1. Multnomah County Health Department Presented by: Consuelo Saragoza, Director, Community Health Promotion, Partnerships and Planning Linda Castillo, Bienestar de la Familia, Clinical & Program Supervisor Ruby Ibarra, La Clinica de Buena Salud, Community Health Specialist

5. Neighborhood Revitalization

6. Strategies  Identified Need  Build Partnerships  Long Term Commitment

7. Demographics  The Hispanic community in Multnomah County is now the largest group of color, representing almost 9% of the population in 2002  The Hispanic community has also been the fastest growing group in the County  The Hispanic population grew 78% between 1990 and 2002, when they numbered close to 59,000  Hispanics have among the lowest incomes in Multnomah County

8. Demographics  According to the 2000 Census, Hispanics had a median annual household income of just $32,244 in 2000, $11,000 below that of White non-Hispanics ($42,947)  In addition, 26% of Hispanics in Multnomah County lived in poverty in 2000, compared with only 10% for White non-Hispanics  Along with African Americans, they have the highest poverty rate of all racial / ethnic groups in the County  Despite their poverty, the Hispanic population nationally and in Multnomah County is healthier overall than the White non-Hispanic population, and does much better than White non-Hispanics on many health measures

10. Health Status Indicators  Examination of the 17 health status indicators for Hispanics, compared to White non-Hispanics, shows that in the 1990-1994 period, statistically significant health disparities (p<0.05) were found for seven measures: homicide, low birth weight babies, lack of early prenatal care, teen births, syphilis, gonorrhea, and chlamydia  The largest health disparities in the 1990-1994 period were for syphilis cases (almost 14 times higher for Hispanics than for White non-Hispanics), gonorrhea (eight times the White non-Hispanic rate), and homicide (almost triple the White non- Hispanic rate)

11. Health Status Indicators  Of the seven health disparities found in 1990-1994, significant disparities persisted for six indicators in the 1998-2002 period. The disparity for low birth weight babies disappeared in 1998-2002.  For the period 1998-2002, the largest disparities occurred in the teen birth rate, which was almost five times the White non- Hispanic rate, and for syphilis, which was close to four times higher than White non- Hispanic

12. Health Status Indicators  Examining indicators individually, health disparities between Hispanics and White non- Hispanics significantly worsened (at p<0.05) over time for three indicators: overall mortality, early prenatal care, and teen birth rates  The highest significant increase in health disparities occurred for teen birth rates, which increased by 87% between the 1990-1994 period and 1998-2002  Disparities for overall mortality and lack of early prenatal care grew 23% and 21%, respectively

13. La Clinica de Buena Salud La Clinica de Buena Salud

14. Strategies  Outreach  Community Collaboration  Culturally Appropriate Health, Mental Health and Social Services

20. Bienestar de la Familia

21. Strategies  Identified Need  Culturally Appropriate Service Delivery  Integrated Physical and Mental Health Services

22. Bienestar de la Familia (Well-being of the Family). Multnomah County, Office of Mental Health and Addiction Services  Program and Clinical supervisor, Linda Castillo, MS. (503) 988-3999 x28814  The team consists of mental health professionals, drug and alcohol evaluation specialist, case managers, and social service resource specialists.  The Bienestar de la Familia Team promotes the well-being of Latinos, in Multnomah County, by:  Respecting values, language, culture, and experiences.  Providing and facilitating culturally competent services.  Advocating, educating, and supporting community leadership.

23. Physical MentalEmotional Spiritual Concept of Health

24. Hispanic Values and Beliefs  Familismo  Respeto y la Buena Educacion  La Comida  Harmony/Armonia (simpatia)  Personalismo  Time Orientation or Presentismo  Concepts of Health  Spirituality/Religion (fatalism) (fatalism)

25. Mental Health Status Indicators  Studies have found that adult Mexican Americans and Whites have similar rates of psychiatric disorders.  However, in the Hispanic group, when subdivided into those born in Mexico and those born in US, the US born have higher rates of depression and phobias.  Hispanics born outside US had lower prevalence rates of any lifetime disorders than there US born counterparts.  Immigrants who live in US 13 years+ have higher prevalence of disorders than those who lived in US fewer than 13 years.

26. Mental Health Status Indicators  Rate differences suggest acculturation may lead to increased risk of mental disorders; changing values & practices, stressors associated with change, negative encounters with American institutions, etc.  Latino youth experience significant number of mental health problems; anxiety-related, delinquency-type problem behaviors, reported more depressive symptoms. Related to higher rates of depression, drug use, and suicide.  For older adults, 26% had major depression or dysphoria. 5.5% reported depression if w/o physical health complications.

27. Mental Health Problems  Sx may reflect actual disorders, general distress associated with social stressors may not necessarily be associated with disorders. Overall, Latinos report higher levels of depression and distress than whites.  Mexican American women, esp. over 40 y/o, tend to report somatic symptoms.  Latinas have highest lifetime prevalence of depression at 24%. Latinas are more likely to to experience severe depression than Caucasian women (53% vs. 37%).  Latino patients half as likely to receive depression dx or medication.

28. Culture Bound Syndromes  Concept of illness is culture bound, these may differ from anxiety disorders or DSM classification.  Ataque de Nervios (attack of nerves)  Nervios (nerves or nervousness)  Susto or Perdida del Alma (fright or soul loss).

29. Bienestar Lessons learned  Know your population, community, and acknowledge and prepare for change in outreach and care. Consult with community specialists/experts. (what to know)  Holistic and Cultural assessment is crucial.  Beware of disparities in health care and assist patients to receive appropriate care. (what to ask)  Cultural competency is necessary in all industries. Be aware of stereotypes, biases, and assumptions. ( What to be aware of )

30. Bienestar Lessons learned  Communities respond to advocacy and activism.  There are not enough programs (funding) to meet the needs.  Evidence based practices are not normed on immigrant populations, we are pioneering practice based evidence programs.  Welcoming,culturally/linguistically specific, consistent, reliable, and episodic care is the most successful.

31. “La Promesa de un Futuro Brillante” “The Promise of a Bright Future”