“Decoding Disparities” in behavioral health access in Camden and South Jersey
The renewed national focus on health equity over the past two years has come with growing understanding of the need for data-driven solutions. The Camden Coalition is proud to announce that our clinical redesign team was one of four awardees across the country of the Decoding Disparities Quickfire Challenge from Johnson & Johnson Innovation.
The Decoding Disparities Quickfire Challenge invites U.S.-based innovators – including entrepreneurs, health systems experts, technologists, researchers, academia, and students — to submit data-driven methodologies or technologies aiming to better detect, understand, or reduce the root causes of health inequities and inform the crucial next steps needed towards achieving equity. Monies from the grant will be used to better collect and report data on the social and systemic barriers faced by individuals with behavioral health needs, as part of our new Pledge to Connect initiative.
Through Pledge to Connect, emergency department (ED) staff and behavioral health providers work together to create smoother transitions of care from the ED to the ongoing mental health and substance use disorder treatment that patients need. The initiative also works on the community level to combat stigma and eliminate other social barriers that prevent many South Jersey residents from accessing the care they need.
We talked with members of our clinical redesign team, including Associate Director Dayna Fondell, Program Managers Sharif Braxton and Mouy Pan, and Director Natasha Dravid, about the Quickfire Challenge project and Pledge to Connect initiative. Read the full Q&A below.
Tell us a little bit about the project you submitted to the Quickfire Challenge.
We know from working with patients and providers in South Jersey that there are many individuals with mental health needs and/or substance use disorders who cannot or do not want to access behavioral healthcare for a variety of reasons — from stigma to lack of timely care options to hard-to-navigate systems. However, despite all the stories we’ve heard, there’s not much data measuring the size and scope of the problem. Our goal for this project is to make it easy to capture the nuanced social barriers, system failures, and patient experiences that impact access to behavioral healthcare.
We’re starting by working with our data and evaluation team to analyze the feedback we have collected from patients about their emergency department (ED) experiences and the barriers they’ve faced accessing behavioral healthcare (care for mental health and/or substance use disorders). We’ll then work with our project team and peer liaisons to develop a list of data points around system failures and barriers as well as successes.
The main work that this grant is funding is developing capacity within the Camden Coalition Health Information Exchange (HIE) to capture and measure the prevalence of social barriers and system failures. We’ll start by developing a series of open-ended questions for our community health worker to document within the HIE, and begin collecting information on patient experiences in a qualitative way. As time goes on, the qualitative responses will be themed and turned into discrete fields within our HIE, allowing us to more easily quantify the information and create reports. The goal is to turn patient voices into a metric that holds systems accountable. This grant is helping support the staff time and the HIE technology to integrate this data capture into our existing system. Our hope is that this data will drive quality improvement and ultimately make it easier for people to access the care they need.
Why did you focus on behavioral health?
The Camden Coalition has been working with patients with behavioral health needs for close to two decades through the implementation of our Camden Core Model and our 7-Day Pledge project. Unfortunately, we found that although we had success in our programs, patients with behavioral health needs were the least aided by these broader, less focused interventions. While many of our partners were working to expand access to behavioral healthcare, our community was still lacking a coordinated approach to address the gaps in care patients are experiencing.
In particular, we saw that patients showing up in emergency departments (EDs) with behavioral health needs were falling through the cracks and not being connected to ongoing care. As a result of seeing this need, we developed the Pledge to Connect program alongside our partners at Oaks Integrated Care, Cooper University Healthcare, and Virtua Health in order to fill this critical service gap and support smoother transitions of care. The improved data collection supported by the Quickfire Challenge grant is just the first step in addressing the many unique challenges within behavioral health, including stigma, lack of resources, and disparities — Black patients, for example, are much less likely than their White counterparts to have access to behavioral healthcare.
What are some of the issues you believe your project could help address?
We think this project will support nuanced quality improvement efforts by helping quantify barriers to transitions of care, while also providing real-time feedback to frontline ED staff and hospital leadership about patients’ experiences of care. By looking at specific system barriers such as unclear instructions, perception of stigma, lack of useful referrals, and waiting list time, this project will help us and our partners target and improve specific aspects of the patient care and referral process.
Right now, patients are often blamed, implicitly or explicitly, for having poorly managed mental health conditions and/or substance use disorders. Raising awareness of current system failures will shift the narrative away from patient ‘compliance’ onto system accountability.
In addition, while we do see system barriers and failures of information, we also hear about a lot of positive experiences in the emergency department. However, we have heard from many ED staff that it is rare for them to hear success stories of what happens after patients leave the emergency room. Our hope is that through this project we can provide specific feedback that can reinforce positive care while also providing constructive feedback and accountability.
In general, how can data (collection, analysis, reporting) help address social determinants of health?
There has been a notable shift within healthcare within the last five or so years to understand the importance of tracking social determinants of health and their impact on patients and patient outcomes. While there is still a long way to go, much of the work around social determinants of health has pushed healthcare providers to have more empathy about the pressures and insecurities that the patients they are serving are facing.
By expanding our efforts to capture additional barriers and system failures, our hope is to challenge the idea of patients being ‘non-compliant’ with follow-up, and instead shed more light on the ways that healthcare systems and behavioral health providers can improve the consistency and quality of transitions of care.
Is this concept scalable? How so?
Most definitely! We are hearing from clinical partners that they are eager for this type of data and analysis, and our partnership with CareEvolution, the software company that powers the Camden Coalition Health Information Exchange, will enable scaling across NJ and the country. The ability to implement these changes within our CareEvolution HIE means that all other platforms that use CareEvolution’s technology can easily begin to incorporate these fields into their respective platforms and scopes of work.
How will this grant advance the work of complex care more broadly?
Ultimately, we hope this project will be a means of amplifying the voices and experiences of patients engaging with the healthcare system. We want to hold the system accountable to them in a concrete way and allow their experiences, perspectives, and desires to drive systems change and quality improvement to better serve those in need of support.