3 - (SYM 103) Addressing Clinician Implicit Bias to Improve Equitable Implementation of Evidence-based Practice in School Mental Health

While school-based mental health has been shown to reduce care access disparities among youth, inequities in treatment engagement and outcomes persist (Whitaker et al., 2018). Healthcare providers' implicit bias has been identified as a significant contributor to disparate outcomes (Zestcott, Blair, & Stone, 2016) due to its negative impacts on the patient-clinician relationship and inequitable delivery of high-quality, evidence-based practices (EBP). The implementation of any EBP runs the risk of worsening existing health disparities due to disparate access and/or treatment effectiveness (Lion & Raphael, 2015). Clinician bias can be a critical and unaddressed barrier to implementation for any EBP. Although some implicit bias interventions for healthcare providers are emerging, studies have rarely included mental health professionals. In a previous study, we iteratively developed a brief (~45 minutes), interactive, self-paced Virtual Implicit Bias Reduction and Neutralization Training (VIBRANT)—an implementation strategy for promoting equitable adoption, penetration, fidelity, and sustainment of EBPs—with and for school mental health clinicians. In a small open feasibility trial (Liu, Coifman, et al., 2022), clinicians (N = 12) rated VIBRANT as highly usable, appropriate, acceptable, and feasible for their school-based practice. After completing the VIBRANT training, clinicians also demonstrated notable improvements in implicit bias knowledge (64.5% to 80.9% correct on an objective quiz). Moreover, 24 weeks post-training, clinicians evidenced increased use of bias management strategies and a downward trend in their implicit biases (as measured by the Implicit Association Test, Greenwald et al., 1998).

Based on these promising findings, we are now conducting a randomized pilot hybrid type-3 effectiveness implementation trial of VIBRANT with school mental health clinicians (target N = 80) and the Black and Latinx youths they serve (target N = 160). The current study will evaluate VIBRANT’s effectiveness as an individual-level equity-explicit implementation strategy for promoting the equitable adoption, penetration, fidelity, and sustainment of a particularly learnable and scalable EBP—Measurement-Based Care (the systematic collection of patient-reported progress data to inform clinical decision-making). This study is also designed to examine VIBRANT's impact on proximal mechanisms of change, including clinicians' implicit bias and clinician-youth therapeutic alliance.