Image For Activity Cover
Equity and Access: The Self-Assessment for Modification of Anti-Racism Tool (SMART) and the Level of Care Utilization System (LOCUS)

Funding for the Striving for Excellence Series was made possible by Grant No. H79FG000591 from SAMHSA of the U.S. Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by SAMHSA/HHS, or the U.S. Government.       



The Self-Assessment for Modification of Anti-Racism Tool (SMART) (Talley et al 2021) is a quality improvement tool recently developed by the American Association for Community Psychiatry (AACP) to address structural racism in a variety of organizational settings, with particular emphasis on mental health. SMART builds on existing healthcare inequity frameworks (Spitzer-Shohat & Chin 2019; Metzl & Hansen 2014; Gomez et al 2016) by facilitating self-directed, stepwise quality improvement processes for eliminating discriminatory practices and policies. The Level of Care Utilization Services Tool (LOCUS) was developed by the AACP in 1996 to promote level of care decision-making processes that are unbiased, effective, and consistent with professional standards (AACP, 1996). In this presentation, panelists will describe the development, content, and implementation processes for the SMART and LOCUS. Panelists will engage the audience in an interactive discussion of the application of a SMART item and LOCUS to a case example and will present the results of a real-world application of the SMART process.


Recorded webinar.

Learning Objectives 

  • Describe the development and recommended implementation process for the SMART and LOCUS tools
  • Understand the barriers and facilitators to successful and equitable allocation of mental health care resources via a real-world example of SMART and LOCUS application
  • Gain concrete experience with system-level inequity assessment via interactive discussion of implementation of a SMART item

Target Audience 



American Association of Community Psychiatrists. (1996). Level of Care Utilization System for psychiatric and addiction services.

California Insurance Commissioner. (2020, December 10). Notice to All Insurance Companies re: “Enactment of Senate Bill 855 – Submission of Health Insurance Policies for Compliance Review”.

New York State Office of Mental Health. (2019, November 25). Guiding Principles for the Review and Approval of Clinical Review Criteria for Mental Health Services.

Talley RM, Shoyinka S, Minkoff K (2021). The Self-assessment for Modification of Anti-Racism Tool (SMART): Addressing Structural Racism in Community Behavioral Health. Community Ment Health J, 57(6): 1208-13

Spitzer-Shohat, S. & Chin, M. H. (2019). The “Waze” of Inequity Reduction Frameworks for Organizations: a Scoping Review. J Gen Intern Med, 34(4), 604-17.

Gomez, M.L., Charnigo, R., Harris, T.T., Williams, J.C., Pfeifle, W. (2016). Assessment of National CLAS Standards in Rural and Urban Local Health Departments in Kentucky. J Public Health Manag Pract, 22(6), 576-85.

Metzl J.M. & Hansen, H. (2014). Structural competency: theorizing a new medical engagement with stigma and inequality. Social Science & Medicine, 103, 126-33.

Instructional Level 


Estimate Time to Complete 

Estimated Duration: 1.0 hour 
Program Start Date: July 27, 2023 
Program End Date: July 27, 2026 

How to Earn Credit 

Participants who wish to earn AMA PRA Category 1 Credit™ or a certificate of participation may do so by viewing the live presentation and completing the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (other disciplines) showing the event date and hours earned. 

Continuing Education Credit 

In support of improving patient care, the American Psychiatric Association is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.  


The APA designates this live event for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.  

Faculty and Planner Disclosures 

The American Psychiatric Association adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CME activity — including faculty, planners, reviewers or others — are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity. 


  • Ken Minkoff, MD. Reports no financial relationships with commercial interests. 
  • Sosunmolu Shoyinka, MD, MBA. Reports no financial relationships with commercial interests. 
  • Rachel Talley, MD. Reports no financial relationships with commercial interests. 


  • Ken Minkoff, MD. Reports no financial relationships with commercial interests. 
  • Sosunmolu Shoyinka, MD, MBA. Reports no financial relationships with commercial interests. 
  • Rachel Talley, MD. Reports no financial relationships with commercial interests. 

Accessibility for Participants with Disabilities 

The American Psychiatric Association is committed to ensuring accessibility of its website to people with disabilities. Please contact the American Psychiatric Association at 202-559-3900, if you require assistance seven (7) business days prior to the start of a live webinar. 

Technical Requirements 

This internet-based CME activity is best experienced using any of the following: 

  • The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari 
  • Internet Explorer 11+ 

This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player. 

Optimal System Configuration: 

  • Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version) 
  • Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version) 
  • Internet Connection: 1 Mbps or higher 

Minimum Requirements: 

  • Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content 
  • Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content 

For assistance: Contact for questions about this activity | Contact for technical assistance 

Availability: On-Demand
Expires on 07/27/2026
Cost: FREE
Credit Offered:
1 CME Credit
1 COP Credit
Powered By