1. A collaborative, multidisciplinary, bicultural/bilingual healthy youth development program in a primary health care setting Aquí Para Tí/Here for You Clinic Based Program Bibiana Garzón, MS, Mónica Hurtado, Cherylee Sherry, MPH, CHES, Verónica Svetaz, MD, MPH

2. Aquí Para Tí, HCMCPoster ID# 20832 Program Description  a collaborative, multidisciplinary, bicultural/bilingual youth program created in 2002  housed at the East Lake Clinic, one of Hennepin County Medical Center’s community clinics  targeted to Latino youth (ages 11-24) and their families  funded by the Eliminating Health Disparities Initiative of the Minnesota Department of Health

3. Aquí Para Tí, HCMCPoster ID# 20833 Program Philosophy To provide comprehensive care in a safe and confidential environment for Latino youth (11 to 24 years old) and their families

4. Aquí Para Tí, HCMCPoster ID# 20834 Program Elements  Culturally appropriate  Confidential family-centered approach  Resilience oriented-Youth Development Approach  Comprehensive  Community based  Patient support and coordination of services

5. Aquí Para Tí, HCMCPoster ID# 20835 Youth Development/Resilience Approach

6. Aquí Para Tí, HCMCPoster ID# 20836  APT team consists of physician, health educator, social worker/therapist and coordinator of services  serves as a bridge between the Latino cultures and the majority culture in which they live Aqui Para Ti Team

7. Aquí Para Tí, HCMCPoster ID# 20837 Services Provided  Medical Services  Health Education  Mental health assessments and referrals to therapy  Education for parents  Referrals to community resources as needed

8. Aquí Para Tí, HCMCPoster ID# 20838 Service Area  80% from Hennepin County  Other counties served:  Ramsey  Dakota  Anoka  16% from zip code 55406 (southeast MPLS)

9. Aquí Para Tí, HCMCPoster ID# 20839 Patients Served From July 2002 to July 2008 Aqui Para Ti has served: 735 youth -482 Teenagers (11-18 yrs) -253 Young adults (19-24 yrs) 307 parents

10. Aquí Para Tí, HCMCPoster ID# 208310 Demographics of Patients Served  66.7% Female  65.6% teens (11-18)  34% young adults (19-24)  76.7% Spanish-speaking  60% of patients aged 11-18 came with a parent

11. Aquí Para Tí, HCMCPoster ID# 208311 APT patients needs & assets

12. Aquí Para Tí, HCMCPoster ID# 208312 APT Program Changes Over Time  Initially majority were considered low risk/needs patients  By 2004 the number of patients with high risk/needs was greater than low risk/needs patients  Today, over 70% of APT patients are high risk/needs patients

13. Aquí Para Tí, HCMCPoster ID# 208313 APT patients’ risks & assets  APT has become a referral center, receiving mainly high needs teens and families  The data that you are going to see represents only our patient population but does not represent the Latino population in Minneapolis

14. Aquí Para Tí, HCMCPoster ID# 208314 Among APT patients:  One out of two youth born outside of the US stated they did not have enough money for food and bills.  One out of three youths born in the US reported the same. This means most of our Latino youth remain in severe poverty regardless they are US born citizens. Socio-Economic Status

15. Aquí Para Tí, HCMCPoster ID# 208315 APT Data Family and Friends From July 2002-2007 Among APT patients:  An equal number of younger and older youth feel that parents listen to them  Significantly more females felt parents were NOT listening to them (35 % females vs. 20 % males)  Only half of all APT patients could identify a role model Family and Friends

16. Aquí Para Tí, HCMCPoster ID# 208316 Family and Friends Among APT patients:  66.6% (regardless of sex) reported having friends and adults to talk to.  US born youth have more friends and adults to talk with compared to those born outside US.  Younger youth have significantly more friends to talk with vs. older youth

17. Aquí Para Tí, HCMCPoster ID# 208317 Among APT patients:  Almost all our younger and older youth found school is a positive place (94 vs. 95 %).  Almost 20% reported that they would NOT continue further studies because they needed to work.  60% of non US born and 70% of US born youth plan to study after High School  Desire to study after high school was independent of gender School Achievement

18. Aquí Para Tí, HCMCPoster ID# 208318 APT Data Reproductive Health From July 2002-2007 Among APT patients:  US born youth’s most frequent age for first sexual encounter was 14 years, while 15 years of age was the most frequent age for first sexual encounter in the non-US born youth  Significantly more non US born youth had sexual contact when they did not want it (14 % compared to 5% for US born youth) Reproductive Health

19. Aquí Para Tí, HCMCPoster ID# 208319 Among APT patients:  Almost 40 % of younger and older youth felt sad in the previous 2 weeks.  Regardless of age almost 20 % have had suicidal thoughts.  Both groups have significant incidence of having been abused (12% younger vs. 20% older). Mental/Behavioral Health

20. Aquí Para Tí, HCMCPoster ID# 208320 Risk Levels  Risk levels were not dependent on age  Females (42%) were significantly more categorized in a high- risk category that males (30%)  Youth born in US (52%) were proportionally significantly more categorized in a high-risk category vs. those youth born outside US (35%) Among APT patients:

21. Aquí Para Tí, HCMCPoster ID# 208321 Lessons learned  Use a systemic approach that involves parents and family and takes into account school, neighborhood and all factors surrounding a teen’s life  Conduct mental health screenings in the primary care setting. Most patients value highly their relationship with their providers and may be more likely to disclose their feelings, and engage in treatment  Be aware that acculturation is dynamic and acculturation levels are not the same for all the members of a family  Know your population, speaking their language is not enough. There are differences in values and beliefs within the same culture

22. Aquí Para Tí, HCMCPoster ID# 208322 Lessons learned  Doing secondary pregnancy prevention among Latino teens is equally important as doing primary pregnancy prevention. Research indicates that without intervention, Latino teen mothers are at a high risk of having a new child in less than 3 years  Integrated health care systems such as HCMC are essential to provide access, quality, and affordable care to underserved populations. In addition, providers have a network of support and do not have to work in isolation  A paradigm shift has to occur in the US health care system if we are serious about eliminating health disparities.