Integral Care remains committed to eradicating institutional racism and structural inequities within our organization. At the recommendation of our Board/Staff Ad Hoc Committee on Racial Equity, Integral Care launched our interim Racial Equity Plan in May 2021. The interim plan was built from crucial conversations with our staff and collaboration with a national expert in the field of racial equity and cultural competency. It was also developed with the intent that racial equity would be incorporated into our strategic planning going forward. We updated our last Strategic Plan to include racial equity efforts and fully integrated it into the process of creating our new FY23-25 Strategic Plan.

In June 2022, Smith Research & Consulting LLC completed a Racial Equity Assessment of Integral Care. The consultants examined racial equity across Integral Care’s services, policies and procedures, environment, workforce, and communications. Client access to services, including preferred language, and overall public perception of the agency were also examined.

The Racial Equity Assessment identified opportunities for growth and improvement throughout the agency and the need for more equitable service provision for clients of color. In the spirit of transparency, here are its key recommendations as well as some of our current efforts in these areas.

1. Conduct an in-depth study of racial inequities across racial groups in intake, diagnosis, Level of Care classification, and engagement in services and programs to understand barriers and develop strategies for remediation.

Integral Care uses data to identify, monitor and respond to racial disparities in the care we provide.

• We partnered with Dell Medical School to address the overdiagnosis of schizophrenia in in Black/African American males. By adding differential diagnosis questions to our EHR, clinicians are prompted to consider other diagnoses before making a schizophrenia diagnosis. Disparate diagnoses trend downward.
• Throughout FY21, we launched initiatives to reduce the overdiagnosis of oppositional defiant disorder (ODD) and conduct disorder (CD) among BIPOC children and youth, including increased cultural competency focused trainings, education and advocacy, and a differential diagnosis process specifically for these diagnoses. We noticed a sizeable decrease in the disparity gap and in the number of ODD and CD diagnoses assigned to BIPOC youth.
• Our Language Access reporting tracks the percentage of clients who received services in their indicated preferred language.
• We continue to meet national standards for Culturally and Linguistically Appropriate Services (CLAS).

2. Develop and adopt a model of authentic community engagement with Integral Care clients, community partners, and the Austin-Travis County mental health ecosystem stakeholders.

• In collaboration with a dedicated planning committee, we have hosted the Central Texas African American Family Support Conference (CTAAFSC) for over 20 years. This conference brings together professionals, people with lived experience, family members and community members to have honest and frank conversations about the impact of mental illness, intellectual and developmental disabilities, and substance use disorder on the Black/African American community and provides resources and offers support to attendees. This work continues year-round by sharing resources and connections through various conference committees, monthly forums focused on Black mental health, and the CTAAFSC Facebook group.
• We are strengthening our relationships with organizations that support underserved communities – having a dialogue on how to best serve the mental health needs. We’re currently working with Asian American Pacific Islander and Muslim organizations to develop mental health presentations with a cultural lens that help ensure underserved communities have access to mental health tools. We will expand this work across the community and bring back important information to staff that could impact client care.

3. Develop long-term strategies for recruiting a more diverse workforce.

One goal of our new FY23-25 Strategic Plan is “Cultivate Workforce.” To us, this means supporting team members’ well-being, providing opportunities for growth and recruiting a team that reflects the people we support. Strategies to achieve this goal include:

• Innovative approaches to recruit and retain new team members and providers that reflect the people we support
• Opportunities for growth, advancement, well-being, and development
• A culture based on our values
• Sustainable funding sources to support our workforce

4. Consider reporting client outcomes disaggregated by race and ethnicity to the community.

• We are in the process of disaggregating client outcomes by race categories and ethnic origin based on the federal definition of Ethnicity and Race and plan to share the results with the community. This will help identify impact on service provision from diagnostic overshadowing to how long clients wait for care.
• In FY20, we created a Health Disparities Report Card that provides leadership an at-a-glance look at potential inequities and gaps in care across our services. It is designed to show us where the biggest disparity gaps are, inform where we allocate resources and track our progress.

5. Review client intake and information gathering processes to reduce time spent repeating past traumas.

• To create a more trauma-sensitive experience for our clients, Intake Optimization has been a focus of our System of Care over the last year. In the past, clients have had to retell their story to multiple providers. Our intake assessments have been streamlined so that clients only share their story once, creating a better client experience and enhancing continuity of care across our programs. Since implementation, client feedback has been overwhelmingly positive.

6. Build cultural competence goals and design regular strategies to achieve those goals.

• All staff are trained on the impact of institutional racism and on how to recognize their own unintended biases. Education is key to identifying our biases, staying informed about culturally relevant care, and ultimately providing welcoming services for those we serve.
• We are improving our trainings to provide more opportunity for staff to interact with people who come from a different background and plan to launch an updated Care for Culture training, which increases awareness of each person’s cultural identity and its impact on communication, health beliefs and practices, and service delivery, in Spring 2023. We are also creating a training for unbiased interviewing.

I am proud of the steps Integral Care has taken toward building racial equity agency-wide. It is critical that we deliver equitable, person-centered, culturally competent care to ensure that BIPOC communities have access to mental health services responsive to their needs. The creation of our interim Racial Equity Plan, results from our Racial Equity Assessment and development of our new FY23-25 Strategic Plan all lead us toward meeting our vision of Healthy Living for Everyone.

David Evans
Chief Executive Officer