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Race, Ethnicity and Gender Identity Discrimination in Access to Mental Health Care
Last registered on October 15, 2020

Pre-Trial

Trial Information
General Information
Title
Race, Ethnicity and Gender Identity Discrimination in Access to Mental Health Care
RCT ID
AEARCTR-0006560
Initial registration date
October 15, 2020
Last updated
October 15, 2020 5:23 PM EDT
Location(s)
Region
Primary Investigator
Affiliation
Tulane University
Other Primary Investigator(s)
PI Affiliation
Tulane University
Additional Trial Information
Status
On going
Start date
2019-11-22
End date
2021-12-31
Secondary IDs
Abstract
Using an audit field experiment, we seek to quantify the extent to which transgender women, transgender men, and racial and ethnic minorities (African American, Hispanic, Chinese people) face discrimination in access to appointments with mental health professionals (MHPs), i.e., therapists, counselors, and psychologists. Understanding the role of discrimination in access to mental health care is especially important given the mental health disparities that racial and gender minorities face: higher rates of anxiety, depression, substance abuse, PTSD, and suicidality. Using a popular online website, we request appointments from mental health providers, including psychologists, counselors, social workers, and psychiatrists. In these requests, we randomly assign names to signal race, ethnicity and gender, and we disclose the sender’s gender identity (i.e., transgender, non-binary, or cisgender), mental health concern (i.e., anxiety, stress, or depression), and insurance status. In this appointment request, we include both an email address and a phone number.
External Link(s)
Registration Citation
Citation
Button, Patrick and Luca Fumarco. 2020. "Race, Ethnicity and Gender Identity Discrimination in Access to Mental Health Care." AEA RCT Registry. October 15. https://doi.org/10.1257/rct.6560-1.0.
Sponsors & Partners
Sponsor(s)
Experimental Details
Interventions
Intervention(s)
Intervention Start Date
2020-01-28
Intervention End Date
2021-12-31
Primary Outcomes
Primary Outcomes (end points)
We record MHP responses to our email inquiries, as well as record and code any voicemails or text messages we receive. We categorize these responses into eight mutually exclusive categories, as well collapse these outcomes in a binary outcome variable. We consider all of these outcomes to be primary outcomes of interest

Mutually exclusive categories:
Appointment Offer (A): The MHP explicitly offer an appointment.
Call/Consultation Offer (C): The MHP offers to speak on the phone but does not explicitly offer an appointment.
Screening Questions (Q): The MHP requests additional information but does not explicitly offer an appointment.
Waitlist (W): The MHP offers to put the prospective patient on a waitlist.
Referral (R): The MHP gives a referral to an alternative provider but does not explicitly offer an appointment.
Rejection (X): The MHP rejects the client
No Voicemail (NV): We receive a phone call from the MHP’s phone number, but the MHP did not leave a voicemail.
No Response (NR): We do not receive a response from the MHP within one week.

These categories are collapsed in a binary variable that equals one if the MHP responded with an Appointment Offer or Call/Consultation Offer, and zero otherwise.
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)

Secondary Outcomes (explanation)
Experimental Design
Experimental Design
We conduct a matched pair email correspondence audit in which each MHP receives an email indicating the client is transgender and an email indicating the client is cisgender. Someone transgender identifies with a gender identity that does not exclusively match one’s assigned at birth. Someone who is transgender may identify as the “opposite” to one assigned at birth (e.g., a transgender woman was assigned male at birth), with both genders, or no gender, i.e., both transgender and non-binary (Liszewski et al., 2018). We signal transgender identity using some version of the following phrase: “I am a transgender woman and am looking for a trans-friendly therapist.” or “I am transgender man and am looking for a trans-friendly therapist.” A transgender woman has a feminine name whereas a transgender man has a masculine name. To signal non-binary identity, a client will reveal they are non-binary (i.e. “I am non-binary and am looking for a trans-friendly therapist.”) and including a signature line that signals non-binary status.
Experimental Design Details
Not available
Randomization Method
Randomization done in office by a computer.
Randomization Unit
Individual mental health practitioner
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
1,500
Sample size: planned number of observations
3,000
Sample size (or number of clusters) by treatment arms
1,500 mental health practitioners with treatment, 1,500 messages without treatment
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Hypothesis One: MHPs are less likely to respond to racial minorities than non-Hispanic white individuals. We will compare the relevant outcome for non-white individuals (Chinese, African American, and non-white Hispanics) to Non-Hispanic whites. Minimal Detectable Effect: 0.5 percentage point, based on total n = 3,000 with a baseline response rate of 67.4 (estimate from pilot study) Hypothesis Two: MHPs are less likely to respond to transgender and non-binary individuals than cisgender individuals. We will compare the relevant outcome for cisgender individuals to transgender and non-binary individuals. Minimal Detectable Effect: 0.5 percentage point, based on total n = 3,000 with a baseline response rate of 67.4 (estimate from pilot study) Hypothesis Three: MHPs are more likely to respond to individuals that reference private insurance or self-pay compared to those that reference Medicaid. We will compare the outcome for the inquiries that reference private insurance or self-pay to inquiries that reference Medicaid. Minimal Detectable Effect: 0.8 percentage point, based on total n = 3,000 with a baseline response rate of 67.4 (estimate from pilot study)
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
Tulane University’s Institutional Review Board
IRB Approval Date
2019-11-22
IRB Approval Number
Ref # 2019-1122
Analysis Plan

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