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The Virginia Mental Health Access Program (VMAP) is a pediatric focused training, consultation and referral model designed to increase the capacity of child and adolescent Primary Care Providers (PCPs) to treat and respond to mental health conditions such as anxiety, depression and attention-deficit hyperactivity disorder. VMAP’s goal is to connect child and adolescent psychiatrists to PCPs so that youth in need across the commonwealth can receive and benefit from mental health services.
Access to health care, particularly mental health care, is not equitable across all racial and ethnic groups. The Agency for Health Research and Quality (AHRQ) reports “racial and ethnic minority groups in the US are less likely to have access to mental health services, less likely to use community mental health services, more likely to use emergency departments, and more likely to receive lower quality of care.”1
Moreover, racism in the United States negatively affects the economics, health and emotional/mental well-being of communities of color, with exposure beginning in early childhood. As youth of color experience racism either directly or systemically, the impact of racism becomes their burden to carry and can manifest as mental and emotional trauma that may persist into adulthood. Studies show that youth of color who experience and perceive racial discrimination in their everyday life suffer more from depression and internalizing symptoms; greater psychological distress; poorer self-esteem; lower academic achievement and engagement; less academic motivation and greater engagement in externalizing behaviors.2 Further adding to this is the effect of “compounded community trauma” when youth of color witness violence in their homes and neighborhoods. This has also been linked to high rates of mental illness including post-traumatic stress disorder, depression and externalizing behaviors.3
VMAP acknowledges that the long history of racism in the United States and in the Commonwealth of Virginia adversely impacts mental and behavioral health among youth of color. We recognize this as an ongoing and important public health issue. As a result, VMAP is committed to decreasing youth mental health disparities. Conversations around the impact of racism on youth of color’s mental health will not be minimized or ignored, but encouraged and embraced as we work to provide services for all youth throughout the commonwealth. Finally, VMAP is committed to putting action behind our words and leading the way in developing and implementing a program that drives change.
It is with this commitment VMAP will do the following:
- Integrate The Office of Minority Health’s Culturally and Linguistically Appropriate Service (CLAS) standards in our work. CLAS standards will guide how we develop our governance structure, leadership and workforce; provide communication and language assistance; engage with community and stakeholders; and hold ourselves accountable for working to advance health equity.4
- Regularly examine the data we collect to monitor and evaluate our progress in ensuring equitable service across racial/ethnic groups. Conversations will take an honest look at our current approach, identify where current gaps exist and develop strategies to address these areas. Strategies will be implemented and monitored to assess how well we are reaching our goal.
- Identify and form partnerships with providers from diverse backgrounds including race, ethnicity and geographic location, as well as providers who serve families and youth of color. We will do this through targeted VMAP marketing/outreach, collaborating with communities to understand specific needs, and working with providers to bring VMAP services to communities of color.
- Use program and health equity data to make informed decisions on how to expand VMAP across the commonwealth to ensure youth of color have access to this valuable service.
We know this will be a concerted effort that will take time. We are committed to moving this program forward with an understanding that racism is a public health issue that can lead to poor mental health outcomes for youth of color, and we believe the children in the Commonwealth of Virginia deserve equitable, high-quality and anti-racist mental health treatment.
1 U.S. Department of Health and Human Resources. Office of Minority Health. Minority Mental Health Awareness Month. Accessed July 1, 2020. https://www.minorityhealth.hhs.gov/omh/Content.aspx?ID=9447&lvl=2&lvlid=12
2 Benner, et. al. 2018. Racial/Ethnic Discrimination and Well Being During Adolescence: A Meta-Analytic Review. American Psychological Association. Accessed July 1, 2020. https://www.apa.org/pubs/journals/releases/amp-amp0000204.pdf
3 Alegria, et.al. 2010. Racial and Ethnic Disparities in Pediatric Mental Health. Child Adolescent Psychiatry Clinics in North America. Accessed July 1, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3011932/
4 U.S. Department of Health and Human Services. National CLAS Standards. Accessed July 1, 2020 https://thinkculturalhealth.hhs.gov/clas/standards