+ Adolescent Health Equity

增强校本健康中心的结构能力，以解决 LGBTQ 青少年健康公平问题

基本信息

批准号：
10608426
负责人：
Cathleen E. Willging
金额：
$ 81.85万
依托单位：
PACIFIC INSTITUTE FOR RES AND EVALUATION
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-03-20 至 2027-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10608426
关键词：
Address Adolescent Adopted Adoption Affect Anxiety Attention Awareness Behavior California Caring Clinical Clinical Services Communities Competence Data Sources Discrimination Disparity Documentation Effectiveness Employee Environment Equity Ethnography Evaluation Foundations Fright Funding Gender Gender Identity Goals Guidelines Health Healthcare Heterosexuals Individual Inequity Insurance Coverage Interdisciplinary Study Intervention Interview Knowledge Language Leadership Lesbian Gay Bisexual Transgender Queer Link Mediator Mental Depression Methods Minority Health Research Motivation New Mexico Obesity Organizational Change Outcome Patients Personal Satisfaction Physical environment Policies Population Positioning Attribute Procedures Process Provider Quality of Care Readiness Recommendation Reproductive Health Research Research Institute Resources Risk Role Rural School-Age Population Schools Services Sex Orientation Sexual Health Sexual and Gender Minorities Sexual and Gender Minority Youth Sexuality Sexually Transmitted Diseases Solid Staff Attitudes Strategic Planning Students Surveys Time Training United States United States National Institutes of Health Universities Work Workforce Development Youth adolescent health barrier to care behavioral health bullying cisgender clinical encounter community partnership experience gender diversity gender minority gender minority health disparity health care delivery health care settings health equity health inequalities implementation outcomes implementation process implementation science implementation strategy improved improved outcome innovation marginalization minority patient minority student organizational climate outcome disparities patient population peer prevention service public health priorities satisfaction scaffold school based health center service delivery service organization sexual minority sexual minority youth social social health determinants social stigma substance use suicidal behavior trial design unintended pregnancy

项目摘要

Project Summary School-based health centers (SBHCs) are at the frontlines of healthcare delivery and prevention services for young patients across the United States. SBHCs provide vital services to school-aged youth, including behavioral, sexual, and reproductive healthcare, often regardless of patients' insurance status or ability to pay. Young patients who are gender or sexual minority (GSM) are far more likely to suffer from adverse health outcomes than their cisgender and heterosexual peers. Structural or societal-based factors (e.g., stigma, discrimination, low awareness of and insensitivity towards their health concerns) contribute to greater unmet needs and poorer quality of care for GSM youth. Structural competency addresses the upstream factors (social determinants of health, inadequate and fragmented treatment, inequities in care) that affect GSM students. Enhancing structural competency within SBHCs will improve the care received by GSM students and, therefore, their health. Emerging structural competency frameworks call for the cultivation of awareness and capacities in SBHCs to modify organizational service delivery environments, including provider and staff knowledge and behaviors, to influence wellbeing within this socially marginalized adolescent population. Nationally recognized recommendations or guidelines for nurturing structural competency include (1) adoption, dissemination, and enforcement of GSM supportive policies and procedures; (2) creation of welcoming physical environments for GSM patients; (3) systematic documentation and use of sexual orientation and gender identity (SOGI) information to inform and improve clinical services; (4) ongoing training for all employees in best practices for interacting with GSM patients; and (5) clinical workforce development to encourage delivery of high-quality services to GSM patients. This community-engaged implementation science study is scaffolded by school- and SBHC-based research conducted in the rural, economically challenged, and culturally rich state of New Mexico. This research provides a solid foundation for employing implementation science approaches to facilitate and evaluate the adoption of these guidelines using the Dynamic Adaptation Process (DAP), a multifaceted implementation strategy. We will conduct mixed-method readiness assessments to determine inner- and outer- context determinants for implementing structurally competent changes in SBHCs; use a stepped-wedge trial design to examine how DAP-enabled implementation impacts the adoption and effect of structurally competent changes on SBHC, student (patient), and implementation outcomes; and assess the role of key inner- and outer- context determinants, bridging factors, and associated mediators and moderators influencing implementation processes and improved outcomes for GSM students. These outcomes include reduced barriers to care and greater satisfaction and engagement in care. This study represents a key steppingstone to achieving our long- term goal of high-quality care and decreased health and behavioral health disparities for GSM youth.

项目概要学校健康中心 (SBHC) 处于医疗保健提供和预防服务的最前沿美国各地的年轻患者。 SBHC 为学龄青年提供重要服务，包括行为、性和生殖保健，通常无论患者的保险状况或支付能力如何。性别或性少数 (GSM) 的年轻患者更有可能遭受健康不良的困扰结果优于同性和异性恋同龄人。结构性或社会性因素（例如耻辱、歧视、对健康问题的认识不足和不敏感）导致更大的未得到满足 GSM 青少年的需求和护理质量较差。结构能力解决上游因素（社会影响 GSM 学生的健康决定因素、不充分和分散的治疗、护理不平等）。增强 SBHC 内的结构能力将改善 GSM 学生获得的护理，因此，他们的健康。新兴的结构性能力框架要求培养以下方面的意识和能力： SBHC 修改组织服务交付环境，包括提供商和员工的知识和行为，以影响这个社会边缘化青少年群体的福祉。国家认可培养结构能力的建议或指南包括 (1) 采用、传播和执行 GSM 支持政策和程序；（二）营造温馨的物质环境 GSM 患者； (3) 性取向和性别认同的系统记录和使用（SOGI）用于告知和改善临床服务的信息； (4) 对所有员工进行持续的最佳实践培训与 GSM 患者互动； (5) 临床劳动力发展，以鼓励提供高质量的为 GSM 患者提供服务。这项社区参与的实施科学研究由学校和基于 SBHC 的研究在经济困难、文化丰富的新墨西哥州农村地区进行。这项研究为采用实施科学方法来促进和使用动态适应过程（DAP）评估这些指南的采用情况，这是一个多方面的过程实施策略。我们将进行混合方法准备评估，以确定内部和外部 SBHC 实施结构性变革的背景决定因素；使用阶梯楔形试验设计以检查 DAP 支持的实施如何影响结构能力的采用和效果 SBHC、学生（患者）和实施结果的变化；并评估关键内部和外部的作用环境决定因素、桥接因素以及影响实施的相关中介因素和调节因素 GSM 学生的流程和改善的结果。这些成果包括减少护理障碍和更高的满意度和参与度。这项研究是实现我们长期目标的关键垫脚石为 GSM 青少年提供高质量护理并减少健康和行为健康差异的长期目标。