Improving Behavioral Healthcare Access Disparities by Training Providers in Disadvantaged Communities - Evidence of Strategy Effectiveness

Ariel B Neikrug; Shreya S Cho; Ethan S Nguyen; Annamarie Stehli; Shutong Huo; Careesa Garcia; Stephanie Au; Mandana Masoumirad; Wendy Cant; Khanh-Van Le-Bucklin; Jane P Gagliardi; Glen L Xiong; Robert M McCarron

doi:10.1007/s11606-024-09020-1

Improving Behavioral Healthcare Access Disparities by Training Providers in Disadvantaged Communities - Evidence of Strategy Effectiveness

J Gen Intern Med. 2024 Oct 31. doi: 10.1007/s11606-024-09020-1. Online ahead of print.

Authors

Affiliations

¹ Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA. aneikrug@hs.uci.edu.
² Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA.
³ Program in Public Health, University of California Irvine, Irvine, CA, USA.
⁴ Office of Medical Education, School of Medicine, University of California Irvine, Irvine, CA, USA.
⁵ University of California, Irvine, Sue & Bill Gross School of Nursing, Irvine, CA, USA.
⁶ Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
⁷ Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA.

PMID: 39482475
DOI: 10.1007/s11606-024-09020-1

Abstract

Background: Inadequate access to behavioral health services disproportionately impacts marginalized populations who live in disadvantaged areas. To reduce this gap, programs dedicated to optimizing behavioral health education and training must focus their efforts to enroll providers who practice in these disadvantaged areas.

Objective: The Train New Trainers (TNT) fellowship program aims to enhance behavioral health knowledge, skills, and attitudes of primary care providers (PCPs) who deliver care in disadvantaged communities. We evaluate the effectiveness of the TNT recruitment strategy and the use of scholarships for targeting and recruiting PCPs who practice in disadvantaged communities.

Design: Observational study.

Participants: TNT fellows from 2016 to 2023.

Main measures: State/federal classifications of medically underserved counties were used to establish scholarship criteria. Area Deprivation Index (ADI) was utilized to provide criterion validity for the use of state/federal criteria in the recruitment strategy, and to evaluate the effectiveness of the program in successfully recruiting PCPs practicing in disadvantaged communities.

Key results: Practice location data were available for 347 fellows, 88.8% of whom received scholarships. Of the 347 practices, 300 (86.5%) primarily served communities meeting at least one state or federal criterion for medical shortage areas and/or underserved areas. According to ADI scores, 32.3% of practices served areas classified in the highest ADI (ADI decile 9 or 10), with a progressive increase in the proportion of fellows practicing in underserved areas each year; in 2023, 89.9% of practices met federal shortage criteria and 40.5% served areas with the highest deciles of ADI.

Conclusions: The TNT program strategy for recruiting PCPs from high medical need geographical areas is associated with bringing primary care psychiatry education to areas considered underserved and disadvantaged. Equipping PCPs practicing in underserved areas with enhanced knowledge and skills in behavioral medicine has the potential to significantly improve the existing access gap in disadvantaged communities.

Keywords: behavioral health; disadvantage; health professional shortage areas; healthcare disparity; mental health.

Abstract

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