Outreach and Engagement to Latino Communities:

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Creating a Healthy Future for Us All
NAMI Convention July 6-9, 2009 San Francisco, CA
Outreach and Engagement to Latino Communities
Estrategies Con Sabor (Strategies with Flavor)
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Objectives
Participants will
1.   Participants will identify at least three
culturally grounded Latino values to consider in
Outreach/Engagement (O/E) to Latinos. 2.  
Participants will learn at least three examples
of organizational readiness related to the
development and implementation of O/E strategies.
3. Participants will learn at least three
examples of culturally based strategies
successful in bridging your organizations to the
community you serve.
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Mission Promote improved mental health for people
of Texas through the support of effective mental
health services, research, policies and
education.
Strategic Priorities Integrated Health Care
Cultural Competence Workforce Development
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What do we mean by Cultural Adaptation?

• Process of modifying MH/BH services to make it
  consistent with the client's culture.
• Any modification to an intervention that
  involves
• Changes to the intervention itself (approach to
  the delivery of the service)
• Adaptations that occur to engage or maintain
  participation in treatment or
• Changes that promote dissemination of the model
  within the agency/organization.

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Principles of Adapting

• Develop procedures to involve the population
  served in the process of adapting EBPs (in-depth
  interviews, surveys, focus groups, etc)
• Documentation of all adaptations
• Evaluate adapted version test its effectiveness
• Evaluate the integrity of the original treatment
  vs the adapted version

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CAI grant program
Lena Pope Home
Family Services of El Paso
Community Family Centers DePelchin
Childrens Center
Family Services of El Paso (El Paso) Lena Pope
Home (Fort Worth) Community Family Centers
(Houston) DePelchin Childrens Center
(Houston) Tropical TX Center (Edinburg)
Tropical TX Center
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Grantee Adaptation to the EBP Model Adaptation to Promote Access Participation Adaptation Within the Organization/Agency/ Community
LENA POPE HOME Staff identifying documenting metaphors (stories) that have particular meaning for African-American children and families that promote the interventions goals and objectives. This is a cultural adaptation. Strong parent component parent group that meets regularly. Empowered to make changes to outreach materials other processes based on parent feedback This is considered cultural adaptation. Incentives to participate. Important in ensure participation of low-income families. This is an adaptation, but not specifically a cultural adaptation. Reached out to local African-American faith-based organizations (i.e., churches) for referrals re-framing MH for Afric-Am families. This adaptation addresses stigma associated w/MH MH treatment that appear to be linked to Afric-Am religious beliefs and positions taken by clergy and congregations. Adaptation is under development appears to be a cultural adaptation. Case mgr to address basic needs of families, so clinical staff do not address these needs during therapeutic sessions. Effective adaptation that appears necessary because of the needs of the low-income families served, which could supersede therapeutic considerat- ions. The adaptation appears to be income-based, rather than cultural. LPH is part of a local collaboration of 50 mental health agencies provide referrals and support to LPH for implementation. Project aligned with and reports its results the Tarrant County System of Care, which gives it more visibility and likelihood of broader impact on African American families in the MH system county-wide. The intervention has not yet achieved significant impact or influence within LPH, but could do so because of where the project is situated organizationally and the authority of its administrative staff.
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Grantee Adaptations to the EBP Model Adaptations to Promote Access Participation Adaptations Within the Organization/Agency/ Community
FAMILY SERVICES OF El PASO The ten characteristics are familismo, respeto, presentismo, fatalismo, deferencia, formalidad, simpatia, machismo, marianismo, jerarquismo. Comparison group of subjects receiving treatment as usual this group will be compared to CA-EBP group to compare findings between both groups. Identified ten characteristics of Hispanic/ Latino families that impact therapeutic relationships in CBT. Trained its therapists and case mgr on characteristics and is now working to collect document information about how these intersect with intervention. This is cultural adaptation. Staff identify integrate dichos that have meaning for Hispanic/Latino clients into therapeutic sessions. Beginn- ing to collect these share w/staff regular staff mtgs facilitate discussion sharing of dichos used. This is cultural adaptation. FSEP is exploring the role of acculturation in CBT. PhD student administering acculturation scales and tracking outcomes. Evidence to date confirms culture is protective factor for depression. FSEP uses a case mgr to address the basic needs of families, so that clinical staff does not address during therapeutic sessions adaptation appears linked to the multitude of economic needs of the low-income families served does not appear specifically linked to Hispanic/ Latino families, although discussing the extent to which there is a culture of poverty, that has stable characteristics. FSEP made several changes prior to launching the CAI to promote access and participation, including moving to a more central location in , extending its hours to serve families, etc. The CAI is benefiting from these adaptations however, these do not appear to be principally cultural in character, but universal adaptations to better serve the Hispanics/Latinos in El Paso. All outreach and therapeutic materials are available in Spanish and English, which is a cultural adaptation that promotes access and participation. The CBT model is having a high level of dissemination penetration into the entire FSEP organization. All FSEP therapists (not just those in the CAI) now have CBT materials in their offices and have received information about CBT and some training in CBT, including special training. There is high demand from all staff to learn more about CBT and the adaptations being made. The Director and project staff have made and continue to make presentations on their CAI Projects processes and outcomes to mental health audiences in the city, region, state and nationally.

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Lessons Learned

• Community input/engagement
• -Interviews/Surveys/Focus groups/Advisory Boards
• Espanol por favorin a language que entiende y
  respeta la cultura
• Workforce
• Data
• Partnerships with CBOs, churches/faith based
  organizations, colleges/universities, etc

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Family Service Association of San Antonio,
Inc.The Neighborhood Place Edgewood (El Hogar
de los Vecinos)
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Family Service Association of San Antonio,
Inc.The Neighborhood Place Edgewood (El Hogar
de los Vecinos)

• Network of community services, supporting a
  community partnership approach promotes
  continuous and active working relationships with
  residents in surrounding neighborhoods.
• All services are provided in a culturally and
  linguistically appropriate and meaningful manner.
  
• Pilot project members from three zip codes
  (78207, 78237, 78228) receive specialized
  services supports

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Getting Started

• Bienvenidos (la primera experencia) feeling
  welcomed welcoming environment provide safe
  environment for families where they can learn and
  develop skills needed to enhance the quality of
  their life
• Cultural values confianza, respeto, familia,
  history/traditions (food), religion/spirituality
• Hours of operation responsive to community needs
• Cafecito y pandulce
• Platica
• Sharing of personal stories

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Estrategies Con Sabor (Strategies with Flavor)

• Info/education in their primary language
• Identifying inner strengths community
  resources
• Leadership development

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• Estrategies Con Sabor
• (Strategies with Flavor)

• Volunteer opportunities reception committee,
  social committee, community advisory group
• Family Night Event community suggests events
  that they will enjoy (loteria, movies, and
  picnics) Community decides on event assist with
  setting up and cleaning building their
  community
• Incentives gift cards and items (detergent,
  toiletries, etc.) in exchange for volunteer hours

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• Estrategies Con Sabor
• (Strategies with Flavor)

• Engagement exchange examples how to address
  concerns like
• - All I get here is paperworkhow is that going
  to help me?
• - I am afraid to seek help. People will think
  que estoy loco/a.
• - They told me taking medication will make me
  feel more sick.

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The Neighborhood Place Family Advocate Program
Program Impact
97 Success Rate Over a two years, The
Neighborhood Place has helped 2,159 family
members.  Only two of those cases have been
referred to Child Protective Services an
incredible 97 success rate in protecting
children.
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Lupe Morin Intake Coordinator / Family
Advocate Family Service Association of San
Antonio, Inc.The Neighborhood Place Edgewood
El Hogar de los Vecinos
Lmorin_at_Family-Service.org http//www.family-servi
ce.org/theneighborhoodplace/
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Hogg Foundation for Mental Health
Rick Ybarra Program Officer
Rick.ybarra_at_austin.utexas.edu http//www.hogg.ute
xas.edu/
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Creating a Healthy Future for Us All
NAMI Convention July 6-9, 2009 San Francisco, CA
Outreach and Engagement to Latino Communities
Estrategies Con Sabor (Strategies with Flavor)