Comprehensive SBHC
Services Addressing the
Mental Health Needs of
Mexican Immigrants
Olga Acosta Price
Michelle J. Lyn
Presenter Disclosures
Olga Acosta Price and Michelle J. Lyn
(1)The following personal financial relationships with
commercial interests relevant to this presentation
existed during the past 12 months:
“No relationships to disclose”
Session Objectives
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Describe the mental health needs of the immigrant/refugee
population in US and the importance of utilizing school-based
health centers as entry to a continuum of prevention, early
intervention, and treatment services.
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Discuss adaptations to mental health screening, prevention, early
intervention, and treatment services to consider making when
working with Mexican children and their families in particular.

Analyze strategies to develop a community collaborative,
integrated school-based health center model that provides a
culturally accepted continuum of prevention, early intervention,
and mental health treatment services.
Demographics
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In 2000, 31.1 million individuals in the US were foreignborn (an increase of 57% since 1990)
According to the 2000 Census, 1 of every 5 children in
the US is a child of immigrants
As of July 2006, Hispanics constituted 15% of the
nations total population and 23% of children under 5
In the past 30 years, over 2 million refugees have
resettled in the US, with a significant number being under
18 years old
19% of children 5-17 speak a foreign language at home
and 5% of all children have difficulty speaking English78% of Hispanic children 5 and older speak Spanish at
home
Mexican Residents
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23 million of US pop are of Mexican origin- 9%
of total population and 64% of Hispanic
population
53% of Mexicans 15 years old+ were married
61% of Mexican origin were native & 31% were
foreign born and did not have citizenship
41% of Mexicans did not speak English at home
37% of those of Mexican heritage under 18
30% of Mexican children under 18 lived in poverty
General Challenges Faced
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Poverty rates are much higher for children in immigrant and
refugee families than children in native-born families
 Parents are more likely to perform low-wage work with no
benefits (lack of health insurance) or limited benefits
Pre-migration, migration, and post-migration exposure to
traumatic events creates vulnerabilities
People with limited English proficiency (LEP) are less likely to
seek care and receive needed services (even when economic
factors and ethnicity are accounted for)
Stigma related to seeking mental health care is a barrier in many
ethnic communities
Caring Across
Communities
Addressing Mental Health
Needs of Diverse Children and
Youth
Robert Wood Johnson Foundation
Caring Across Communities National
Program: Key Elements
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15 grantees identified and awarded up to $100,000 a year for
three years (started March 2007)
Serving an immigrant or refugee-dense community
Building on the combined strengths of a community
partnership
Utilizing a school base
Understanding the target community & its most pressing
mental health issues
Reducing barriers to care created by language and cultural
difference
Utilizing a School Base & SBHCs
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Important resources at hand
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ESL, student support services, special education, offices of
multicultural services, physical health providers (i.e., nurse)
Multidisciplinary staff and collaborative structures exist
Familiarity with translation and interpretation
Understand the value of/need for community partnership
Can offer a continuum of health services (prevention,
early intervention, treatment)
SBHCs were created to overcome barriers to health care
access for underserved youth and families
Often less stigmatizing to receive services as part of
support offered in school
Integrated SBHC Model
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Within SBHC:
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Within School:
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Physical health and mental health services
May include dental health, health education, case management
SBHC staff and school staff
Parent/family involvement
Between School & Community:
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Integration between school and home
Collaboration between school & community providers
Cultural Competence
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How do we know that our constructs around
mental health mean the same thing to our
clients?
Do processes for obtaining informed consent
need to be modified?
Are our evidence-based practices really
appropriate for the families and children from
other countries of origin?
What adaptations are necessary to make sure our
treatment programs are effective?
Emerging Best Practice
Key Components
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Partnership Involvement
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Education and Training
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Identification of Partners and Development of Collaboration
Supporting Meaningful Engagement
Cultural Competence
Stigma Reduction
Mental Health Service Delivery
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Prevention
Early Intervention
Treatment
One Community’s Experience : Moving
Toward an Integrated Model of SchoolBased Medical and Mental Health Services
BieneSTAR: School-Connected Prevention,
Early Identification, and Direct Mental
Health Services
A Caring Across Communities Grantee
Our Community Context
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Durham County Total Population: 246,896
Racial and Ethnic Composition for
Durham Public Schools (32,749 students):
53.9% African-American
22.6 %White
17.1 %Hispanic
3.6%Multi-racial
2.6%Asian
0.2%Native American
U.S. Census
Durham Public Schools Website,
www.dpsnc.net, accessed June 10, 2008
Our Community Context:
Our Changing Demographics
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Between 1990-2000, North Carolina experienced
a 394% increase in the documented Latino
population as compared to the national growth
rate of 58%.
Most Latinos in North Carolina are of Mexican
Origin (65%).
Latino preschool children age 4 or younger
increased by 814% from 1990 – 2000, while
Latino children 5-17 grew by 729%.
North Carolina Latino Health 2003,
Report of the North Carolina Institute of Medicine
The New Latino South, Pew Hispanic Institute
Our Youth: Challenges Faced
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2007 Durham County YRBS – Mental Health
 Middle School
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18.1% have thought seriously about killing themselves
15.2% reported they had made a plan about how to kill themselves
22% agreed or strongly agreed they felt alone in life
High School
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27.5% reported feelings of depression during last 12 mos.
16.4% seriously considered attempting suicide
12.8% made a plan about how they would attempt suicide
18% said that they had attempted suicide in the past 12 months
24% agree or strongly agree that they feel alone in their lives
Our Youth: Challenges Faced
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2007 Durham County YRBS – Mental Health
 For Latino/Hispanic Youth
Lower grade scores
 Higher levels of feelings of insecurity
 Over 25% didn’t go to school in the last 30 days because
they felt unsafe
 32% said that they had attempted suicide within the past
12 months.
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Our Latino Youth and Families:
Challenges Faced
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Depression, grief, and traumatic grief associated
with loss and change
Traumatic experiences while immigrating
Adjustments that include language, social
interaction, school expectations, stigma, laws
that are different from country of origin
Unfamiliar with resources and services within
the community
The Partners
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Division of Community Health, Duke
Durham Public Schools
El Centro Hispano
Center for Child and Family Health
Division of Community Health
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Created in 1998 to build a bridge between Duke and
the communities it serves
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More than 40 Programs: Clinical Services, Disease
Prevention and Health Promotion, and Education
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multi-partnered
collaboratively planned, operated, and funded
serving at-risk, vulnerable populations who face barriers to
care
built around patients, not facilities/faculty
El Centro Hispano
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Grassroots Latino community center
Created in 1992 for newly arrived immigrants
Services ↔ Education ↔ Community Organizing
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Programs for children, youth, and adults
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Linkages to Community Resources
Health Education, Disease Prevention & Access to Care
ESL classes
Women’s empowerment
Youth support
Family Literacy
Economic Development
Center for Child & Family Health
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Consortium (est. 1996)
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Duke University
North Carolina Central University
University of North Carolina
Child & Parent Support Services
Child maltreatment & trauma
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Services
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Training
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Trauma treatment, primary & secondary prevention, pediatric/MH forensic
assessment
Evidence based mental health, multidisciplinary collaboration & intervention,
assessment, court consultation
Research
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Home based prevention, service delivery, assessment & intervention with
orphans & vulnerable children
Supporting Meaningful Engagement:
Our Partnership’s Guiding Principles
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Community needs and stakeholders determine the services
to be developed
Programs are overseen by steering committees composed
of community stakeholders/partner organizations, faculty
and staff
Programs focus on populations facing health disparities
Programs are designed to be financially stable
Programs are rigorously evaluated
Supporting Meaningful Engagement:
From Principles to Practice
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Three Ways
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Planning – Assessing Mental Health and Health Needs
Operating – Designing and Managing Shared Programs
and Services
Advisory – Sharing Expertise to Address Specific Health
Needs and to Establish New/Improved Services
Our decision-making process
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Informed by practice, program evaluation/review
Everyone has an equal voice
Informal and structured opportunities for discussion
tweaking
Supporting Meaningful Engagement:
A Few Partnership Activities
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Four School-Based Health Centers
Tooth Ferry Dental Van
Adolescent Centered Care, Education, and Social Support
(ACCESS)
Amigas Latinas Motivando el Alma (ALMA)
Local Access to Coordinated Healthcare (LATCH)
Utilizing a School-Base:
BieneSTAR Pilot Sites
1. Three Elementary School-Based Health Centers in DPS
Operated by the Duke’s Division of Community Health:
Total
Students
AfricanAmerican
Hispanic
White
MultiRacial
Free/
Reduced
Lunch
LEP
Watts
355
28%
43%
21%
4.5%
59.89%
22%
EK Powe
325
45%
29%
18%
6.4%
70.64%
24%
Glenn
764
53%
39%
3.7%
3.4%
81.34%
24%
2. El Centro Hispano: Registration and ESL Testing
for DPS
Durham Public Schools, www.dpsnc.net
BieneSTAR Goals
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Prevent and reduce exacerbation of mental health disorders
of children enrolled in 3 elementary school clinics through
the provision of mental health education and outreach to
parents and school personnel with special emphasis on
immigrant children and families.
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Create sustainable mental health services, including early
identification and counseling that are accessible, culturally
competent, and integrated into school services with special
emphasis on immigrant at-risk children enrolled in the
SBHCs.
BieneSTAR Activities
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Education and Training
Prevention
 Early Intervention
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Mental Health Service Delivery
BieneSTAR Team
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Bilingual Licensed Clinical Social Worker
from Center for Child and Family Health
Bilingual, Bi-Cultural Health Educator from
El Centro Hispano
Who work with:
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SBHC Mid-level practitioners and LCSWs
School Guidance Counselors and Social
Workers
School Classroom Faculty and Administration
Prevention
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Child Groups
Parent and Family Groups
Teachers, Counselors, and ESL Teachers InService Education
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Child and Family Experiences
Identifying Needs Before They are Problems
Early Intervention
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Mental health screening services
Educate DPS registration and ESL testing
personnel at El Centro Hispano about
mental health screening services and referral
process
Educate DPS school personnel about mental
health screening services and referral
process
Direct Mental Health Services
Group, family, or individual mental health therapy at the
SBHC, El Centro Hispano, or CCFH
Year One Statistics:
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Number of Children Referred and Demographics
Reason for Referral
Disposition
Diagnosis
Encounters by Referral
Consultations with Teachers, Administrators, Parents, School
Counselors, etc.
Contact Information
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Olga Acosta Price, Ph.D.
Co-Director, Center for Health and Health Care in Schools School
of Public Health and Health Services, GWU
 Email: [email protected]
 Phone: 202-466-3396
 http://www.healthinschools.org

Michelle J. Lyn, MBA, MHA
Assistant Director, Division of Community Health, Department of
Community and Family Medicine, Duke University Medical Center
 Email: [email protected]
 Phone: 919-681-3192
 http://communityhealth.mc.duke.edu
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