Abstract
Problem:
The purpose of this project is to address a well-known gap in pediatric care for the AI/AN community within the state of Minnesota, specifically tribal communities, and the seven county area served by our urban tribal program. The gap includes lack of adequate access to pediatric medical care and psychiatric care for AI/AN children and adolescents. Although regional pediatric psychiatric teleconsultation is available and providers exist they are not providing culturally specific care and are under-utilized by AI/AN communities.
Goals and objectives:
The overarching goal of this project is to expand access and enhance mental health care for those who suffer the greatest disparities, are at greatest risk, and who have historically been underserved in the area of mental health - Native American children and adolescents in both urban and rural tribal communities across Minnesota. GOAL 1) Increase the availability and accessibility of culturally informed pediatric mental health care, through a multidisciplinary teams composed of child and adolescent psychiatrists, licensed mental health professionals, and care coordinators through telehealth consultation and referral topediatric primary care providers and other providers caring for American Indian and AlaskanNative (AI/AN) children and adolescents with behavioral disorders. GOAL 2) Conduct culturally- and trauma-informed training (i.e., Indigenous Health Toolkit (IHT); Indian Country Child Trauma Center (ICCTC)) and provide technical assistance (i.e., PrairieCare's Psychiatric Assistance Line (PAL); ICCTC) to pediatric primary care providers and other providers to enable them to conduct early identification, diagnosis, and treatment for AI/AN children and adolescents with behavioral health conditions. GOAL 3) Provide information, and assist pediatric and other providers in accessing pediatric mental health care providers, with the overarching goal of providing timely detection, assessment, treatment, and referral of children and adolescents with behavioral disorders through telehealth, using evidence-based practices and methods such as web-based education and training sessions. GOAL 4) Improve access through telehealth to culturally tailored treatment and referral services for AI/AN children and adolescents with identified behavioral disorders. GOAL 5) Focus on achieving health equity related to racial, ethnic, and geographic disparities in access to behavioral health care among urban and rural tribal AI/AN communities. GOAL 6) Establish and sustain the use of PAL to provide culturally responsive care to AI/AN children and adolescents, with a network of teams including but not limited to care coordinator; spiritual care; a child and adolescent psychiatrist; and a licensed clinical behavioral health professional, such as a psychologist, social worker, or mental health counselor.
Methodology:
The use of telehealth and teleconsultation for psychiatry and behavioral health therapy has become increasingly accepted and successful among many Native American clients since the pandemic; this model has the ability to greatly increase our reach. A key component of the success of this project is to train pediatric providers and professionals using the Indigenous Health Toolkit (IHT), aimed at reducing provider bias and increasing cultural responsivity through education and experiential activities. With the support from our Pediatric Advisory Board we will tailor the IHT to be used with the pediatric provider group. We will video record the seven module IHT training to be used for future training purposes.
Coordination:
We will leverage this model with our partners' services PrairieCare's Psychiatric Assistance Line (PAL) and inpatient services, and Native American Community Clinic's primary care, behavioral health, and dental services. We will also hire a small behavioral health trained team to support the launch and deliverables of this grant which will be housed out of the Mino Bimaadiziwin Wellness Clinic in Minneapolis (newly built and owned by Red Lake). Furthermore, this funding will also help us to improve referral processes, communication, and collaboration across pediatric care providers within the state. Additionally, we will collaborate with the Minnesota Department of Maternal and Child Health to maximize the effectiveness of our program and theirs.
Evaluation:
Our evaluation will consist of tracking and monitoring the success of our referrals and collaboration with partners (e.g., # of children and adolescents who received telepsychiatry), addition of more partnerships, and we will also measure the effectiveness of the Indigenous Health Toolkit. The provider pre- and post-survey measures self-reported bias, their ability to perform effective cultural care, and their experience of burnout using an online survey, Redcap. At the same time, patients will be surveyed about their satisfaction with services, the degree to which they received culturally appropriate care, and their experiences of bias while receiving care.