An Efficacy Study of a Culturally Responsive and Anti-Racist Behavioral Healthcare Pedagogical Model for Bipoc and Lgbtqia+ Youth

Background & Purpose

Disparities in behavioral and mental health outcomes among Black, Indigenous, and People of Color (BIPOC) raise persistent concerns in the US. For LGBTQIA+ youth, levels of unmet need are even higher, with 54% of those who wanted counseling not receiving it; for Black, Hispanic/Latino, and Asian or Pacific Islander youth who are LGBTQIA+, rates exceeded 60%. The significant disparities in health and mental health outcomes and quality of care among marginalized groups are partly due to a lack of cultural competency among providers. Research suggests that providers need additional training on how to provide culturally responsive and anti-racist care for BIPOC and LGBTQIA+ patients. Despite so, there is a lack of evidence-based training or pedagogical model for this purpose.

Funded by Health Resources & Services Administration (HRSA), this study examines the outcomes of a pedagogical model that aims to prepare graduate level students to specialize in providing anti-racist, culturally responsive and respectful behavioral health services for BIPOC and LGBTQIA+ youths and their families. This one-year pedagogical model includes: (a) practicum at a behavioral or mental health setting; (b) ongoing anti-racist and anti-oppressive coaching/mentoring; (c) interprofessional seminars; (d) training modules on topics related to BIPOC and LGBTQIA+ youth and families, trauma-informed care, and healing justice; and (e) a course on child and adolescent mental health.

Methods

This efficacy study adopts a quasi-experimental design to examine outcomes of the program students (54) versus a comparison group of non-program students from the same cohort year and practice focus area (68). Assessment of clinical knowledge and skills (Multicultural Counseling Self-Efficacy Scale - MCSE), cultural responsiveness (Anti-Racism Behavioral Inventory - ARBI, Self-Reflection & Insight Scale - SRIS & Intercultural Effectiveness Scale - IES) occurred pre-program and at graduation. In addition, thematic analyses were used to analyze data from focus groups with students at the end of the program to explore their lived experience of their participation as well as how the program helped them in their learning process.

Results

Program students made gains from baseline to graduation in anti-racist behaviors (t=2.047, p=.053), and significant gains in self-reflection (t=2.706, p=.013), self-efficacy in providing culturally responsive services to BIPOC and LGBTQIA+ populations (Multicultural Counseling Self-Efficacy Scale, t=6.658, p<.001; Intercultural Effectiveness Scale, t=4.014, p<.001), and interprofessional education (t=5.423, p<.001).

Significant gains between the program students and comparison group were found in Intercultural Effectiveness Scale (t=2.575, p=.013); Multicultural Counseling Self-Efficacy Scale (t=4.681, p<.001); Self-Reflection & Insight Scale (t=2.080, p=.043); and Student Perceptions of Interprofessional Clinical Education (t=2.437, p=.019).

Thematic analysis on focus group data showed that students valued the content they learned and the interprofessional learning experiences they participated in, noting the personal and professional benefits gained from this program.

Conclusions & Implications

Intentional pedagogical preparation of the behavioral health workforce to provide anti-racist, culturally responsive, and respectful services for BIPOC and LGBTQIA+ youths and their families should be an integral part of coordinated educational and professional efforts to facilitate equitable behavioral healthcare to diverse populations.