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 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)

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

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

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

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

Community Health Work with Russian Clients

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

Common Themes of Russian Speaking Clients  Acculturative Stress  Religion  Mental Health Stigma

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

Community Health Work with Latino Clients

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

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)

Tomando Control de Su Salud (Lorig)

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

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

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