1. 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.

2. Faculty Disclosure
The presenters of this session have NOT had any relevant financial relationships during the past 12 months.
You must include ONE of the statements above for this session.
CFHA requires that your presentation be FREE FROM COMMERCIAL BIAS. Educational materials that are a part of a continuing education activity such as slides, abstracts and handouts CANNOT contain any advertising or product‐group message.
The content or format of a continuing education activity or its related materials must promote improvements or quality in health care and not a specific propriety business interest of a commercial interest. Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the educational material or content includes trade names, where available trade names for products of multiple commercial entities should be used, not just trade names from a single commercial entity. Faculty must be responsible for the scientific integrity of their presentations. Any information regarding commercial products/services must be based on scientific (evidence‐based) methods generally accepted by the medical community.

3. 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

4. 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.

5. 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

6. Who do we see?

7. 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

8. 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

9. 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%)

10. Results: ACE v PHQ9

11. Results: ACE v PHQ9
First Administration
Second Administration

12. Results: PHQ9 By Ethnicity
First Administration
Second Administration

13. 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

14. 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?

15. 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

16. 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)

17. 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

18. 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 DOI: /fare © 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 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
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):
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.

19. Session Evaluation
Please complete and return the evaluation form before leaving this session.
Thank you!
This should be the last slide of your presentation