Conversation with Dr. Katherine Sanchez, Baylor Scott & White Research Institute

Fostering Inclusion Among Patient and Provider Populations

NIMHD’s Conversations with Researchers Innovating to Promote Health Equity

National Hispanic Heritage Month is September 15 – October 15 each year. As we celebrate the significant contributions to the United States—from its history through present day—by people who represent Latino/Hispanic communities, we recognize researchers who are promoting health equity through their work funded by NIMHD’s Small Business Innovation Research and Small Business Technology Transfer (SBIR/STTR) Program.

Meet Katherine Sanchez, Ph.D., LCSW, principal investigator in minority health and health disparities research.

Photo of Dr. Katherine Sanchez
Photo of Dr. Katherine Sanchez

Dr. Katherine Sanchez is a research investigator and director of diversity and inclusiveness in research for Baylor Scott & White Health’s Research Institute (BSWRI) in Dallas, Texas. She serves as the principal investigator (PI) for an NIMHD-funded Small Business Technology Transfer (STTR) program grant, TAPS-ESP: Tobacco, Alcohol, Prescription Drug, and Illicit Substance Use - Electronic Spanish Platform: Technologies to Increase Screening in Primary Care to Reduce Behavioral Health Disparities.

As a clinician-researcher, Dr. Sanchez has extensively investigated effective interventions to reduce behavioral health disparities and examined the role of cultural and linguistic competence in health care and behavioral health care delivery.

Dr. Sanchez has trained culturally diverse, bilingual social workers in evidence-based interventions. She is also the BSWH representative to the governing board of the Health Care Systems Research Network, a network of 20 non-profit healthcare delivery systems.

In addition to her NIMHD-funded STTR grant, she serves as the BSWH site PI for the NIH-funded Mental Health Research Network and the National Institute on Drug Abuse Clinical Trials Network Addiction Research Network for the Health Systems Node. Both networks utilize a population-based approach to transforming behavioral health care and bring together researchers and research departments from large and diverse health care systems.

During her 2019 fellowship with the National Institute of Mental Health Implementation Research Institute, she studied barriers in community practice to implementing evidence-based interventions in low-resourced settings to reduce the mental health treatment gap for disparity populations.

Q&A with Dr. Katherine Sanchez

What is your research goal, purpose, and aim?
I am a clinician-researcher, meaning I provide direct behavioral health services to patients and conduct research. I have extensive experience investigating effective interventions to reduce behavioral health disparities and an interest in the roles culture and language play in health care delivery.

Specifically, through the NIMHD SBIR/STTR-funded TAPS-ESP study, my team and I are enrolling 1,000 Spanish-speaking primary care patients to validate a substance use disorder (SUD) screening and brief assessment tool to utilize with tobacco, alcohol, illicit drugs, and non-medical use of prescription drugs. We hope our research will pave the way for the broad dissemination of the tool throughout the health care system.

My work also seeks to increase the number of providers who reflect the demographics of our communities by training culturally diverse, bilingual social workers in evidence-based interventions, thus improving access to mental health care.

My goals are:

  1. To increase the availability of effective, evidence-based treatments for populations who experience disparities in health care access and outcomes.
  2. To grow a workforce of well-trained, competent providers who reflect the communities we serve.

How is your work advancing the science and health of populations experiencing disparities? Are you seeing specific changes in particular communities or groups?
Accurate screening, diagnosis, and treatment are entirely dependent on linguistically accurate and culturally appropriate identification and assessment, especially for sensitive topics such as substance use. The lack of these contributes to health disparities, low patient satisfaction, and poor understanding of their disorders. Health disparities among ethnic and racial minority populations are amplified by comorbid substance use and psychiatric disorders. Despite the clear need for substance use screening tools available in Spanish, few are validated with Spanish-speaking people.

Additional known barriers to a more representative mental health workforce include:

  • Massive shortages and an inequitable distribution of providers
  • High costs and the need for scalability of training and supervision
  • Fewer acceptable treatment delivery channels
  • Less attention to social and structural drivers of health

In the communities where I work, there is an immense interest in exploring and understanding ways to task share interventions available through highly specialized providers to other, more accessible providers such as community health workers.

From the research you are doing, what has surprised you about the discoveries from your work and its impact?
We have been pleasantly surprised by how few patients meet the criteria for an SUD diagnosis in primary care settings. This finding does not suggest that SUD isn’t a concern in our populations, but it may indicate that the prevalence is lower in primary care than we expected.

On the other hand, it has disappointed me to discover the continued reluctance of many racial and ethnic minority populations to seek specialist mental health care due to stigma.

Barriers such as cost and inadequate health insurance are also key factors to address. One of the most significant findings in my research comes from investigating the use of the fotonovela, a traditional Mexican comic-book style print medium used to provide patient education.

There remains a persistent stigma related to accessing mental health care and the use of medication. Compounding the stigma, the burden of mental disorders has dramatically increased since the start of the COVID-19 pandemic. People who receive their preferred treatment–such as counseling instead of medication–show significantly higher treatment completion rates and achieve superior clinical outcomes.

What inspired you to become a researcher in minority health and health disparities?
As the third daughter of a Mexican-American immigrant mother in a single-parent household in El Paso, I was raised with a strong sense of obligation and interdependency. I entered the Ph.D. program at the University of Texas at Austin after 15 years of working as a bilingual clinical social worker, primarily in medical settings with uninsured, underserved Spanish-speaking people. During my years of clinical social work practice, I cultivated an interest in providing mental health services to monolingual Spanish-speaking people.

How do we encourage the next generation of scientists?
It is incumbent upon all of us to be intentional in how we recruit the next generation of scientists. These efforts must include an explicit focus on fostering research questions generated by members of the populations we serve and with the interests and needs identified by people from these populations at the center of our work. As my colleagues and I like to say, “in community, by community, and for community.”

The lack of diversity in clinical trials compromises the quality of health care delivered to those who are not represented adequately. Underrepresented groups have a higher prevalence of disease than the general population and may benefit the most from novel interventions or therapies. Failure to include adequate representation in a scientific workforce furthers inequalities in treatment and outcomes and perpetuates science that benefits a privileged few.

The next generation of scientists will be encouraged and passionate about research that is meaningful to the communities they are from and will lead to science that is trustworthy and relevant.

What do you envision as the future of minority health and health disparities research?
The future of health disparities research will require initiatives that support, facilitate, and foster the inclusion of historically underrepresented patient populations. Engagement with a diverse team of patients and stakeholders who are representative of their communities will promote inclusiveness in all clinical research in a manner that is appropriate to the scientific question under study. Inclusion helps to ensure that research findings are applicable to the entire population.

Page created Oct. 10, 2023