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Building Equitable Mental Health Care for Latino Children: Perspectives from Providers and Communities

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Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Background

The current pediatric mental health crisis has disproportionately impacted Latino youth in the United States (US), as demonstrated by their elevated risks of depression, substance use disorder, and anxiety. Despite this, research suggests Latino youth receive inequitable mental health services.

Objective

To understand best practices, challenges, and priorities in providing accessible and equitable mental health care for Latino youth from the perspectives of front-line mental health providers and Latino community members.

Methods

A bicultural, bilingual researcher conducted semi-structured interviews with 20 participants with expertise in Latino mental health. Topics included barriers and facilitators to mental health care access and cultural tailoring of treatment for Latino youth. Rapid qualitative analysis was used to identify themes.

Results

Four themes were identified: (1) Navigating immigration concerns and acculturation, practitioners should consider immigration-related concerns and be trained to address acculturation-related stressors respectfully; (2) Adapting to the cultural needs and strengths of the communities, cultural humility education can allow providers to engage with both the strengths and needs of Latino families; (3) Engaging Latino caregivers as partners, it is critical to engage with Latino caregivers’ cultural perspectives on parenting and mental health collaboratively; and (4) Addressing systemic barriers to promote access, providers must recognize and attempt to alleviate the systemic barriers that limit families from seeking care.

Conclusions

Participants identified several practical strategies to improve the provision of mental health services for Latino children. Future directions, policy and practice implications, and limitations are discussed.

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Funding

This work was supported by a Duke University Bass Connections Grant. Dr. Cholera was supported by K12HD105253 from the National Institute of Child Health and Human Development (NICHD) of the US National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Department of Psychological Science, University of Texas Rio Grande Valley, Edinburg, TX, USA

    Francisco Banda

  2. Center for Health Policy, Robert J. Margolis, Duke University, 100 Fuqua Drive, Box 90120, Durham, MDNC, 27708-0120, USA

    Francisco Banda, Greeshma James, Michelle Franklin, Andrea Thoumi & Rushina Cholera

  3. University of North Carolina-Chapel Hill, Chapel Hill, NC, USA

    Karina Vasudeva

  4. Duke Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA

    Michelle Franklin

  5. Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA

    Rushina Cholera

  6. Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA

    Rushina Cholera

  7. Duke University, Durham, NC, USA

    Francisco Banda

Authors
  1. Francisco Banda
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  3. Karina Vasudeva
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  4. Michelle Franklin
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  6. Rushina Cholera
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Corresponding author

Correspondence to Rushina Cholera.

Ethics declarations

Ethics Approval and Consent to Participate

This study was determined exempt from obtaining informed consent by the Duke University Health System Institutional Review Board. Informed consent was obtained from all individual participants. The participants of this study did not give written consent for their data to be shared publicly. Our IRB regulations thus prevent the public sharing of our study data.

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Appendix

Appendix

A. Interview Guide

Verbal Consent:

My name is Francisco and I am a research assistant at Duke University. Thank you once again for agreeing to participate in our study.

The aim of our project is to understand barriers and facilitators to accessing behavioral health or mental health services among Latino children and families. We are conducting exploratory interviews with participants like you who have connections to mental health in the Latino communities in order to gain a better understanding of ongoing programs, strategies, and experiences. We will be audio-recording this interview to ensure accuracy as our team reflects on what you share with us and will discard recordings after the study is complete. To protect your privacy, we will not report your name, organization name, or any other identifying information. This data will be handled carefully and safely. It will only be seen by members of our team before being permanently deleted at the end of our research.

Your participation in this study is completely voluntary. If you would like to take a break, decline to answer a question, or end the interview at any time let me know.

Before we proceed do I have your permission to record and transcribe this interview? We can still proceed with the interview if you prefer it not be recorded.

Do you have any questions for me before we get started?

Interview Questions:

  • 1. I’d like to start off by confirming the information I was able to find about your work/organization. [Explain your understanding of their work]. Is this all accurate? Is there anything you would add?

  • 2. A major goal of health policy is that of pushing for equitable healthcare. We can define this as the fair and just distribution of healthcare services and resources to communities according to their need—especially to support disadvantaged groups. In your opinion, what are the biggest obstacles hindering the equitable mental health care treatment of the Latino population?

    • A. Probing questions:

      • i. If not mentioned by the participant: What sort of direct experiences with this/these obstacles, if any, either from your background or from your work, can you share?

      • ii. If not mentioned by the participant: Our major interest is with Latino children specifically. How do these obstacles you mention, or any other that come to mind, apply to children?

      • iii. What steps should be taken and what policies implemented to address these obstacles?

      • iv. Do any major campaigns in the country that push for these efforts come to your mind?

  • 3. Next, I want to get your thoughts on obstacles and responses. Through our research, I found an emphasis on practical issues for the Latino population such as language barriers, financial limitations, transportation, and even just difficulties in finding the time of day or someone to watch children while receiving treatment. From your perspective, what steps could policymakers and/or practitioners take to address the systematic nature of such problems?

    • A. Probing questions:

      • i. If not mentioned by participant: What are your thoughts on telehealth as a tool meant to address these problems?

      • ii. Are there any limitations to telehealth that you see?

      • iii. How can we address these limitations?

  • 4. Other commonly mentioned obstacles in the literature can be described as socio-cultural. These include stigma against mental health treatment, distrust of healthcare systems, and insufficient cultural humility. From your perspective, what initiatives and/or policies can we take to address and overcome such barriers?

    • A. Probing questions:

      • i. If not mentioned by participant: What are your thoughts on promotora, or community health worker, initiatives as a response to these obstacles?

      • ii. If not mentioned by participant: I know other similar initiatives have attempted to reach out to community centers like schools and particularly churches. What are your thoughts on these programs as a response to these obstacles?

      • iii. What limitations or pending questions, if any, do you see with such initiatives?

  • 5. Now I’m hoping to hear from you what ideally tailoring mental health care for children in the Latino communities looks like. What specific components of Latino cultures, traditions, values, and perspectives should mental health specialists be especially adaptive to?

    • A. Probing questions:

      • i. In some ways, addressing the obstacles impeding the equitable behavioral health treatment of the Latino communities can sometimes imply changes to components of its culture. As a quick example… [Give stigma/faith example] Some see this process as problematic while others feel it’s for the best. Do you have any thoughts on this?

      • ii. If participant expresses concerns about acculturation process: How do you think medical professionals and policymakers can go about implementing change into these communities in a respectful way?

  • 6. As a final question, do you recommend any other programs/individuals we should reach out to help us with this project? Is there anything else you’d like to share with us that you think might be helpful for our research?

Spanish Version

Mi nombre es Francisco y yo soy un asistente de investigación en Duke University. Gracias de nuevo por platicar con nosotros para nuestro estudio.

El objetivo de nuestro proyecto es entender las barreras y ayudas para el acceso de servicios por la salud del comportamiento y de la salud mental. Estamos conduciendo entrevistas exploratorias con individuos y organizaciones como usted que tienen conexiones a la salud mental en la comunidad Latina para obtener una mejor comprensión de los programas en curso, estrategias, y experiencias. Estaremos grabando esta entrevista en el interés de evitar errores cuando nuestro equipo empieza a reflexionar sobre todo lo que usted comparta con nosotros antes de borrar las grabaciones cuando el estudio este completo. Para proteger su privacidad, nosotros no vamos a reportar su nombre, nombre de su organización, o alguna otra información que se pueda usar para identificar lo/la. Los datos de nuestra conversación serán tratados con cuidado y seguridad. Solo serán vistos por miembros de nuestro equipo antes de ser permanentemente borrados al fin de nuestra investigación.

Su participación en este estudio es completamente voluntaria. Si le gustaría tomar un descanso, brincar cualquier pregunta, o terminar la entrevista a cualquier momento por favor solo avíseme.

¿Antes de empezar, tengo su permiso para grabar y transcribir esta entrevista? Aun podemos continuar con la entrevista si prefiere que no se grabe.

¿Tiene alguna pregunta para mi antes de que empecemos? [Can we share interview data with participant?].

Preguntas de Entrevista:

  • 1. Me gustaría comenzar confirmado la información que pude encontrar sobre su trabajo/organización. [Explica tu comprensión de su trabajo]. ¿Me podría confirmar que todo lo que dije es correcto? ¿Hay algo que usted agregaría?

  • 2. Una de las principales metas de la política pública de salud es la equidad en el servicio de salud. Podemos definir este concepto como la distribución justa de los servicios y recursos de salud según las necesidades de las comunidades—especialmente para apoyar a los grupos desfavorecidos. En su opinión, ¿Cuáles son los obstáculos que impiden el tratamiento equitativo de la salud mental para los niños en la población Latina?

    • i) Preguntas suplementarias:

      • (1) Si no es mencionado por el entrevistado: ¿Si es que tiene experiencias directas con estos obstáculos que ha mencionado, ya sea por parte de su pasado personal o por su trabajo, que nos puede compartir sobre esas experiencias?

      • (2) En su opinión, ¿Qué pasos se deben tomar y que pólizas se deben implementar para abordar estos obstáculos?

      • (3) ¿Hay algunas campañas importantes en el país que le vengan a la mente las cuales estén apoyando estas iniciativas que menciona?

  • 3. Ahora me gustaría conocer su opinión sobre los obstáculos y respuestas a ellos. A través de nuestra investigación, encontré un énfasis en cuestiones prácticas para la comunidad, como las barreras de idioma, limitaciones financieras, el transporte e incluso las dificultades para encontrar tiempo en el día o alguien para cuidar a los niños durante el tratamiento. En su opinión, ¿Qué pasos podrían tomar líderes de política pública y profesionales médicos para abordar la naturaleza sistemática de tales problemas?

    • i) Preguntas suplementarias:

      • (1) Si no es mencionado por el entrevistado: ¿Qué piensa sobre la telesalud, o específicamente en nuestro caso la terapia virtual, como una herramienta que pueda abordar estos problemas?

      • (2) ¿Hay alguna limitación para la telesalud que usted vea?

      • (3) ¿Qué pasos debemos tomar para abordar estas limitaciones?

  • 4. Otros obstáculos comúnmente mencionados en la literatura se podrían categorizar como socioculturales. Estos incluyen el estigma contra el tratamiento de salud mental, la desconfianza en los sistemas de atención médica, y la falta de humildad cultural. En su opinión, ¿Qué iniciativas y pólizas podemos tomar para abordar y superar tales barreras?

    • i) Preguntas suplementarias:

      • (1) Si no lo menciona el entrevistado: ¿Qué piensa sobre las iniciativas de promotoras, o por otro nombre, las trabajadores comunitarias de salud, como respuesta a estos obstáculos?

      • (2) Si el entrevistado no lo menciona: ¿Qué le parece las medidas adoptadas para llegar a locales comunitarios como escuelas y especialmente las iglesias como una respuesta a estos obstáculos?

      • (3) ¿Qué limitaciones o cuestiones pendientes ve con este tipo de iniciativas?

  • 5. Ahora me gustaría aprender sobre cómo sería la atención de salud mental creada especialmente para niños de la comunidad Latina. ¿A cuáles componentes específicos de las culturas, tradiciones, valores y perspectivas Latinas deberían adaptarse los especialistas en salud mental?

    • i) Preguntas suplementarias:

      • (1) De ciertas maneras, abordar los obstáculos que impiden el tratamiento equitativo de la salud mental para la comunidad Latina a veces puede implicar cambios en los componentes tradicionales de su cultura. Por ejemplo, es muy común que los Latinos busquen la ayuda de la Iglesia o figuras religiosas antes de la ayuda de profesionales de salud mental. Para algunos, este proceso es problemático, pero para otros es preferible. ¿Usted tiene algunos pensamientos sobre esto?

      • (2) Si el entrevistado menciona dudas sobre el proceso de aculturación: ¿De qué manera podrán los profesionales médicos y líderes de política pública implementar tales cambios de maneras respetosas?

  • 6. Como pregunta final, ¿recomienda algún otro programa o persona a la que debamos contactar para que nos ayude con este proyecto? ¿Hay algo más que le gustaría compartir con nosotros que podría ser útil para nuestra investigación?

B. LOGIC Model

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Banda, F., James, G., Vasudeva, K. et al. Building Equitable Mental Health Care for Latino Children: Perspectives from Providers and Communities. J. Racial and Ethnic Health Disparities (2024). https://doi.org/10.1007/s40615-024-01992-4

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