In July 2023 the KidsPeace organization, with the guidance of the Joint Commission, embarked on a comprehensive effort to advance the quality and safety of care through improving the health care equity for individuals served by our Joint Commission-accredited programs.
In explaining why they were enhancing the standards to include Health Care Equity as a National Patient Safety Goal (NPSG), the Joint Commission noted that almost twenty years ago, the Institute of Medicine (now the National Academy of Medicine) published “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.” That report reviewed the voluminous literature on differences in quality of care and use of services by racial and ethnic minorities and concluded, “A large body of published research reveals that racial and ethnic minorities experience a lower quality of health services and are less likely to receive even routine medical procedures than are white Americans.”2
When looking at more specific data related to health care equity, we can look at the July 2023 Life Sciences Intelligence article by Veronica Salib:
“Data from 2021 revealed that 52% of non-Hispanic White adults with mental illness receive care. Comparatively, 39% of Black or African American, 25% of Asian, and 36% of Hispanic or Latino Adults were treated for mental health conditions, pointing to significant mental health disparities.”1
In addition, she notes:
“Beyond patients’ personal experiences and perspectives, data has shown that children from racial or ethnic minority groups are statistically less likely to receive mental health services when struggling with a mental health condition. More specifically, while 31% of White children with a mental health disorder receive care, only 13% of children from minority populations receive care…
Another barrier to minority mental health equity is the stigma associated with mental illness across minority communities.”1
KidsPeace’s experience has shown, that along with stigma, barriers including lack of transportation, food insecurity and housing can be problematic and lead to the potential for less participation in care.
KidsPeace’s Approach
KidsPeace identified health-related social needs (HRSN) of individuals served within their Joint Commission-accredited programs in Pennsylvania, Maine, Georgia, and North Carolina. The HRSNs identified for assessment are access to transportation, food insecurity, and housing insecurity.
The federal Centers for Medicare & Medicaid Services (CMS) identifies HRSNs as “individual-level, adverse social conditions that can negatively impact a person’s health or health care. Examples include food insecurity, housing instability, and lack of access to transportation. Screening for HRSNs as part of routine clinical care allows health care providers to efficiently identify and potentially help address HRSNs among patients they serve.” 3
According to CMS, there are important distinctions to be made between HRSNs and social determinants of health: “HRSNs are distinguished from social determinants of health—the structural and contextual factors that shape everyone’s lives for better or worse—and can be identified by the health care system and addressed in partnership with community resources. Identifying and addressing HRSNs can have many benefits, including improvements to individuals’ health and reduced health care spending.” 3
KidsPeace agrees with the Joint Commission that to truly complete individualized best practice care, the whole person must be addressed. Without knowing or attempting to understand the barriers that individuals face in their daily lives, even the best-intentioned care and recommendations could lead to significant problems in the long run. A plan that looks to include a very tight diet and exercise component, for example, may be unsafe or unattainable if individuals have food insecurity. In addition, someone that may benefit from in-person family therapy may suffer due to transportation security.
Looking through the core assessments that most Joint Commission programs utilize, we were able to identify an assessment and added the identified questions pertaining to the identified health-related social needs within KidsPeace programs.
The questions below will be used to assess the identified HRSNs among clients of KidsPeace.
- Does the client/client’s family experience any difficulties with transportation to services (office visits, appointments, etc)?
Yes/No/Unknown
- Does the client/client’s family experience any difficulties with access to food?
Yes/No/Unknown
- Does the client’s family experience any difficulty maintaining stable housing?
Yes/No/Unknown
When an individual within a KidsPeace program answers “yes” to any of these questions, they are identified as having a potential health-related social barrier. When a barrier is identified, programs will provide support and information about community resources and support services. Documentation of the assessment, identified need(s), and support resource(s) to the individual are kept within KidsPeace’s electronic health record (EHR).
Each program within the KidsPeace organization developed a programmatic action plan detailing this process to ensure compliance with NPSG elements of performance.
The Quality Assurance leadership will review action plans and tools associated for areas of deficiency and will ensure retraining for employees on identified areas. Retraining documentation and historical versions of the NPSG healthcare equity action plan will be kept with the managing leadership of Corporate Quality Assurance.
Program and Corporate level reports can be pulled from the EHR by Quality Assurance leadership; data from these reports is used in the KidsPeace Annual Reports, for programmatic tracer audits, and at the request of the Joint Commission due to incident or accreditation survey.
KidsPeace identifies and reports out annually the following sociodemographic characteristics: age, gender, race/ethnicity. This data is collected using the intake forms located on the EHR. This data is analyzed at a minimum annually by the Corporate Quality Assurance Department, using key performance indicator (KPI) dashboards.
All demographics and health care equity data are analyzed by Corporate Quality Assurance; specifically, we are stratifying HRSNs using the sociodemographic characteristics of the individuals served by the organization. We will do this by the sociodemographic characteristics of age, gender, and race/ethnicity. That way we fall in line with the Simmons and John Hopkins research, giving us a national comparison for our populations.
The outcome of the data analysis is reported to key stakeholders in the KidsPeace Annual Report. Stakeholders include organizational leadership on all levels, licensed practitioners, staff, and the communities in which KidsPeace serves. The report is created and disseminated via the Communications and Public Relations Department, and is available to the public online at www.kidspeace.org.
With this new process, KidsPeace looks to enhance our strategies to ensure we are providing the highest level of Hope, Help and Healing to our clients, families, and those that love them.
As a result of the work to address these barriers within the populations we support, we also saw the importance of applying these insights to the well-being and care of our staff. This is because the effect of someone’s HRSN do not stop at access to treatment, but spill over into other aspects of life, such as safety and belonging at work.
Because of this we have created a Diversity, Equity, Inclusion and Belonging (DEIB) committee to address the needs of our staff. KidsPeace DEIB Committee’s mission is to effect change, where needed, to promote a KidsPeace culture that values diversity, affirms each person’s difference, and prioritizes an inclusive working environment, which will help the overall safety and security of everyone at KidsPeace.
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Kaitlin Stefanski attended Moravian University and has an educational background in psychology and public health. She is currently the Corporate Quality Assurance Coordinator for KidsPeace. She holds a certification in integrated employment through the Association of Community Rehabilitation Educators (ACRE) as well as certificates in housing and community participation through the Office of Developmental Programs (ODP). She previously served as a Certified Investigator through the Temple University/ODP program for multiple years, providing quality investigations for incidents of abuse, neglect and other significant events that occur in the lives of individuals with developmental disabilities.
Dominick DiSalvo is the Corporate Director of Quality and Clinical Services at KidsPeace. He is a Licensed Professional Counselor, and holds a master’s degree in clinical counseling from LaSalle University. He was among the first clinical professionals in Pennsylvania to become nationally certified as a Trauma Focused Cognitive Behavior Therapy (TF-CBT) therapist, and became the first in the nation to be re-certified in 2018. Dominick is also certified as a Certified Professional in Healthcare Quality (CPHQ), and has served as an Adjunct Professor of Psychology at Lehigh Carbon Community College (PA). At KidsPeace, Dominick has developed clinical programming with the emphasis on Trauma-Informed, Family/Youth Led, Data-Driven, and Evidence-Based interventions helping to ensure holistic care of families.
References
1 Veronica Salib “Addressing Disparities in Minority Mental Healthcare: Risk and Access”. July 2023 Life Sciences Intelligence. Available at https://lifesciencesintelligence.com/features/addressing-disparities-in-minority-mental-healthcare-risk-and-access#:~:text=More%20specifically%2C%20while%2031%25%20of,mental%20illness%20across%20minority%20communities
2 Joint Commission. “R3 Report: Requirement, Rationale, Reference.” Issue 38, December 20, 2022. Available at https://www.jointcommission.org/-/media/tjc/documents/standards/r3-reports/r3-report_npsg_16.pdf
3 CMS and Accountable Health Communities (ACH). “A Guide to Using the Accountable
Health Communities Health-Related Social Needs Screening Tool.” Promising Practices and Key Insights, Updated 2022. Available at https://www.cms.gov/priorities/innovation/media/document/ahcm-screeningtool-companion
