Why Disparity Impact Statements Matter
Across behavioral health and criminal justice systems, there are well documented disparities in services for and poorer outcomes among groups of different cultures or ethnic backgrounds, genders, and sexual orientations. To address these problems, it is important that agencies and institutions clearly understand the groups they serve and develop strategies to ensure that services and programs are delivered equitably.
Early diversion provides optimal opportunities for reducing criminal justice disparities, as it may result in individuals avoiding a criminal charge and the long-lasting collateral consequences that go along with a criminal case. Early diversion can also remedy behavioral health disparities by finally linking individuals to care when they may have previously lacked access to services and treatment. However, because implicit bias and other factors that increase the exclusion of certain groups may persist in the face of general measures, it is important to plan for and clearly outline how early diversion programming will be leveraged specifically to address disparities.
Disparity impact statements measure and inform how different services will be delivered to, and received by, underserved groups within the general population. These statements clarify what inequalities exist and outline plans to ensure that groups experiencing the disparities can attain the same level of access, quality of care, and positive outcomes as others in the served population.
To following along an example for the steps below, please refer to SAMHSA’s example statement at https://www.samhsa.gov/sites/default/files/disparity-impact-statement-example-services.pdf.
Steps to Developing a Disparity Impact Statement
Clarify the Intended Population
To start, create a table with the proposed number of individual to be served broken down into subgroups. These subgroups are generally organized by demographics that pertain to that geographical area: race/ethnicity, gender, and sexual orientation/identity status. The table should clearly show the number of individuals intended to be served within these different subgroups. It is important that documented disproportionality or disparities be taken into account when developing the proposed number of individuals to be served within the different subgroups. (Further discussion on collecting data to inform this process is discussed in the next section.)
In addition to the table, provide a narrative to describe context and explain the intended service population. Here, it is important to describe characteristics that may impact different groups’ access to care, such as the primary language spoken, access to transportation, physical disabilities, socioeconomics, etc. This will provide a rationale to explain why funds and efforts will be used to reach underserved groups at risk of not connecting with or benefitting from the program.
Develop a Quality Improvement Plan
Next, a plan should be briefly outlined for addressing the known disparities, including specific action steps and partners that will be involved. These plans should be developed in conjunction with knowledgeable and trusted stakeholders who represent the underserved populations. The plan should incorporate steps to remedy identified disparities and needs in the areas of access, use of services, and outcomes:
Equitable access to services includes:
- Culturally and linguistically appropriate providers of services
- Providers in geographically accessible locations
- Proper transportation to and from providers and services
Use of services
Equitable use of services includes:
- Availability of quality treatment options that are free of cultural bias
- A range of treatment options that accounts for health literacy and cultural/linguistic preferences
- Consistent rates of entering and staying in treatment for all groups served
Equitable outcomes include:
- Increased staff capacity to better serve the needs of disparate populations
- Improved quality of care for disparate populations
- Engagement with underserved populations
- Identified and addressed gaps in current services
In addition to having a plan to reach underserved groups, it is important to regularly check for adherence to the plan, progress, and resulting optimal outcomes. From a behavioral health lens, quality improvement is the process of systematically using data to inform and improve the ways care is delivered. There are several different quality improvement models that can be used as a framework to guide this process. At minimum, data should be gathered an analyzed to understand the accessibility of services, levels of utilization, and outcomes for the priority subpopulations with the group being served.
Programs utilizing evaluators to document and analyze processes and outcomes can leverage their work to assess for whether or not the program is implemented in a way that meets cultural and linguistic needs, provides high-quality and effective programming to underserved groups, and addresses behavioral health disparities.
Adhere to Culturally and Linguistically Appropriate Services (CLAS) Standards
The last step in creating a Disparity Impact Statement is to specify how the program will adhere to CLAS standards. The National CLAS standards are “intended to advance equity, improve quality, and work to eliminate health care disparities by establishing a blueprint for health care organizations.” The 15 standards center around the topics of responsiveness to diverse cultural health needs; governance, leadership, and workforce; communication and language assistance; engagement, continuous improvement, and accountability.
Adopting these standards can help reduce disparities found in the access to, use, and outcomes of services for individuals of various cultural backgrounds. Shaping a quality improvement plan towards implementing the standards that are not currently met by care providers is a next step in achieving equity. The Disparity Impact Statement should specify any particular National CLAS standards that the program will target and provide brief descriptions regarding that work.
For more information and support, please see the following resources: