By Maxine Henry, MSW, MBA
Co-Director, National Hispanic and Latino ATTC
This year’s Hispanic Heritage Month chose as a theme “A History of Serving Our Nation: Celebrating Hispanic and Latino American Culture, Heritage and Contributions” (hispanicheritagemonth.org, 2019). From September 15 through October 15 we will celebrate our culture, our music, our food, our traditions and everything that makes us the beautiful, vibrant community that we are.
This month we are also celebrating the first anniversary of the newly funded National Hispanic and Latino Addiction Technology Transfer Center (NHL ATTC), funded September 2018 by the Substance Abuse and Mental Health Services Administration (SAMHSA) and housed at the National Latino Behavioral Health Association (NLBHA) based in New Mexico. In 2001 NLBHA was established to fill a need for a unified national voice for Latino populations in the behavioral health arena and to bring attention to the great disparities that exist in areas of access, utilization, practice-based research and adequately trained personnel.
Hispanic and Latinos represent the largest minority population in the US, at 58.9 million or 18% of the entire population as of July 2017 (US Census, 2018). Furthermore, according to the Migration Policy Institute (2016) there was a “record number of 64.7 million people ages 5 and older in the United States [who] spoke a language other than English at home in 2015.” While representing a large portion of the entire US population, minorities as a whole make up only a fraction of professionals working to provide behavioral health needs. More specifically, minorities account for 19.2% of all psychiatrists, 5.1% of all psychologists, 17.5% of all social workers, and 10.3% of all counselors (SAMHSA, 2013). This obvious gap between a workforce made up of individuals who come from the same culture and speak the same language as the people who may likely need behavioral health services, creates an environment which breeds disparities in access to equitable care and outcomes that are positive and sustainable.
To address these disparities the NHL ATTC is focusing on a three overarching goals:
We recognized early on that these goals, while worthwhile and commendable, are not enough to move the needle toward the realization of tangible change for the better. Digging deeper into the specific needs of our communities, being bold in our delivery of training and technical assistance and building a more robust pipeline for Hispanic and Latinos to enter the professional field has to be done with innovation and transformation at the core of our work. We plan to do this for the behavioral health workforce in much of the same way other Hispanic and Latino leaders have done in the past in other sectors of society.
By taking up the torch and organizing communities with the goal to make change, much like that of Cesar Chavez and Dolores Huerta who were willing to take on the agricultural industry to make lasting change for farm workers. Being fearless in our willingness to make a call for action, just as Sonia Sotomayor, who has boldly taken on the honor of the first Latina to sit on the Supreme Court and is determined to make reforms to our criminal justice system. And being innovative and forward thinking with our efforts for changing the future for those who will lead the charge, such as the lesser known, but not any less impactful, Dr. Severo Ochoa who synthesized ribonucleic acid (RNA) and won the noble prize for his work in 1959 (hispanicheritagemonth.org, 2019).
These leaders are truly exceptional in their gifts and contributions, but they are not the exception in the Hispanic/Latino communities across the globe; instead they are the rule. Attributes derived from our culture, language, traditions, strong family ties and our faith ensure our diverse Hispanic/Latino communities can build they types of individuals and groups needed to blaze trails.
Our behavioral health workforce needs to address the cultural and linguistic needs of the entire spectrum of our population. This means addressing the assimilation, acculturation, country of origin, limited English proficiency and other factors that make up wide range of experiences in our community; factors that often lead to barriers when provider lack the knowledge and expertise needed for equitable care. We must create a workforce that can provide services in English, Spanish and Portuguese; that understands the importance of Curanderismo or Santeria in some sectors of our community; that understand Familismo and Fatalismo in all communities. By doing so, we build a workforce that uses some of our most valued protective factors to break down and overcome barriers.
Developing a linguistically competent workforce is not only done by hiring a bilingual person. We must help systems understand that if you provide a service in a different language, you MUST have a support system in place to effectively continue services in that language. This means, that just like we do for our general practitioners, we have to develop the support infrastructure for our language appropriate providers. System-wide support includes opportunities to receive training in their language, supervision in their language and forums for discussion and support by their colleagues in their language. With such a diverse community there is a tremendous amount of support that these practitioners will need as they deliver services in a language other than English.
A culturally competent workforce is one that is able to understand and address some of the other barriers experienced by Latinos. Often called the “Latino Paradox” or the “Immigrant Effect” Hispanic communities have seen steep declines in health and behavioral health outcomes the longer our families reside in the US (Carteret, 2016). This ‘paradox’ is attributed to experiences such as the inability to afford behavioral health services, lack of transportation, inability to take time off work to attend appointments, fear of questions about documentation, etc. For example, some ways in which we can address the `paradox’ is to offer services on a fee sliding-scale, building and supporting peer groups, offering services in the evenings or on the weekends, and other reasonable accommodations that will go a long way in engaging and supporting Latinos in behavioral health care. Studies have shown that integration of behavioral health care into health care services can reduce disparities for Latino communities (Bridges, et al., 2014).
Furthermore, we also have to develop and continue to validate the evidence-based practices that truly work in our communities, those that have been tailored to the unique needs of our communities. We must help those organizations that are using these practices be able to document their success, and their challenges, so can improve them in order to benefit other communities. And we cannot forget about our Promising Practices and Community Defined Evidence Practices, those that are providing great benefit but need support to be evaluated and measured to reach a level that can then be shared at a national level. Finally, and just as vital, we need to provide financial support for implementation and sustainability so communities can have lasting positive outcomes.
When it comes to addressing issues in terms of access, we must approach barriers at the individual, provider/agency, and system level. Engaging Latinos by educating them on behavioral health and reality of recovery can open the door to their willingness to access services. By preparing and building our workforce and improving our service delivery models we can better meet the individual needs. For providers, we need to not only train and support those who can deliver bilingual and bicultural services, we also need to change the perception of those providers who serve Latino communities so they can help eliminate the stigma attached to behavioral health issues. Finally, on the system level we need to increase recruitment of Latinos at both the collegiate and professional level. And once bilingual/bicultural providers are hired and culturally and linguistically appropriate services are offered delivery systems need to be supported with policy changes and financial backing to create lasting change.
Latinos tend to have positive outcomes when receiving high quality and equitable treatment services delivered in a cultural and linguistically appropriate manner. The NHL ATTC is committed to improving the lives of Hispanic Latino communities in the United States through honoring our culture, uplifting our leaders and eliminating health disparities. We look forward to partnering with our sister TTCs, other providers and community-based organizations throughout the nation in order to accomplish this goal.
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In recognition of National Hispanic and Latino Heritage Month, this article is also available in Spanish here.
Maxine Henry, MSW, MBA has been committed to improving access to and decreasing disparities in behavioral health services, especially for minority communities. Maxine’s work with the National Latino Behavioral Health Association (NLBHA) is focused on the delivery of culturally and linguistically competent services to several communities across the Country. Most recently, her role as the Project Co-Director for the National Hispanic and Latino Addiction Technology Transfer Center (ATTC) has allowed her to create access to culturally and linguistically tailored training and technical assistance to Latino communities and Latino serving communities. Much of her career has also been dedicated to providing peer-run services to those living with co-occurring mental health and substance use disorders; focusing on community defined needs and solutions. She resides in the Denver Metro Area in Colorado.
REFERENCES:
Bridges, A. J., Andrews, A. R., 3rd, Villalobos, B. T., Pastrana, F. A., Cavell, T. A., & Gomez,
D. (2014). Does Integrated Behavioral Health Care Reduce Mental Health Disparities for Latinos? Initial Findings. Journal of Latina/o psychology, 2(1), 37–53. doi:10.1037/lat0000009
Carteret, M. (2016). Addressing Disparities in Mental Health Care for Latinos. Retrieved from:
https://www.dimensionsofculture.com/2016/05/addressing-disparities-in-mental-health-care-for-latinos/
Hispanic Heritage Month. (2019). 2019 Hispanic Heritage Month Theme Announced.
https://www.hispanicheritagemonth.org/index.php/hispanic-heritage-month/88-hispanic-heritage-month-theme-2019
Migration Policy Institute. (2016). Language Diversity and English Proficiency in the United
States. https://www.migrationpolicy.org/article/language-diversity-and-english-proficiency-united-states
Substance Abuse and Mental Health Services Administration (SAMHSA). (2013). Report to
Congress on the Nation’s Substance Abuse and Mental Health Workforce Issues. https://store.samhsa.gov/shin/content//PEP13-RTC-BHWORK/PEP13-RTC- BHWORK.pdf
US Census. (2018). Hispanic Heritage Month 2018.
https://www.census.gov/newsroom/facts-for-features/2018/hispanic-heritage-month.html