1. Substance Use and Hispanic/Latinos, New Mexico: Implications for Work Round Table Discussion September, 2015

2. Introduction and Presentations Welcome Purpose Goals Roles and Responsibilities General Presentation Ground Rules Questions and Discussion Closing and Evaluation

3. Icebreaker Name Name of Organization Position/Role Location Why did you decide to participate on this meeting and what would you expect to gain?

4. Purpose Meet with stakeholders serving Hispanic and Latinos in need of substance use disorder treatment and recovery support services to gather information on how the National Hispanic and Latino ATTC can support the work and strengthen the workforce capacity.

5. Goals Identify available resources and needs regarding training and capacity building of culturally appropriate services for Hispanic and Latino populations requiring substance abuse treatment and recovery services. Ensure that Hispanic and Latino populations in need of substance abuse treatment and recovery services are seen as a priority among stakeholders. Broaden the Regional ATTCs scope on implementation practices and system transformation focusing on Hispanic and Latino effective and culturally competent practices.

6. What is the National Hispanic and Latino ATTC?

7. ATTC Network Model of Technology Transfer in the Innovation Process Copyright 2010 ATTC Network

8. Strategic Plan: Goals Serve as the national subject matter expert and key resource for the workforce providing substance abuse treatment and recovery support services in order to reduce health disparities among Hispanic and Latino populations. Develop and strengthen the workforce that provides substance abuse treatment and recovery support services to Hispanic and Latino populations throughout the United States by maintaining relevant and up-to-date information and resources to be used for the provision of training and technical assistance. Vision and Mission

9. Strategic Plan: Goals Identify available resources and needs. Ensure that Hispanic and Latino populations are seen as a priority. Broaden the ATTCs’ scope on implementation practices and system transformation. To develop and strengthen the skills and capabilities of the workforce. Build a collaborative and communication relationship. Strategic Plan: Goals

10. These goals will be accomplished by … Developing and implementing the strategic plan. Building a collaborative and communicative relationship. Identifying regional differences and commonalities. Identifying training needs and assessing capacity building needs. These goals will be accomplished by …

11. Developing and disseminating educational products and trainings. Supporting the effective utilization of culturally competent practices. Promoting collaboration and maintaining effective communication. These goals will be accomplished by …

12. Assessment Curriculum and Education TOT Sustainability Training Factsheet- Webinars Stakeholders Workflow of Services

13. Substance Use and Hispanic/Latinos, New Mexico: Implications for Work Miguel A Cruz-Feliciano, PhD Associate Director September, 2015

14. Unnatural Causes – Becoming American Source: Unnatural Causes, http://www.unnaturalcauses.org/episode_descriptions.php?page=3

15. Hispanic vs. Latino Relation with Spain (territory, culture, colonization) Language (Brazilians are Latinos but not Hispanics) Identity (Caribbean and South America vs. Mexican) East vs. West Inclusiveness Preference

16. Operational Definition Individuals of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin regardless of race (US Bureau of Census).

17. Percent of Hispanic Population in the United States: Trends and Projections Source: US Census Bureau. (2013). 2012 National population projections. Population as of April 1Projections for Population as of July 1

18. Hispanic or Latino by Origin United States, 2011-2013 Source: US Census Bureau (2014). FactFinders, 2011-2013 American Community Survey 3- Year Estimates

21. Hispanic Population – Concentration by States Arizona, California, Colorado, Florida, Illinois, New Jersey, New York, and Texas –States with more than 1 million Hispanics California, Florida, and Texas –Represents 55% of Hispanics in United States Arizona, California, Colorado, Connecticut, Florida, Idaho, Illinois, Iowa, Kansas, Massachusetts, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, Oregon, Rhode Island, Texas, Utah, Washington, and Wyoming –22 States where Hispanic are the largest minority. Source: US Census Bureau. (2014, September). Hispanic Heritage Month 2014: Sept. 15-Oct. 15. Washington, DC: US Department of Commerce.

22. Hispanic and Latinos as Group vs. non-Hispanic Whites Younger (median age 27.8 vs. 37.5 Years) Less educational attainment –(27% High School vs. 29%) Low median income ($21K vs. $32K) Higher poverty levels (25.6% vs. 11%) Less health insured (29% vs. 11%) Speak other language than English (38 million) Source: U.S. Census Bureau, 2011-2013. 3-Years American Community Survey.

23. Language Speak Spanish at home: 38 million –58% speak English very well One-third of all Hispanics (33%) do not speak English very well Immigrants Latinos that speak only English or English very well –Children (5-17 years) : 70% –Adults : 32% Source: U.S. Census Bureau, 2011-2013. 3-Years American Community Survey.

24. Persons Below Poverty Level by Race and Hispanic Origin United States, 2012 Source: National Center for Health Statistics (2014). Health, United States, 2013: With special feature on prescription drugs. Hyattsville, MD.

25. Health Uninsured Percentage by Race/Ethnicity United States, 2013 Sources: Krogstad, J. M., & Lopez, M. H. (2014). Hispanic immigrants more likely to lack health insurance than U.S.-born. Retrieved from http://www.pewresearch.org/fact-tank/2014/09/26/higher-share-of-hispanic-immigrants-than-u-s-born-lack-health-insurance/ Smith, J. C., & Medalia, C. (2014). Health Insurance Coverage in the United States: 2013. Washington, DC: U.S. Government Printing Office.

26. Life Expectancy by Race and Hispanic Origin United States, 2010 Source: National Center for Health Statistics (2014). Health, United States, 2013: With special feature on prescription drugs. Hyattsville, MD. 83.8 77.7 81.8 78.5 71.4 76.4 81.2 74.7 78.8 Total

27. Why do Hispanic and Latinos live longer? Hispanic Epidemiological Paradox –Refers to the contradictory finding that indicates Hispanics in the United States tend to have significantly better health and mortality outcomes than the average population despite generally low socioeconomic status. Salmon bias or return-immigrant effect (equally represented by Hispanic group?) Healthy immigrant effect Social construct and artifact of research Cultural factors –Diet –Support network –Smoking –Identity

28. Birth and Fertility Rates by Race and Hispanic Origin United States, 2012 Source: National Center for Health Statistics (2014). Health, United States, 2013: With special feature on prescription drugs. Hyattsville, MD. Birth Fertility

29. Distribution of Hispanics by ATTC Region R1: 10.4% R2: 19.3% R3: 7.7% R4: 12.1% R6: 30.3% R7: 6.8% R8: 15.0% R10: 12.4% R9: 37.2% R5: 8.0% Source: US Census Bureau (2014). FactFinders, 2011-2013 American Community Survey 3- Year Estimates

30. Treatment Episode Data Set-Admission Why New Mexico? Arkansas2.6% Louisiana1.9% New Mexico50.8% Oklahoma4.7% Texas35.1% Source: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality (2014). Treatment Episode Data Set -- Admissions (TEDS-A), 2010-2012. ICPSR 25221. Retrieved from: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/sda

31. Distribution of Hispanic and Latinos: New Mexico N=2,069,706 (M=49.5% : F=50.5%) Total: 46.7% Mexican62.7% Spaniard/Spanish18.1% Puerto Rican0.7% Cuban0.5% Guatemalan0.3% Other H/L, S-C A17.7% Source: US Census Bureau, 2009-2013 5-Year American Community Survey

32. Distribution of Hispanic and Latinos: New Mexico Source: U.S. Census Bureau, 2010 Census. 2010 Census Summary File 1, Tables P5 and P8. H/L Total: 46.3% Foreign born9.7% Spanish Language28.7% 18-6467.4% GeographyTotalForeign born Mora81.0%3.2% Guadalupe79.6%3.4% San Miguel76.8%4.0% Rio Arriba71.3%6.0% Doña Ana65.7%17.1% Luna61.5%15.6% Valencia58.3%7.9% Hidalgo56.6%5.9% Taos55.8%5.0% Chaves52.0%14.0% Lea51.1%15.5% Santa Fe50.6%13.5%

33. Distribution of Persons Below 125% Poverty Level New Mexico Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey.

34. Distribution of Persons Health Uninsured New Mexico Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey.

35. Substance Use Distribution by Race/Ethnicity: 2013 Source: Substance Abuse and Mental Health Services Administration [SAMHSA]. (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of national findings. Rockville, MD: Author. NSDUH Series H-48, HHS Publication No. (SMA) 14- 4863.

36. Abuse/Dependence of Illegal Drugs by ATTC Region R1: 10.1% R2: 19.7% R3: 4.7% R4: 7.5% R6: 27.0% R7: 4.5% R8: 13.0% R10: 9.0% R9: 32.9% R5: 7.0% Source: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality (2014). National Survey on Drug Use and Health: 2-Year R-DAS (2002 to 2003, 2004 to 2005, 2006 to 2007, 2008 to 2009, and 2010 to 2011). ICPSR 34482. Retrieved from: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/sda

37. Prevalence of Alcohol Abuse or Dependence in New Mexico by Years and Hispanic Origin Source: National Survey on Drug Use and Health: 2-Year R-DAS (2002 to 2003, 2004 to 2005, 2006 to 2007, 2008 to 2009, 2010 to 2011, and 2012 to 2013). Analysis ran on 2015-05-13 (11:08 AM EDT) using SDA 3.5: Tables

38. Prevalence of Illicit Drug Abuse or Dependence in New Mexico by Years and Hispanic Origin Source: National Survey on Drug Use and Health: 2-Year R-DAS (2002 to 2003, 2004 to 2005, 2006 to 2007, 2008 to 2009, 2010 to 2011, and 2012 to 2013). Analysis ran on 2015-05-13 (11:08 AM EDT) using SDA 3.5: Tables

39. Lifetime Prevalence of Psychiatric Disorders by White not Latino and Latinos Source: Alegria, M., Canino, G., Shrout, P.E., Woo, M., Duan, N., Vila, D., Torres, M., Chen, C.N., & Meng, X.L. (2008). Prevalence of mental illness in immigrant and non-immigrant U.S. Latino groups. The American Journal of Psychiatry 165(3):359–369. doi:10.1176/appi.ajp.2007.07040704

40. Past Month Substance Use among Hispanics by Nativity: 2008-2012 Source: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2013). 2012 National Survey on Drug Use and Health. Rockville, MD. ICPSR 34933. Retrieved from: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/sda

41. Lifetime Prevalence of Substance Use Disorders by Hispanic Subgroup and Immigration Status Source: Alegria, M., Canino, G., Shrout, P.E., Woo, M., Duan, N., Vila, D., Torres, M., Chen, C.N., & Meng, X.L. (2008). Prevalence of mental illness in immigrant and non-immigrant U.S. Latino groups. The American Journal of Psychiatry 165(3):359–369. doi:10.1176/appi.ajp.2007.07040704 Puerto Ricans Cubans Mexicans Other Latinos

42. Mental Illness Distribution by Race/Ethnicity: 2013 Source: Substance Abuse and Mental Health Services Administration [SAMHSA}. (2014). Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings. Rockville, MD: NSDUH Series H-49, HHS Publication No. (SMA) 14-4887.

43. Unmet Need for Substance Abuse Treatment: Hispanics Source: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2014). 2013 National Survey on Drug Use and Health. Rockville, MD. ICPSR 35509. Retrieved from: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/sda 9.9% Received Treatment vs. 11% Overall United States

44. Perception of Need for Treatment New Mexico by Hispanic Origin Source: National Survey on Drug Use and Health: 2-Year R-DAS (2002 to 2003, 2004 to 2005, 2006 to 2007, 2008 to 2009, 2010 to 2011, and 2012 to 2013). Analysis ran on 2015-05-13 (11:08 AM EDT) using SDA 3.5: Tables

45. Spanish Service Indicator, Substance Abuse Treatment ATTC Region 6 StateTotalSpanish Arkansas587(12.1%) Louisiana905(5.6%) New Mexico8544(51.8%) Oklahoma16215(9.3%) Texas357128(35.9%) Source: Substance Abuse and Mental Health Services Administration (2015). Behavioral Health Treatment Services Locator. Retrieved from: https://findtreatment.samhsa.gov/locator?sAddr=&submit=Go

46. Treatment Admissions by Hispanic Population and ATTC Region R1: 12.4% R2: 19.0% R3: 5.5% R4: 5.8% R6: 20.2% R7: 4.8% R8: 19.1% R10: 10.2% R9: 33.2% R5: 4.9% Source: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality (2014). Treatment Episode Data Set -- Admissions (TEDS-A), 2010-2012. ICPSR 25221. Retrieved from: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/sda

47. Latinos, n= 1,748 Male: 73.2% Age Median: 32 Service –Ambulatory, Non Intensive Outpatient : 79.1% –Ambulatory, Intensive Outpatient : 16.6% Referral –Criminal Justice: 52.2% –Individual: 24.9% –Other Community Referrals: 11.3% No prior TX: 47.9% Primary Substance (Alcohol: 56.6% / Marijuana: 10.7%) Secondary Substance (Marijuana: 10.1%) Treatment Admission Characteristics, New Mexico 2012 Not Latinos, n= 1,693 Male: 67.5% Age Median: 32 Service –Ambulatory, Non Intensive Outpatient : 79.6% –Ambulatory, Non Intensive Outpatient : 16.5% Referral –Criminal Justice: 36.8% –Individual: 34.0% –Other Community Referrals: 15.6% No prior TX: 42.9% Primary Substance (Alcohol: 60.2% / Marijuana: 8.5%) Secondary Substance (Marijuana: 14.7%) Source: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality (2014). Treatment Episode Data Set -- Admissions (TEDS-A), 2010-2012. ICPSR 25221. Retrieved from: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/sda

48. Latinos Substance Reported Alcohol: 66.0% Cocaine: 11.5% Marijuana: 23.6% Heroin: 8.0% IDU: 5.8% Substance Abuse Type Alcohol Only: 43.9% Other Drugs Only: 27.7% Alcohol and Other Drugs: 22.2% Co-occurring condition: 33.4% Health Insurance (None: 80.2% / Medicare: 12.5%) Treatment Admission Characteristics, New Mexico 2012 Not Latinos Substance Reported Alcohol: 66.8% Cocaine: 7.1% Marijuana: 25.8% Heroin: 3.5% IDU: 7.9% Substance Abuse Type Alcohol Only: 44.7% Other Drugs Only: 24.5% Alcohol and Other Drugs: 22.1% Co-occurring condition: 38.7% Health Insurance (None: 79.2%/ Medicare 12.2% Source: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality (2014). Treatment Episode Data Set -- Admissions (TEDS-A), 2010-2012. ICPSR 25221. Retrieved from: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/sda

49. Latinos n= 4,394 Reason –Transferred: 88.8% –Treatment completed: 5.8% –Left against advise: 3.4% –Terminated: 0.5% –Incarcerated: 0.6% –Death: 0.1% Treatment Discharge Top Reasons, New Mexico 2011 Source: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality (2014). Treatment Episode Data Set -- Discharges (TEDS-D), Concatenated, 2006-2011. ICPSR 30122. Retrieved from: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/sda Not Latinos n= 3,653 Reason –Transferred: 87.8% –Treatment completed: 4.9% –Left against advise: 5.1% –Terminated: 0.3% –Incarcerated: 0.8% –Death: 0.1%

50. Implications for service Service availability Service accessibility Representation –Data, research, workforce, policy Language/Communication –Generational differences (conflict resolution) Inclusion Assessment and screening

52. Ground Rules Respect each other One person at a time No right or wrong answers Turn off or in vibration mode your cellphone Taking notes and recording You are the experts

53. Question 1 Based on your experience, what are the major issues/situations service providers face while working with H/L populations?

54. Question 2 What are the training needs faced by service providers to deliver culturally appropriate service and treatment for H/L?

55. Question 3 What strengths can you mention from providers of your organization to deliver specific services to H/L?

56. Question 4 Is your organization currently involved with any Training Center of particular aspects of workforce development with specific orientation towards H/L? What about behavioral health?

57. Question 5 Based on what you have learned today, how the NHL ATTC and the ATTC in general can be an integral part of your workforce development?

58. Question 6 What does the recovery culture look like for H/L in your area?

59. Question 7 Has Health Care Reform affected or influenced the way you are currently delivering treatment services?

60. Closing and Evaluation National Hispanic and Latino ATTC http://attcnetwork.org/hispaniclatino Tel. 787-785-5220 Fax 787-785-4222