Redlining across Systems: The Experiences of Black Behavioral Healthcare Business Owners and Strategies to Support Them

Background and Purpose: Access to behavioral healthcare providers, particularly racially and ethnically diverse clinicians, is a critical unmet need in the US (CITE). Further, Black-owned behavioral healthcare businesses are uniquely positioned to increase access to services for diverse populations, offering a plausible solution to addressing health disparities. Increasing research indicates improved outcomes and efficacy when providers match the racial identity of their patients (Cooper et al., 2003; Greenwood et al., 2019; Synder et al., 2023). Black behavioral healthcare business owners are less studied. The aim of this research study is twofold: to examine specific business-related needs of Black behavioral healthcare entrepreneurs from a systems-level perspective and identify ways to support them with sustaining successful businesses.

Methods: Using Critical Systems Theory (Bertalanffy (1968), this qualitative research study engaged Black behavioral healthcare business owners (N=7) in focus groups to explore issues of sustainability and needed support among minority behavioral healthcare business owners in a southeastern U.S. urban city. Qualitative data was analyzed causing interpretive grounded theory methods (Charmez, 2014). Using this methodology, we utilized open and axial coding (Lofland & Lofland, 1995), compared independent analysis, sought group consensus, and mapped our final themes.

Results: Our findings underscore the resilience of Black behavioral healthcare business owners, despite facing significant reported challenges of engaging in trial and error in business due to a lack of support, experiencing “business redlining” across various systems, developing a village of multi-sector supports, and addressing ongoing bias and inequities. The study revealed the significance of building trust amongst multiple systems (i.e., hospitals, outpatient clinics, healthcare practices). Additionally, it exposed the need to offer culturally inclusive business development and training. Lastly, results reiterated that sector-specific business knowledge, often missing from clinical graduate education programs (i.e., social work, counseling, psychology; Blinded, 2022), was crucial for business start-up and sustainability.

Conclusion and Implications: This research contributes to the racial equity literature and provides a valuable depiction of the experiences and needs of Black behavioral healthcare business owners, a less studied population. Our findings underscore the urgent need for support for Black-owned behavioral healthcare businesses to increase access to care for underserved populations and strengthen social impact. The practical implications include systems-level strategies to support the sustainability of Black-owned behavioral healthcare businesses, including providing culturally inclusive business development and start-up content in the graduate social work curriculum (Blinded, 2022), thus increasing overall social impact.

Interactions within and across systems to support their businesses have been substandard, uncoordinated, and not prioritized. The strategies developed will aid in helping to free them from oppressive system interactions and provide them with advocacy in these systems. Ultimately, developing and providing a more supportive and coordinated system will liberate them from unnecessary labor, increase access to more resources, and relieve their burden of self-reliance. If implemented, these strategies will support their overall success, allowing them to focus more on meeting the community's behavioral health needs while setting their businesses for success.