Latino Access Study

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Latino Access Study

• Report to the California Mental Health Planning
  Council
• Department of Mental Health
• October 2009

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Latino Access Study (LAS)

• Background Information
• LAS Requirements
• LAS Details
• Challenges
• LAS Methodology
• Access Barriers
• County Examples
• LAS Promising Strategies

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Background Information

• In 2001, the Statewide Quality Improvement
  Council (SQIC) and the Cultural Competence
  Advisory Committee made a recommendation to the
  Department of Mental Health (DMH) to include a
  Latino Access Study (LAS) as a part of the
  quality improvement plans required in the Mental
  Health Plan (MHP) contracts for FY2002-03.
• DMH agreed with this recommendation and issued a
  letter to counties requiring the county mental
  health plans to conduct the LAS (May 2002).

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Latino Access Study Requirements

• All county Mental Health Plans with Medi-Cal
  eligible populations of 10,000 or more and/or
  counties with Spanish identified as a threshold
  language were required to complete the LAS.
• Nine small counties were exempt because they did
  not meet the population and/or language
  requirements at the time Alpine, Amador,
  Calaveras, Mariposa, Nevada, Plumas, Siskiyou,
  Trinity, and Tuolumne.

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Latino Access Study Requirements

• The SQIC recommendations focused on two areas for
  examination initial access and secondary access
• Initial access studies could include outreach
  efforts to increase access, stigma, and/or
  healthcare/mental health partnerships
• Secondary access studies could include retention
  issues, the effects of extended clinic hours,
  and/or barriers for Latinos with Limited English
  Proficiency (LEP)

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Latino Access Study Details

• 37 county MHPs submitted a copy of their LAS to
  DMH
• The focus of the studies varied greatly from
  county to county
• 47 Barriers for Latinos with LEP
• 28Outreach efforts to increase access
• 28 Retention
• 25 Stigma
• 22 Utilization Rates
• 19 Penetration Rates
• 14Health/Mental Health partnerships
• 8 Miscellaneous (e.g. organizational
  self-assessment)
• 6 Effects of extended hours
• 6 Cultural competence training for staff

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Challenges of the LAS

• Limited direction/guidance on how to conduct the
  study
• No funding for the studies or to implement
  strategies
• Limitations on the data that were available
• Small sample sizes (small counties)
• Very few counties were able to substantiate a
  significant increase in Latino access as a direct
  result of the LAS
• Some counties limited the scope of the LAS to a
  review of penetration and/or utilization rates
• County MHPs were not initially required to submit
  copies of their studies to DMH

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LAS Methodology

• The study methodology also varied from county to
  county
• 46 Data Review
• 43 Interview/ Focus Groups
• 22 Outreach Efforts
• 16 Consumer Satisfaction Surveys
• 14 Organizational Self-Assessment
• 11 Increase Bilingual Staff/ Interpreters
• 06 Chart Reviews
• 06 Cultural Competence Training for Staff
• 06 Partner with Healthcare/Primary Care

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LAS identified these barriers to access for
Latino populations

• Limited staff resources to make services more
  widely available
• General lack of information or understanding of
  mental illness/ mental health services
• Stigma
• Language barriers/lack of bilingual staff/lack of
  trained interpreters
• Transportation barriers
• Restricted hours of service
• Fear related to immigration/residency status

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LAS County Examples San Mateo County

• Data review, including penetration rates by
  location and language an analysis of the
  correlation of penetration rates and other
  indicators of access with available data on the
  ethnic and language distribution of staff and a
  cultural competence self-study completed by CMH
  staff
• Review of all policies, procedures, and practices
  affecting Latino access at primary points of
  access
• Analysis of available summary data on
  satisfaction and complaints concerning Latino
  consumers

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LAS County Examples San Mateo County

• Analysis of MHP staff satisfaction surveys
• Interviews and focus groups with Latinos
  representing mental health consumers and family
  members, community members not involved with the
  mental health system, key contacts in the Latino
  community, and local Latino mental health
  clinicians
• San Mateo Countys LAS resulted in key
  recommendations to improve access for Latino
  mental health consumers.

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LAS County Examples Sacramento County

• Initiated an 18-month study to examine and
  identify barriers to community based mental
  health services for the Latino community
• Multi-tier approach included a large countywide
  study and individual LAS for each agency or
  program
• A system-wide committee, the Latino Access Study
  Focus Group, was convened to develop the
  countywide study

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LAS County Examples Sacramento County

• The Latino Access Study Focus Group committee
  conducted five countywide focus groups
  representing current and former clients, family
  members, community leaders, and Healthy Start
  Coordinators
• Focus group questions were developed in both
  English and Spanish
• The goal of each focus group was to identify
  barriers for the Latino community in the county
  and design strategies to remove those barriers
• In response to the focus groups findings,
  Sacramento County planned a second phase of the
  LAS to develop strategies and interventions to
  address the barriers identified.

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LAS County Examples Los Angeles County (LACDMH)

• LAS conducted as a multiple phase project
• Conducted an extensive literature review
  regarding available research on Latino access to
  mental health services
• Assessed quality of data collection (both
  Medi-Cal and non Med-Cal) and procedures which
  impact data collection
• Convened focus groups with mental health
  consumers and clinicians
• As a result of data review and focus groups,
  LACDMH focused on addressing one of the most
  critical barriers identified language access

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LAS County Examples Los Angeles County (LACDMH)

• Developed a pilot study to evaluate Interpreters
  Training outcomes with a goal to increase
  cultural competence of the providers when working
  with monolingual or Limited English Proficiency
  populations
• The data indicated a significant improvement of
  knowledge from the pre-instruction time point to
  the post-instruction time point. The
  interpreters attitudes toward interpretation did
  not change significantly as a result of the
  training.
• LACDMH continues to evaluate the Interpreter
  Training Program and has dedicated resources from
  the MHSA Workforce Education and Training
  component to increase the capacity for the
  Interpreter Training Program.

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LAS County Examples Small Counties, Small Steps,
Big Results

• Both Madera and Imperial counties were able to
  improve access for Latino consumers by offering
  flexible clinic hours
• Imperial County MHP regularly allows consumers to
  access services on a walk-in basis. They also
  provide information (about mental health
  services, intake, and referrals, etc.) via
  telephone Monday-Friday, evenings, holidays, and
  weekends.
• Similarly, the Madera County MHP found that
  having open clinic hours during which time
  clients could walk-in and receive an assessment
  made it easier for consumers to overcome barriers
  (i.e., restricted clinic hours, child care, lack
  of transportation, stigma, shame for missing
  appointments, etc.), and increased access to
  mental health services.

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LAS Promising Strategies

• Engagement Engaging local community leaders and
  community members in the development of local
  anti-stigma campaigns.
• Organizational Structure Latino access was
  increased by offering flexible service hours and
  walk-in appointments.
• Workforce Identified need for increasing the
  number of bilingual staff to address needs of
  large Spanish-speaking communities in counties.
• Training Funding interpreter training increases
  competency and is a beneficial investment.
• Program Practicing enhanced case management
  as an outreach strategy between first contact and
  the initial assessment and building
  relationshipbased connections grew Latino
  access.
• Welcoming Environment Providing comfortable,
  culturally appropriate surroundings (i.e., use of
  Latino art, Spanish language videos, brochures,
  posters, etc.)

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Contact Information

• Department of Mental Health
• Office of Multicultural Services
• Rachel Guerrero
• Autumn Valerio
• Autumn.Valerio_at_dmh.ca.gov
• [phone]
• www.dmh.ca.gov/Multicultural_Services