Initiative for Decreasing Disparities in Depression Pilot CME

Provider Self-Assessment CME Model Incorporating Cultural and Linguistic Competence into the Diagnosis and Treatment of Depression

Statement of Need

Continuing disparities in the diagnosis and effective treatment of depression persist. Many of these contributing factors can be grouped into three broad categories. First, larger societal issues such as poverty, racism and discrimination, unemployment and underemployment, and inadequate housing have an impact on health/mental health status of diverse racial and ethnic groups. Second, differential access to services has been demonstrated to be a factor in disparities. Access involves more than availability and affordability of services, as it also requires an active connection with the patient, thus acceptability of services—how they are offered, where they are offered and by whom—is a significant factor in access. Third, cultural and linguistic factors have been identified as contributing to disparities including language barriers, diverse belief systems related to health, mental health, healing and well-being, culturally influenced help-seeking behaviors, attitudes toward care providers, and individual preferences and approaches to care.

While continuing medical education (CME) can not address all of these issues, all may be positively impacted in the long run by health and mental health care providers who are aware of disparities and societal issues that contribute to them, and who have the knowledge and skills necessary to diagnose and treat depression effectively in culturally and linguistically diverse patient populations.

Project Objectives

One of the five essential elements of cultural competence is the capacity for self-assessment at both the organizational and individual levels. Based on extensive experience with an existing Web-based instrument, the Cultural Competence Health Practitioner Assessment (CCHPA), http://www11.georgetown.edu/research/gucchd/nccc/features/CCHPA.html, the NCCC proposes to develop and pilot test an approach that uses self-assessment as a learning tool for providers to: (1) heighten awareness, (2) influence attitudes toward practice and (3) motivate the development of knowledge and skills to incorporate cultural and linguistic competence into the diagnosis and treatment of depression.

Intended Audience

This CME is designed for a broad array of primary care providers that includes but is not limited to Family and Community Medicine, Pediatrics and Adolescent Medicine, Obstetrics-Gynecology, Internal Medicine, and Gerontology. The CME is also appropriate for psychiatrists seeking to add to t heir base of knowledge on cultural and linguistic competence. Lastly the CME may prove to be a useful tool to physicians in academic medicine both for their own professional development and for the courses they teach including continuing medical education.

CME Model: Seven Step Approach

The NCCC proposes to:

convene a panel to modify the CCHPA consisting of experts in cultural and linguistic competence, psychiatry, and community and family medicine, and Web-based CME designs,
convene a Web design and deployment team to develop a user friendly format for the CCHPA,
update and revise the compendium of Web-based resources accordingly,
identify a sample to pilot-test the CCHPA for usability and make any necessary revisions,
select an appropriate sample to test the efficacy of the CCHPA in meeting its objectives,
report on the efficacy of the CCHPA as a CME , and
identify partners either within Georgetown University Medical Center and/or externally to offer the CCHPA to the medical community.

Georgetown University Medical Center Faculty and Project Consultants

Georgetown Faculty

Tawara D. Goode, M.A.
Director, National Center for Cultural Competence
Co-Principal Investigator, Provider Self-Assessment CME Model

Suzanne Bronheim, Ph.D.
Senior Policy Associate, National Center for Cultural Competence
Co-Principal Investigator, Provider Self-Assessment CME Model
Associate Research Professor of Pediatrics

Bonnie L. Green, Ph.D.
Director of Research, Director of Trauma Studies, Department of Psychiatry
Professor of Psychiatry

Joyce Y. Chung, M.D.
Principal Investigator, Ethnographic Studies of Depression and Help-seeking Clinical
Associate Professor of Psychiatry

John Richards, M.A.
Director of Information Technology, The MCH Group
Principal Investigator, Bright Futures MCH/EPSDT Distance Learning Project

Project Consultants

Altha Stewart, M.D.
President/Managing Associate, Stewart Behavioral Health Associates (SBHA) a minority healthcare consulting group.

Initiative for Decreasing Disparities in Depression (I-3D)

The Provider Self-Assessment CME Model is project is funded by the Initiative for Decreasing Disparities in Depression, developed by the Praxis Partnership, a co-operative consortium of the Schools of Medicine of University of Alabama at Birmingham, Vanderbilt Medicine, and Indicia Medical Education, LLC. I-3D is designed to resolve the significant gap between the mental health care services that ethnic and racial minority groups are receiving and those they could be receiving. It is funded by an unrestricted educational grant from Wyeth Pharmaceuticals.

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First, larger societal issues such as poverty, racism and discrimination, unemployment and underemployment, and inadequate housing have an impact on health/mental health status of diverse racial and ethnic groups. Second, differential access to services has been demonstrated to be a factor in disparities. Access involves more than availability and affordability of services, as it also requires an active connection with the patient, thus acceptability of services—how they are offered, where they are offered and by whom—is a significant factor in access. Third, cultural and linguistic factors have been identified as contributing to disparities including language barriers, diverse belief systems related to health, mental health, healing and well-being, culturally influenced help-seeking behaviors, attitudes toward care providers, and individual preferences and approaches to care. While continuing medical education (CME) can not address all of these issues, all may be positively impacted in the long run by health and mental health care providers who are aware of disparities and societal issues that contribute to them, and who have the knowledge and skills necessary to diagnose and treat depression effectively in culturally and linguistically diverse patient populations. Project Objectives One of the five essential elements of cultural competence is the capacity for self-assessment at both the organizational and individual levels. Based on extensive experience with an existing Web-based instrument, the Cultural Competence Health Practitioner Assessment (CCHPA), http://www11.georgetown.edu/research/gucchd/nccc/features/CCHPA.html, the NCCC proposes to develop and pilot test an approach that uses self-assessment as a learning tool for providers to: (1) heighten awareness, (2) influence attitudes toward practice and (3) motivate the development of knowledge and skills to incorporate cultural and linguistic competence into the diagnosis and treatment of depression. Intended Audience This CME is designed for a broad array of primary care providers that includes but is not limited to Family and Community Medicine, Pediatrics and Adolescent Medicine, Obstetrics-Gynecology, Internal Medicine, and Gerontology. The CME is also appropriate for psychiatrists seeking to add to t heir base of knowledge on cultural and linguistic competence. Lastly the CME may prove to be a useful tool to physicians in academic medicine both for their own professional development and for the courses they teach including continuing medical education. CME Model: Seven Step Approach The NCCC proposes to: convene a panel to modify the CCHPA consisting of experts in cultural and linguistic competence, psychiatry, and community and family medicine, and Web-based CME designs, convene a Web design and deployment team to develop a user friendly format for the CCHPA, update and revise the compendium of Web-based resources accordingly, identify a sample to pilot-test the CCHPA for usability and make any necessary revisions, select an appropriate sample to test the efficacy of the CCHPA in meeting its objectives, report on the efficacy of the CCHPA as a CME , and identify partners either within Georgetown University Medical Center and/or externally to offer the CCHPA to the medical community. Georgetown University Medical Center Faculty and Project Consultants Georgetown Faculty Tawara D. Goode, M.A. Director, National Center for Cultural Competence Co-Principal Investigator, Provider Self-Assessment CME Model Suzanne Bronheim, Ph.D. Senior Policy Associate, National Center for Cultural Competence Co-Principal Investigator, Provider Self-Assessment CME Model Associate Research Professor of Pediatrics Bonnie L. Green, Ph.D. Director of Research, Director of Trauma Studies, Department of Psychiatry Professor of Psychiatry Joyce Y. Chung, M.D. Principal Investigator, Ethnographic Studies of Depression and Help-seeking Clinical Associate Professor of Psychiatry John Richards, M.A. Director of Information Technology, The MCH Group Principal Investigator, Bright Futures MCH/EPSDT Distance Learning Project Project Consultants Altha Stewart, M.D. President/Managing Associate, Stewart Behavioral Health Associates (SBHA) a minority healthcare consulting group. Initiative for Decreasing Disparities in Depression (I-3D) The Provider Self-Assessment CME Model is project is funded by the Initiative for Decreasing Disparities in Depression, developed by the Praxis Partnership, a co-operative consortium of the Schools of Medicine of University of Alabama at Birmingham, Vanderbilt Medicine, and Indicia Medical Education, LLC. I-3D is designed to resolve the significant gap between the mental health care services that ethnic and racial minority groups are receiving and those they could be receiving. It is funded by an unrestricted educational grant from Wyeth Pharmaceuticals.

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