EquiCare Toolkit

Abstract: Tailoring care, programs, and services to the cultural, social, gender, and other socio-demographic contexts of individuals served yields positive outcomes. Communities and individuals benefit when they receive behavioral health services that are clinically proven effective, equitable, and culturally appropriate. This guide focuses on the process of adapting evidence-based practices (EBPs) for under-resourced populations who experience obstacles in obtaining healthcare services because of their socio-demographic characteristics, and the research supporting such adaptations. The guide provides examples of research on adapted EBPs for mental health and substance use disorders for clients with a wide range of demographic characteristics. The guide provides considerations and strategies for community leaders and advocates, behavioral health practitioners, administrators, and organizational decision-makers.

Substance Abuse and Mental Health Services Administration. (2022). Adapting evidence-based practices for under-resourced populations. National Mental Health and Substance Use Policy Laboratory, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/resource/ebp/adapting-evidence-based-practices-under-resourced-populations

Overview: Behavioral health disparities persist among Black, Indigenous, and other communities of color despite decades of research on effective interventions. Addressing these inequities requires culturally appropriate, evidence-supported practices tailored to specific racial and ethnic groups. However, implementing evidence-based practices (EBPs) in diverse populations presents challenges, including the need for community-driven adaptations and greater representation in outcome studies. Since 2011, SAMHSA’s Office of Behavioral Health Equity has addressed these issues through NNEDLearn, an annual training program equipping community-based practitioners to implement culturally relevant behavioral health practices. This report evaluates NNEDLearn’s impact through qualitative interviews with nine alumni and six trainers from 2011–2020.

Substance Abuse and Mental Health Services Administration. (2021). Evidence-based and culturally relevant behavioral health interventions in practice: Strategies and lessons learned from NNEDLearn (2011-2020). Office of Behavioral Health Equity, Substance Abuse and Mental Health Services Administration. https://store.samhsa.gov/sites/default/files/pep21-05-02-001.pdf    

Abstract – Objective: In the United States, people of color (POC) are disproportionately affected by various sources of stress and prevalent mental and physical health issues that may benefit from Mindfulness-based Interventions (MBIs). However, effects of MBIs for POC are unclear. This meta-analysis examines the efficacy of MBIs through randomized controlled trials (RCTs) that included predominately POC (>75% of the sample). Method: Random effects models were used to synthesize effect sizes. A total of 24 RCT samples were analyzed. Results: Samples were on average 94.4% POC and predominantly from low-income backgrounds (total N = 2,156). At post-treatment, MBIs yielded small but statistically superior outcomes to active controls (Hedges’ g = 0.11) and inactive controls (g = 0.26). Compared to active controls, MBIs’ effects on well-being were smaller than their effects on other outcome types. Compared to inactive controls, MBIs that focused on non-clinical populations and had higher proportion of POC had larger effect sizes. Attrition rates of MBIs did not differ from other active conditions in outpatient settings. Conclusion: Findings provide modest, preliminary empirical support for MBIs among POC. We discuss main findings, limitations, and implications for future MBI research for health promotion among POC.

Sun, W., Goldberg, S. B., Loucks, E. B., & Brewer, J. A. (2021). Mindfulness-based interventions among people of color: A systematic review and meta-analysis. Psychotherapy Research, 32(3), 277-290. https://doi.org/10.1080/10503307.2021.1937369

Overview: This toolkit offers a comprehensive guide to the teach-back method, a straightforward and effective approach to confirming patient understanding, widely recognized as a best practice in health literacy communication. It outlines when, where, and how to implement the method, while also providing training materials and tools for measuring outcomes.

Talevski, J., Beauchamp, A., Wong Shee, A., Rasmussen, B., & Hilbers, J. (2021). The Teach-Back Toolkit: A guide to the use and implementation of the teach-back method.  https://teachback.org/wp-content/uploads/2022/02/Teach-Back-Toolkit_for-website_Sept-2021.pdf

Abstract: The emerging era of integrated care represents a major opportunity for clinical psychology to migrate empirically supported treatments (ESTs) into the mainstream of public health. To succeed will require us to modify current ESTs to make them brief, cost-effective, patient-centered and acceptable to and easily learned by both the mental health and health-care professionals that will deliver them. Changes to the recently modified standards for designating ESTs are proposed that will facilitate adoption of a population health model of treatment development and testing, designed to promote rapid dissemination of empirically supported interventions that are a “good fit” for integrated settings. Defining characteristics of the “new look” for ESTs are examined.

Strosahl, K. D., & Robinson, P. J. (2018). Adapting empirically supported treatments in the era of integrated care: A roadmap for success. Clinical Psychology: Science and Practice, 25(3), Article e12246. https://doi.org/10.1111/cpsp.12246 or https://psycnet.apa.org/record/2018-31680-001?doi=1

Abstract: Patients often have difficulty comprehending or recalling information given to them by their healthcare providers. Use of ‘teach-back’ has been shown to improve patients’ knowledge and self-care abilities, however there is little guidance for healthcare services seeking to embed teach-back in their setting. This review aims to synthesize evidence about the translation of teach-back into practice including mode of delivery, use of implementation strategies and effectiveness. We searched Ovid Medline, CINAHL, Embase and The Cochrane Central Register of Controlled Trials for studies reporting the use of teach-back as an educational intervention, published up to July 2019. Two reviewers independently extracted study data and assessed methodologic quality. Implementation strategies were extracted into distinct categories established in the Implementation Expert Recommendations for Implementing Change (ERIC) project. Overall, 20 studies of moderate quality were included in this review (four rated high, nine rated moderate, seven rated weak). Studies were heterogeneous in terms of setting, population and outcomes. In most studies (n = 15), teach-back was delivered as part of a simple and structured educational approach. Implementation strategies were infrequently reported (n = 10 studies). The most used implementation strategies were training and education of stakeholders (n = 8), support for clinicians (n = 6) and use of audits and provider feedback (n = 4). Use of teach-back proved effective in 19 of the 20 studies, ranging from learning-related outcomes (e.g. knowledge recall and retention) to objective health-related outcomes (e.g. hospital re-admissions, quality of life). Teach-back was found to be effective across a wide range of settings, populations and outcome measures. While its mode of delivery is well-defined, strategies to support its translation into practice are not often described. Use of implementation strategies such as training and education of stakeholders and supporting clinicians during implementation may improve the uptake and sustainability of teach-back and achieve positive outcomes.

Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-back: A systematic review of implementation and impacts. PLoS One, 15(4), e0231350. https://doi.org/10.1371/journal.pone.0231350