Characteristics of Latinos Seen In a PCBH Model and Session # B7 Characteristics of Latinos Seen In a PCBH Model and Differences In Utilization and Outcomes From Other Racial/Ethnic Groups. Catie Beck, LCSW, South Regional Lead, Behavioral Health Consultant Martha V. Saucedo, LCSW, Latino Engagement Lead, Behavioral Health Consultant Neftali Serrano, PsyD, Director of Clinical Training, Center of Excellence for Integrated Care Please insert the assigned session number (track letter, period number), i.e., A2a Please insert the TITLE of your presentation. List EACH PRESENTER who will ATTEND the CFHA Conference to make this presentation. You may acknowledge other authors who are not attending the Conference in subsequent slides. CFHA 18th Annual Conference October 13-15, 2016 • Charlotte, NC U.S.A.

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Learning Objectives Analyze and describe PHQ-9 and ACE scores reported by Latinos versus other racial/ethnic groups from 2015 data at a midwestern Community Health Center. Analyze and describe utilization data (behavioral health encounters) for this subset of patients. Describe the types of issues that this subset presents in contrast to other racial/ethnic groups. Include the behavioral learning objectives you identified for this session

Learning Assessment A learning assessment is required for CE credit. A question and answer period will be conducted at the end of this presentation. Please incorporate audience interaction through a brief Question & Answer period during or at the conclusion of your presentation. This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy accreditation requirements.

BHC Team at Access 1 in 5 patients met with BHC in 2015 17% of BHC visits were with children Over 5800 BHC visits in 2015

Who do we see?

2015 breakdown of patients seen by BHC in terms of gender: 59% Female, and 41% Male. These numbers are across clinic sites. Erdman: 42% Hispanic/ Latino Wingra: 22% Hispanic/ Latino WTE: 23% Hispanic/ Latino

Methods EHR data extraction of all patients screened with the ACE screener in initial screening pilot during 2015 year Included PHQ9 scores (first administration and most recent administration) BHC encounters Demographic variables (age, sex, ethnicity) Statistical analysis using Wizard software

Results: Descriptive Data Raw Ns: Hispanic (110), Caucasian (266), African-American (140) No difference in mean visits with BHCs (2.5 visits) Hispanics were slightly younger: Hisp (38), Caucasian (44), AA (42) Majority female samples across all groups (62%)

Results: ACE v PHQ9

Results: ACE v PHQ9 First Administration Second Administration

Results: PHQ9 By Ethnicity First Administration Second Administration

Findings There is not a significant relationship between PHQ9 scores and ACE scores, which means they are measuring different things Hispanics reported higher ACE scores statistically than African- Americans or whites While Hispanics have equivalent PHQ scores at the outset they have lower PHQ scores upon subsequent administration

Implications Measuring both ACE and PHQ are important since they address different aspects related to health/healthcare Latino immigrant groups may be at higher risk for ACEs Latino PHQ9 scores will vary somewhat more than other racial groups We can and should target trauma categories in pediatric populations, especially Hispanic families, to prevent ACEs Are higher ACEs for immigrant groups part of the reason for worsened health in the US for Latinos?

Other things to consider that the screeners don’t capture. Immigration. PTSD Unresolved grief Trauma that was not addressed, family separation or reunification, extended family Legal status - fear of deportation Acculturation

Other things to consider that the screeners don’t capture. Barrier to services ( Medical, safety, employment, education) Exposure to environmental violence in the country of origin. Physical and emotional abuse that is not a family member. Systemic discrimination and micro-aggression. Collective trauma? MH issues that manifest as somatic sx? (in terms of dep/anx)

Other things to consider Latino Resiliency (equivalent PHQ scores with other racial groups despite reluctance to take medication) Familismo: Family structure and cohesiveness Community Religious or spirituality

Bibliography / Reference The Role of Close Relationships in the Mental and Physical Health of Latino Americans. Jacob B. Priest1,* and Sarah B. Woods2,†. Article first published online: 4 MAR 2015. DOI: 10.1111/fare.12110 © 2015 National Council on Family Relation Assessing Racial/Ethnic Disparities in Treatment across Episodes of Mental Health Care. Health Services Research. Volume 49, Issue 1, pages 206-229. February 2014 Does Integrated Behavioral Health Care Reduce Mental Health Disparities for Latinos? Initial Findings. Bridges, A. J., Andrews, A. R., Villalobos, B. T., Pastrana, F. A., Cavell, T. A., & Gomez, D. (2014). Journal of Latina/o Psychology,2(1), 37–53. Perceived social support mediates anxiety and depressive symptom changes following primary care intervention. Dour HJ , Wiley JF , Roy-Byrne P , Stein MB , Sullivan G , Sherbourne CD , Bystritsky A , Rose RD and Craske MG Depression and anxiety, 2014, 31(5), 436 http://onlinelibrary.wiley.com.ezproxy.library.wisc.edu/o/cochrane/clcentral/articles/638/CN-01000638/frame.html Cumulative burden of lifetime adversities: Trauma and mental health in low-SES African Americans and Latino/as. Myers, Hector F; Wyatt, Gail; Ullman, Jodie B., Loeb, Tamara B; Chin Doroty; et at. Psycological Trauma: Theoery, Research, Practice, and Policy. 7.3 (May 2015): 243-251. Continuing education approval now requires that each presentation include five references within the last 5 years. Please list at least FIVE (5) references for this presentation that are no older than 5 years. Without these references, your session may NOT be approved for CE credit.

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