Limited Access to Mental and Psychiatric Health Services in Underserved Communities Essay

Limited Access to Mental and Psychiatric Health Services in Underserved Communities Essay

Communities with ethnic and racial disparities, low socioeconomic status, and isolated geographically often face barriers to accessing mental and psychiatric services. In clinical practice, healthcare workers have ensured that these communities are engaged and provided adequate mental health services. They have served as educators, providers of comprehensive services, and advocates of these communities. There is a collaboration between different healthcare workers in developing culturally sensitive interventions based in the communities to promote mental health in these individuals. In the future, nurses can rely on technology such as telehealth to help reduce the geographical gaps in access to high-quality mental health services. Suppose the access to mental health services for underserved communities is addressed. In that case, the overall mental wellness of these individuals will improve, and there will be equity in the access to services by all, regardless of geographical location or socioeconomic status.

General Problem

The general problem is that there are people still unable to access mental health services despite the increased awareness raised by healthcare workers. The situation necessitates that the nursing practice focuses on the advocacy and engagement of patients and communities unable to access mental and psychiatric health services (Kates et al., 2019). Healthcare workers must build trust and good therapeutic relationships with patients to provide culturally sensitive services. They also need to deeply understand these individuals’ challenges and tailor the interventions accordingly to meet their unique needs (Purtle et al., 2020). If the community members are engaged, the nurses can identify their challenges and increase awareness about mental health, helping to promote early prevention and diagnosis of mental health issues (Purtle et al., 2020). This approach can help to empower the communities to take charge of their health.

Communities and patients that do not have access to mental and psychiatric services often delay being diagnosed, receive inadequate treatment for their conditions, and do not have access to support for their health conditions. They are likely to experience severe symptoms of the illnesses, prolonged hospitalizations, and a reduction in overall well-being (Carbonell et al., 2020). Through timely, appropriate interventions, their health can be improved. The overall quality of life and a reduction in the relapse of mental health conditions can be achieved through coordination of care and patient education.

When individuals cannot access mental and psychiatric services, there is a rise in healthcare disparities, which can later burden healthcare organizations. When the conditions are not prevented and diagnosed early, individuals will seek healthcare services in the emergency departments or present to the other hospital departments with severe acute symptoms of the disease (Kates et al., 2019). The latter increases the healthcare workers’ workload, increases healthcare costs, and challenges the institution in providing high-quality services to the patients (Kates et al., 2019). Addressing this problem can help reduce unnecessary hospitalizations and decrease costs associated with care.

The Problem of Interest

The specific problem is limited access to and underutilization of mental and psychiatric health services in underserved communities. This problem has perpetuated disparities the communities face in access to healthcare services. The communities are unable to access holistic and equitable services. The current nursing practice focuses on providing individuals with care in traditional healthcare settings like hospitals and clinics. Even though most individuals can access services from these settings, those living in geographically isolated areas may fail to benefit from these services. Some barriers that increase the inaccessibility to healthcare services include stigmatization surrounding mental health services, lack of means of transportation and financial constraints these individuals face (Coombs et al., 2021). A culturally sensitive and comprehensive approach to address this problem is also lacking.

The healthcare workers have not understood the unique economic, social, and cultural challenges facing underserved communities, which is essential to tailoring interventions to meet their healthcare needs. The current allocation of resources to the healthcare systems does not help bridge the gap in access to healthcare services. The current practice has overlooked community-based preventive approaches to mental health conditions. People have to rely on emergency departments to manage their conditions and when seeking follow-up services, which places a burden on the healthcare system and impedes the provision of high-quality services.

Identification of the Problem of Interest

A needs assessment, objective analysis of data, and evaluation of different outcomes relating to the quality, allocation of resources, and satisfaction of the patients were carried out. A needs assessment is essential to understand the needs of the individuals in the underserved communities. Quantitative and qualitative data is gathered from different healthcare providers, community members, and relevant organizations in the communities. Some barriers to access to healthcare services identified include lack of transportation, financial constraints, geographical isolation of the communities, and cultural stigmatization. Health utilization patterns, epidemiological reports, and data on health disparities were utilized in objective data analysis to provide a quantitative image of the disparities in access to mental health services. There was an apparent disproportionate representation of the communities regarding the high frequency of emergency department visits for individuals with mental health issues, delayed diagnoses, and limited follow-up care.

Incident reports and staff survey analysis were used to assess the impact of limited access to mental health services on the satisfaction and safety of the patients. There were higher frequencies of adverse events, reduced morale of the healthcare workers, and high dissatisfaction among the patients in the underserved communities. The current practice and allocation of resources were assessed to ascertain if it is evidence-based and if the resources are utilized effectively. Literature was reviewed to provide more information on addressing the problem. There is a need for culturally sensitive services, community-based interventions, and telehealth to enhance community access to healthcare services (Cleary et al., 2019). Financial analysis to assess the impact of the limited access to services indicated that potential financial savings could be achieved if the access to mental health services in underserved communities is increased.

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Parameters of the Problem

The parameters of the limited access to mental health services in underserved communities entail the population impacted and the healthcare system. Healthcare workers are affected as they try to ensure that they provide patients with holistic and equitable care to all individuals. They have to ensure that they use the limited resources efficiently, address the issues of stigmatization and develop strategies that increase the engagement of the affected communities (Cleary et al., 2019). Patients in underserved communities directly face the effects of limited access to mental health services. They face a delay in diagnosing their conditions, difficulty getting support in managing their condition, and limited treatment options (Kassam et al., 2021). They are likely to face severe symptoms, a reduction in overall well-being, and an increase in readmission rates.

The support systems and families of the patients may face burdens in ensuring that their loved needs get the essential care they need; they may be drained emotionally and financially while doing this (Carbonell et al., 2020). Healthcare institutions are forced to deal with the workforce shortage, limited allocation of resources, and the development of essential interventions to address the disparities in accessing healthcare services. The financial constraints make it challenging for these institutions to provide high-quality, comprehensive care to the communities.

Conclusion and Transition

Limited access to mental and psychiatric health services in underserved communities negatively impacts the safety of the patients. A delay in access to health services can lead to severe symptoms of the condition, increase the risk of self-harm and make the patients vulnerable to crises. If the individuals in these communities do not receive timely interventions, they will likely face poor mental health outcomes and develop adverse events. The quality of care provided to these communities is likely to be affected. Lack of culturally sensitive approaches, inadequate follow-up care, and insufficient treatment options contribute to poor health outcomes (Cleary et al., 2019).

Patients with mental health conditions suffer for an extended time, have decreased overall well-being, and face reduced functionality. More resources will be required to provide sophisticated care when patients present with severe conditions at the hospitals. The healthcare system is burdened, the available resources are strained, and the financial costs associated with care increase. Limited access to services has physical, emotional, and spiritual effects on the community members. The impact of the mental health condition on their well-being and self-care can ultimately affect their physical health, making them less functional.

The significant effects of the limited access to healthcare services in underserved communities necessitate an evidence-based practice and quality improvement project. This project can help to improve the safety of the patients, increase the quality of care, promote the overall well-being of the individuals, and decrease the costs associated with care. By addressing the barriers to access to mental and psychiatry health services, implementing evidence-based interventions, and ensuring that the services are culturally sensitive, the EBP/QI project can increase the satisfaction of the patients, improve their overall health and ensure that there is equitable access of healthcare services to all individuals regardless of the geolocation or socioeconomic status.

PICOT Question

In underserved communities facing limited access to psychiatry health services (P), does the use of telehealth (I), compared to in-person hospital visits(C), affect the number of patients accessing psychiatry health services (O) within 3 months (T)?

The Evidence

Several important conclusions were drawn from research by Xu et al. (2022) that examined telehealth utilization trends during the COVID-19 pandemic in underserved populations. The study aimed to evaluate how telehealth services would affect the availability of psychiatric care in regions with poor access to in-person hospital visits. The study examined three unique periods: pre-pandemic (January 2019 to February 2020), early pandemic (March to June 2020), and late pandemic (July to October 2020). It used Medicaid claims data. Telehealth services increased significantly throughout the pandemic, especially in underserved populations (Xu et al., 2022). Notably, telehealth claims significantly increased in the early and late pandemic eras compared to the pre-pandemic period, increasing 40-fold and 30-fold, respectively. All racial and ethnic groups showed increased telehealth use, with the Hispanic community showing the largest monthly claim growth (Xu et al., 2022). However, the African American group saw a relatively smaller increase in telehealth usage.

Xu et al. (2022) indicated that urban and rural areas adopt telehealth at different rates. Compared to rural areas, metropolitan areas had a higher proportion of telehealth use, with the counties with the highest percentage of telehealth claims coming next to the counties with the lowest percentage. This finding implies that issues, including the lack of high-speed internet and digital devices in remote locations, may have hampered the uptake of telehealth services in certain areas (Xu et al., 2022). Even though telehealth services may improve access to healthcare in underprivileged areas, the study highlighted several issues that need to be resolved. Crucial considerations include providing culturally acceptable telehealth programs for varied populations and enhancing internet infrastructure in remote areas.

The McCord et al. (2022) study compared the efficacy of in-person and telebehavioral health treatments in rural populations across the United States. More than 1,000 patients participated in the study, which took place at 95 clinical locations throughout 13 states. The study’s primary finding was that telebehavioral health services were as effective as in-person visits in lowering anxious and depressive symptoms among rural underserved patients. In both groups, anxiety and depression symptoms decreased by an average of three points between the pre-intervention and post-intervention assessments one month later (McCord et al., 2022). This finding is significant because it agrees with meta-analyses that examined the efficacy of in-person psychotherapy and telemedicine in direct comparison randomized controlled trials.

Furthermore, McCord et al. (2022) highlighted the advantages of telebehavioral health therapies, particularly in rural areas. According to participants, patients who resided a significant distance from healthcare facilities were most likely to benefit from telebehavioral health services. There was a consensus that telebehavioral health services saved money since they reduced or eliminated the need for travel and needed fewer personnel and facilities. Implications for the future of telebehavioral health service delivery in rural areas are substantial in light of the findings of this study. According to McCord et al.’s (2022) findings, telebehavioral health services can be a good, affordable substitute for in-person care for underserved rural communities. By investing in and enhancing telebehavioral health services, healthcare professionals and policymakers can improve access to mental health care in rural locations (McCord et al., 2022).

According to Bulkes et al. (2021), a comparison was undertaken between the clinical outcomes of patients who got in-person, intensive psychological treatment before the COVID-19 pandemic and those who received telehealth treatment during the pandemic. The main objective was to determine whether telehealth may be a practical substitute for in-person care for people receiving intense therapy. Bulkes et al. (2021) concluded that there were no appreciable differences between the telehealth and in-person groups in the admission scores for quality of life and depressive symptoms. Notably, both groups showed significant improvements in self-reported quality of life and significant decreases in depressive symptoms. To isolate the effect of therapy delivery modality on treatment results independent of these characteristics, the researchers matched the in-person and telehealth groups for pre-treatment covariates, such as age, sex, race, and level of care.

According to observations, patients who received therapy via telehealth at the partial hospitalization level of care had lengthier treatment times (Bulkes et al., 2021). Due to its effectiveness in lowering depression symptoms and enhancing the quality of life, telehealth is a workable care alternative for people requiring intense treatment (Bulkes et al., 2021). The absence of a formal, clinician-administered diagnostic examination upon admission, which would have strengthened the existing diagnoses, limits the findings of Bulkes et al. (2021). However, the initial diagnostic evaluations were carried out by qualified psychiatrists with substantial expertise in diagnosing mental health illnesses, and patient records were often updated to reflect any adjustments to diagnoses made throughout therapy. This study has important implications for patients and healthcare institutions alike. Telehealth presents a practical alternative for patients who live far from treatment facilities or cannot attend in-person sessions (Bulkes et al., 2021). The huge sample size of the study from a systemic perspective supports telehealth’s efficacy as comparable to in-person therapy for people requiring intense treatment.

Snoswell et al.’s (2021) study combed through meta-analyses on the clinical effectiveness of telehealth services from 2010 to 2019 to conclude its benefits across different medical fields. The analysis found telehealth interventions beneficial to patient outcomes in mental health, psychiatry, chronic illness management, and postoperative care. The authors found that telehealth interventions correlated with lower healthcare costs and more patient satisfaction. They identified several factors that contributed to the success of telehealth therapies. This included integrating telehealth services into existing healthcare systems, mobile health applications for real-time patient monitoring and feedback, and videoconferencing technology to assist remote consultations (Snoswell et al., 2021).

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Notably, it was also discovered that patient involvement and education were crucial for promoting the acceptance and efficiency of telehealth services. However, the research revealed certain barriers to the widespread adoption and use of telehealth services. Some of these challenges included privacy and security issues, a lack of healthcare professionals’ confidence in telehealth, and the absence of regulatory frameworks to ensure the reliability of telehealth services. The study highlighted the need for greater research to guarantee telehealth therapy’s longevity and long-term usefulness.

McElroy et al. (2020) looked into how the COVID-19 epidemic caused hospitals to reassess their approaches to patient care. Due to reimbursement constraints, previously ignored telehealth became critical to successfully reimagining safe healthcare delivery in the wake of the pandemic. Removing the crucial obstacle of reimbursement made it easier for people to use telehealth services. The delivery of healthcare has changed significantly as a result of technological developments and legislative efforts, and this has created an opportunity to reduce gaps in access to care, especially for vulnerable groups (McElroy et al., 2020). In this change, telehealth has become a significant role, allowing medical professionals to continue providing care while reducing the chance of contracting a virus.

The McElroy et al. (2020) study brought attention to the possible advantages of telehealth in addressing healthcare disparities. Thanks to telehealth, patients who might have encountered difficulties receiving care can now get the critical care they need. This change had the potential to alleviate inequities and enhance results, particularly for disadvantaged populations. The findings highlighted the need to address discrepancies in telehealth access. The capacity of a patient to utilize telehealth services can be strongly impacted by factors like connectivity, privacy, and digital literacy (McElroy et al., 2020). To eliminate these discrepancies and guarantee equitable access to healthcare for all, immediate and targeted action is needed.

Studies by Lai et al. (2020) looked at the preventive effects of telehealth on dementia patients and the people who care for them during the COVID-19 epidemic. The study concentrated on the advantages of telehealth, specifically videoconferencing platforms, for neurocognitive disorders (NCD) care recipients and their at-home spouse carers. The study involved 62 pairs of care recipients with NCD and their spousal caregivers who were randomly assigned to either a videoconferencing or telephone-only group. The study was conducted in Hong Kong, where social distancing measures were implemented to stop the spread of COVID-19. The telephone-only group received the same health information and assistance via traditional telephone delivery, but the videoconferencing group received additional health information and support using videoconferencing platforms.

Compared to the telephone-only group, the videoconferencing group experienced noticeably superior results (Lai et al., 2020). In the videoconferencing group, caregiver burden, depressive symptoms, anxiety, and quality of life were markedly improved. The videoconferencing group’s care recipients scored higher for their functional abilities, quality of life, and neuropsychiatric symptoms (Lai et al., 2020). The study concludes that telehealth, particularly videoconferencing platforms, can provide additional benefits to care receivers with NCD and their spousal carers, improving results and well-being at home. The study focused on the immediate effects of supplementing video conferences with health information; however, this opened the question of whether the advantages would continue once the extra sessions stopped. Additionally, the research implies that to evaluate the generalizability of the findings, comparative studies between various geographic regions and socioeconomic groups would be useful (Lai et al., 2020). The efficiency and adaptability of telehealth solutions in various settings may be better understood by considering communities that differ in the style and degree of social distance enforcement.

Studies by Chang et al. (2021) address the implications of the post-COVID era’s rapid adoption of telehealth for primary care access and equity. The authors stress the potential benefits of telehealth in infectious disease epidemics, such as less exposure to infectious diseases, enhanced patient convenience, and improved access to care. However, the writers also discuss the difficulties and restrictions of telemedicine, notably concerning health inequalities. They draw attention to the issue that telehealth can worsen already-existing health inequities, especially for underprivileged and marginalized people who might not have access to critical technology or have poor internet connectivity.

Chang et al. (2021) call for policy measures to ensure more telehealth equity to overcome these potential discrepancies. These adjustments can include better broadband availability, higher financing for telehealth infrastructure, and telehealth service reimbursement procedures. These policy changes are important to ensure that all patients, especially those disadvantaged and underserved, access fair and equitable telehealth services. The digital divide in telehealth is another important topic covered in the. According to Chang et al. (2021), patients in rural or low-income locations may not have access to the required technology or have poor internet connectivity, creating hurdles to the use of telehealth. For all patients to have equitable access to telehealth, it is essential to address the digital gap. Telehealth may not be suitable for all patients or all forms of care, even while it can potentially increase access to care, particularly for individuals in rural or underserved areas (Chang et al., 2021).

Literature Synthesis

Lai et al. (2020), McElroy et al. (2020), and Chang et al. (2021) all established that telehealth has a lot to offer rural communities and primary care during infectious disease epidemics like the COVID-19 pandemic. They strongly emphasize patient convenience, enhanced access to care, and decreased exposure to infectious diseases. In their study of people with dementia and the carers who support them, McElroy et al. (2020) show how telehealth, particularly videoconferencing platforms, improved caregiver burden, sadness, anxiety, and quality of life outcomes. Furthermore, telemedicine can increase access to care, particularly for patients in remote or underserved locations, according to (Chang et al., 2021).

Despite the benefits, writers Bulkes et al. (2021), Lai et al. (2020), and Chang et al. (2021) emphasize the difficulties and restrictions associated with telehealth, particularly regarding health inequalities. They admit that telehealth can potentially widen existing gaps, especially for marginalized and underserved groups who lack access to essential equipment or have poor internet connectivity. According to a study by Lai et al . (2020) on dementia patients and their spouse carers, governmental changes are required to achieve improved telehealth equity, including higher investment in infrastructure and increased broadband availability.

Several authors have emphasized addressing health equality in telehealth, notably Bulkes et al. (2021) and McElroy et al. (2020). They contend that closing the digital gap is necessary to guarantee equal access to telehealth services. Furthermore, Chang et al. (2021) stress the significance of additional studies to ascertain the most efficient applications of telehealth in primary care and its potential influence on health equity. The adoption of telehealth services in underserved communities is the subject of a study by Xu et al. (2022), which highlights the potential advantages of telehealth in eliminating healthcare access inequities.

To guarantee equitable telehealth services, authors Bulkes et al. (2021), Lai et al. (2020), and Chang et al. (2021) call for reforms in policy. They demand better broadband availability, more money for telehealth infrastructure, and better telehealth service reimbursement guidelines. Furthermore, Chang et al. (2021) stress the significance of tackling the digital divide and providing essential resources to guarantee universal patient access to telehealth.

Literature Analysis

The findings from the literature review give significant insights that can help improve the number of patients in underserved populations obtaining psychiatry care through the implementation of telehealth. To remove obstacles and improve marginalized areas’ access to mental health services, the literature study delivers significant results and policy recommendations. Access to physical healthcare facilities is a major barrier for marginalized individuals seeking psychiatric treatment, particularly in rural locations. According to Xu et al. (2022) and McElroy et al. (2020), telehealth can close this gap by offering remote consultations and lowering travel requirements. Patients can get psychiatric care using telehealth platforms like video conferencing, which increases convenience and lowers barriers linked to commuting. People in underprivileged communities who have trouble getting to healthcare facilities because of distance restrictions or a lack of transportation options may find this helpful.

The research by Xu et al. (2022) and McElroy et al. (2020) highlights how critical it is to resolve inequalities in access to telehealth services. To ensure fair access to telehealth, Bulkes et al. (2021) supported policies focused on increasing broadband access and enhancing digital infrastructure. Underserved communities can acquire equal access to telepsychiatry services by concentrating on bridging the digital divide, hence lowering inequities in mental health care.

According to Chang et al. (2021), telehealth also can address issues with infectious disease epidemics. Telehealth can maintain the continuity of psychiatry healthcare during public health crises like the COVID-19 pandemic while lowering the risk of infection. Healthcare systems can better prepare for upcoming emergencies and guarantee service continuity for marginalized populations by promoting the implementation of telepsychiatry.

The research by Lai et al. (2020) and McElroy et al. (2020) proves that telehealth, particularly videoconferencing platforms, can enhance the mental health of dementia care recipients and their caregivers. These results imply that telepsychiatry interventions can go beyond conventional mental health services and address particular needs in underprivileged communities. Telehealth can offer additional health information and support to caregivers in underserved areas, lowering caregiver load and enhancing overall mental health outcomes.

Policy improvements are essential to increase the number of patients in underserved populations who receive telehealth for psychiatry services. The authors stress the necessity of enhanced reimbursement regulations, more financing for telehealth infrastructure, and increased broadband availability. The authors also support a greater investigation into the value of telehealth in primary care and its effects on health equity. Healthcare practitioners and governments can decide how best to give telehealth services to underserved communities by undertaking thorough research to evaluate the specific advantages and difficulties of telepsychiatry therapies in these populations.

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 Scaffolding the project

EBP Framework: RE-AIM

The RE-AIM framework is a comprehensive methodology that can be used to assess the impact of policies, programs, or health interventions. In this scenario, it is ideal for determining the effectiveness of telehealth in expanding access to mental health care for those in underserved areas.

The RE-AIM framework comprises five dimensions:

1. Reach: This criterion helps to assess how many individuals have been affected by the interventions. This project will determine how many individuals use telehealth and what they have experienced. It could show how well telehealth works to remove geographical constraints and expand access to mental health services.
2. Effectiveness: The effectiveness of an intervention is measured by how well it achieves its intended goals. In this scenario, the efficacy criterion would evaluate if more patients could access mental health services directly using telehealth. It would entail looking at the data to see if telehealth helped increase the number of people accessing mental health services in underserved areas.
3. Adoption: Adoption refers to the degree to which many settings, clinics, or providers accept an intervention. This project aims to determine the degree of uptake of telehealth services by healthcare practitioners and facilities in medically underserved areas. If successful, it would shed light on whether or not telehealth can be used to deliver mental health care to these populations effectively.
4. Implementation: The implementation dimension assesses how well the intervention is carried out and incorporated into existing systems or workflows. In the context of this project, implementation would analyze the degree to which telehealth services were successfully integrated into the healthcare systems of underprivileged populations. Effective implementation could be hindered or aided by analyzing technical infrastructure, provider training, and patient engagement.
5. Maintenance: The maintenance phase assesses how well an intervention holds up over time. Maintenance will look into the long-term adoption of telehealth services and its ongoing influence on access to mental health care in marginalized communities. Evaluating issues, including patient retention rates, continued provider adoption, and financial sustainability, would be necessary to determine if telehealth services can be sustained and scaled up over time.

The RE-AIM framework offers a holistic and comprehensive method of measuring the results of telehealth programs. It allows for a thorough evaluation of the intervention’s efficacy and viability in the actual world by examining different factors (Holtrop et al., 2021). Second, the framework will help evaluate how telehealth infrastructure affects the availability of mental health care in underprivileged areas. The essential features of the intervention’s impact and sustainability are addressed by the RE-AIM dimensions, which provide a structured framework for evaluating reach, effectiveness, adoption, implementation, and maintenance. Finally, the RE-AIM framework’s widespread adoption in healthcare research and assessment both adds credibility and makes it easier to connect with previous studies.

Project objectives

The project addressing the inadequate access to mental and psychiatric health treatments in underprivileged populations is highly justified by the evidence acquired. It draws attention to these communities’ considerable obstacles, such as racial and ethnic differences, low financial position, and isolation from other areas. These obstacles cause mental health issues to go undiagnosed for long periods, and patients receive insufficient care and little support, which worsens symptoms, lengthens hospital stays, and lowers overall well-being (Kassam, 2020). The effects of restricted access to services result in healthcare disparities, strain healthcare institutions, and raise healthcare expenses. The study also underlines the value of community-based approaches and treatments that are culturally appropriate in closing the access gap. Additionally, it is suggested that telehealth technology integration be used to reduce geographical obstacles. By addressing these problems, people in underserved communities’ overall mental wellness can be increased, increasing equity in access to mental health care.

Objective 1: Identify potential strategies and interventions that can be used to improve the accessibility of individuals to high-quality healthcare in underserved communities

Identifying the causes of disparities in healthcare access in underserved communities and addressing them can help ensure that these individuals get the healthcare services for their illnesses (Stormacq et al., 2019). Successful interventions that have been implemented in similar contexts and involving the stakeholders can help come up with effective recommendations and ideas. Existing literature, data, and reports can be reviewed to establish what interventions have successfully increased the access of underserved populations to healthcare. Some populations facing the same challenges that can be considered for review include marginalized groups, low-income communities, and rural areas (McMaughan et al.,2020). After the interventions have been identified, they can be evaluated to determine if they are feasible and can be implemented and sustained to benefit these populations. Some factors that should be considered include the availability of resources, training requirements, infrastructure, scalability of the interventions, and cultural acceptability. The set of interventions identified can then be tailored to meet the unique needs of the people.

Objective 2: Evaluate the impact of telehealth technology in reducing geographical barriers and improving access to high-quality mental health services in underserved communities.

People living in underprivileged areas have more difficulty accessing mental health care because of their location. Evidence highlights telehealth as a possible way to close this gap and improve people’s access to high-quality healthcare. Telehealth comprises a wide range of technologies that allow for remote consultations, digital monitoring, and digital communication, removing the barriers of distance and accessibility (Myers, 2019). It is crucial to evaluate the effects of telehealth in marginalized communities to get insight into its efficacy and guarantee its successful deployment. Healthcare providers can assess the effectiveness and usefulness of telehealth therapies by considering aspects including patient satisfaction, healthcare outcomes, cost-effectiveness, and accessibility (Myers, 2019). Data on patient satisfaction, healthcare utilization, and health outcomes will help evaluate telehealth’s efficacy and efficiency compared to in-person care.

In addition, cultural factors should be considered to guarantee that telehealth treatments suit all community members. Understanding the community’s familiarity with technology, internet connection, and virtual platforms is crucial for fair and equal access. Challenges and restrictions, such as privacy, technology, and insurance coverage, should be considered during assessments. Through data collection on the efficacy of telehealth technology, healthcare professionals can push for its incorporation into mental health service delivery, increasing access to quality care for marginalized groups.

Objective 3: Measure the financial implications of increasing access to mental and psychiatric health services in underserved communities.

Individuals needing mental and psychiatric health services are not the only ones impacted by underserved communities’ lack of access to these services. More extraordinary healthcare expenses owing to late diagnosis, unnecessary hospitalizations, and more significant strain on healthcare providers during the onset of acute disease are caused by this problem (Aranda et al., 2021). Quantifying the economic effects of expanding service delivery to underserved areas is essential to show the potential savings that can be generated. Healthcare professionals can demonstrate the economic benefits of investing in accessible and comprehensive mental health treatments by completing a full financial analysis. Reductions in ER visits, hospital readmissions, and the cost-effectiveness of preventative and early intervention initiatives should be considered to achieve positive health outcomes (Coombs, 2021).

Knowing the financial toll can help policymakers prioritize mental health services and provide long-term healthcare solutions. Increased access to mental health services in underprivileged places may have a positive economic impact, and this project can help politicians and healthcare administrators understand that. By stressing the financial gains, healthcare professionals can push for policy shifts and funding initiatives that put a premium on universal access to mental and psychiatric health care (Aranda et al., 2021). In the long run, this can improve health outcomes, lower healthcare costs, and boost well-being in neglected areas.

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 Methodology

Project team (include the team members)

Setting the stage

The project will take place in an outpatient psychiatry setting in New Jersey. The setting provides healthcare to an average of 40-60 patients weekly.

Project design

To thoroughly examine the effectiveness and viability of employing telehealth to address the limited access to psychiatric health treatments in underprivileged regions, the study will utilize a mixed-methods research methodology. The research design will include both quantitative and qualitative elements.

The recruitment of a varied sample of people from marginalized neighborhoods looking for psychiatric health treatments will be necessary for the quantitative data gathering. Random grouping will place participants in the telehealth intervention group or those receiving in-person hospital visits. Over three months, the number of psychiatric health services patients will be monitored and compared between the two groups. Additionally, quantitative measures such as patient satisfaction surveys, symptom improvement assessments, and engagement metrics will be collected to evaluate the effectiveness of the telehealth intervention.

Qualitative data will be collected through semi-structured questionnaires with participants from both groups, healthcare providers, and administrators. These interviews will explore participants’ experiences, perceptions, and barriers to accessing mental health services. The qualitative data will provide contextual insights into the factors influencing the adoption, implementation, and maintenance of telehealth services within underserved communities.

Population and sample

The population of interest for this study comprises individuals seeking psychiatric health services in an outpatient clinic located within the local community of New Jersey. This outpatient clinic serves as a crucial healthcare hub for individuals facing mental health challenges within the community.

Given the average weekly patient load of 40-60 individuals at the outpatient psychiatric clinic, a sample size of 120 participants will be recruited for the study. Participants will be selected through a combination of convenience and random sampling methods to ensure representation of the diverse population seeking psychiatric care in the local community.

Inclusion Criteria

Participants for this study will be selected based on the following inclusion criteria:

1. Individuals aged 18 years and above will be included in the study.
2. Participants must reside within the local community in New Jersey, where the outpatient psychiatric clinic is located.
3. Participants should be seeking psychiatric health services, either for assessment, diagnosis, or treatment, at the outpatient clinic.
4. Participants must provide informed consent to participate in the study. They should be willing and able to actively engage in telehealth sessions or attend in-person hospital visits as assigned.
5. For the telehealth intervention group, participants must have access to the necessary technology (e.g., internet-enabled device, webcam, microphone) for remote sessions.
6. Participants should be medically stable and not in immediate crisis, as determined by healthcare professionals during the screening process.

Exclusion Criteria

Participants who meet any of the following criteria will be excluded from participation in the study:

1. Individuals below the age of 18 will be excluded from the study.
2. Individuals residing outside the local community in New Jersey, where the outpatient psychiatric clinic is situated, will be excluded.
3. Individuals who are not seeking psychiatric health services or who do not have an appointment at the outpatient clinic during the study period will be excluded.
4. Participants who do not provide informed consent or withdraw their consent during the study will be excluded.
5. Participants with severe medical conditions that prevent their engagement in the study activities or individuals experiencing acute psychiatric crises that require immediate attention will be excluded.
6. Participants who lack access to the necessary technology for remote sessions (e.g., internet-enabled device, webcam, microphone) will be excluded from the telehealth intervention group.
7. Individuals who express unwillingness or inability to participate in telehealth sessions or in-person visits as required by the study will be excluded.

Human subject protection (include the statement)

Instruments and tools

All the instruments and tools used in the project are attached in the Appendix.

Appendix A: The RE-AIM Framework Flowchart

Appendix B: The Informed Consent Form

Appendix C: Recruitment Script for Healthcare Worker

Appendix D: Demographic Information Collection Form

Appendix E: Post-Intervention Questionnaire

Appendix F: Data Collection Worksheet

Appendix G: Healthcare Worker Decision Tree

Implementation plan

The RE-AIM framework will be used to implement the project and guarantee that telehealth technology is successfully integrated to increase access to mental health services in underserved communities. The acceptance and reach of the intervention are two of the essential parts of the implementation, and the framework will help address these issues while also considering characteristics critical to its sustainability and scalability.

The first step in rolling out telehealth to underprivileged areas is locating healthcare organizations and clinicians open to making the switch. Partnerships will be formed, and buy-in for implementing telehealth technologies will be obtained through active involvement and collaboration with critical stakeholders such as hospital administrators, providers, and community organizations. The advantages and processes of telehealth services will be explained in detail through educational resources.

The technical prerequisites for telehealth service implementation will be established following an evaluation of infrastructure readiness. Examining the accessibility and stability of internet connections, the power of purchasing the appropriate telecommunications equipment, and adhering to privacy and security requirements to safeguard patient data may all be part of this process. Incorporating telehealth technologies into current healthcare systems will be facilitated by addressing any identified gaps or obstacles.

Strategies will be implemented to focus on underserved neighborhoods to expand the reach of telehealth services. Raising awareness of the availability and benefits of telehealth services may involve organizing community outreach activities, sharing information through local media outlets, and cooperating with community leaders and groups. To ensure people of all backgrounds can participate, removing any linguistic and cultural hurdles that may stand in the way is essential.

Healthcare providers’ uptake and consumption of telehealth services can be rigorously tracked as part of the implementation process. Providers’ complaints and technical difficulties can be addressed through regular communication and feedback channels. Training sessions and continuing assistance will bolster providers’ self-assurance and skill in providing telehealth therapies for mental disorders. To evaluate the adoption component of the RE-AIM paradigm, data on the prevalence of telehealth adoption among providers, the regularity with which services are provided, and the level of patient participation can be collected.

In addition, monitoring the rates of telehealth service consumption will be critical for gauging the framework’s reach. Data on the number of patients using these services and patient demographics can be collected to evaluate the efficacy of expanding access to telehealth mental health services. Integrating electronic health records or other data management systems will help guarantee precise and thorough data collecting.

Continuous Quality Improvement approaches can be used throughout the implementation phase to ensure the best possible telehealth care is provided to patients. Audits, feedback sessions, and performance reviews can be scheduled regularly to help highlight areas of concern and overcome any obstacles encountered throughout implementation. Successful implementations will result in the spread of telehealth services by sharing lessons learned and best practices with other healthcare settings.

The Process

Step 1: Admission and Group Assignment

• Admit the participant into the intervention group (telehealth or in-person) based on random assignment.
• Provide necessary instructions and resources for the chosen intervention mode.
• Explain the purpose of the study and what is expected from the participant.

Step 2: Baseline Data Collection

• Obtain informed consent from the participant.
• Gather demographic information and initial mental health status.
• Explain the data collection process, including weekly interactions and surveys.

Step 3: Weekly Interactions and Data Collection

• Initiate weekly interactions with the participants according to their assigned intervention.
• Collect data during these interactions, including service utilization information and participant’s experiences and feedback.
• Ensure the participant’s engagement and comfort throughout the study period.

Step 4: Data Analysis and Evaluation

• Collate the collected data into a structured format for analysis.
• Analyze the quantitative data using appropriate statistical methods.
• Conduct qualitative analysis of interview transcripts and open-ended responses.
• Identify patterns, themes, and trends within the data.

Step 5: Findings Synthesis and Conclusion

• Integrate quantitative and qualitative findings to draw comprehensive conclusions.
• Identify key insights and implications for addressing limited access to psychiatric health services.
• Summarize findings in preparation for reporting and presentation.

Step 6: Reporting and Presentation

• Craft a research report outlining the project process, findings, and conclusions.
• Ensure the report adheres to formatting guidelines and includes relevant visuals.
• Prepare a concise presentation of the research for stakeholders.

Step 7: Project Closure and Knowledge Sharing

• Reflect on project strengths, limitations, and lessons learned.
• Present findings to the community, healthcare providers, and relevant organizations.
• Archive project documents, data, and reports for future reference.
  

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Project Timeline

The project is estimated to take place over 3 months (12 weeks). Most of this time has been allocated to data collection and weekly interactions with the individuals.

Week	Activities
1-2	Project Initiation and Preparation Admission and Group Assignment Baseline Data Collection
3-10	Weekly Interactions and Data Collection
11	Data Analysis and Evaluation Findings Synthesis and Conclusion
12	Reporting and Presentation Project Closure and Knowledge Sharing

Budget

The budget is estimated to cost roughly $2500.

Category	Expense	Estimated Cost
Participant Recruitment	Printing Flyers	$150
Participant Incentives	Gift Cards	$1000
Data Collection	CSPT costs	$1000
Data Analysis	Statistical Software	$50
Miscellaneous	Communication Costs	$300
Total Budget		$2500

References

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Bulkes, N. Z., Davis, K., Kay, B., & Riemann, B. C. (2021). Comparing efficacy of telehealth to in-person mental health care in intensive-treatment-seeking adults. Journal of Psychiatric Research, 145. https://doi.org/10.1016/j.jpsychires.2021.11.003

Carbonell, Á., Navarro‐Pérez, J., & Mestre, M. (2020). Challenges and barriers in mental healthcare systems and their impact on the family: A systematic integrative review. Health & Social Care in the Community, 28(5), 1366–1379. https://doi.org/10.1111/hsc.12968

Chang, J. E., Lai, A. Y., Gupta, A., Nguyen, A. M., Berry, C. A., & Shelley, D. R. (2021). Rapid transition to telehealth and the digital divide: Implications for primary care access and equity in a post‐COVID era. The Milbank Quarterly, 99(2), 340–368. https://doi.org/10.1111/1468-0009.12509

Cleary, M., West, S., Arthur, D., & Kornhaber, R. (2019). Change management in health care and mental health nursing. Issues in Mental Health Nursing, 40(11), 1–7. https://doi.org/10.1080/01612840.2019.1609633

Coombs, N. C., Meriwether, W. E., Caringi, J., & Newcomer, S. R. (2021). Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study. SSM – Population Health, 15, 100847. https://doi.org/10.1016/j.ssmph.2021.100847

Hartley, S., Raphael, J., Lovell, K., & Berry, K. (2020). Effective nurse-patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance. International Journal of Nursing Studies, 102(1). https://doi.org/10.1016/j.ijnurstu.2019.103490

Holtrop, J. S., Estabrooks, P. A., Gaglio, B., Harden, S. M., Kessler, R. S., King, D. K., Kwan, B. M., Ory, M. G., Rabin, B. A., Shelton, R. C., & Glasgow, R. E. (2021). Understanding and applying the RE-AIM framework: Clarifications and resources. Journal of Clinical and Translational Science, 5(1). https://doi.org/10.1017/cts.2021.789

Kassam, S., Serrano-Lomelin, J., Hicks, A., Crawford, S., Bakal, J. A., & Ospina, M. B. (2021). Geography as a determinant of health: health services utilization of pediatric respiratory illness in a Canadian province. International Journal of Environmental Research and Public Health, 18(16), 8347. https://doi.org/10.3390/ijerph18168347

Kates, N., Arroll, B., Currie, E., Hanlon, C., Gask, L., Klasen, H., Meadows, G., Rukundo, G., Sunderji, N., Ruud, T., & Williams, M. (2019). Improving collaboration between primary care and mental health services. The World Journal of Biological Psychiatry, 1–18. https://doi.org/10.1080/15622975.2018.1471218

Lai, F. H., Yan, E. W., Yu, K. K., Tsui, W.-S., Chan, D. T., & Yee, B. K. (2020). The protective impact of telemedicine on persons with dementia and their caregivers during the COVID-19 pandemic. The American Journal of Geriatric Psychiatry, 28(11), 1175–1184. https://doi.org/10.1016/j.jagp.2020.07.019

McCord, C., Ullrich, F., Merchant, K. A. S., Bhagianadh, D., Carter, K. D., Nelson, E., Marcin, J. P., Law, K. B., Neufeld, J., Giovanetti, A., & Ward, M. M. (2022). Comparison of in-person vs. telebehavioral health outcomes from rural populations across America. BMC Psychiatry, 22(1). https://doi.org/10.1186/s12888-022-04421-0

McElroy, J. A., Day, T. M., & Becevic, M. (2020). The influence of telehealth for better health across communities. Preventing Chronic Disease, 17(64). https://doi.org/10.5888/pcd17.200254

McMaughan, D. J., Oloruntoba, O., & Smith, M. L. (2020). Socioeconomic status and access to healthcare: Interrelated drivers for healthy aging. Frontiers in Public Health, 8, 231. https://doi.org/10.3389/fpubh.2020.00231

Purtle, J., Nelson, K. L., Counts, N. Z., & Yudell, M. (2020). Population-based approaches to mental health: history, strategies, and evidence. Annual Review of Public Health, 41(1), 201–221. https://doi.org/10.1146/annurev-publhealth-040119-094247

Snoswell, C. L., Chelberg, G., De Guzman, K. R., Haydon, H. H., Thomas, E. E., Caffery, L. J., & Smith, A. C. (2021). The clinical effectiveness of telehealth: A systematic review of meta-analyses from 2010 to 2019. Journal of Telemedicine and Telecare, 0(0), 1357633X2110229. https://doi.org/10.1177/1357633×211022907

Stormacq, C., Van den Broucke, S., & Wosinski, J. (2019). Does health literacy mediate the relationship between socioeconomic status and health disparities? Integrative review. Health Promotion International, 34(5), e1–e17. https://doi.org/10.1093/heapro/day062

Xu, P., Hudnall, M., Zhao, S., Raja, U., Parton, J., & Lewis, D. (2022). Pandemic-triggered adoption of telehealth in underserved communities: Descriptive study of pre- and post-shutdown trends. Journal of Medical Internet Research, 24(7), e38602. https://doi.org/10.2196/38602

 APPENDIX

Appendix A: The RE-AIM Flowchart

Appendix B:Informed Consent Form

Title of the Study: The Effect of Telehealth Compared to In-Person Visits on Limited Access to Psychiatric Health Services in Underserved Communities

Date: [Date]

We cordially invite you to participate in our study, “Limited Access to Psychiatric Health Services in Underserved Communities.” Before you decide to join, We want to educate you about the study’s objectives, methods, risks, and advantages. Please take the time to carefully read this article, and feel free to contact us with any questions. Your participation is voluntary, and you can stop anytime without incurring fees.

Purpose:

This study aims to determine how well telehealth works in underprivileged locations to increase access to psychiatric health services. To understand the experiences of participants, healthcare professionals, and administrators engaged, we seek to evaluate whether telehealth, compared to in-person visits, can positively impact the number of patients accessing psychiatric care throughout three months.

Procedures:

If you agree to participate, you must answer a few quick demographic questions and a questionnaire regarding your prior use of psychiatric health services. You will attend telehealth sessions for your psychiatric treatment if you are in the telehealth intervention group. If assigned to the group that receives hospital visits in person, you will receive care through customary in-person visits. Participants may also be requested to participate in a qualitative interview to describe their experiences further.

Risks and Benefits:

Participating in this study carries minimal risk. The survey questions and interview conversations could be too emotional for some individuals. Although we will take precautions to protect your privacy, there is a slight chance that someone else could obtain your information. The benefits of this study include contributing to the understanding of telehealth’s impact on psychiatric care accessibility and potentially benefiting from improved mental health services.

Confidentiality:

All information collected will be kept confidential to the extent permitted by law. Your responses will be coded; no personally identifiable information will be included in any reports or publications. Only the project team will access the data; all digital data will be securely stored.

Voluntary Participation:

Participation in this study is entirely voluntary. If you choose to participate, you can withdraw at any time without penalty or loss of benefits to which you are otherwise entitled.

Contact Information:

If you have any questions about this study, please contact [Your Name] at [Your Contact Information]. If you have questions about your rights as a research participant, you can contact the [Institution’s Ethics Committee] at [Ethics Committee Contact Information].

Consent:

I have read and understood the above information about the study titled ” The Effect of Telehealth Compared to In-Person Visits on Limited Access to Psychiatric Health Services in Underserved Communities.” I have had the opportunity to ask questions and have received satisfactory answers. I voluntarily agree to participate in this study. I understand that I can withdraw my participation at any time without penalty.

Participant’s Name: _______________________________

Participant’s Signature: ____________________________

Date: _____________________

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 Appendix C: Recruitment Script for Healthcare Worker

Hello! My name is [Healthcare Worker Name], and I am a healthcare worker here at [Hospital/Clinic Name]. We are conducting a research study focused on improving our community’s access to mental health services. Our project focuses on improving mental health services access in underserved communities by comparing telehealth to in-person visits. Participants benefit from specialized care, convenience, and research contribution. Risks include privacy concerns and potential discomfort. Informed consent ensures understanding and voluntary participation. Withdrawal is always an option. Our priority is participant well-being, with trained professionals providing support. The study aims to impact policy and practice positively. Questions and concerns are appreciated since informed decisions and participant welfare are vital. We feel that your cooperation will be highly beneficial to our efforts.

Option 1: Patient Agrees to Engage

If the patient agrees to engage in the study:

1. Introduction: “We are inviting patients to take part in this study, and your participation could have a significant impact.” Attending telehealth or in-person programs aimed to promote access to mental health services will be part of your involvement.”
2. Study Explanation: “We will gather certain demographic data about you throughout the study, including your age, gender, and educational background. This will improve our comprehension of the different needs in our community.”
3. Informed Consent: “Additionally, you will be needed to sign an informed consent form that guarantees you are aware of the study’s objectives, your part in them, and how your privacy and rights will be protected.”
4. Privacy Assurance: ” Your participation in this survey is entirely voluntary, and we promise to keep your information private. Anytime you choose, you can leave the study without any repercussions.”
5. Permission to Proceed: ” Do you want to take part in our investigation? If so, we can collect your demographic information and give you the informed consent form to go over and sign.”

OPTION 2: Patient Refuses to Engage

If the patient refuses to engage in the study:

1. Introduction: “We are conducting a research study to improve access to mental health services in our community. We believe your input could be valuable, but your participation is voluntary.”
2. Patient’s Choice: “We understand that participating in research might not suit everyone. If you choose not to participate, we completely respect your decision, and it will not affect your healthcare services in any way.”
3. End of Script: “Thank you for considering our study. If you have any questions or concerns in the future, feel free to ask. Your comfort and well-being are our priorities.”

 Appendix D: Demographic Information Collection Form

1. Full Names:
2. Patient Identifier ID:
3. Home Town:
4. The random group assigned:
5. Telehealth
6. In-person visit
7. Age:
8. Under 18
9. 18-24
10. 25-34
11. 35-44
12. 45-54
13. 55 and above
14. Gender:

1. Male
2. Female
3. Non-binary
4. Prefer not to say

3. Ethnicity:

1. American
2. Black or African-American
3. Asian
4. Hispanic or Latino
5. Other

4. Education Level:

1. High School or GED
2. College
3. Bachelor’s Degree
4. Master’s Degree or higher

5. Employment Status:

1. Employed full-time
2. Employed part-time
3. Unemployed
4. Student
5. Retired

 Appendix E: Post-Intervention Questionnaire

Thank you for participating in our study. Your feedback is valuable for improving our intervention and understanding its impact. Please take a few minutes to answer the following questions:

Intervention Experience

1. Patient Identifier ID:
2. Which intervention group were you assigned to?
3. Telehealth
4. In-person visits
5. How many intervention sessions did you complete?
6. How satisfied were you with the intervention?
7. Very Unsatisfied
8. Unsatisfied
9. Neutral
10. Satisfied
11. Very Satisfied
12. Did you find the intervention content relevant to your needs?
13. Not at all relevant
14. Somewhat relevant
15. Moderately relevant
16. Very relevant
17. Extremely relevant
18. Did you find the intervention materials easy to understand?
19. Not at all easy
20. Somewhat easy
21. Moderately easy
22. Very easy
23. Extremely easy
24. Did the intervention meet your expectations?
25. Not at all
26. Somewhat
27. Moderately
28. Mostly
29. Completely
30. How likely are you to recommend this intervention to others?
31. Very Unlikely
32. Unlikely
33. Neutral
34. Likely
35. Very Likely

Impact Assessment

9. Did the intervention help you manage your mental health concerns?
10. Yes
11. Somewhat
12. No
13. How has your overall well-being improved since participating in the intervention?
14. Significant improvement
15. Moderate improvement
16. No change
17. Some decline
18. Significant decline

Service Utilization:

11. Did you utilize any additional mental health services during the intervention period?
12. Yes
13. No
14. If you utilized additional services, how would you rate your experience?
15. Very Positive
16. Positive
17. Neutral
18. Negative
19. Very Negative

Thank you for completing this questionnaire. Your input is greatly appreciated!

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Appendix F: Data Collection Worksheet

Patient identifier	Date of contact with the clients
	Week 2	Week 3	Week 4	Week 5	Week 6	Week 7	Week 8	Week 9	Week 10	Additional services offered
Assigned numeric ID: Example 00001	Example 11/10/2023

 Appendix G: Healthcare Worker Decision Tree

Please find attached project rubrics and follow the instructions to complete it. I also attached my project topic and picot question, theoretical frame work, a sample of project which might be useful as a guide.

Please use at least 5 peer review nursing/psychiatric journals or texr books for the assignment. The project should be addressing Psychiatric patients in local/ rural comminities in New Jersey

The assignment should come under headings like

1. Project Scaffolding

2. Project design

3. Project method

It must be strictly on telehealth as an intervention stated on picot question. No deviation please.