Mental Health Care For Foreign Born Latinos: A Grant Proposal. Samuel Munoz California State University, Long Beach May 2017

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1 Mental Health Care For Foreign Born Latinos: A Grant Proposal Samuel Munoz California State University, Long Beach May 2017

2 Introduction One of the areas that has impacted Latino immigrants, particularly foreign born Latinos, is less access to mental health care and the underutilization of these services when compared to the White population (Cabassa & Zayas, 2007). A major concern is the underreporting of mental health diagnoses because of the underutilization of mental health services among Latino immigrants (Martinez,Tyson, Arriola, & Corvin, 2016). A significant concern is the underdiagnosing of depression in foreign born Latinos (Cabassa & Zayas, 2007). High rates of uninsured Latino immigrants who lack access to care are undiagnosed and unreported (Wassertheil-Smoller et al., 2014). Among foreign born Latinos research has found an excess chronicity and disease burden of major depression (González, Tarraf, Whitfield, & Vega, 2010; Woodward et al., 2012). Goal: The goal of this program is to provide accessible culturally and linguistically appropriate services in order to address the gap in mental health services for the Latino immigrant population. The proposed program will be available to foreign born Latinos, age 25 and older, experiencing depression and needing access to mental health services. Services will be provided in Los Angeles, California Service Planning Area (SPA) 6.

3 Social Work Relevance The NASW Standards and Indicators for Cultural Competence in Social Work Practice states that social workers should be able to understand their clients' cultures and demonstrate competence in order to provide services that are sensitive and adequate to their needs (NASW, National Committee on Racial and Ethnic Diversity, 2015). Providing culturally competent and bilingual mental health providers will potentially bridge the gap in mental health disparities in Latinos (Cook, Doksum, Chen, Carle, & Alegría, 2013). A primary reason for the underutilization of mental health services is due to mental health providers not speaking the same language as Latino clients (Ruiz, Aguirre, & M itschke 2013). There is a growing demand of bilingual mental health providers for the Latino population. The shortage of bilingual mental health providers is also accompanied by a need for culturally competent social workers.

4 Cross Cultural Relevance The Behavioral Model for Vulnerable Populations attempts to explain that an individual s use of health services is affected and determined by a predisposition to the use of services (Andersen, 1995). A latter revision to the model by Gelberg, Andersen and Leake (2000) stated that social characteristics, including acculturation, immigration status, literacy, having psychological resources (e.g. coping, mastery, and self esteem), history of mental illness and victimization, are factors that impact the likelihood of using health services. Due to the barriers to treatment, often the result of a lack of financial resources and higher rates of uninsured individuals, many Latinos struggle with undiagnosed depression. To better serve the Latino immigrant population, culturally adapted interventions can achieve positive outcomes in decreasing depressive symptoms and in engaging a population that perceives depression and mental illness as a stigma.

5 Met hods Target Population The target population is non-u.s. born Latinos, age 25 and older, with symptoms of a depressive disorder and who lack access to mental health services in SPA 6 and are receiving primary care at one of six clinics. Strategies Used to Select a Funding Source Google, Yahoo, and the Foundation Directory Online library were the sources that were utilized. Funding sources and grants awarded to non-profit organizations and community mental health providers yielded information on possible matches for this grant proposal. Funding Source Selected The grant provider that was chosen was the California Wellness Foundation. The California Wellness Foundation s mission of improving the health of the citizens of the state of California, in particular the health and well-being of uninsured, underserved and vulnerable populations, is consistent with the goals of this grant.

6 Methods (cont.) Sources Used for Needs Assessment Data from the following: U.S. Census Bureau SAMHSA Uniform Reporting System the National Council of La Raza Los Angeles Community H ealth Needs Assessment As well as a review of current relevant literature Projected Budget Range Personnel Costs: $144,150 Full-time bilingual (English/Spanish) master s level Program M anager Bilingual (English/Spanish) master s level therapist with a degree in social work for 30 hours per week Administrative Assistant (Bilingual) for 40 hours/week Direct program costs: $24,800 Indirect program 10%: $16,895 Total projected budget: $185,845

7 Grant Proposal Program Summary and Description The purpose of this project was to write a grant proposal to fund a program that will provide mental health services in the Los Angeles, California Service Planning Area (SPA) 6 for foreign born Latinos experiencing depression. The project s purpose is to address the discrepancy in mental health services in the non U.S. born Latino community in SPA 6 and improve participants quality of life. The program aims to provide individuals the necessary tools to reduce symptoms of depression through the use of culturally adapted individual and group therapy. Population Served Latinos, age 25 and older, foreign born and needing access to mental health services. Sustainability Funding for this program will be for one year. Referrals will be received from partner agencies. Funding for the following year will be sought at the six month mark. The host agency has long-term community partnerships to sustain this project.

8 Grant Proposal Program Objectives A total of 100 clients will be referred from 6 identified primary care providers in SPA 6. Culturally adapted individual and group therapy will be provided to foreign born Latino clients in SPA 6. A total of 10 individual therapy sessions will be provided once per week for a total of 10 weeks and 10 weekly group therapy sessions (90 minutes) will be provided per client. Culturally modified interventions will provide individuals the necessary tools to reduce depressive symptoms in clients. Program Evaluation The program manager will evaluate the program in terms of the number of referrals generated, the number of intakes and assessments performed, the level of satisfaction with groups and individual sessions, the retention of the clients in in the program by the number of sessions attended, and the level of clients depression before during and after completing the program.

9 Lessons Learned/ Implications for Social Work Mental health services in the Latino immigrant community are lacking despite a growing need. The Latino community lacks affordable services for individuals with depressive symptoms. Service Provider Area 5 (SPA 5) and SPA 6 in Los Angeles County stood out as being particularly at risk among the Latino immigrant population. Understanding the cultural needs of the population was important due to the unique aspects of the Latino culture and the way they interpret depressive symptoms. Cultural competence among staff is important in order to help clients overcome the perceived stigma of mental illness.

10 References Andersen, R. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of H ealth and Social Behavior, 36(1), Cabassa, L. J., & Zayas, L. H. (2007). Latino immigrants' intentions to seek depression care. American Journal of Orthopsychiatry, 77(2), Cook, B., Doksum, T., Chen, C., Carle, A., & Alegría, M. (2013). The role of provider supply and organization in reducing racial/ethnic disparities in mental health care in the U.S. Social Science & Medicine, 84, Gelberg, L., Andersen, R., & Leake, B. (2000). The behavioral model for vulnerable populations: Application to medical care use and outcomes for homeless people. Health Services Research, 34(6), González, H. M., Tarraf, W., Whitfield, K. E., & Vega, W. A. (2010). The epidemiology of major depression and ethnicity in the United States. Journal of Psychiatric Research, 44(15), M artinez Tyson, D., Arriola, N., & Corvin, J. (2016). Perceptions of depression and access to mental health care among Latino immigrants. Qualitative Health Research, 26(9), National Association of Social Workers, National Committee on Racial and Ethnic Diversity. (2015). Standards and indicators for cultural competence in social work practice. Retrieved from Ruiz, E., Aguirre, R. T. P., & M itschke, D. B. (2013). What leads non-u.s.-born Latinos to access mental health care. Social Work in H ealth Care, 52(1), Wassertheil-Smoller, S., Arredondo, E., Cai, J., Castaneda, S., Choca, J., Gallo, L.,... Penedo, F. (2014). Depression, anxiety, antidepressant use, and cardiovascular disease among H ispanic men and women of different national backgrounds: Results from the hispanic community health study/study of latinos. Annals of Epidemiology, 24( 11), Woodward, A. T., Taylor, R. J., Bullard, K. M., Aranda, M. P., Lincoln, K. D., & Chatters, L. M. (2012). Prevalence of lifetime dsm-iv affective disorders among older african americans, black caribbeans, latinos, asians and non hispanic white people. International Journal of Geriatric Psychiatry, 27(8),