Cultivating Outcomes through Equity in Behavioral Telehealth (COE-BT)
Cultivating Outcomes through Equity in Behavioral Telehealth (COE-BT) was a learning collaborative intended to help specialty behavioral health organizations improve meaningful outcomes for individuals from communities with historic behavioral health inequities by increasing their access to high quality and effective behavioral telehealth and hybrid practices.
Challenge
The COVID-19 pandemic led behavioral health organizations to significantly increase telehealth services, but racial inequities in access became evident, particularly among Black and Latinx communities, those with limited English proficiency, people facing poverty, and older adults. Key barriers include limited access to technology and digital literacy, as well as institutional racism within behavioral health organizations, which affects both telehealth access and quality. These factors contribute to persistent inequities in behavioral telehealth outcomes. As telehealth becomes a permanent practice, addressing racial equity must be a central focus.
Solution
Twelve behavioral health provider teams from across California were selected to participate in COE-BT. As part of the collaborative, each team partnered with a community-based provider that had historic and trusted relationships with Black, Indigenous, People of Color (BIPOC) communities. Community partners facilitated a Community-Based Participatory Research (CBPR) process, wherein community partners gathered information from community members about the most important challenges facing the community. They analyzed the data collected and met with their clinical partner to share their findings. COE-BT teams were encouraged to incorporate the recommendations from the community into their COE-BT specific aims.
The COE-BT Learning Collaborative included a number of different activities and supports throughout the collaborative. Key collaborative structures included:
Coaching Calls
Monthly one-on-one meetings between teams and their coaches are structured sessions designed to foster collaboration and enhance team performance. During these meetings, coaches work closely with teams to address specific goals, challenges, and progress on collaborative activities.
Learning Sessions
Three gatherings (two in-person and one virtual) of all teams, coaches, and community partners (where applicable) where teams heard presentations from experts and other collaborative participants and participated in small group discussions of relevant topics.
Foundational Trainings
Webinars facilitated by COE-BT faculty intended to build skills and create a shared understanding of the following topics: Equity and Structural Racism, Community-Based Participatory Research, and Activation.
Digital Navigation Trainings
In-person workshops facilitated by team members from the Division of Digital Psychiatry at Beth Israel Deaconess Medical Center.
COE-BT’s objectives were organized into four main themes:
- Implementation Processes: Focused on improvements in organizational telehealth practices and procedures.
- Recovery-Oriented Outcomes: Focused on improvements in individuals’ access to care, activation in their own health care, and overall well-being.
- Equity: Focused on improving organizations’ ability to serve individuals from traditionally marginalized communities and populations and measure inequities in their service offerings.
- Co-Design: Focused on improving the participating COE-BT teams’ implementation of community engagement practices into their decision-making.
Impact
COE-BT was a large-scale effort across participating teams, community partners, and facilitators. The collaborative was successful in supporting teams to engage their communities, implement recovery-oriented data collection procedures, and promote equity within their organizations. Participating teams were overwhelmingly interested in future activities similar to COE-BT, and there are opportunities to both expand support to participating teams and to broaden the reach of the assistance provided.
