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Effectiveness of Implementing Sustainable Evidence-Based Mental Health Practices in Low-Resource Settings to Achieve Equity in Outcomes for Traditionally Underserved Populations


Denise Juliano, M.S.W.
Division of Services and Intervention Research


The goal of this initiative is to encourage studies that develop and test the effectiveness of strategies for implementation and sustainable delivery of evidence-based mental health practices (EBPs) in settings where limited capital and human resources create barriers to care delivery, in order to improve mental health outcomes for underserved populations and reduce or eliminate health disparities. The initiative would encourage innovative approaches to remediate barriers to provision, receipt, and/or benefit from EBPs and is intended to generate new information about factors integral to achieving equity in mental health outcomes, with due consideration for the needs of individuals across the life span.


Ample evidence suggests that EBPs are often not delivered in low-resource settings and in settings where clients are predominantly from traditionally underserved populations. These populations are also more likely to have worse mental health outcomes, and more inpatient hospitalizations and emergency room use for psychiatric crises. Recent research also suggests that disparities in receipt of mental health treatment and services may be increasing. Current findings from implementation science along with deployment-focused approaches to intervention development and testing may inform new delivery strategies that can better account for setting challenges.   

Within low-resource settings, implementation strategies might address EBP delivery barriers at provider-, clinic-, organizational-, within- or cross-systems levels- factors which may also be integral to achieving sustainment of delivery. Supported studies will assess not just whether implementation can be accomplished but whether it results in improvement in mental health and related functional outcomes with significant impact to achieve mental health equity. 

This initiative expands on the Centers for Medicaid and Medicare Services (CMS) definition of underserved populations as those who face barriers based on race/ethnicity, language, and disability, to include persons from sexual and gender minority groups; those in rural or frontier areas; those facing economic barriers to health care; individuals who are homeless or unstably housed; and persons with criminal justice involvement 

The ultimate goal of this research is to establish the effectiveness of new, scalable strategies for broadly and equitably providing and sustaining delivery of EBPs in order to reduce disparities in outcomes.