Statement on Health Equity & Addressing Underserved Youth
The Virginia Mental Health Access Program (VMAP) is a pediatric-focused training, consultation and referral program designed to increase capacity for child and adolescent primary care providers (PCPs) to treat and respond to mental health conditions such as anxiety, depression and attention-deficit hyperactivity disorder. One of VMAP’s primary goals is to connect PCPs to child and adolescent psychiatrists so that youth in need across the commonwealth can receive and benefit from mental health services.
Virginia is a diverse state with coastal regions, mountains and bustling cities, all within close proximity to our nation’s capital. As diverse as it is in landscape, so too are Virginia’s citizens with respect to their culture, race/ethnicity and socioeconomic status. However, while diversity is one of the commonwealth's greatest strengths, its healthcare system fails to serve all communities equitably. Minority adults and youth, individuals of low socioeconomic status, and residents in certain geographic locations (e.g. rural) continue to face disparities in access to adequate care and subsequent health outcomes. On top of this, a lack of medical professionals to provide care has led to large underserved areas within the state.
The Department of Health and Human Services (HHS) classifies populations as underserved if they receive fewer health care services, encounter barriers to accessing primary care health care services (economic, cultural, and/or linguistic), lack familiarity with the health care delivery system and/or face a shortage of readily available providers. Research shows that youth who grow up in underserved areas have poorer health outcomes and are more likely to remain underserved in adulthood. 14% of Virginia children under age 18 live in poverty. In Virginia’s Appalachian region, which faces severe economic challenges in addition to barriers to accessing health care, 24% of youth (0-18) and 42% of young adults (18-24) live in poverty. Furthermore, 77% of Virginia localities are mental health professional shortage areas and only two counties in the state have a sufficient number of child psychiatrists.
Since its beginning, VMAP has been committed to supporting PCPs and their patients through its psychiatric consultation services and behavioral health trainings. 75% of PCPs who have participated in VMAP’s Project Extension for Community Healthcare Outcomes (ECHO) training provided services to rural populations. To date, almost a quarter of youth (24%) who received mental health support via VMAP were enrolled in Medicaid. As VMAP expands across the state, we anticipate the need for its mental health resources to grow, especially for underserved communities.
VMAP has made great strides in increasing mental health care access, but more needs to be done. As a result, VMAP is committed to developing and implementing strategies that: 1) provide access to mental health services for youth in underserved areas; 2) provide resources and learning opportunities for primary care providers who serve these youth; and 3) develop program goals and objectives that are inclusive to the challenges faced by underserved youth. Specifically, we aim to do the following:
Identify and form partnerships with providers from underserved areas (and those who treat youth from underserved populations) with respect to insurance status, geographic location and socioeconomic status. We will do this through targeted VMAP marketing/outreach, collaborating with communities to understand specific needs, and working with providers to bring VMAP services to these communities.
Continue to provide training to PCPs with a concerted focus on identifying and engaging those who work in underserved communities. We will encourage feedback from PCPs on ways we can integrate learning opportunities into our training curriculum that address the mental health needs of underserved youth.
Provide telehealth services for underserved youth in coordination with VMAP behavioral health providers.
Integrate Culturally and Linguistically Appropriate Service (CLAS) standards in our work as we strive to decrease mental health disparities among underserved youth. CLAS standards will guide how we develop our governance structure, leadership and workforce; provide communication and language assistance; engage with community and stakeholders; and hold ourselves accountable for working to advance health equity.
Use program and health equity data to make informed decisions on how to expand VMAP across the commonwealth to ensure underserved youth have access to this valuable service.
Regularly examine the data we collect to monitor and evaluate our progress in ensuring equitable service for underserved youth. Conversations will take an honest look at our current approach, identify where current gaps exist, and develop strategies to address these areas. Strategies will be implemented and monitored to assess how well we are meeting our goals.
We recognize that in striving to meet our goal of increasing access to mental health care for all Virginia children, VMAP is especially critical to underserved communities who are in even greater need. As a result, VMAP is committed to reducing barriers to care and improving access for our state’s underserved youth. We realize that this will be a concerted effort that will take time, but as the great Nelson Mandela once said, “It is in your hands to create a better world for all who live in it.”
 Serving Vulnerable and Underserved Populations. Accessed July 29, 2020. https://marketplace.cms.gov/technical-assistance-resources/training-materials/vulnerable-and-underserved-populations.pdf
 Skopec L and Aarons J. Urban Institute. A Profile of Virginia’s Uninsured in 2018. Accessed July 30, 2020.
 American Academy of Child and Adolescent Psychiatrists. Workforce Maps By State. 2020. Accessed June 11, 2020 2020. https://www.aacap.org/aacap/Advocacy/Federal_and_State_Initiatives/Workforce_Maps/Home.aspx
 VMAP Program Data Derived from either REDCap and/or Performance Reports.
 U.S. Department of Health and Human Services. National CLAS Standards. Accessed July 1, 2020 https://thinkculturalhealth.hhs.gov/clas/standards