Despite a similar prevalence of mental disorders as whites, only 1 in 11 Latino adults with a mental disorder receive services compared to 1 in 3 white adults. Differences in Latino's use of mental health services persist even after accounting for health status and the mediating effect of socioeconomic status. Latinos report openness to receipt of mental health services in general and from primary care providers in particular, but face barriers related to language, expectations, and differences in styles of patient-doctor communication. Community health worker and patient activation models have been applied to these sorts of barriers in primary care, but not for maternal and child mental health problems. Goals and specific aims: This project will develop and evaluate an intervention to improve the delivery of mental health services to Latino mothers and children in primary care. The intervention will train native Spanish-speaking Latino paraprofessionals to help mothers and children (1) articulate mental health concerns for discussion with their doctor prior to the visit;(2) formulate an agenda for the visit;and (3) overcome barriers to follow-through with mental health treatment. The paraprofessionals will also help primary care providers understand culturally-specific ways in which mothers and children may express concerns related to mental health.
The specific aims of this intervention development proposal are to determine if it is feasible to train paraprofessionals in skills that promote use of mental health services, if the training is perceived as engaging to the paraprofessionals and useful to the physicians they support, and if the intervention alters therapeutic interactions and intermediate outcomes as predicted by its underlying theoretical model. Methods: The study takes place in a free-standing community center providing primary care services to low- income Latino mothers and children. It will enroll 375 parent-child pairs (children ages 3-16), using a pre-post design to evaluate the impact of paraprofessionals'training. Skills in the training come from the literature on patient-centered interaction, solution-focused cognitive therapy, and motivational enhancement;the training is based on a similar model successfully employed with primary care providers themselves. The training is highly interactive, allowing for combining the culturally specific knowledge of the paraprofessionals with the communication/activation skills taught by the investigators. Three waves of data collection will first establish a baseline for detection and discussion of mental health issues, then look at the impact of the training, and then assess persistence of training effects 6 months later.
Paraprofessionals are commonly employed to promote efficient care in clinic settings and in multicultural communities. Improving their ability to promote the effective discussion of mental health concerns could be an efficient and replicable method for reducing cultural barriers to mental health care among Latinos and other ethnic groups.
| Christensen, Anna L; Brown, Jonathan D; Wissow, Lawrence S et al. (2016) Spillover of Ratings of Patient- and Family-Centered Care. J Ambul Care Manage 39:308-15 |
| Lê Cook, Benjamin; Brown, Jonathan D; Loder, Stephen et al. (2014) Acculturation differences in communicating information about child mental health between Latino parents and primary care providers. J Immigr Minor Health 16:1093-102 |
| Brown, Jonathan D; Wissow, Lawrence S; Cook, Benjamin L et al. (2013) Mental health communications skills training for medical assistants in pediatric primary care. J Behav Health Serv Res 40:20-35 |
