Kevin Dedner, Hurdle Health, on cultural humility in mental healthcare
In this episode, we sat down with Kevin Dedner, Founder & CEO of Hurdle Health. Based in Washington D.C, Hurdle Health provides culturally intentional teletherapy to eliminate barriers that make it harder for people of color to get mental healthcare. Kevin recently published his first book, “The Joy of the disinherited: Essays on oppression, trauma, black mental health”, on the ways racism impacts mental health. An award winning public speaker, Kevin has over 20 years of public health experience. He is a graduate of the University of Arkansas in Fayetteville, and also has a Master’s of Public Health from Benedictine University in Illinois.
- Kevin’s personal struggles with finding culturally responsive mental healthcare as the motivation for founding Hurdle.
- Hurdle’s emphasis on training its therapists in cultural humility to provide more efficacious mental healthcare for low to moderate-acuity patients.
- How minority founders must build a solid business plan instead of only following a vision and nurture mentor relationships to raise capital and overcome systemic barriers for launching successful companies.
Start to 7:30: An early dedication to public service
- An early interest in public service: When he was young, Kevin loved designing cities and playing Hot Wheels. This sparked his interest in becoming an architect to construct cities in a way that would provide a high quality of life for everyday citizens.
- Exposure to public health: Kevin began his career in public service, but quickly became disillusioned at the politicization of the work. Pivoting away from public service, Kevin took an advocacy role at the American Cancer Society and through this gained exposure to public health. Public Health became a focal point of Kevin’s career as he enjoyed the ability to help others address the critical issue of healthcare.
- On the motivation to found Hurdle: Years after founding a company that provided consulting services on public health topics, Kevin suffered from burnout and mental exhaustion. This culminated in depression. For support, Kevin searched for a therapist who could help him tackle his challenges. However, Kevin struggled to find a culturally responsive therapist. Hurdle was born out of a deeply personal recognition of the challenges of finding a culturally competent therapist and how few resources are available for ethnic minorities struggling with mental health.
“This company is born out of my own experience interacting with the mental health system. And what I know for sure is that it doesn’t feel good to sit in therapy and talk about your experiences in life and the person sitting across from you looks like a deer in headlights and they’re asking you questions that seem to be challenging your truth and what you’re experiencing.”
7:30 to 30:07: Deep dive into Hurdle Health
- The challenge: Studies show that therapy will fail for ~50% of ethnic minorities compared to ~33% of white patients. The lack of therapists who can service the diversity of cultures in the American population is one driver of the limited efficacy of mental healthcare services.
- Tackling invisible barriers to care: Mental healthcare services in the U.S. have been deficient in serving ethnic minorities in many ways. In 2018 when Kevin founded Hurdle, only 3–4% of therapists identified as people of color. Since then, more ethnic minorities have entered psychology although many ethnic minorities today still have limited access to these therapists. In addition, the predominantly employer-based model of health insurance in the U.S. restricts the providers many Americans can engage. Furthermore, the need to apply to practice in different states also prevents top therapists from serving patients living outside their geographic domain.
- Hurdle’s core offerings: Hurdle provides culturally intentional teletherapy services. Hurdle therapists are trained in evidence-based practices that prime them to be culturally responsive and develop cultural humility. Hurdle’s phone-based app also sends members daily motivational messages and meditation prompts to provide further engagement between therapy sessions. Hurdle also offers an enterprise solution through facilitating workshops that help companies understand internal culture gaps and diversity issues. Hurdle currently operates across 6 states, including Washington, D.C., Maryland, Virginia, Texas, California, and Massachusetts.
“The thesis of the company is that in the current system, the way that we deliver care is inappropriate for diverse populations.”
- On Hurdle’s therapists: Hurdle currently engages a hybrid model of contractors and full-time therapists. Given Hurdle’s mission of improving the cultural know-how of therapists, training its therapists to be prepared for a wide range of cultural issues and nuances is critical. In fact, one key factor differentiating Hurdle from competitors is its unique training program. Hurdle therapists receive core training supported by ongoing supplemental training across a wide range of cultural dilemmas. Therapists can also request separate consultations for unique cases.
- Challenging the paradigm for culture training: One bias in mental healthcare is therapists who share the same demographic profile as their patients generate better clinical outcomes because patients feel more comfortable sharing information with them. While studies have shown that racial match between the patient and the therapist is important for minority patients, Hurdle believes that creating a consistent training plan focused on cultural sensitivity and humility enables therapists who do not resemble their patients to be equally effective at achieving clinical outcomes. Not only does this allow Hurdle to hire across a larger base of potential therapists, but this approach also does not assume that culture is static and can be “taught” through a set of seminars. Hurdle therapists learn how to listen to patients and in a way that doesn’t invalidate the patient’s experience.
“What we’re seeing is, because of the way that we support our therapists, our clients are persisting in therapy two to three times the historical national averages. When we think about what that means, particularly among minorities who have been more likely to experience mental health problems. If they’re not dropping out too early, they are going for the long haul and working to meet their clinical outcomes.”
- On tracking efficacy: Hurdle tracks the patient’s length of stay in care as well as clinical indicators to measure how effective the teletherapy program is at improving the health outcomes for patients. Length of care is a proxy for how much treatment patients seek before they no longer require further care.
- Focusing on low to moderate-acuity patients: Hurdle’s solution is not meant for high acuity patients who require the support of a psychiatrist and medical prescriptions. Hurdle’s offering is supplemental care to more clinically intensive therapies. At first, the choice to deliver care that is not clinically intensive evolved from the logistics of launching the business. Hiring Master’s level psychologists and social workers without needing the licensure for online prescriptions enabled Hurdle to launch more quickly. Now, Hurdle has found a niche serving low to moderate-acuity patients and is intentionally crafting solutions for this patient segment.
“We do members a disservice by leading them to believe that the only persons who can be sensitive or empathetic to their challenges have to look like them. That’s where this idea of cultural humility and cultural responsiveness becomes a superior idea to matching people [based on race or ethnicity].”
- On adopting a commercialization model to promote accessibility: Hurdle initially launched as a direct-to-consumer offering, while also establishing relationships with payers and employers. Given most people in the U.S. receive health insurance through their employers and many of these employers also provide their health insurance, getting insurance coverage for Hurdle was essential in enabling more patients to affordably access this service. Cultivating commercial relationships with payers and employers has been a key aspect of Hurdle’s strategy for scaling and reaching more patients.
30:07 to 37:17: On the fight for equal access to mental healthcare
- On the crowded landscape: Today, the mental healthcare space is crowded with startups and incumbents working to address a wide array of patient needs. The impact of the COVID-19 pandemic and various social movements such as the one that mobilized around the killing of George Floyd generated greater public awareness for mental health services, including services for minorities. Kevin predicts the industry will consolidate in the near-term as companies that demonstrate clinical efficacy build greater traction with payers and employers.
- More work needed to ensure equal access: Figuring out a way to provide quality mental healthcare access to all Americans has been and continues to be a significant challenge. Mental healthcare is regulated at the state level, and every state has distinct laws governing service requirements and reimbursement schedules. Key federal legislation, such as the Mental Health Parity Act Patrick Kennedy authored, have helped push the industry in the direction of instituting more consistent guidelines for mental healthcare access across states. However, more work is needed to ensure all Americans have tangible access to high quality and culturally relevant mental healthcare. In reaching this milestone, both the private sector and the public sector play important roles.
- The gap in nominal vs. actual mental health parity: The federally sanctioned Mental Health Parity and Addiction Equity Act states that insurers must provide similar levels of coverage for mental health conditions as other ailments. While this law was recently reinforced in 2020 to ensure greater accountability that insurers are providing adequate mental healthcare coverage, in reality many patients are not receiving high quality mental healthcare services and may also be waiting 6 months to a year to receive full care.
- A solution to cross-state licensure: The state-specific licensures healthcare providers must attain have traditionally limited the ability for providers to quickly bring their service to Americans all over the U.S. During COVID, many states loosened these rules, issuing temporary waivers that permitted healthcare providers to practice across state lines. As the country learns to live with COVID, states have already started to wean off of these temporary waivers. In place of these temporary waivers, Kevin envisions a national compact where states can opt in and allow reciprocity of licensures amongst states that are all members of this compact.
“The important thing is to realize that culture is not a stagnant idea. Culture is a very dynamic and active idea that is pretty nuanced.”
37:17 to End: The challenges of succeeding as a minority founder
- On challenges minorities face when raising funding: Currently, black founders only receive ~1% of VC funding, with a majority of funding going to white male founders. Raising funding can be difficult for minorities from the outset because most businesses begin with financial support from family and friends. Many minority groups have lower levels of generational wealth than white peers, and are thus less able to raise the critical rounds of early funding that can set them up for greater success later on and struggle to propel their company to be more attractive to VC or institutional investors.
“Raising capital is especially challenging for minorities typically because of how generational wealth is structured in this country. The expectation is that you will have a circle of family and friends who can help get your company going. But if you don’t have a circle of friends who can write those very early checks, you can’t prove your concept out.”
- Mastering the art and science of raising capital: According to Kevin, raising capital is an art and a science. Founders must pick up on what investors are looking for to have productive conversations. Founders can also be flexible on how to run the business to ensure profitability metrics are met. In this way, companies should not lose sight of the practical in the sole pursuit of a vision.
- Finding mentors and joining accelerator programs help: Founders should proactively reach out to others who have successfully raised funding to seek advice. In doing so, founders should be able to communicate sharply and be accommodating to scheduling check-ins even if they fall on Sunday mornings. Though minority founders face systemic challenges in starting successful businesses, there are others a little further along who are willing to lend a hand.
“We have an incredible mission, but there will be no mission if we can’t figure out the business.”
- Courting investors as if this were a marriage: The first thing to do is research the investor and ensure that both parties feel comfortable working together. It’s also important to like each other. Would you be willing to take a Saturday morning call from the investor? What about getting stuck at the airport after a canceled flight? Fundamentally, a strong investor relationship relies on mission alignment and similar perspectives on where you collectively want to take the business.
- Advice to listeners: Be humble, and keep learning what you didn’t know yesterday. Many issues are nuanced and require further research.