Addressing Clinician Bias to Improve Equitable Implementation of Evidence-Based Practice

Abstract

Project Abstract Pediatric mental health disparities persist despite decades of research recognizing inequities. Black and Latinx youth (BLY) continue to receive lower quantity and quality of needed mental healthcare compared to non- Hispanic White (NHW) youth. Even in settings where access disparities are reduced between BLY and NHW youth, such as in schools (the most common setting in which youth access mental healthcare), treatment disparities persist. Healthcare providers’ implicit bias has been identified as a contributor to these disparities via negative impacts on the patient-clinician relationship and inequitable delivery of high-quality evidence- based practices (EBP). The implementation of any EBP runs the risk of worsening existing health disparities due to inequitable access, delivery, or benefit of the intervention. Clinician bias can be a critical and unaddressed determinant of implementation for any EBP. Although some implicit bias interventions for healthcare providers are emerging, studies have rarely included mental health professionals.

In a previously NIMH funded project, our research team iteratively developed a brief (~45 minutes), interactive online Virtual Implicit Bias Reduction and Neutralization Training (VIBRANT) for school mental health clinicians. In a small proof-of-concept study, school mental health clinicians found VIBRANT to be highly usable, appropriate, acceptable, and feasible to implement in their clinical practice. After completing the VIBRANT training, clinicians demonstrated notable improvements in implicit bias knowledge, and a downward trend in implicit bias (as measured by the Implicit Association Test) over 14 weeks. Moreover, clinicians with the greatest reductions in implicit bias also reported the strongest alliance with their youth patients.

Given these promising findings, the current study aims to conduct a pilot randomized Hybrid Type 3 Effectiveness Implementation Trial of VIBRANT—an implementation strategy for promoting equitable adoption, penetration, fidelity, and sustainment of EBPs—with 80 school mental health clinicians. One highly learnable, efficient, and scalable EBP that is particularly well-suited for the education sector is Measurement-Base Care (MBC)—the systematic collection of patient-reported progress data to inform clinical decision-making. The proposed study aims to evaluate VIBRANT’s feasibility to promote equitable adoption, penetration, fidelity, and sustainment of MBC, with a validated, brief, interactive online training for MBC. We will also examine VIBRANT’s impact on proximal mechanisms of change including clinicians’ implicit bias as well as distal youth mental health outcomes (i.e., symptoms and functioning) with 160 BLYs. Finally, we will evaluate research feasibility of a future large-scale efficacy trial.