EMHD Initiative

Selected List of Eliminating Mental Health Disparities (EMHD) Initiative Activities

The Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Mental Health Services (CMHS) has undertaken a major initiative to eliminate disparities in mental health care. This effort includes a focus on racial and ethnic groups in addition to disparities created by gender, gender expression, sexual orientation, disability, religion, socio-economic status, geography (e.g., rural, remote and frontier services), language, immigration status and family composition. The overall goal of the Initiative is to develop and implement strategies that will facilitate the elimination of disparities across the life span. The initial contractor for the Initiative is Human Resources Research Organization (HumRRO). Activities concerning the project will be transitioned over time to AFYA, Inc., the second contractor for the Initiative. The EMHD Initiative includes a number of projects and activities as outlined below:

Development and Maintenance of a Communication and Information Dissemination System across Partner Organizations and Constituency Groups

In collaboration with The National Alliance of Multi-Ethnic Behavioral Health Associations (NAMBHA)

One of the primary tasks associated with the EMHD Initiative is the development of the website - www.endmentalhealthdisparities.org. The website is designed to serve as the locus for information associated with the entire Initiative, thus users may access a variety of documents and resources including meeting minutes related to the EMHD Initiative; materials associated with the SAMHSA NNED Initiative; the Training of Trainers Project; research studies; funding and job announcements; events in the field and other information related to mental health disparities. The website serves as an outlet for posting information about efforts involving cultural and linguistic competence and strategies to reduce and eliminate health disparities. Space is provided for interested groups to communicate in a private forum. Members can offer and receive feedback from constituents utilizing the site. The website is geared toward Federal, state and community parties, as well as others interested in the elimination of mental health disparities.

Collaborate with the SAMHSA Cultural Competence/Eliminating Disparities (CCED) Initiative and the National Network for Eliminating Disparities (NNED) in the Creation of an External Workgroup on Mental Health Services Disparities

The External Workgroup provides input and guidance into the activities of CMHS and SAMHSA and works to ensure that continuity and collaboration exists between them and the NNED Steering Committee. The Workgroup also contributes direction on how to reduce duplication of efforts in the field. The members of this workgroup are representatives of national, state and local organizations; family members; youth and consumers. Particular emphasis is placed on ensuring adequate representation of racial and ethnic groups within the body of the Workgroup. The External Workgroup is composed of three committees that collaborate to eliminate mental health disparities in the areas of Policy, Consumer Empowerment, and Workforce Development. The second meeting of the External Workgroup was held May 19-20, 2008 at SAMHSA.

Enhance the Ability of CMHS to Increase Knowledge of and Opportunities for Culturally Competent Behavioral Health Care for American Indian and Alaska Native Populations

In collaboration with the First Nations Behavioral Health Association (FNBHA)

The following activities are part of this project:

• Convene an American Indian and Alaska Native Expert Panel meeting to develop specific strategies for CMHS that will result in disparity reduction for tribal populations
• Implement an online link from the existing national tribal website for dissemination of tribal behavioral health best practices, including the ability of tribal interests to submit behavioral health resource questions and receive answers within a specified timeline
• Develop a catalog that will outline ongoing questions and answers (FAQs) in a database for use by Tribal behavioral health interested parties

Develop a Database of Consultants who Can Provide Expertise and Technical Assistance on Behalf of SAMHSA on Issues of Latino Mental Health

In collaboration with the National Latino Behavioral Health Association (NLBHA)

The following activities are included in this endeavor: 

• Establish a Steering Committee that will provide input about the criteria and content of a database of trainers, consultants, and contractors working on Latino behavioral health issues
• Create a database of trainers, consultants, and contractors working on Latino behavioral health issues; agencies that specialize in Latino behavioral health; and consumers, family members and advocates
• The target audiences for the database are SAMHSA/CMHS staff, SAMHSA/CMHS grantees, mental health providers, community mental health centers and individual providers who are interested in or work with Latino-American communities
• Develop a manual on how to use the database

Develop an Outline for a Training Curriculum Targeted to Mental Health Providers Working in Cambodian-American Communities

In collaboration with the National Asian American Pacific Islander Mental Health Association (NAAPIMHA)

The following activities are part of this effort:

• Conduct a literature review/scan on the mental health needs of Cambodians across the country
• Convene an expert panel to identify critical factors that must be addressed in developing a training curriculum for mental health providers working in Cambodian-American communities
• Develop an outline for a training curriculum that will target providers working with Cambodian communities
• The ultimate target audiences for this outline are mental health providers and community mental health centers that serve areas with high Cambodian populations

Document the Mental Health Needs of African American College Students

In collaboration with the National Leadership Council on African American Behavioral Health (NLC) and the University of Texas/Austin

The primary goal of this undertaking is to advance the knowledge and understanding of mental health in the African American community by conducting a pilot Mental Health Needs Assessment at three Historically Black Colleges and Universities in the United States. They are:

• Fayetteville State University in Fayetteville, NC
• Benedict College in Columbia, SC
• Huston-Tillotson University in Austin, TX

This assessment will gather information from two sources: students and counseling center personnel. The student data will focus on the identification of specific mental health needs and the psychosocial factors that contribute to the development/exacerbation of those needs. Data collected from counseling center personnel will include information on training and educational background, the service provision models utilized (e.g., guidance counseling, psychotherapeutic, and outsourcing), the awareness of culturally-centered interventions, and educational outreach efforts. The assessment will guide the development of the HBCU Culturally Centered Service Delivery model.

Engage Diverse Communities to Reduce Mental Health Disparities

CMHS engages representatives of diverse communities to provide guidance in developing strategies to reduce mental health disparities across the nation. To this end, a one-day meeting was held with representatives from NAMBHA and its affiliates (FNBHA, NLBHA, NAAPIMHA and NLC) on April 21, 2008 at SAMHSA to assist CMHS in identifying priorities and establishing activities focused on diverse populations.

Expand Efforts to Promote the Use of Technology to Improve Access to Mental Health Services

In collaboration with the University of Colorado/Denver

The following activities are part of this venture:

• Expand the TeleHealth care services in communities served by the U.S. Department of Veterans Affairs
• A Resource Guide on how a community can implement a TeleMental health service is now online: http://www.tmhguide.org
• Implement a systematic research program that focuses on TeleHealth care service for 15 American Indian Veterans with Post Traumatic Stress Disorders (PTSD) on the Wind River Reservation in Wyoming

Facilitate the Implementation of Specialized Curriculum and Training on Cultural and Linguistic Competence in Children's Mental Health

In collaboration with The National Alliance of Multi-Ethnic Behavioral Health Associations (NAMBHA)

As part of the EMHD Initiative, a Training of Trainers (TOT) Curriculum for CLC will be constructed. The following activities are part of this task:

• Establish a Steering Committee for the TOT Curriculum to include representatives of NAMBHA, AIR, Georgetown University, NNED, the EMHD External Workgroup and HumRRO
• Conduct research on curricula designs and models to include curricula materials on cultural and linguistic competence and/or disparities
• Finalize the TOT Curriculum content and materials
• Identify trainers and trainees and conduct one pilot training for the TOT Curriculum
• Produce a final TOT Curriculum and related materials

Expand Efforts to Increase Workforce of Color by Increasing Commitment to Universities

In collaboration with The University of South Florida

• This project involves conducting an outreach program to relevant universities and colleges as well as developing and offering a Graduate Certificate in Children's Mental Health with an emphasis on Systems of Care
• USF will expand this program to universities and colleges with large enrollments of students of color in an effort to increase the workforce of color
• Targeted outreach and involvement will be conducted to engage and involve entities such as:
  • Historically Black Universities and Colleges (HBCUs)
  • Tribal Colleges
  • Hispanic Association of Colleges and Universities (HACUs)

Implement and Evaluate a Training Curriculum to Providers Working with Asian American, Native Hawaiian and Pacific Islander Children, Youth and Families

In collaboration with the National Asian American Pacific Islander Mental Health Association (NAAPIMHA)

The following activities are part of this task:

• Finalize an outline of the modified Children's Training Curriculum
• Deliver and evaluate a pilot course on the Children's Training Curriculum
• Develop a Training Plan that includes recommendations on how to implement the curriculum

Convene a Roundtable to Identify Best Practices in the Cultural Adaptation of Evidence-based Practices and the Systematic Development of Practice-based Evidence

In collaboration with The University of California/Davis and the Institute for Scientific Analysis

The following activities were part of this completed task:

• A national conference was held March 13-14, 2008 in Bethesda, MD
• A report on the conceptual problems in identifying and accounting for cultural variables that may mitigate the effectiveness of evidence-based psychological interventions was developed
• A report on measurement approaches that can enhance the sensitivity of research in assessing impact and outcomes of evidence-based psychological interventions when applied to ethnic minority populations was produced
• A package of articles, reports, and other materials that focuses on ethno-cultural issues in evidence-based practice research was posted on the EMHD website

Reducing Mental Health Disparities in Minority Older Adults: A Research Agenda to Improve Culturally Responsive Services

In collaboration with Emory University Department of Medicine, Division of Geriatrics

The following activities are part of this task:

• Conduct a literature search on the topic
• Develop an article on the current state of research on mental health disparities in older adults
• Construct a set of recommendations to guide a research agenda on mental health disparities in the elderly
• Develop a state-of-the-art article that explores the use of information technology (IT – computers and the Internet) to increase mental health literacy in diverse older adults

Utilize Public Education, Social Marketing and Awareness to Reduce Stigma and Increase Access to Mental Health Services

In collaboration with Vanguard Communications

Over the past several years, numerous experts across SAMHSA, CMHS and the mental health field have weighed in on effective strategies for eliminating mental care health disparities. A critical step in improving the system is to apply what is known about evidence based and promising practices to a comprehensive social marketing plan that, when implemented, can transform mental health services delivery beginning at the grassroots level.
The following activities were part of this completed project:

• Develop a matrix of existing resources and efforts related to the EMHD (Environmental Scan)
• Construct a social marketing plan for the EMHD Project
• Develop a set of adjunctive materials that are consistent with a situational analysis and a resulting marketing plan

Develop, Adapt and Promote Materials and Pathways to Reduce Stigma across Cultural and Linguistic Settings

In collaboration with Sebastian Lantos, LLC

This task has involved several activities to promote the use of translation and interpretation services and provide training and information to enhance the capacity of interpreters and translators working in mental health settings across the life span.
The following activities are part of this endeavor:

• The translation of products and materials developed by the EMHD Project
• The provision of interpretation sessions at selected meetings, workshops and conference calls to meet the linguistic needs of the participants
• The execution of workshops on “ Language Interpreting Guidelines” at conferences
• Four “Webinars” have been held on the use of interpreting services in mental health settings

Convene a Policy Summit to Improve States' Capacity to Eliminate Mental Health Disparities – The National Policy Summit on the Elimination of Disparities in Mental Health Care

In collaboration with Georgetown University and AFYA, Inc.

The purpose of this project is to convene a Policy Summit that furthers the impact of EMHD Initiative by leading efforts to design and implement policy supporting the elimination of mental health disparities with particular focus on cultural and linguistic competence. The Policy Summit on the Elimination of Mental Health Disparities will be held June 8 – 11, 2009 in New Orleans.

• Six state delegations of seven persons each will be selected to participate in the two and one half day Policy Summit
• The event is designed to facilitate states’ development and implementation of policies that will address the elimination of mental health disparities
• The target population will be racial and ethnic groups, special populations and people living in rural areas
• Delegations will participate in work sessions to develop action plans that they will implement upon their return home
• Delegation membership must include meaningful consumer participation and family participation as defined by family members and consumers
• The delegations will include individuals who are strategically positioned to significantly influence efforts to address this issue in their respective states

Members of Policy Summit's delegations will be selected based on: demonstrated need of the delegation's community for furthering policy development supporting equity in mental health service/support delivery (Community self-assessment); level of readiness and commitment of delegation participants to facilitating change; and ability to collaborate with grass-roots organizations.

Review Community-based Practices within the Major Racial and Ethnic Communities

In collaboration with the National Latino Behavioral Health Association (NLBHA)

The result of this effort will be an alternate and supplemental means of measuring community-defined evidence in Latino behavioral health agencies and/or projects, and the establishment of a framework for other racial and ethnic groups to demonstrate the validity of their community-defined evidence-based practices.
The following activities are part of this venture:

• Develop a directory of community based programs that provides exemplary behavioral health services to Latino communities
• Construct a brief or monograph for individuals in the field and other interested parties that will summarize an inventory of culturally based practices that successfully serve Latino populations
• Compose a brief or monograph that outlines the meaning of “Community Defined Evidence”- why it is important, and how the concept relates to evidence-based practice and practice-based evidence

The CMHS “Working Together Toward Cultural and Linguistic Competence” Self-Assessment

The purpose of this project is for CMHS to conduct a self-assessment using participatory action research to implement a process to enhance organizational knowledge, skills and commitment in the area of mental health disparities and cultural competence. A steering committee will work with CMHS and HumRRO to complete the selected tasks that are listed below:

• Develop a self-assessment instrument
• Administer the self-assessment and analyze the results quantitatively and qualitatively
• Develop a report with the results of the self-assessment

Building Cultural Competency among Service Providers Working with Youth who are Homeless and Lesbian, Gay, Bisexual and Transgender

In collaboration with the Homelessness Resource Center (HRC)

To increase awareness among service providers who interact with youth who are homeless and LGBT, HRC will create three videos on providing culturally competent care to this population. The videos will be accessible via the HRC website and will be linked to best practices and culturally competent tools in the field for working with LGBT youth.
The following activities are part of this project:

• Create an LGBT youth sponsored topic page that describes the videos and provides links to each video
• Develop three final videos with graphics and soundtracks

Promote Integrated Care for Racially and Ethnically Communities Using a Primary and Behavioral Healthcare Collaborative

In collaboration with the National Council for Community Behavioral Healthcare (National Council)

The National Council coordinates the Primary Care-Mental Health Collaborative Care Project, which helps community mental health centers (CMHCs) create a mutually beneficial relationship with community health centers (CHCs) in their community. During this process, organizations are expected to increase referrals from primary care, create a structure that ensures collaborative care for shared patients, and increase clients’ access to primary care services. HumRRO, in conjunction with CMHS, the National Network to Eliminate Disparities (NNED) and the National Council will convene a cohort of this project in an Initial Learning Session. This session will focus specifically on providers working in and with traditionally undeserved communities.
This project will employ a Learning Collaborative model, in which primary care and specialty mental health teams from the selected sites will convene in an initial Learning Session. During this session, the participants will receive clinical education materials and training, review the project outcome metrics, and plan their initial approach to achieving the goals. This initial Learning Session will be scheduled for two days in Baltimore, MD during 2009. A plan for next steps will be developed from the Initial Learning Session.