ASPIRE Project

Even though psychosocial distress is recognized as a key component of cancer-related treatment and survivorship, a 2022 review found that only 54.8% of cancer patients are screened for psychosocial distress, and Hispanic survivors were screened at lower percentages. The mental health impact of cancer is significantly worse for Latinos than for non-Hispanic Whites. Overall cancer-related disparities for Latina/os are disproportionately higher in Texas and the U.S. as compared to their peers. Health outcomes in counties around the Rio Grande Valley (RGV), a majority Hispanic population, fall in the bottom third of national health rankings, indicating lower access to care in general and higher unmitigated risk in health behaviors, health conditions such as cancer, and, access to mental health. Behavioral health integration in primary care is a reasonable solution to exponentially increase access to behavioral health services for patients and to support the already overwhelmed Primary Care Provider (PCP) workforce. The Alleviating Social and Psychological Ill-being Research and Evaluation (ASPIRE) study will implement the Primary Care Behavioral Health (PCBH) integration model in two underserved primary care clinics in the RGV, aimed at increasing access to behavioral health services for all health needs, with a targeted approach to eliminating disparities in mental health support for cancer survivors and patients. As a health services research initiative, the study will use the Reach, Effectiveness, Adoption, Implementation Fidelity, and Maintenance (RE-AIM) dissemination and implementation framework to examine the overall impact of PCBH services. Using a pragmatic trial approach, we will also evaluate a targeted 5-visit psychological flexibility intervention's impact on psychological and biological markers. Finally, we will use focus groups with patients and providers to examine the acceptability of PCBH services and interventions. The PCBH service aims to impact all biopsychosocial health-related needs in primary care and aims to help the populations efficiently self-manage their acute and chronic health conditions. Primary Care Behavioral Health (PCBH) integration is the most promising solution to mitigate fragmentation in care and advance timely access to behavioral health care in the RGV.