i-training March, 2013 Presenters:Darice Orobitg, PhD Victor Flores, MC, LAC

Definition of Hispanic and Latino According to the US Census Bureau, 2010: “Hispanic or Latino” refers to a person of Mexican, Cuban, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

16.7% of the total US population million Hispanic and Latinos. (US Census Bureau, 2010)

In the past decade, the Hispanic/Latino population has grown…

Dynamic community Diversity Disparity Needs Differences Whole

1 in 3 [16 million] Hispanics are health uninsured. Public Health Crisis

Hispanic and Latinos and Health Care Reform Expected to provide increased coverage of health insurance to at least 6 million Hispanics and Latinos. Hispanics and Latinos are expected to experience the largest increase in insurance coverage.

Hispanic and Latinos Drug Use/Abuse 9.7% of Hispanics (12yrs or older) reported substance abuse (SAMHSA, 2011)

Hispanic and Latinos Drug Abuse/Dependence Disproportionately Impacted. Over-represented in the data on addiction.

Disparity “A population is a health disparity population if there is a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality or survival rates in the population as compared to the health status of the general population.” Minority Health and Health Disparities Research and Education Act (2000). Health disparities are differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions that exist among specific population groups in the United States (NIH, 1999 as cited in NCI, CRCHD, 2013).

Health Disparities Hispanic and Latinos seeking addiction and mental health treatment confront barriers to accessing culturally and linguistically competent care. (Negron-Ayala, Delgado, & Cruz, 2006)

Barriers Language Culture Discrimination Misdiagnosis Workforce (Guarnaccia, Martínez & Acosta, 2005)

Workforce Lack of a bilingual/bicultural behavioral health workforce.

Workforce and Disparities Hispanic and Latinos are underrepresented in professions related to behavioral health.

Disparities Few service models developed for the Hispanic and Latino population.

Culturally and Linguistically Appropriate Services in Health Care The collective set of CLAS mandates, guidelines, and recommendations issued by the HHS Office of Minority Health intend to inform, guide, and facilitate required and recommended practices related to culturally and linguistically appropriate health services.

Cultural Competence Includes being able to recognize and respond to health-related beliefs and cultural values, disease incidence and treatment efficacy. (USDHHS & OMH, 2001)

Challenges Insufficient epidemiological data Inadequate representation of Hispanics in treatment research Incomplete assessments Biases, assumptions and stereotypes Misdiagnosis

Issues in treatment for Hispanic and Latino Populations Immigration may lead to: –Family dislocation, fragmentation and reconstruction –Culture change across generations Language Family difficulties Customary behavior Cultural sensibility Barriers. (CBHATTC, 2006)

Strengths and recovery capital Faith Family ties Literacy Work ethic

ATTC Priority Need

Purpose of the National Hispanic & Latino ATTC To develop and strengthen the workforce that provides addictions treatment and recovery support services to Hispanic and Latino populations across United States.

Primary Focus Population Service providers that offer training to the professionals servicing the Hispanic and Latino population. The workforce that provides addictions treatment and recovery support services to Hispanic and Latino populations.

Project Goals in Accordance with SAMHSA Initiatives

Project Goals

Goal 1 To serve as the national subject matter expert and key resource for the workforce that provides addictions treatment and recovery support services.

Goal 2 Ensure that Hispanic and Latino populations are seen as key and given priority among stakeholders (SSAs, local governments, addictions professionals, etc.) and provided services through effective, culturally and linguistically competent strategies and services.

Goal 3 Broaden the ATTCs scope on implementation practices and system transformation focusing on Hispanic and Latino effective and cultural competent practices.

Goal 4 To develop and strengthen the skills and capabilities of the workforce that provides addictions treatment and recovery support services to Hispanics and Latinos through innovative technology transfer strategies, so they overcome the health disparities that hinder their access to quality substance abuse disorders treatment.

To build a collaborative and communication relationship with other training, TA centers, and technology transfer providers to improve services and avoid duplication of efforts. Goal 5

Addressing Regional Needs

Partnerships and Collaborations Critical elements to reach the Center’s purpose. Three key groups: –ATTC Regional Centers. –Advisory Board. –Panel of Experts.

Partnerships Competencies Strategies Non duplication Delivery Strengthen ATTC Regional Centers

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References Caribbean Basin and Hispanic Addiction Technology Transfer Center. (2006). Cultural elements in treating Hispanic populations: Dialogue on science and addiction. Bayamón, PR: Author. Chapa, T., & Acosta, H. (2010). Movilizandonos por nuestro futuro: Strategic development of a mental health workforce for Latinos. National Resource Center or Hispanic Mental Health. Clemans-Cope, L., Kenney, G. M., Buettgens, M., Carroll, C.,& Blavin, F. (2012). The affordable care act’s coverage expansions will reduce differences in un insurance rates by race and ethnicity. Health Affairs, 31(5), doi: /hlthaff Dababnah, S. & Cooper, J. (2006). Challenges and opportunities in children’s mental health: a view from families and youth. Retrieved February 2013, from

De Navas-Walt, C., Proctor, B. D., & Smith, J. C. (2010). Income, poverty, and health insurance coverage in the United States: Washington, DC: U.S. Government Printing Office. Ennis, S. R., Ríos-Vargas, M., & Albert, N. G. (2011, May). The Hispanic population: Retrieved June 2012, from Guarnaccia, P. J., Martínez, I., & Acosta, H. (2005). Mental health in the Hispanic immigrant community: An overview. Journal of Immigrant and Refugee Services, 3, National Caner Institute (2013). Health disparities defined. Retrieved March 7, 2013, from National Council of La Raza [NCLR]. (2011). 20 FAQs about Hispanics. Retrieved 2012, from sked_questions_about_hispanics_in_the_us/ Negron-Ayala, J. L., Delgado, Y., & Cruz, M. (2006). Hispanic Initiative: Dialogue on Science and Addiction. Retrieved June 2012, from nitiative.pdf

S th Congress: Minority Health and Health Disparities Research and Education Act of (1999). In Retrieved January 23,2013, from Substance Abuse and Mental Health Data Archive [SAMHDA]. (2012). Treatment Episode Data Set - Admissions (TEDS-A), Retrieved from Substance Abuse and Mental Health Services Administration [SAMHSA]. (2001). Mental health: Culture, race, and ethnicity: A supplement to mental health: A report of the surgeon general. Rockville, MD: Author. Substance Abuse and Mental Health Services Administration [SAMHSA]. (2011b). Results from the 2010 National Survey on Drug Use and Health: Summary of national findings. Rockville, MD: Author.

United States Census Bureau (2010). Income, poverty and health insurance coverage in the United States: Retrieved February 20, 2013 from: html United States Department of Health and Human Services. The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for Phase I report: Recommendations for the framework and format of Healthy People Section IV. Advisory Committee findings and recommendations. Available at: United States Department of Health and Human Services, OPHS, Office of Minority Health (2001). National Standards for Culturally and Linguistically Appropriate Services in Health Care, Final Report. Washington, DC: Author United States Department of Health and Human Services, OPHS, Office of Minority Health. Hispanic/Latino profile. Retrieved January 2013, from:

National Hispanic and Latino ATTC Universidad Central del Caribe P.O. Box Bayamón, PR