Enhancing Mental Healthcare – The Role of Cultural Competence and Evidence-Based Screening at Palms Medical Group

Enhancing Mental Healthcare – The Role of Cultural Competence and Evidence-Based Screening at Palms Medical Group

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Responding to Sita

Hello Sita,

This is an excellent post. You have responded well to the discussion questions. Indeed, your clinical practice at Palms Medical Group provides you with an opportunity to serve a diverse population of both age and race/ethnicity. In such a setting, one must develop intercultural competence and humility. Being culturally competent means possessing the right skills in terms of behavior, cognition, attitude, and language, while having cultural humility means reflecting on the biases of one’s cultural views and how they affect how one relates with others. Both support effective communication with diverse patient populations. Cultural competence and cultural humility are essential in mental healthcare as they help develop collaborative mutual partnerships, leading to the delivery of patient-centered care with positive client and provider experiences and outcomes (Stubbe, 2020).

Further, you have noted that you utilize the PHQ-9 and GAD-7 as your preferred screening tools for mental health in your facility. I believe this is the reason the quality of mental health care delivered within the facility is considered high quality. The delivery of quality care starts with the use of evidence-based screening techniques. Accordingly, both the PHQ-9 and GAD-7 screening tools have been thoroughly tested and validated and found to be effective in the diagnosis of various mental health issues such as posttraumatic stress disorder, depression, and generalized anxiety (Ahmadi et al., 2023). As you have noted, early screening allows for early treatment. However, screening opportunities may be missed, especially among vulnerable populations. Your recommendations, such as partnering with other institutions such as the local University of Florida, can help in providing free mental health services and even educating the population on mental health care and available services and resources for the community.

 References

Ahmadi, A., Galusha, J. M., Ponder, W. N., Carbajal, J., Schuman, D. L., Whitworth, J., & Yockey, R. A. (2023). Validation of the PCL-5, PHQ-9, and GAD-7 in a sample of first responders. Journal of Occupational and Environmental Medicine, 65(6), 467–476. https://doi.org/10.1097/JOM.0000000000002823

Stubbe, D. E. (2020). Practicing cultural competence and cultural humility in the care of diverse patients. Focus, 18(1), 49–51. https://doi.org/10.1176/APPI.FOCUS.20190041

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The Role of Cultural Competence and Evidence-Based Screening at Palms Medical Group

Hello class & Dr. Andrews,

Identify your clinical practicum setting (primary care office, urgent care, etc.) & a population that you typically see (i.e., adolescents, women, older adults).

My clinical practice setting is a primary care clinic called Palms Medical Group, and the population I usually see are patients less than 1 year old to greater than age 85 years old. A majority of the patients are older adults. Most of the patients are either Caucasian, African American, or Hispanic.

Discuss mental health screening tools used at your clinical site. If no screening tools are currently used, which ones would you recommend?

Mental health screening tools used at my clinical site are the Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 (GAD-7). PHQ-9 is a questionnaire that includes 9 questions used to screen patients for depression. The scores for the PHQ-9 are from 0 to 27 with a score 10 and greater correlating to moderate to severe depression (Levis et al., 2020). This tool helps allow the NP at the clinic to assess which patients are suffering from depression and gives them the opportunity to discuss pharmacological and non-pharmacological options with the patients. GAD-7 is a screening tool used to assess patients for generalized anxiety disorder. The scores for GAD-7 are from 0 to 21 with a score of 10 or more correlating to moderate to severe anxiety. With older adults, poor physical health, low socioeconomic class, and loneliness were some reasons for depression and anxiety in this population (Sams et al., 2021). The GAD-7 allows the NP to screen older adults with anxiety, address their concerns, and provide them with options for treatment.

Describe the quality of the mental health care you have observed. Discuss disparities or biases, if any, in the care provided to different members of the population.

I think the quality of mental health care I observe at the clinic is excellent. All patients aged 12 and up are screened using the PHQ-9 and GAD-7 at Palms Medical Group. These screening tools are located in the sign-in form at the clinic. Patients who speak different languages are also able to read the PHQ-9 and GAD-7 questionnaires written in many different languages to answer appropriately. Based on the results of these screening tools, the NPs are able to intervene and provide the patients with the appropriate resources and medications to get the patients the mental health care they need. Palms Medical Group also has a 24/7 translator available in order to translate the plan of care with patients who speak different languages. Also, for patients who do not have health insurance, Palms Medical Group has their own pharmacy which offers patients without insurance anxiety and depression medications at an affordable price. I think one disparity would be access to medical pamphlets appropriate to the patient’s health literacy. However, the NPs do a good job at explaining mental health options and medications in ways the patients can understand their mechanism of action, side effects, the time span to when the medication should start working, and how to wean themselves off of the medications.

Screening opportunities are often missed in vulnerable populations and those with limited access to care. Describe at least TWO changes you recommend in your practice setting and community to increase the frequency of mental health screenings within vulnerable populations.

Screening, detecting, and early treatment is important for patients with mental health disorders to help increase quality of life for patients. Unfortunately many patients with mental health issues are low-income, disadvantaged, or homeless. These populations may not have health issurance, adequate transportation, or they may be embarrassed to speak about their mental illness due to social stigmas. Making sure these vulnerable populations receive appropriate mental health care can be a challenge for NPs. One recommendation for my community would be to partner with the University of Florida to provide this rural population with free mental health education and services. Increasing the public health knowledge on affordable mental health care options available to the individual can help improve the lives of many in the community (Mongelli et al., 2020). Another recommendation would be to provide patients information about the Substance Abuse and Mental Health Services Administration (SAMHSA) which has a national helpline, social support services, and homeless programs and resources. This can help vulnerable populations receive the mental healthcare they need (Egede et al., 2020).

References

Egede, L. E., Ruggiero, K. J., & Frueh, B. C. (2020). Ensuring mental health access for vulnerable populations in COVID era. Journal of Psychiatric Research, 129, 147. doi: 10.1016/j.jpsychires.2020.07.011

Levis, B., Sun, Y., He, C., Wu, Y., Krishnan, A., Bhandari, P. M., … & Thombs, B. D. (2020). Accuracy of the PHQ-2 alone and in combination with the PHQ-9 for screening to detect major depression: Systematic review and meta-analysis. Jama, 323(22), 2290-2300. doi:10.1001/jama.2020.6504

Mongelli, F., Georgakopoulos, P., & Pato, M. T. (2020). Challenges and opportunities to meet the mental health needs of underserved and disenfranchised populations in the United States. Focus, 18(1), 16-24. https://doi.org/10.1176/appi.focus.20190028

Sams, N., Fisher, D. M., Mata-Greve, F., Johnson, M., Pullmann, M. D., Raue, P. J., … & Areán, P. A. (2021). Understanding psychological distress and protective factors amongst older adults during the COVID-19 pandemic. The American Journal of Geriatric Psychiatry, 29(9), 881-894. https://doi.org/10.1016/j.jagp.2021.03.005