Reducing Disparities in Identification and Treatment of Mental Health Disorders of Latino and Russian-speaking Primary Care Clients: a Community Health Work approach Multnomah County, OR

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Reducing Disparities in Identification and
Treatment of Mental Health Disorders of Latino
and Russian-speaking Primary Care Clients a
Community Health Work approachMultnomah County,
OR

• Sergiy Barsukov, BA, CHW, Marcela Dixon, CHW, and
  Graham Harriman, MA, LPC
• A Project Supported by the Center for Mental
  Health Services of the
• Substance Abuse Mental Health Services
  Administration (SAMHSA)

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Multnomah County Health Department

• County-run system of primary care safety net
  clinics part of public health department
• Portland, Oregon and suburbs 675,000
• 7 clinics serving approximately 26,000
  patients/year, 99 below 200 of poverty
• 44 Hispanic
• 11 identify Russian as their first language

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Environment

• Primary care clinics under-diagnosing mental
  disorders in Latino and Russian-speaking patients
• When mental disorders identified, barriers
  connecting to community system of care

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Utilization of Community Health Worker Approach

• Use of CHWs effective at reaching clients
• Empower community members to identify own needs
  and help them to find solutions to their problems
• Relationship based on common culture, language
• Located in primary care setting for ease and
  availability

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MH Disparity Project CHW Tasks

• Act as cultural mediator between provider and
  patient
• Screening and education with patients
• Lead Chronic Disease Self Management Groups
  (Lorig)
• Assist with problem solving, referrals
• Prepare clients for referral to mental health
  specialists

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Community Health Work with Russian Clients
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Russian/ Ukrainians in Portland, OR

• Immigration increase began in 1988
• Currently 60,000 Russian speaking immigrants in
  Portland metro area
• First group of immigrants came to the US due to
  religious persecution in former Soviet Union
• Majority of these immigrants are Pentecostal
  Christians

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Common Themes of Russian Speaking Clients

• Acculturative Stress
• Religion
• Mental Health Stigma

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Chronic Disease Self Management (Lorig et al) in
Russian

• Two Pilot Groups
• Client evaluation verbal and written
• Pre/Post group assessments
• Patient Satisfaction
• Patient Self Reported Results

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Community Health Work with Latino Clients
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Latino Clients in Portland, OR

• 87 increase in Latino population in last 10
  years
• 50,000 Latinos in Portland metro area,
  approximately 62 are of Mexican origin

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Common Themes of Latino Clients

• Many Latinos are living binational lives
• Poverty, acculturation, domestic violence
  isolation are common issues
• Language issues are common barrier to care
• McGlade, M, Dahlstrom, M. Salir Adelante A needs
  and assets assessment of the Hispanic community
  of Multnomah County(2000)

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Tomando Control de Su Salud (Lorig)
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How is it helpful?

• Teaches self care management through the use of
  popular education tools.
• appropriate use of medication
• effective communication with friends/ health
  professionals
• CHW empowers the client by helping them to manage
  and foster a better understanding of chronic
  disease without limitations of language barriers
  and cultural competency

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Behavior Changes

• Eating habits
• Exercise routines
• Self initiated health interventions
• Increased patient/physician communication skills
• Increased management of acculturation
• Increased confidence engaging new people and
  supporting one another with their chronic
  condition
• Less inhibition to search for services that will
  help them feel better

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Learnings

• Religious/cultural beliefs create special
  challenges to delivering mental health treatment
  which CHWs can address effectively
• Providing mental health services in primary care
  clinics produce clinically significant results
  for Latino patients and Russian-speaking refugees
  diagnosed with depression
• Community Health Workers are a recognized and
  valued component of clinical support especially
  their ability to do outreach, education, referral
  and assistance services