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The University of Maryland, Baltimore (UMB) will operate SAMHSA’s Center for Excellence on Behavioral Health Disparities Impacting the LGBTQ Community (CoE BHD LGBTQ) in partnership with Affirmative Research (AR) and Judge Baker Children’s Center, Harvard Medical School (JBCC). In collaboration with SAMHSA, the CoE BHD LGBTQ will provide training and technical assistance (TTA) to effectively implement change strategies within mental health (MH) and substance use (SU) disorder treatment systems to address disparities. The target audience for TTA is health care practitioners in clinical care settings as well as the broader public. Disparities research shows that LGBTQ people are at greater risk for MH diagnoses with increased likelihood to attempt and complete suicide, experience depression and anxiety, engage in substance misuse, and experience hospitalization for emotional reasons. Behavioral health (BH) disparities for the LGBTQ community have been connected to pervasive misperceptions held by the MH and SU workforce as well as a lack of culturally responsive BEBPs. Efforts to decrease and eliminate BH disparities for the LGBTQ population need to be grounded in an affirmative practice framework, strong implementation science, responsive TTA, development and implementations of culturally responsive BEBPs, and safe identification of sexual orientation and gender identity in data collection efforts. The CoE BHD LGBTQ will address these needs through a nimble and responsive TTA approach, grounded in implementation science and research on effective TTA provision, and designed to meet the interests, needs, and preparedness of practitioners. The CoE BHD LGBTQ will be structured to include subject matter experts (SMEs) from UMB, AR, JBCC, and an Expert Consultant Pool comprised of other researchers and implementers of best and evidence-based practices (BEBPs) in LGBTQ culturally responsive care at leading universities nationally, provider organizations, youth, young adults and their families, and adults with lived experience. Universal TTA will ensue broad-based dissemination aimed to increase awareness of BH disparities, Minority Stress, and effective strategies and BEBPs to address the MH and SU needs of the LGBTQ community. The CoE will disseminate resources through a monthly e-newsletter and maintain a website and searchable resource portal. Developed resources will include animated and video shorts, fact sheets, briefs, webinars, and online learning modules, as well as an annual environmental scan of latest research and BEBPs to support BH of LGBTQ people. Tailored TTA will include individualized supports through emailed rapid response, office hours, and virtual TTA. Intensive TTA will be individualized, in-depth TTA with training in BEBPs, expert consultation, and peer learning through Quality Learning Collaboratives utilizing the AFFIRM practice models. Across all partners and SMEs, the CoE BHD LGBTQ will have an extensive listserv reach and is projected to provide TTA to 3,000-6,000 practitioners per year for a total of up to 25,000-30,000 over 5 years. The CoE BHD LGBTQ will collaborate with other SAMHSA TTA providers.

Building on the expertise of Morehouse School of Medicine and our large and diverse community of AA stakeholders, scientists, and educators, The Center of Excellence (CoE) for Behavioral Health Disparities - African Americans will use innovative, evidence-based, culturally aligned systems-change, workforce development, technology transfer, and collaborative national partnerships to eliminate disparities and promote behavioral health and health equity for African-Americans. Our audience of focus includes the range of behavioral health (BH) leaders and practitioners, who often struggle to bridge cultural divides and make services more accessible, acceptable, and effective. We propose serving 3,000 practitioners a year, 15,000 people over 5 years. Strategies and interventions will include providing multi-modal training, technical assistance, education and resources to system leaders and practitioners, focusing on health equity through systems change, engagement and retention, eliminating bias, and creating welcoming and inclusive environments. Goal 1: Increase the capacity of BH systems to provide outreach, engage, retain, and effectively care for B/African-American (B/AA) people through: (1a) a multi-modal needs-assessment identifying challenges and opportunities; (1b) systems-change initiatives with our Black Stakeholders Engagement Council; (1c) development, delivery, and (1d) dissemination of a Systems Transformation Learning Community focusing on social determinants of health; (1e) Leadership Institute giving 100 participants knowledge and skills for addressing disparities; and (1f) access to 50-80 new tools, resources and modules on engagement and retention care for B/AA people per year. Goal 2: Improve dissemination of up-to-date information and culturally appropriate evidenced-based practices and approaches for B/AA people, through (2a) annotated listing of emerging best practices for B/AA people; (2b) a website section on EBP for B/AA people; (2c) an outline course addressing effects of historical trauma and everyday racism on BH; (2d) 45 webinars on practical application of EBPs; (2e) quarterly role-specific implementation affinity calls with practitioners; and (2f) a monthly e-newsletter. Goal 3: Increase workforce development opportunities focused on implicit bias, social determinants of health, structural racism, and other factors that impede high-quality care for B/AA people, through: (3a) a strategic report on infusing knowledge of B/AA BH considerations into academic and job training curricula; (3b) 5 learning communities on prescribing for B/AA patients; (3c) 10 interactive trainings and (3d) an online course on recognizing and addressing implicit bias; (3e) a 10 podcast series on stigma reduction and the impact of racism on health; (3f) annual outreach to higher education to promote career paths for potential B/AA BH practitioners; and (3h) guidelines for creating welcoming and inclusive service environments. Goal 4: Increase collaboration between CoE and SAMHSA TTA providers, to infuse culturally appropriate information on B/AA people in all SAMHSA-funded TTA Centers, through (4a) presentations, coordination calls, and collaborative projects that engage all SAMHSA TTA providers.

Led by the Rush Center for Excellence in Aging, the SAMHSA Engage, Educate, Empower for Equity: E4, The Rush Center of Excellence for Behavioral Health Disparities in Older Adults (E4 Center) will measurably advance workforce capacity expansion through innovative practitioner training, with a specific focus on community-based providers’ implementation of evidence-based practices and programs (EBPs) for vulnerable older adults who experience the greatest behavioral and physical health disparities. Specifically, the E4 Center will target healthcare workforce enhancement to reduce behavioral health disparities for older adults in four SAMHSA strategic priority areas: (1) depression and suicide; (2) substance use disorders; (3) serious mental illness; and (4) socioeconomically disadvantaged and underserved ethnic and racial minority groups, and where they uniquely intersect to negatively impact physical health and mortality of older adults. To achieve this aim, the E4 Center will provide education in the necessary unique knowledge, skills, and attitudes necessary for providing high quality behavioral health services for older adults. This training will leverage both existing online training developed by the E4 Center team as well as the development of new resources and provision of technical assistance (TA). It will also include the 4Ms (What Matters, Medication, Mentation, Mobility) of an Age-Friendly Health System, which are critical factors in eliminating behavioral health disparities for older adults. Based on that foundation, we will provide extensive training in EBPs addressing mental health and substance abuse prevention, treatment, and recovery support services for older adults by national experts, and the TA to assure effective and efficient implementation. Because care for older adults is complex and fragmented, we will build on our extensive experience in catalyzing integrated partnerships between health systems and community-based organizations (CBOs) to create age-friendly health communities through the development of a Partnership Toolkit along with TA and implementation support. We will also develop a Business Case Toolkit with TA for administrators to provide effective, efficient EBP for older adults in welcoming and inclusive environments. Central to eliminating behavioral health disparities in older adults is patient and family caregiver engagement, for which the E4 Center will create, refine, and disseminate older adult engagement and educational resources to health care systems, clinics and CBOs. E4 Center activities will focus on scaling and spreading culturally tailored EBPs to the broad environment of care, including not only licensed mental health providers but also CBOs, direct care workers, and the aging network, in highly varied modalities and lengths to meet learner preferences. Across the grant period, we anticipate reaching nearly 3,000 learners each year, for a total of 15,000 in five years. The E4 Center will have broad and lasting impact on the care of our most vulnerable older adults with mental health and substance use disorders.