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#BlackLivesMatter to C-L Psychiatrists: Examining Racial Bias in Clinical Management of Behavioral Emergencies in the Inpatient Medical Setting [Meeting Abstract]

Caravella, R A; Ying, P; Ackerman, M; Deutch, A; Siegel, C; Lin, Z; Vaughn, R; Madanes, S; Caroff, A; Storto, M; Polychroniou, P; Lewis, C; Kozikowski, A
Background: CL psychiatrists are uniquely positioned to combat structural racism in medicine Currently, there are no published papers examining racial bias in the management of psychiatric emergencies in the general medical hospital. Given the potential for restrictive clinical interventions that directly challenge a patient's autonomy (including intramuscular injections and restraints), our group embarked on a long-term, quality improvement project to detect and address racial bias affecting the clinical management of these psychiatric emergencies.
Method(s): Our institution has a multidisciplinary behavioral code team known as the Behavioral Emergency Response Team (BERT) that responds to behavioral emergencies throughout the medical hospital. Secondary BERT event data occurring from 2017 to 2020 was combined with demographic data from the electronic medical record. Race and ethnic data were collapsed into unique, phenotypic categories. BERT events were coded based on the most restrictive intervention utilized. Descriptive statistics were used to describe the sample and examine whether race / ethnicity correlated with BERT intervention utilized, diagnostic impression, reason for BERT activation, or recurrent BERTs.
Result(s): Our sample included 1532 BERT events representing N = 902 unique patients. The main interaction of BERT intervention by Race / Ethnic category reached statistical significance (p=0.04). Though most BERTs only required verbal de-escalation (n=419, 46.45%), 3% of BERTs (n = 29) escalated to 4-pt restraints (most restrictive intervention). Though reaching level 5 was rare, Black patients had a statistically significant higher likelihood of receiving this intervention compared with White patients (6% v 2%, p=0.027) and compared with all other non-Black patients (6% v 2%, p=0.040). Although the overall comparison for Race/Ethnicity and the diagnostic impression "Psychosis" did not reach significance (p=0.086), targeted analysis showed that Black patients were significantly more likely to have "Psychosis" listed as a contributing factor compared with White patients (p=0.009) and all other non-Black patients (p=0.016). Several other comparisons with Race / Ethnic category reached statistical significance: Age (p=0.048), and need for interpreter yes/no (p<0.001). Closer examination of the interaction of Race/Ethnicity x Need for Interpreter revealed that half of events involving Asian patients (n=22, 53.66%) and a third of events involving Hispanic patients (n=29, 30.53%) required interpreter services.
Discussion(s): This study demonstrates the feasibility of investigating racial bias in behavioral emergency management. The results of this preliminary analysis suggest multiple areas for enhanced education, self-awareness development, and programmatic improvement to target systemic racism, decrease racial bias, and improve patient care. These areas include bias in restraints use, the role of language in behavioral emergencies, and the influence of race on perception of underlying diagnosis.
Copyright
EMBASE:2019334423
ISSN: 2667-2960
CID: 5291782

The role of the on-call psychiatric consultant

Chapter by: Vaughn, Rubiahna L; Harris, Amanda Paige
in: On call : Psychiatry by Bernstein, Carol A [Ed]; Poag, Molly [Ed]; Rubinstein, Mort [Ed]; Ahn, Christina [Ed]; Maloy, Katherine F [Ed]; Ying, Patrick [Ed]
Amsterdam, Netherlands : Elsevier, 2019
pp. 6-13
ISBN: 9780323531092
CID: 4104932

Challenges Faced When Caring for Foreign Nationals With Comorbid Medical and Psychiatric Problems in the General Hospital

Vaughn, Rubiahna L; Stern, Theodore A
PMID: 29150211
ISSN: 1545-7206
CID: 2785122

Expanding the Pipeline: The New York University School of Medicine-University of Ghana School of Medicine and Dentistry Psychiatric Education Initiative

Vaughn, Rubiahna L; Smith, Lianne Morris; Bernstein, Carol A; Hansen, Helena; Ofori-Atta, Angela; Ohene, Sammy
As many low- and middle-income countries (LAMICs), Ghana is affected by a severe shortage of mental health specialists: there are 11 practicing psychiatrists for a population of 25 million. The pipeline for Ghanaian psychiatrists remains restricted for the foreseeable future given the low expressed interest in the field by junior medical trainees. The few senior psychiatric specialists are overextended with clinical and professional duties leaving them with minimal time to teach and mentor trainees. This limits opportunities for mentorship, modeling, teaching, and curricular development, leaving trainees with little exposure to psychiatric practice, and therefore, little motivation to enter a highly stigmatized and underresourced field. To support the training of Ghanaian medical students in psychiatry, the New York University School of Medicine-University of Ghana School of Medicine and Dentistry (NYUSOM-UGSMD) Psychiatric Education Initiative, and the NYU Global Mental Health Elective were formed (1) to provide educational support to medical students and residents at UGSMD and (2) to provide a sustainable international experience for NYUSOM residents with a strong interest in leadership in global mental health and underserved populations.
PMCID:5673107
PMID: 29118456
ISSN: 0020-7411
CID: 2771832

Toward a smoke-free Harlem: engaging families, agencies, and community-based programs

Northridge, Mary E; Scott, Gwendolyn; Swaner, Rachel; Northridge, Jennifer L; Jean-Louis, Betina; Klihr-Beall, Sandra; Vaughn, Rubiahna L; Pradier, Yvonne J; Vaughan, Roger D; Hayes, Roger; Caraballo, Ralph S
The aim of this collaborative public health study was to engage families, agencies, and programs in reducing secondhand smoke exposure in Central Harlem, New York City. Baseline interviews (n=657) and focus groups (n=4) were conducted with adult members of households with children who had asthma and asthma-like symptoms in the Harlem Children's Zone Asthma Initiative. The interviews concerned the prevalence and determinants of exposure of enrolled children to secondhand smoke. Key findings were that participants: (1) were generally aware of the hazards of secondhand smoke; (2) used strategies to reduce exposure to secondhand smoke in their homes; (3) believed that outdoor pollutants are sometimes just as bad for the health of their children as secondhand smoke; and (4) used smoking to provide stress relief and help diffuse otherwise volatile situations in their homes. The Harlem Smoke-Free Home Campaign was launched in October 2007 based in part on these findings.
PMID: 19202251
ISSN: 1049-2089
CID: 160799