Integrated Primary Care and Behavioral Health Services for Latinos: A Blueprint and Research Agenda

School of Social Welfare, University of California at Berkeley, Berkeley 94703, USA.
Social Work in Health Care (Impact Factor: 0.62). 02/2008; 47(4):438-54. DOI: 10.1080/00981380802344480
Source: PubMed


Disparities in Latino utilization of mental health services have been documented for some years. Factors such as stigma, low rates of health insurance, paucity of culturally competent providers, and linguistic inaccessibility have contributed to this underutilization. The documented tendency of many Latinos to experience the mind and body as a unified whole, often referred to as "non-dualism"; provides a unique opportunity to address these disparities in utilization. This article advocates a specific model of engagement of Latinos into a continuum of needed behavioral health services via the primary care clinic, and suggests a variety of clinical and administrative outcome measures for evaluating the effectiveness of the model. The model centers on the inclusion of a behavioral health specialist who is "nested" within the primary care team. The preparation and perspectives of clinically trained social workers make them ideal for this role.

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    • "For instance, services might be expanded to incorporate a broader range of settings and providers such that they are responsive to U.S. Latinas/os cultural preferences for help seeking (Acevedo-Polakovich et al., 2011; Hernandez et al., 2009). Typically , the expansion of services into settings that are not traditionally associated with mental health, such as schools and primary care settings, has rendered positive results in terms of engaging historically underserved groups, including U.S. Latina/o families, into services (Atkins et al., 2006; Manoleas, 2008). Latinas/os are more likely to seek help or advice regarding their children's mental health problems from friends, family, community members, or their medical doctors than to contact a mental health professional (Callejas et al., 2006; McMiller & Weisz, 1996). "
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    ABSTRACT: Left untreated, conduct problems can have significant and long-lasting negative effects on children's development. Despite the existence of many effective interventions, U.S. Latina/o children are less likely to access or receive evidence-based services. Seeking to build the foundation to address these service disparities, the current study used a Community-Based Participatory Research approach to examine U.S. Latina/o parents' perceptions of the need for interventions to prevent childhood disruptive behaviors in their community in general, and of an existing evidence-based intervention-parent-child interaction therapy (PCIT)-in particular. Results suggest that parents recognize a need for prevention resources in their community and value most of the core features of PCIT. Nevertheless, important directions for potential adaptation and expansion of PCIT into a prevention approach were identified. Results point to several goals for future study with the potential to ameliorate the unmet mental health needs experienced by U.S. Latina/o families with young children at risk for developing conduct problems. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychological Services 11/2014; 11(4):410-20. DOI:10.1037/a0036200 · 1.08 Impact Factor
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    • "Participants also described long-term mental health challenges such as depression and substance abuse, issues that have also been described in other studies with migrant men in NC (McQuiston et al. 2005). Latino migrants tend to underutilise mental health services for a variety of reasons, including stigma, lack of medical insurance, lack of knowledge and other access issues (Garcia et al. 2011; Manoleas 2008; Nadeem et al. 2007). These findings highlight the need for improved attention to mental health among migrants as a risk factor for HIV, especially in a new destination such as NC, where many migrants experience isolation and loneliness. "
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    ABSTRACT: Latino men in the Southeastern USA are disproportionately affected by HIV, but little is known about how the migration process influences HIV-related risk. In North Carolina, a relatively new immigrant destination, Latino men are predominantly young and from Mexico. We conducted 31 iterative life history interviews with 15 Mexican-born men living with HIV. We used holistic content narrative analysis methods to examine HIV vulnerability in the context of migration and to identify important turning points. Major themes included the prominence of traumatic early-life experiences, migration as an ongoing process rather than a finite event, and HIV diagnosis as a final turning point in migration trajectories. Findings provide a nuanced understanding of HIV vulnerability throughout the migration process and have implications including the need for bi-national HIV-prevention approaches, improved outreach around early testing and linkage to care, and attention to mental health.
    Culture Health & Sexuality 05/2014; 16(7):1-15. DOI:10.1080/13691058.2014.918282 · 1.55 Impact Factor
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    • "Although MedFTs' utility has been outlined in multiple venues with specific disease states and populations (Anderson et al. 2008; Davey et al. 2009; McDaniel et al. 2001; Phelps et al. 2009; Pratt et al. 2009; Willerton et al. 2008), no primary care model utilizing MedFTs in an integrated and/or consultant capacity with a non-targeted population, up until now, has been described in contemporary literature. It is worth mentioning that the unique and substantive contributions of this study are threefold; (a) an outline of how the provision of horizontally IPC services might look (Peek et al. 2009; Peek 2011), (b) a description of how a MedFT might specifically function in providing those services, and (c) while other researchers have discussed broad models of and/or principals regarding integrated care (e.g., Baird 1998; Gerada et al. 2000; Judd et al. 2004; Manoleas 2008; Robinson and Strosahl 2009; Robinson and Reiter 2007; Strosahl 1996; Williams et al. 2006), none have broken down the interactional sequence of events from initial patient contact to coordination of treatment to this degree of specificity. "
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    ABSTRACT: Abstract As the profession of marriage and family therapy (MFT), as well as the emerging sub-specialty of medical family therapy (MedFT), continue to grow and evolve within the current healthcare system, the arena of integrated primary care (IPC) presents an ideal environment for professionals who are relationally and systemically inclined. Although there has been a inundation of literature detailing collaborative systems of healthcare, several gaps still exist: (a) a lack of horizontally integrated models (i.e., models that do not target specific diseases or demographic populations), (b) a lack of model utilization regardless of disease trajectory (i.e., decline, stabilization, improvement), and (c) a lack of IPC models explicitly utilizing MedFT/MFTs as the mental health providers within the system. In lieu of these gaps, the authors present a framework for IPC, utilizing MedFTs/MFTs, that is neither population nor disease specific, as well as a model geared towards implementation regardless of disease trajectory. The framework, which was obtained using ethnography of communication, details MedFTs’ interactions with front line medical providers and patients from initial contact through coordination of a shared treatment plan. Recommendations for future research studies incorporating the use of MedFTs in integrated primary care settings are extended in the context of a three world view framework (Peek in Collaborative medicine case studies: Evidence in practice. Springer, New York, pp 25–38, 2008; Peek and Heinrich in Family Syst Med 13:327–342, 1995, Integrated primary care: the future of medical and mental health collaboration. Norton, New York, pp 167–202, 1998).
    Contemporary Family Therapy 06/2012; DOI:10.1007/s10591-012-9195-5
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