As one of the four new ATTCs that serve as national subject matter experts and key resources on selected focus areas, the National Hispanic and Latino ATTC is an example of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) commitment to reducing health disparities. This new focus area ATTC will capitalize on the Network’s experience in developing and enhancing the addictions treatment and recovery workforce.
Within this context, the Hispanic and Latino ATTC will work to develop the personnel who train the workforce that treats Hispanics and Latinos in need of treatment and recovery services. It will provide information on the latest research-based best practices and coordinate efforts with other ATTCs to promote health equity and culturally competent care for Hispanics and Latinos across the United States.
The US Census Bureau uses the label “Hispanic and Latino” to categorize individuals of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race (Humes, Jones, & Ramirez, 2011). However, the term Hispanic and Latino encompasses more than a label. In the United States Hispanics and Latinos consist of individuals from over 20 Latin American countries across the Americas (Chapa & Acosta, 2010). This is not a homogeneous population—Hispanics and Latinos are diverse group, representing a dynamic and fluid community dispersed throughout the nation. Rather then use the term “Hispanic” or “Latino,” members of this group are more likely to self-identify by their country of origin—for example, as Mexican, Puerto Rican, or Cuban.
In 2011, there were 52 million Hispanics and Latinos in the United States, composing 16% of the total U.S. population (US Census, 2011) and comprising the largest minority group in the country. Between 2000 and 2010, this population grew by 43%, from 35.3 million. With a growth rate almost three times the rate (14%) of the total U.S. population, it accounted for half of the nation´s population growth over the same period (Ennis, Ríos-Vargas, & Albert, 2011). The Census estimates the Hispanic and Latino population within the U.S. to increase to over 132 million, or 30.2% of Americans by 2050. Yet, information and effective services have not been developed in parallel to meet the needs of this rapidly growing population.
The U.S. Hispanic and Latino population is facing a public health crisis due to poorly met or unmet behavioral health needs (Chapa & Acosta, 2010). Access is hindered by the fact that one of every three Hispanics/Latinos (16 million) lacks health insurance, as compared to 11% of white, non-Hispanics and 20% of Afro-Americans. However, health reform is expected to increase health insurance coverage for at least six million Hispanics and Latinos. In fact, Hispanics and Latinos are poised to experience the largest increase in insurance coverage (18.2%) as compared to other ethnic groups and to the overall U.S. population (10.9%) (Clemans-Cope, Kenney, Buettgens, Carroll, & Blavin, 2012).
Rates of drug use and abuse have increased in the Hispanic and Latino population. In 2010, the rate of current illicit drug use was 8.1% among Hispanics and Latinos aged 12 or older (SAMHSA, 2011). The National Survey on Drug Use and Health indicates that 9.7% of Hispanics and Latinos (12 years and older) reported substance dependence or abuse during the past year (SAMHSA, 2011). Treatment admissions for Hispanic and Latinos have increased from 9.9% to 13.8% since 1992 to 2009, with PCP and amphetamines reported as the most frequently abused substances (Substance Abuse and Mental Health Data Archive [SAMHDA], 2012).
This population has been disproportionately affected and is over-represented in the national data on alcohol and other drugs addictions. Several states and local health departments with large Hispanic and Latino populations are concerned with this disparity and the lack of resources to address it. Despite the growing need of services, studies show that Hispanics and Latinos seeking addiction and mental health treatment confront many barriers to accessing culturally and linguistically competent care (Negron-Ayala, Delgado, & Cruz, 2006). Many of those accessing some level of care may leave treatment early because their needs are not adequately assessed and/or addressed.
Several studies have found that patients who are bilingual or who have limited English proficiency are evaluated differently when interviewed in English as opposed to Spanish, and that Hispanics and Latinos are more frequently undertreated (SAMHSA, 2001). Hispanics and Latinos often report experiencing distrust, discrimination, and linguistic and cultural barriers that lead to miscommunication, misdiagnosis, and culturally irrelevant and insensitive treatment practices (Guarnaccia, Martínez & Acosta, 2005). Also, the lack of a bilingual and bicultural behavioral health workforce plays a significant role in disparities across all key areas of behavioral health care service delivery (Chapa & Acosta, 2010).
Hispanics and Latinos need a diverse, multidisciplinary, bilingual, and bicultural behavioral health workforce, but there is a critical shortage of Hispanic and Latino health providers. In addition, this population frequently depends on service models and information that may succeed with non-Hispanic populations, but do not necessarily meet the needs or respond to the circumstances of Hispanics and Latinos. This mismatch between the population‘s needs and the service models available reduces access to and participation in drug treatment programs and lowers retention rates. It also hinders community strategies to remove cultural barriers and promote the use of culturally-appropriate, science-based addiction treatment models.
Some distinctive characteristics of the Hispanic and Latino culture have been associated with reducing substance abuse among its members: deep religious faith and strong family ties; placing a high value on children; strong extended family networks; and a high overall literacy rate. Incomes among Hispanic and Latino population have increased and tend to improve over the years, in part because most Hispanic and Latinos immigrants who come to the United States are highly motivated to work hard and improve their lives (L. Torres, personal communication, January 29, 2013). Hispanics and Latinos have many strengths for building and supporting wellness, resilience, and recovery. The Hispanic and Latino ATTC recognizes the importance of taking into account these strengths as critical elements of a culturally competent approach.
The urgent need for ATTC services among Hispanics and Latinos warrants an ATTC dedicated to meeting them. The Hispanic and Latino ATTC will strengthen the addictions treatment and recovery support systems available to Hispanic and Latinos, narrow health disparities, help the health system anticipate and meet the increased demand for services expected with healthcare reform, and promote system transformation.
The Hispanic and Latino ATTC will focus on developing products to train and support the workforce serves Hispanics and Latinos in need of treatment services. It will work to strengthen the workforce through diverse technology transfer strategies, services, and practices that have demonstrated effectiveness and are appropriate to Hispanic and Latino populations in need of treatment services. Also, by using culturally and linguistically-competent methods and strategies, the Hispanic and Latino ATTC will increase awareness of SAMHSA’s eight Strategic Initiatives among Hispanic and Latino populations. The Hispanic and Latino ATTC will integrate the Strategic Initiatives into its strategic plan and the suite of services it develops, ultimately infusing them into the addiction treatment and recovery services provided to Hispanics and Latinos.
The Hispanic and Latino ATTC will serve as the national subject matter expert and key resource for the workforce that provides treatment and recovery support services to Hispanic and Latino populations throughout the United States. It will work to reduce health disparities among Hispanics and Latinos, by maintaining relevant and up-to-date information and resources for training and technical assistance (TA). Other key goals include:
The ten Regional ATTCs are a critical part of the Hispanic and Latino ATTC effort. The Regional Centers will be direct partners in ensuring that Hispanic and Latino populations are seen as key and given priority among stakeholders, and are provided services through effective, culturally and linguistically competent strategies and services. The Hispanic and Latino ATTC will develop a suite of services specifically for the Regional Centers. This suite of services will promote the skills needed to deliver culturally competent practices for treating Hispanic and Latino people with substance use disorders. The Hispanic and Latino ATTC will also collaborate with the Regional Centers in applying innovative technology transfer strategies to develop and strengthen the workforce that serves Hispanics and Latinos in need of treatment services. By working closely with the Regional ATTCs to produce culturally appropriate training and tools, and through activities to promote development of a culturally competent workforce, the Hispanic and Latino ATTC will strive to achieve system transformation.
The National Hispanic and Latino Task Force Meeting in January 2013 marked the beginning of this important collaboration. Each Regional Center gave a brief presentation describing the Hispanic and Latino population, behavioral health care needs and disparities it faces, and the treatment capacity and training needs of the workforce serving Hispanics and Latinos in its respective region. The Task Force Meeting provided valuable information that will advance the development of the suite of services.
In addition to the collaboration with the Regional Centers, the Hispanic and Latino ATTC receives support and advice from an Advisory Board and a Panel of Experts—a group of leading professionals representing research, policy, mental health, credentialing, recovery community and substance abuse treatment. The Board and the Panel of Experts will provide direction and guidance regarding project outcomes and will provide up-to-date and relevant resources and information on Hispanic and Latino health disparities, lending their expertise to the Hispanic and Latino ATTC’s efforts toward system transformation.
Get to Know the National Hispanic and Latino ATTC!
Attend the ATTC Network’s Third Thursday iTraining
March 21, 2013, 2:00-3:30p.m. Eastern
Presenters: Darice Orobitg, PhD, and Victor Flores, MC, LAC
For more information please visit our website: www.attcnetwork.org/hispaniclatino
Digmarie Alicea-Santana, PhD
Product Planning and Development Coordinator
National Hispanic and Latino ATTC
Miguel Cruz, MS, PhDc
Associate Director
National Hispanic and Latino ATTC