Building Infrastructure for Community Capacity in Accelerating Integrated Care

PROJECT SUMMARY
Although individuals from racial/ethnic and linguistic minority groups make up a considerable—and growing—
proportion of the US population, they experience greater unmet need for mental health care than non-Latino
Whites. Members of these groups are heavily represented in Medicaid, the largest insurer covering the most
vulnerable individuals. And although the Affordable Care Act expanded Medicaid eligibility, research to date
has not found that expansions have decreased the gap in mental health treatment between Whites and
racial/ethnic minorities. Experts have identified a lack of culturally competent, bilingual/bicultural mental health
providers as a factor contributing to the maintenance of these disparities. Similar challenges have been
addressed in lower-income countries facing severe workforce constraints through the training of community
health workers (CHWs), who originate from the communities they serve and have shown promise
internationally as mental health service providers. However, they have not yet typically served in this role in US
care delivery systems. State Medicaid-based accountable care organizations (ACOs) are forming in large
numbers to provide care coordination via team-based approaches, with accumulating evidence suggesting that
this strategy can greatly benefit resource-poor populations. However, many ACOs have not yet incorporated
mental health services into their networks, despite the observed link between addressing mental health needs
and improving physical health. Building staff capacity to provide these needed services would help ACOs
implement evidence-based mental health interventions and improve the overall well-being of their assigned
patients. Thus, our proposed collaborative R01 will develop ACO-academic-community partnerships in two
demographically different states at different stages of ACO development and test a model that trains CHWs to
serve as mental health providers within clinics/physician's organization and community-based organizations
linked to ACOs in North Carolina and Massachusetts. This effort should expand ACO infrastructures and
increase access to and quality of mental health care for low-income racial/ethnic and linguistic minorities in
resource-poor communities. If successful, we will work with our ACO site partners to assess implementation
outcomes of adoption, fidelity, maintenance, and explore implementation processes (facilitators and contextual
factors) as potential mediators of implementation within diverse clinics, CBOs, and ACO networks.