California Health Care Improvement Projects (CHIPs)

Mandating Equity: Promoting Health Justice and Avoiding the Minority Tax

After issuing statements on racial justice during Summer 2020, health care institutions’ attention towards health justice has decreased substantially. Meanwhile, health equity work is often (1) uncompensated and (2) undertaken by people from under-represented communities. This combination results in a “minority tax” on these colleagues, causing ongoing professional and psychological harm.

This project aimed to set an expectation that health equity promotion should be valued similarly to other “normal” professional goals (e.g., clinical productivity, academic involvement, and Division citizenship). During FY2020-2021, “an equity mandate” was implemented in our Division of Primary Care at an academic safety net hospital in Oakland, California. Eligible faculty had 1% of total potential compensation made contingent on specifying and meeting a health equity goal in their non-clinical work. Goals were made through shared decision-making between the Division Chief and faculty members, centering on two questions: “How might your work impact health equity?” and “How might you measure the impact of your work on health equity?”

Meeting Clients Behavioral Needs During a Global Pandemic

How do we continue to provide high quality behavioral health services to clients during a global pandemic? Research suggests that the interventions most essential for pandemics necessarily disrupt the very social processes that facilitate mental health, including social support availability, day-to-day interaction, and social influences on coping (Marroquín et al., 2017). Research on true quarantine (i.e., complete isolation to contain an illness) shows substantial effects on emotional distress and mental health including depression, generalized anxiety, insomnia, and post-traumatic stress (Brooks et al., 2020). Knowing this how we continue to provide this much needed care, while keeping our staff and community safe. Our objective was to ensure we were able to provide this essential care to our clients while keeping the clients and our staff safe. We developed systems to distribute PPE to all locations, developed safety protocols, quarantine protocols, and set aside isolation rooms in our residential programs to continue to serve COVID positive clients. We pivoted many of our in-person services to a telehealth model, which had not been previously used by our behavioral health staff. As a result, in our Southern California programs we were able to serve 2141 clients with mental health care, 2671 with outpatient substance use disorder services, 394 clients received recovery bridge housing, and we were able to serve 3513 clients in residential substance use disorder treatment services.