2 BH Disparities in Hispanic and Latino Populations Dennis o. Romero, M.A. Regional Administrator HHS Region II: NJ, NY, PR USVI Substance Abuse and Mental Health Services Administration National Hispanic & Latino ATTC Conference 2014 Integrating Research, Education and Services to Reduce BH Disparities in Hispanic and Latino Populations October 8 9, 2014 Austin, TX SAMHSA s Vision America is a nation that understands and acts on the knowledge that Behavioral health is essential to health. Prevention works. Treatment is effective. People recover. 1
SAMHSA S Strategic Initiatives 1. Prevention of Substance Abuse and Mental Illness 2. Health Care and Health Systems Integration 3. Trauma and Justice 4. Recovery Support 5. Health Information Technology 6. Workforce Development 4 A Closer Look... WHY I. Largest Minority II. Growing Population III. New Destination IV. Health Insurance Coverage V. Substance Abuse and Mental Health VI. Culturally competent workforce VII. SAMHSA s Response 5 I. Largest Minority 53 million Hispanic and Latinos 17% of the total US population 133 Million 10 Million Florida More than 50% (Ca Tx Fl) 14.5 Million Reference: US Census Bureau (2012, August). Hispanic Heritage Month 2012. Retrieved from http://www.census.gov/newsroom/releases/archives/facts_for_features_special_editions/cb12-ff19.html 6 2
II. Growing Population 7 III. New Destinations Source: Starks, B. (2012, March 14). Data for the day: Growth in Hispanic populations 2000-2010. Retrieved from University of Notre Dame: http://blogs.nd.edu/thecc/2012/03/14/data-for-the-day/ 8 IV. Health Insurance Almost 1 in 4 (25 %) individuals uninsured in the U.S. is Hispanic or Latino. Visit: Visit HealthCare.gov to learn more, or CuidadoDeSalud.gov if you prefer Spanish 9 3
Behavioral Health And Diverse Populations African Americans are 20% more likely to report having serious mental distress than Whites. Hispanic adolescent females report significantly higher rates of suicidal thoughts and suicide attempts than other youth. Asian American women have the highest suicide rate of all women over age 65 in the United States. 10 Behavioral Health And Diverse Populations (continue) American Indians or Alaska Natives have the highest rates of substance dependence or abuse and binge alcohol use, compared to other racial/ethnic groups. Native Hawaiians and Pacific Islanders have higher rates of smoking and alcohol use compared to other racial/ethnic groups. 11 ACA Solutions in Progress: 10 Essential Health Benefits 1) Ambulatory patient services 2) Emergency services 3) Hospitalization 4) Maternity and newborn care 5) Mental health and substance use disorder services, including behavioral health treatment 6) Prescription drugs 7) Rehabilitative and habilitative services and devices 8) Laboratory services 9) Preventive and wellness services and chronic disease management 10) Pediatric services, including oral and vision care 12 4
ACA Solutions in Progress: Free Prevention Services for Adults Health reform requires health plans to cover a number of preventive services related to behavioral health without cost sharing (for plans effective on or after 09/23/10). Adults Alcohol misuse screening and counseling Tobacco use screening & cessation interventions Depression screening HIV screening for those at higher risk And more 13 ACA Solutions in Progress: Free Prevention Services for Children Alcohol and Drug Use assessments for adolescents HIV screening for adolescents at higher risk Depression screening for adolescents Developmental screening for children under age 3, and surveillance throughout childhood Behavioral assessments for children of all ages Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years And more 14 ACA Solutions in Progress for Latino/Hispanics: Young Adults & Prevention ~ 913,000 young adults (19-25) are now insured on their parents policies ~ 8.8 M (all ages) now have access to expanded preventive services on most plans, including: Alcohol & tobacco screening and intervention HIV screening Well-child visits Mammograms & pap smears BP & cholesterol screening 15 5
ACA Solutions in Progress for Latino/Hispanics: Lifetime Limits, Medicaid Expansion, & More ~11.8M no longer have lifetime limits on their health insurance plans. Medicaid expansion in 27 states including CA, AZ, NM, IL, NY & KY Increased support for Community Health Centers where ~1/3 clients are L/H. ACA requires ongoing/new federal health programs to collect & report racial, ethnic, and language data, which will be used by HHS to redress disparities. And more 16 ACA & the Mental Health Parity and Addiction Equity Act Strengthen Behavioral Health Services MHPAEA Final Rule published November 8, 2013. Requires insurance groups that do offer benefits for mental health or substance use disorders, to provide the same level of coverage that they do for general medical treatment. http://www.gpo.gov/fdsys/pkg/fr 2013 11 13/pdf/2013 27086.pdf 17 V. Substance Abuse and Mental Health 8.4% of Hispanics (12yrs or older) reported current illicit drug use. Treatment admissions for Hispanic and Latinos have increased from 10.7% to 14.0% since 1992 to 2010. References Substance Abuse and Mental Health Services Administration [SAMHSA]. (2012). Results from the 2011 National Survey on Drug Use and Health: Summary of national findings. Rockville, MD: Substance Abuse and Mental Health Data Archive [SAMHDA]. (2013). Treatment Episode Data Set - Admissions (TEDS-A), Concatenated, 1992 to 2010. Retrieved from http://www.icpsr.umich.edu/icpsrweb/samhda/sdatools/resources 18 6
Past Month Substance Use among LH Adults by Nativity: 2008 to 2012 Percent 70 60 50 40 30 20 10 0 57.3 37.1 32.8 21.7 Born in the United States Not Born in the United States 12.2 Alcohol Use* Binge Alcohol Use* Illicit Drug Use* 3.2 *The difference between those born in the United States and those not born in the United States is statistically significant at the.05 level. SAMHSA NSDUH 2013 19 Latino/Hispanic Unmet Need for SAT 3.4 Million Needing But Not Receiving SAT 2.7% 1.9% (Age >12) Didn't feel they needed tx Felt needed tx but no effort 95.4% Felt needed tx made effort 95.4% Don t recognize their need for tx SAMHSA NSDUH 2013 20 Mental Illness Distribution in the US Latino/Hispanic Population (2012) In Past Year >18 yrs. old Hispanic/ Latino White Asian African American >2 Races American Indian/ Alaska Native Any MI 16.3% 19.3% 13.9% 18.6% 20.7% 28.3% Serious MI 4.4% 4.2% 2.0% 3.4% 4.2% 8.5% Major Depressive Episode 7.0% 7.1% 3.2% 6.3% 7.7% 10.0% SAMHSA NSDUH 2013 21 7
Past Year Co Occurring MI & SUD for Latino/Hispanic Adults (>18 years old) 14.0% 12.0% 10.0% 14.0% 8.0% 6.0% 4.0% 1.1% 2.0% 0.0% Asian SAMHSA NSDUH 2013 Black 3.3% 3.4% 3.8% 4.3% Latino/ Hispanic White >2 Races American Indian/ Alaska Native 22 New HIV Infections by Race/Ethnicity, 2010 1% 1% <1% <1% 1% 100% 5% 2% 2% 90% 16% 21% 80% 12% 70% 60% 44% 50% 40% 64% 30% 20% 31% 10% 0% U.S. Pop. New HIV Infections HIV data are estimates & don t include U.S. dependent areas Adapted from http://kff.org/hivaids/fact sheet/the hivaids epidemic in the united states/ Nat. Hawaiian/ Other Pacific Islander Am. Indian/ Alaska Native Multiple Races Asian Latino Black White 23 23 VI. Workforce and Disparities National Hispanic and Latino ATTC http://attcnetwork.org/regcenters/in dex_nfa_hispaniclatino.asp One of only 4 SAMHSAfunded National Focus Area ATTCs. Reduce health disparities Raise visibility & awareness Promote cultural competencies Support workforce development 24 8
Northeast and Caribbean Regional ATTC 1 of 10 regional SAMHSA funded ATTCs serving the U.S. Works with the Hispanic/Latino focus area ATTC & IRESA at the Universidad Central del Caribe, PR http://attcnetwork.org/regionalcenters/?rc=northeastcaribbean 25 25 VII. SAMHSA s Response SAMHSA s BH Disparities Impact Statement BHbusiness Initiative & HL Communities SAMHSA Publications in Spanish SAMHSA Spanish-language Website: Office of Behavioral Health Equity HHS Latino Health Policy Primary Care Behavioral Health Integration 26 BHbusiness Network: Free Training & Technical Assistance First 2 years: provided TA to over 1,000 provider groups, helping them ready their organizations for health care change. Application deadline for next cohort is December 15, 2014 http://bhbusiness.org/ 27 9
SAMHSA Publications in Spanish SAMHSA offers Spanish language editions of many of our resources including reports and issue briefs. http://store.samhsa.gov/espanol 28 SAMHSA Spanish language Website: New Version in Development 29 SAMHSA s Office of Behavioral Health Equity http://beta.samhsa.gov/about us/who we are/offices centers/obhe 30 10
National Network to Eliminate Health Disparities A SAMHSA & National Alliance of Multi ethnic Behavioral Health Associations Partnership http://nned.net/ 31 Latino Health Policy: Plug into HHS Social Media Forums https://twitter.com/hhslatino 32 SAMHSA s Response (Continue) Integrated Services: Public Health Perspective Robert Wood Johnson Foundation Commission to Build a Healthier America, www.commisiononhealth.org 33 11
SAMHSA PBHCI Pioneers for Community Based Integrated Health Care PBHCI Grantees Improve access to primary care services; Improve prevention, early identification, and intervention to reduce the incidence of serious physical illnesses, including chronic disease; Increase availability of integrated, holistic care for physical and behavioral disorders; and Result: Better overall health status of clients. SAMHSA HRSA Center for Integrated Health Solutions http://www.integration.samhsa.gov/ Promotes development of integrated primary and MH/SUD services to better address the needs of individuals with mental health and substance use conditions, whether seen in behavioral health or primary care provider settings. Thank You Dennis O. Romero, MA Regional Administrator Region II (NJ, NY, PR, VI)) Substance Abuse and Mental Health Services Administration (SAMHSA) U.S. Department of Health and Human Services (HHS) 26 Federal Plaza, Suite 3337 New York, New York 10278 Phone: 212-264-8097 Fax: 212-264-2673 E-mail: dennis.romero@samhsa.hhs.gov Website: www.samhsa.gov / 1-877-726-4727 Behavioral Health is Essential To Health Prevention Works Treatment is Effective People Recover 36 12