Behavioral Health Equity

What does equity have to do with emotional wellness? Our health is influenced by five main factors: genetics, behavior, environmental and physical influences, healthcare, and social factors. Issues relating to equity—race, education level, income, etc.) contribute to the social factor of health, also often referred to as SES social determinants of health). It may come as a surprise that something as insignificant as the house a person lives in can have an effect on health, but such is the causal relationships in life. Childhood enrichment and parents’ involvement boosts education, education determines career, and career determines community and what resources a person has at their disposal.

There is no one-size-fits-all approach to effective care: language, ethnicity, lived experience, culture, income level, immigration status, and an individual’s community have a tremendous impact on their ability to seek, obtain, and stick with treatment. Attaining equity means elevating marginalized people by preventing adverse childhood experiences, helping families break harmful cycles, and endowing them with the knowledge, tools, and resilience to cope with stressors in healthy ways.

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Social determinants of health like race and socioeconomic status have a significant impact on people’s access to and quality of behavioral healthcare. These inequalities trickle down into educational outcomes, career success, life expectancy, crime and substance abuse.

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Disparities in Access to Behavioral Healthcare

Social-emotional and behavioral health services are not widely available to the general public, and there is a critical shortage of behavioral healthcare providers. For example, as it stands, the behavioral health workforce needs to double in order to serve autistic children in need. People with low income, Asians, Pacific Islanders, BIPOC, and those living in rural areas are more likely to experience additional barriers to receiving treatment.

Asians

are the least likely to seek or receive care out of all populations.

11% Increase

in academic performance from social-emotional education

Educational Outcomes

When Hispanic/Latino and BIPOC children enter the school system, they are significantly more likely than white children to be referred for special education evaluations, more likely to be placed in separate classrooms or schools, and more likely to be disciplined in harsh, exclusionary ways which result in lost instructional time and increases the chances of being held back a grade, dropping out, and/or entering the justice system. Symptoms of trauma, language barriers, poor parental and family mental health can appear as behavioral and social challenges. Without a culturally sensitive lens, many students are placed in special education inappropriately in the first place, leading to poorer educational outcomes.

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Provider Diversity

Rebuilding trust in health care remains an issue, particularly among racially and ethnically diverse populations. Helping families establish trust with their psychologists and behavior therapists is critical to a healthy and collaborative relationship. Trust between them relates to a refined patient experience, health outcomes, and the patient’s perception of the care they receive. Studies show that barriers to this therapeutic alliance exist, regardless of the behavioral therapists’ level of education, training, and techniques.

Can you understand me?

The challenge of finding providers who look like them or share their cultural experiences is significant and a barrier to care for people of color. curaJOY advocates increasing the availability of providers who speak the same language as the minorities to ensure the accuracy of evaluation, effective treatment, and efficient crisis interventions

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Repercussions of Behavioral Healthcare Inequity

Education

The Achievement Gap

The “achievement gap” is the longstanding pattern of white and Asian students outperforming BIPOC and Pacific Islanders academically. This gap exists before students even start school: they enroll with different readiness levels based on the resources available to their families and communities. Social-emotional learning–children’s ability to regulate emotions, make healthy decisions, establish good relationships, and set goals–has been shown to boost academic performance by 11 percentile points.

-$272,000

loss to the US economy per student dropout

Students drop out for many reasons, including becoming a parent, having a job with a conflicting schedule, too many school absences, and poor grades. Each student that drops out costs the US economy $272,000 across their lifetime due to lower tax contributions, a higher reliance on state healthcare and assistance programs, and higher criminal activity.

Absenteeism

Healthy social-emotional development predicts academic and career success.

Workers who are college-educated not only make more but have better job security and increased access to employee benefits. Institutional racism limits opportunities for career advancement and mentorship. Mental illnesses are the leading causes of disability and loss of productivity. Institutional racism limits opportunities for career advancement and mentorship. Absenteeism, which can be caused by health problems, a lack of childcare, domestic violence, or other factors further limits job performance and prospects.

Start Early – Proactive Prevention

It’s easier to build healthy children than fix broken adults. Students in preschool enrichment programs that involve and support their parents have better academic and social skills, require fewer special education services, and are less likely to be retained a grade. The prevention of ACEs protects against future criminal activity and involvement in the justice system, gang involvement, and substance abuse problems. Lack of positive support from parents, schools, peers, and the community is associated with gang affiliation, which is associated with substance use, criminal activity, and incarceration. These outcomes perpetuate cycles of oppression, violence, and poverty.

Children Lean on Their Parents’ Wellbeing

Parental mental health is of the utmost importance – the next generation literally depends on it. Feeling emotionally connected to stable, mentally healthy parents is the single most significant protective factor in children’s mental health. Nobody can pour from an empty cup: in order to break cycles of generational trauma perpetuated by unhealthy family dynamics, parents need emotional support and tools for themselves. Learning to cope with stress in healthy ways improves the quality of life for adults, and healthy adults are better able to nurture their children’s development. Research shows that learning positive parenting skills and creating a supportive and nurturing environment guards children against ACEs; the fewer ACEs experienced in childhood, the better the outcome. Teachers who use praise and positive reinforcement for prosocial behavior had reductions in disciplinary actions which disproportionately affect BIPOC.

Adverse Childhood Events (ACEs)

ACEs or traumatic events (such as having a parent with a substance abuse problem, living in poverty, having an incarcerated parent, etc.), are the enemy of healthy development. Outcomes are successively poorer with each additional ACE, with 1/4 of adults having experienced 3+ ACEs: these have lasting negative effects on brain development and physical health and are associated with increased risk of addiction, injury, STIs, teen pregnancy, involvement in sex trafficking, and substance abuse disorders. The fallout of trauma costs hundreds of billions of dollars each year.

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Image Source: CDC

Education, Social Emotional Development and Overall Life Outcome

The value of improving social skills early on cannot be understated. Socially competent children were significantly more likely to graduate from college and work full-time at age 25 than those with poorer social skills. Workers with a high school diploma boost their earnings by $162 per week, and a college degree adds another $112 per week. That’s an extra $8400 – $14,000 annually – life-changing money that could be used to break cycles of poverty and build generational wealth.

How curaJOY levels the playing field

Multilingual and Culturally sensitive Support

Behavioral Healthcare Equity Leads to Overall Equity

The US Surgeon General has identified a major deficit in cultural competence across existing behavioral health and education providers. For those from whom English is a second language, having a non-white provider who speaks their native language can be crucial to treatment success. For example, according to the APA, only 5.5% of therapists report the ability to provide treatment in Spanish, though Hispanics make up the largest ethnic minority in the US (18% of the population). curaJOY has created the first social-emotional learning interactive game in Chinese and is designing a new digital outreach program to be inclusive: it’s multilingual, culturally sensitive, and always learning to improve. We focus on digitally delivered programs so families can access support privately and safely in their homes.

Diverse Providers

curaJOY makes behavioral health support accessible to a greater and more diverse audience

79% of psychologists in the US are white. A white provider can certainly treat a person of color, but be biased, culturally insensitive, and engage in micro-aggressions even if they have the best intentions. A survey of 635 behavior therapists revealed that only 30% of respondents received any graduate training that addressed cultural competence, 3% reported that the topic was a degree emphasis, and 25% reported no training at all. Ethnic minorities are the least likely to seek mental and behavioral healthcare. curaJOY is committed to making every user feel safe and comfortable by matching them with a virtual therapist who speaks their language and comes from their culture.

Context of Care and Advocacy

Sometimes the packaging/framing matters a LOT!

Stigma is a major barrier to seeking and receiving mental/behavioral health treatment, and certain cultures carry higher levels of stigma than others. Many ethnic minorities believe seeking help is shameful, selfish, or unnecessary. This belief is especially common in Asian communities. curaJOY is led and driven by people from the communities we serve.

curaJOY normalizes behavioral and mental health with a growth-oriented, positive, proactive approach that focuses on delivering the most amount of direct benefits to our communities. Our deep understanding of the diverse populations we serve motivated our avoidance of terms like mental health, learning disabilities, and other triggering terms that raise barriers to care.

Want to help?

Be the change

Talk to us, follow curaJOY on social media, sign up for our newsletter,

participate in the conversation, and take control of the dialogue to help us change the system.

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Collaborate

curaJOY needs partners to reduce behavioral healthcare inequity. Your organization can help by offering Quest Depot to your clients. Quest Depot not only generates valuable clinical data but provides an additional layer of support for children and parents who need it – whether they are on your waitlist or current clients. Quest Depot augments the reach of your existing staff, saves time, reduces overhead, and automates portions of your FBAs. Please join us on our quest to deliver equitable, accessible, inclusive behavioral healthcare to people regardless of language, ethnicity, or ability to pay.

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Fund

We seek practical root-cause change to behavioral healthcare inequity by availing basic behavioral health support through scalable digital delivery. Our new program, Quest Depot, for example, makes Applied Behavior Analysis available to regions in the world without such infrastructure and expertise.

We cannot do this alone. We need your help.

Join our movement to elevate behavioral health inequity. We are all connected in this world. Rise by lifting others.

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