Creating Confianza: Addressing Stigma through Trust and Access Mimi V. Chapman, MSW, Ph.D. presenting on behalf of the Confianza Team: UNC Chapel Hill, El Futuro and Chatham County Schools Funded by the Robert Wood Johnson Foundation, Caring Across Communities Initiative

Our Purpose The goal of Confianza is to design a new service delivery system for new immigrant and Spanish-speaking middle and high school youth and their families. The goal of Confianza is to design a new service delivery system for new immigrant and Spanish-speaking middle and high school youth and their families.

School Characteristics Chatham Middle School Chatham Middle School 64% Latino students 64% Latino students 8% Latino teachers 8% Latino teachers 89% of students qualify for free/reduced lunch 89% of students qualify for free/reduced lunch Jordan Matthews High School Jordan Matthews High School 36% Latino Students 36% Latino Students 6% Latino teachers 6% Latino teachers 58% of students qualify for free/reduced lunch 58% of students qualify for free/reduced lunch

Service Use Patterns (n=164) Importance of Getting Help Importance of Getting Help 98% say that it’s important to get help for emotional and behavioral problems 98% say that it’s important to get help for emotional and behavioral problems 99% say would probably get help for kid displaying problems 99% say would probably get help for kid displaying problems Barriers to getting Intervention Barriers to getting Intervention Time Time 77% worried that they would not have enough time in general 77% worried that they would not have enough time in general 94% worried they would not have enough time to go to appointments 94% worried they would not have enough time to go to appointments 70% reported that they would have to miss work to take their adolescent 70% reported that they would have to miss work to take their adolescent Cost Cost 72% worried about the cost of services 72% worried about the cost of services Of those who were concerned about the cost: Of those who were concerned about the cost: 76% had no insurance 76% had no insurance 17% worried that their insurance would not cover services 17% worried that their insurance would not cover services Information Information 80% stated that they did not know who in their community helped adolescents 80% stated that they did not know who in their community helped adolescents 40% wished that their community offered different types of services. Of those: 40% wished that their community offered different types of services. Of those: 35% wished for more professional helpers/career counseling, 35% wished for more professional helpers/career counseling, 27% for more recreational 27% for more recreational 28% prevention programs, 28% prevention programs, 0% said traditional/cultural healer 0% said traditional/cultural healer

Service Use (Continued) Culture Culture 27% would find it difficult to speak with someone outside their family about personal issues 27% would find it difficult to speak with someone outside their family about personal issues 22% said it was difficult to ask for help 22% said it was difficult to ask for help 23% said they would feel shame asking for help 23% said they would feel shame asking for help 12% worried about what their family would think 12% worried about what their family would think 10% worried about what their friends would think 10% worried about what their friends would think 11% worried about what other people would think 11% worried about what other people would think To Best Help, Helpers Should: To Best Help, Helpers Should: Speak their language Speak their language 81% say language is important or very important 81% say language is important or very important 9% say language is not important at all 9% say language is not important at all Understand their culture Understand their culture 68% say cultural understanding is important or very 68% say cultural understanding is important or very 21% say it would not be important at all 21% say it would not be important at all

Are they getting services? Only 3% of parents said adolescents have received mental health services.

Confianza Update 150 students served 150 students served 3 additional schools 3 additional schools 5 Parent Nights (20-30 parents attending) 5 Parent Nights (20-30 parents attending) Newsletter – Spanish/English Newsletter – Spanish/English Finalist for additional Teacher Training funding Finalist for additional Teacher Training funding Sustainability discussions beginning. Sustainability discussions beginning.

What Types of Student & Family Needs? Pregnancy Pregnancy Inhalant Use Inhalant Use Cutting Cutting Depression Depression Pre-gang involvement Pre-gang involvement Anxiety Anxiety ADHD ADHD Trauma Trauma Adjustment to a New Environment Adjustment to a New Environment Family Concerns Family Concerns Parent Concerns Parent Concerns Child Maltreatment Child Maltreatment Domestic Violence Domestic Violence Parental Substance Abuse Parental Substance Abuse Unaccompanied Minors Unaccompanied Minors

The Past is Always Present…

Caring Across Communities?

What makes a successful interventionist: Boundary Spanning. Concept from organizational theorists. Concept from organizational theorists. Successful organizations have porous boundaries that incorporate new information. Successful organizations have porous boundaries that incorporate new information. Boundary spanners are people who link their organization to the external environment. Boundary spanners are people who link their organization to the external environment.

Qualities of Effective Boundary Spanners. Systems thinkers Systems thinkers Abstract thinkers. Abstract thinkers. High Tolerance for Ambiguity. High Tolerance for Ambiguity. Negotiate goals with outsiders. Negotiate goals with outsiders. Meaning-Makers Meaning-Makers Stimulate reflection, assessment, & creativity. Stimulate reflection, assessment, & creativity. Leadership Leadership Must have authority to implement their ideas. Must have authority to implement their ideas. Speak multiple “languages”. Speak multiple “languages”.

Changing the Environment: What We Planned to Do… A training directed to teachers and other school personnel to create a school environment that is receptive to newcomers. A training directed to teachers and other school personnel to create a school environment that is receptive to newcomers. Beyond Diversity/ Courageous Conversations by Pacific Education Group Beyond Diversity/ Courageous Conversations by Pacific Education Group “consider the implications of racism, exclusion, and prejudice” on students by focusing on personal self-awareness.” “consider the implications of racism, exclusion, and prejudice” on students by focusing on personal self-awareness.” Personal views of power, privilege, and the impact on school climate. Personal views of power, privilege, and the impact on school climate.

What Actually Happened... Riding around with the school resource officer. Riding around with the school resource officer. Having meetings in Spanish with key staff members listening through simultaneous translation. Having meetings in Spanish with key staff members listening through simultaneous translation. Helping a new ESL teacher know how to respond to charges of “racism.” Helping a new ESL teacher know how to respond to charges of “racism.” Telling teachers youth stories when youth can’t tell their own. Telling teachers youth stories when youth can’t tell their own. Change in school leadership. Change in school leadership.

Thank You! Questions and Comments?

Acknowledgements Robert Wood Johnson Foundation Robert Wood Johnson Foundation Julia Lear for allowing me to adapt her slides on school context for this presentation. Julia Lear for allowing me to adapt her slides on school context for this presentation. Confianza Partners: El Futuro, Chatham County Schools, The Chatham School- Based Mental Health Work Group Confianza Partners: El Futuro, Chatham County Schools, The Chatham School- Based Mental Health Work Group

Context: the School Setting  School system -- locally & state driven and funded. Federal government pays about 10% cost. States & local governments, and private sources provide 48%, and 9% respectively.  Local communities and individual schools often take active roles in deciding what programs and services are allowed in schools. Incorporate targeted interventions for particular issues (i.e. complex trauma, unaccompanied minors) Incorporate targeted interventions for particular issues (i.e. complex trauma, unaccompanied minors) Bring in additional community members. Bring in additional community members.

What Makes Confianza Special? Data-driven Data-driven Uses the expertise of a local mental health group– El Futuro. nc.org/index.htm Uses the expertise of a local mental health group– El Futuro. nc.org/index.htmhttp:// nc.org/index.htmhttp:// nc.org/index.htm Takes advantage of strong pre-existing relationships between agencies and the principal investigator. Takes advantage of strong pre-existing relationships between agencies and the principal investigator.

Local/State pay the majority of costs Local Communities/School decide what programs will be allowed.

School Mental Health Services: Decisions  Population-targeted v. individual- targeted?  What level of services to be offered? Prevention? Screening? Diagnosis? Short-term? Long-term?  Whose goals is mental health care in schools supporting - an education agenda or a mental health agenda?

Project Plan Three Pronged Effort Three Pronged Effort Create an environment that is welcoming to new immigrant youth Create an environment that is welcoming to new immigrant youth Foster increased awareness and knowledge of mental health difficulties (teachers/parents) Foster increased awareness and knowledge of mental health difficulties (teachers/parents) Provide services for early intervention, referral, and treatment. Provide services for early intervention, referral, and treatment.

Why Schools?  A school “base” overcomes access barriers for most children.  52 million American children and youth between ages 5 and 17 attend school; 90% attend public schools.  Perversely, economic and racial segregation in schools enables targeting to populations with particular needs and tailoring to be culturally synchronous.  Many school districts, especially the largest, have established mental health-service arrangements of some sort.

Providing Culturally Tailored Services School - Family Liaison School - Family Liaison Service Provision through El Futuro either at the Schools or El Futuro’s Siler City Office. Service Provision through El Futuro either at the Schools or El Futuro’s Siler City Office.

What’s Happened So Far. Served approximately 150 students since the start of the school year. Served approximately 150 students since the start of the school year. Had five parent discussion nights. Had five parent discussion nights. Instituted bi-weekly student assistance team meetings. Instituted bi-weekly student assistance team meetings. Incorporated targeted interventions for particular issues (i.e. complex trauma, unaccompanied minors) Incorporated targeted interventions for particular issues (i.e. complex trauma, unaccompanied minors) Brought in additional community players/stakeholders. Brought in additional community players/stakeholders.

Next Steps Continue Education/Discussion Forums for Parents. Continue Education/Discussion Forums for Parents. Begin Teacher Education/Discussion Forums. Begin Teacher Education/Discussion Forums. Project Newsletter Project Newsletter Focus on sustainability efforts/planning. Focus on sustainability efforts/planning.