Services In Spanish Research Articles

The ACA Medicaid expansions and the supply of substance use disorder treatment services in Spanish

BackgroundGiven persistent disparities in substance use disorder (SUD) treatment for Spanish speakers, it is important to understand whether major health policy changes may improve access to linguistically competent services. We estimate changes in the supply of SUD treatment facilities that both accept Medicaid as payment and offer services in Spanish after the Medicaid expansions under the Affordable Care Act. MethodsWe use data from the Mental Health and Addiction Treatment Tracking Repository for years 2010–2020 to calculate the number of facilities per 100 that offered both services in Spanish and accepted Medicaid as payment, facilities per 100 that accepted Medicaid as a form of payment overall, and facilities per 100 that offered Spanish language services overall. We use a difference-in-differences strategy exploiting variation in the timing of the Medicaid expansions across states, and county-level variation in the share of Spanish speaking Latinos across and within states. ResultsWe find that treatment facilities that both accepted Medicaid as a form of payment and offered Spanish language services increased by roughly 2–3 per 100, on average, in counties with the highest shares of Spanish speakers compared to counties with low to medium shares. This increase may be explained by more facilities accepting Medicaid as a form of payment. ConclusionThe Medicaid expansions under the ACA produced a modest increase in the supply of SUD treatment facilities that both accepted Medicaid as payment and provided services in Spanish in areas with highest shares of Spanish speakers.

Challenges Encountered by Latinx Bilingual Service Providers Working With Survivors of Intimate Partner Violence

The purpose of this study was to identify the challenges encountered by bilingual service providers working with survivors of intimate partner violence (IPV). Latinx experience IPV at a high rate, and their ability to seek services is affected by multiple factors, including their immigration status, English language proficiency, and lack of familiarity with the U.S. healthcare system. Bilingual service providers working in shelters often treat Latinx in Spanish. While some research exists on the stressors associated with providing IPV services in shelters, nothing is known about how being bilingual affects service providers. This qualitative study was designed to fill this gap. The findings yielded two themes: difficult workload and service provider exhaustion. The disproportionate rate of IPV services requiring services in Spanish and the available staff equipped to serve them often results in high caseloads and additional responsibilities for bilingual service providers. The lack of training in both service provision in Spanish and serving monolingual Spanish-speaking IPV survivors increases the strain of providing quality client care. Emotional and mental exhaustion is a common experience when serving trauma clients; however, it can be compounded for bilingual service providers, who must also use a second language. Agencies must consider the work demands of bilingual service providers to ensure that the expectations are balanced and reasonable. More Spanish-speaking providers are needed to meet the need, and evidence-based training must be developed and widely disseminated.

H - 21 ¿Habla Español? Increasing Access to Clinical and Educational Materials for Non-English Speakers.

Effective communication is an essential factor in successful health care delivery. However, Hispanic-Americans, many of whom are non-English speakers, face disparities related to a lack of multilingual providers and resources in their preferred language. The goal of this quality improvement project was to increase access to clinical and educational materials for non-English speakers at an outpatient pediatric clinic. A survey assessing the availability of bi- or multilingual providers and staff as well as Spanish materials utilized by providers was disseminated to all staff working at the Pediatrics Department, including the Division of Developmental/Behavioral Sciences, of an academic medical center. Participants uploaded resources they use to assist in the development of a departmental repository of Spanish materials. Data was collected November 2022-January 2023. Sixty-five participants completed the survey with 28% speaking Spanish, and 23% reporting they provide health care services in Spanish. Forty-six different kinds of resources were identified, and eight were uploaded and compiled into a repository with the goal of being distributed across the department to be used by providers and staff. Although valuable work has been done to develop culturally-appropriate materials in Spanish for health care use, the availability and use of these resources appears to be limited. Building an infrastructure for sharing these materials department-wide, and broader within healthcare systems is essential. Further research is needed to understand the cultural appropriateness of health-related materials translated into Spanish, and in developing guidelines for the translation and adaptation of materials for a growing culturally-diverse patient population.

Association between no-show rates and interpreter use in a pediatric otolaryngology clinic.

To understand how primary language and interpreter use affect no-show rates in pediatric otolaryngology. This is a retrospective cohort study using medical records of new patients in a pediatric otolaryngology clinic from 2014 to 2019. Data was collected on patient demographics including age, primary language, insurance type, maternal education level, maternal primary language, interpreter use at the first visit, total number of appointments scheduled, number of missed appointments, and number of completed appointments. Inferential statistics using parametric (ANOVA) and non-parametric (Mann-Whitney U tests, Kruskal-Wallis tests, and Spearman correlation coefficient) methods were used. Primary language was associated with significant differences in no-show rates (p=0.0474), with Spanish and English speakers having the lowest no-show rate (33%). Overall, interpreter use at the first visit was not significantly associated with subsequent appointment attendance (p=0.3674). Patients with a documented Spanish interpreter at the first visit had the lowest average no-show rate (31%±19%) compared to Haitian Creole (42%±18%) and all other languages (32%±19%) (p=0.0265). Hispanic ethnicity, maternal education level, and maternal primary language were not associated with attendance. Interpreter use at the first visit was not significantly correlated with no-show rates, but among patients that did require an interpreter at the first visit, those receiving services in Spanish had the best clinic attendance.

Downward National Trends in Mental Health Treatment Offered in Spanish: State Differences by Proportion of Hispanic Residents.

This study aimed to determine how the prevalence of mental health treatment facilities that offer services in Spanish has changed over time in the United States. Data from the National Mental Health Services Survey conducted in 2014 (N=13,015 facilities) and 2019 (N=12,345 facilities) were used to measure changes in the proportions of facilities that offered treatment in Spanish overall and by year, state, and proportion of Hispanic residents. Descriptive statistics were used to illustrate state-level changes in services offered in Spanish. Between 2014 and 2019, the national Hispanic population increased by 4.5%, or 5.2 million people. During the same period, the proportion of facilities that offered treatment in Spanish declined by 17.8%, or a loss of 1,163 Spanish-speaking mental health facilities. Overall, 44 states saw a decline in the availability of services in Spanish, despite growth in Hispanic populations across all states. Among states with the fastest Hispanic population growth, several also experienced the greatest reduction in Spanish-language services. The findings indicate that availability of Spanish-language mental health services decreased in most U.S. states during 2014–2019. Promoting mental health service delivery in Spanish is critical for reducing barriers to treatment and ensuring health equity across populations.

Person-Centered Cultural Assessment Can Improve Child Mental Health Service Engagement and Outcomes

ABSTRACT Objective Disparities in child mental health service engagement suggest traditional evidence-based practices do not properly consider cultural and contextual factors relevant for marginalized families. We propose a person-centered approach to improve the cultural responsiveness of services. Preliminary research supports broadening standard assessments to include a person-centered evaluation of patient cultural factors, however, controlled studies have not been conducted in the context of children’s mental health care. Methods Participants included families (N = 89; 89% racial/ethnic minority) receiving services for child externalizing problems. Prior to intake, caregivers were randomized to receive either Assessment as Usual (AAU) or AAU augmented with the Cultural Formulation Interview (CFI+AAU), a brief caregiver assessment of cultural factors affecting their child’s problems and family help-seeking. Results Implementation data showed strong provider fidelity and clinical utility. Following assessments, CFI+AAU caregivers (relative to AAU caregivers) reported feeling better understood by their provider, and providers reported better understanding CFI+AAU families’ values. Caregiver satisfaction was rated highly overall, yet providers reported being more satisfied with the assessment when the CFI was incorporated. Engagement outcomes found CFI+AAU families were significantly more likely than AAU families to subsequently complete the first phase of treatment. Further, among families receiving services in Spanish, CFI+AAU, relative to AAU, was associated with significantly higher treatment attendance, homework completion, and treatment response. Conclusions The results underscore the utility of incorporating a brief cultural assessment in pretreatment assessments. To improve the cultural responsiveness of services, efforts may do well to promote the uptake of person-centered approaches such as cultural assessment into usual care. Registered at clinicaltrials.gov (NCT03499600).

28.1 UNA OPORTUNIDAD PARA ENTENDERNOS: THE IMPORTANCE OF SPANISH LANGUAGE CONCORDANCE

Forty percent of all Hispanics in the United States are immigrants. Of those foreign-born, 60% claim to speak Spanish primarily. Approximately 34.8 million Hispanics aged 5 years and older speak Spanish at home. However, in the United States there is not a sufficient supply of bilingual psychiatrists to meet the needs of patients and families seeking services in Spanish. This presentation addresses the challenges and opportunities that this discrepancy represents for adolescents, their families, and physicians.

Measuring the Cultural Competence of Latinx Domestic Violence Service Organizations.

Domestic violence (DV) represents a significant public health concern in the United States, including among Latinx populations. Despite the negative consequences associated with experiencing DV, research has shown that Latinx DV survivors may be less likely than others to utilize important services. One potential barrier is cultural competence (CC) in the provision of services specific to Latinx survivors among DV organizations. Thus, a beneficial addition to the field of DV service provision for such survivors is a better understanding and measurement of CC for this unique population. The exploratory, cross-sectional study herein presents the development and evaluation of a novel instrument for measuring the CC of DV organizations. Exploratory factor analysis was used on a purposive sample of 76 organizations in North Carolina who completed a comprehensive survey on their characteristics, practices, norms, and values. Psychometric results found best support for a 29-item, 4-factor bifactor model with both a general CC factor as well as three sub-factors. The general scale was named “General Cultural Competence,” while the three sub-scales were named “Organizational Values and Procedures,” “Latinx Knowledge and Inclusion,” and “Latinx DV Knowledge.” The final measure also demonstrated convergent validity with key organizational characteristics. Overall, higher CC scores were associated with organizations having more DV services in Spanish, a higher percentage of staff attending CC training, a higher percentage of staff attending Latinx service provision training, and a medium or greater presence in the Latinx community, and a moderate or stronger relationship with the Latinx community. The development of this measure is particularly useful in addressing knowledge gaps regarding the measurement of CC for Latinx DV services. Implications have importance for both the measurement of organizational CC and the scope of the measure’s associations with organizational, provider, and client outcomes.

Buscando el Cuidado: Spatial Mismatch of Physician Services in Spanish for Latinxs in Suburban Chicago

The gap between the large and growing Latinx population and culturally matching physicians presents a potentially significant barrier to health care access, especially for Latinx immigrants. Latinxs’ racial, cultural, and linguistic characteristics, along with their socio-economic behaviors, are changing the health care needs landscape. This paper examines the spatial mismatch of Latinx physicians and Latinx patients in the United States, particularly those in exurban areas. This paper employs a health geographic perspective based on intersectionality and a framework influenced by Latinx Studies, asserting that ethnic and immigrant groups have unique health care interests different from the majority population. Such interests include needing culturally and linguistically matching physicians while obtaining high-quality, low-cost care, along with concerns about visibility and citizenship. To identify spatial mismatch, this research surveyed 32 Latinx adults living in an exurban Chicago suburb about their health care experiences. In addition, travel times were estimated for Latinx residents to all nearby physicians providing Spanish language service in the selected community with rapid recent growth in the Latinx population. Results showed high travel times to Spanish-language physicians for Latinx residents who rely on public transit and a lack of such physicians in the community despite rapid Latinx population growth. Many respondents identified resource barriers including lack of insurance, high cost, and poor public transportation options.

Mental health services for maternal depression: A need for system-level change

ABSTRACTIntroduction: Women who are impacted by poverty are at heightened risk for depression, yet are unlikely to engage in mental health services due to to practical and perceptual barriers about treatment, including transportation and childcare difficulties, and misperceptions about mental health providers and treatment. The mental health service system has also been shown to limit access due to a lack of providers, extensive wait lists for services, and language barriers. The purpose of this study was to examine agency-level barriers to treatment among a poverty-impacted sample of women with depressive symptoms, as well as any supports that agencies have implemented to engage consumers into services.Method: This study conducted an environmental scan of mental health agencies and practitioners within three districts comprising nine zip codes representing the most socioeconomically disadvantaged areas in Harlem, New York. Following a standardized script, 46 private practitioners (n=27) and agencies (n=19) located within these zip codes provided information about their services, wait times, and any supports they offered consumers to attend.Results: Private practitioners were statistically less likely to accept insurance than agencies, yet agencies had significantly greater waitlists for services, particularly for Spanish-speaking clients. Few private practitioners offered services in Spanish, or offered affordable treatment (less than $100 per session). Only two agencies offered transportation vouchers; no other supports were offered by either private practitioners or agencies.Discussion: Mental health care remains largely inaccessible for mothers living in poverty, particularly if they are Spanish speaking. Systems-level changes are needed in order to provider affordable, accessible treatment and ultimately reduce the risk of maternal depression upon the family.

The Highland Health Advocates: a preliminary evaluation of a novel programme addressing the social needs of emergency department patients

ObjectivesPatients commonly come to the emergency department (ED) with social needs. To address this, we created the Highland Health Advocates (HHA), an ED-based help desk and medical-legal partnership using undergraduate...

“You know Spanish, right?”: Language for Specific Purposes and the Challenge of Teaching Content Areas and Lexical Domain

“You know Spanish, right?” Most undergraduates with a bachelor’s degree in Spanish or another world language will, sooner or later, have to answer this question or one similar. This is particularly true for students educated in South Carolina, a state that houses over 1,200 international businesses within its borders (“International Presence”) and which has one of the fastest-growing Hispanic populations in the United States (Krogstad and Lopez). In a typically monolingual state (see the Modern Language Association Language Map), those students who do possess a second language are poised to better integrate themselves into this international business community. However, what many monolinguals inaccurately assume is that being bilingual also means that one will be a skillful translator or interpreter, but this is not the case. Possessing a Spanish degree does not indicate proficiency in, for example, metallurgy or emergency medicine, in which it is necessary to provide quality language services. Unless students have been exposed to a variety of subjects relating to law, health care, business, and educational services in both English and Spanish, they will find themselves unprepared for the demand the community will place on them just because they are bilingual. With conversation, composition, literature, and culture classes providing the bulk of the core curriculum for the language major, how do language departments address the communities’ needs for quality translators and interpreters? Languages for Specific Purposes (LSP) not only provide a solution for the community, but they also allow connections with other disciplines. LSP is not a new concept, but rather a flashback to when the grammar-translation method was still considered the go-to teaching method. Due to the increased need for Spanish speakers, just being able to speak English and Spanish is not enough for language students to have an impact in their field. Students will find themselves hurled into a new profession, or even one for which they are supposedly prepared. As educators, have we explored every possible option for vocabulary acquisition in order to prepare students to understand the new lexical domains imposed on them by their jobs? As universities decrease, and even eliminate, world language requirements in their general education curriculum, while some are cutting language programs altogether, languages for a specific purpose become even more vital and must begin at the lower levels. First, language departments must identify the most critical needs on their campuses and evaluate their available staffing resources. Genesis of such a program might start with the biggest opponents of world languages on a campus. Once the detracting disciplines are identified, language instructors need to demonstrate the value for these classes. For example, if one can develop a first-year Spanish

Ability to deliver services in Spanish: a survey of Michigan home health agencies, 2012.

The capacity of home health agencies to serve children from families with low English proficiency is not well understood. We conducted an exploratory survey of home health agencies in Michigan in 2012 to document whether they can provide services in Spanish, serve children, and accept Medicaid.

Spanish language proficiency among providers and Latino clients' engagement in substance abuse treatment

Quality of care, such as provision of services in Spanish, is a common factor believed to improve treatment engagement among Spanish-speaking Latinos in health care. However, there is little evidence that Spanish language proficiency among providers increases treatment access and retention in publicly funded substance abuse treatment. We analyzed client and program data collected in 2010–2011 from publicly funded treatment programs in Los Angeles County, California. An analytic sample of 1903 Latino clients nested within 40 treatment programs located in minority communities was analyzed using multilevel negative binomial regressions on days to initiate and spent in treatment. As hypothesized, Spanish language proficiency was negatively associated with client wait time and positively associated with retention in treatment, after controlling for individual and program characteristics. The path analysis models showed that Spanish language proficiency played a mediating role between professional accreditation and client wait time and retention. These preliminary findings provide an evidentiary base for the role of providers' Spanish language proficiency and Latino engagement in treatment for a population at high risk of treatment dropout. Implications related to health care reform legislation, which seeks to enhance linguistically competent care, are discussed.

International Service That Really Serves

International Service That Really Serves

Multivariate Analysis of the Factors Affecting Attitude Toward Living Liver Donation among Workers in Surgical Services in Spanish, Mexican, and Cuban Hospitals

IntroductionCurrent liver donation rates are insufficient to cover transplant needs. Therefore, it is essential to promote living liver donation (LLD) given the ever decreasing morbidity and mortality in the donor and the improving results in the recipient. LLD is becoming increasingly accepted. However, in the health care system, a percentage of the personnel are not in favor. ObjectiveTo analyze the attitude of personnel in surgical services in Spain and Latin-America hospitals toward LLD. Materials and methodsAs part of the “International Collaborative Donor Project,” a random sample was taken and stratified according to surgical service and job category in 10 hospitals; three in Spain, five in Mexico, and two in Cuba (n = 496). Attitude was evaluated using a validated survey that was completed anonymously and self-administered. ResultsEighty-six percent (n = 425) of respondents were in favor of related living liver donation, and 30% (n = 147) were in favor if it were not related. According to country, 88% of the Mexican respondents were in favor of living liver donation, 85% of the Cubans, and 82% of the Spanish (P > .05). In the multivariate analysis of the variables with most weight affecting attitude toward LLD, the following significant associations were found: (1) a favourable attitude toward living kidney donation (odds ratio [OR] = 91; P < .001); (2) acceptance of a donated living liver if one were needed (OR = 11; P < .001); and (3) family discussion about donation and transplantation (OR = 2.581; P = .037). ConclusionsAttitude toward related living liver donation was very favorable among hospital personnel in Spanish and Latin American surgical services.

Travel distance to outpatient substance use disorder treatment facilities for Spanish-speaking clients

BackgroundTravel distance and English proficiency skills are widely recognized factors associated with service access and treatment engagement. As Latino populations represent one of the most rapidly growing populations in the United States, methods are needed to better understand availability of linguistically appropriate services in Latino communities. Given regional variability in the density of Latino communities, the current study examines treatment access as travel distance to outpatient substance use disorder treatment facilities in one of the largest and most rapidly changing Latino communities in the United States – Los Angeles County, CA. MethodsData from the 2010 U.S. Census and the National Survey of Substance Abuse Treatment Services were analyzed using a geographic information system approach to determine the street-level distance between treatment facilities with services in Spanish and Latino communities throughout L.A. County. This study used an innovative approach that included network analysis and spatial autocorrelation to identify “hot spots,” i.e. clusters of census tracts with high-density Latino populations that were relatively far from treatment services in Spanish. ResultsThe analysis identified several key hot spots with significantly large Latino populations and far street distances to the closest facility offering Spanish-language services. The average distance between these hot spots and the closest facilities was 2.74 miles (SD=0.38), compared to a county average of 2.28 miles (SD=2.60). In several key hot spots, the distance was greater than 3 miles. ConclusionDespite the growing presence of Latinos in L.A. County in 2010, constrained access to services in Spanish was found in geographic locations highly represented by Latinos. The distances identified in this study are almost triple the 1-mile threshold representing reduced access to treatment as determined by other studies. Geographic information systems represent an innovative and user-friendly approach for effectively and efficiently identifying areas with the greatest service needs. This approach can inform policies to increase the capacity of ethnic minority communities to develop linguistically responsive social services.

Examining the Sociolinguistic Context in Schools and Neighborhoods of Pre-adolescent Latino Students: Implications for Ethnic Identity

This study examined the sociolinguistic contexts of neighborhoods and schools in two predominantly Latino communities in the United States. We used census data to assess social and ethnic composition and observational data to compare and contrast environmental print, language use, and availability of community services in Spanish in these schools and neighborhoods. Structured interviews with pre-adolescent (5th grade) students raised questions about how these sociolinguistic contexts might contribute to ways they viewed themselves as part of their ethnic community. Observational results revealed striking differences in the prevalence and use of Spanish across these two communities. Student interviews raised questions about how pre-adolescent Latino students in these two very different sociolinguistic contexts may see themselves in relation to their ethnic group. Implications for supporting ethnic-identity-development processes are discussed.

Availability of substance abuse treatment services in Spanish: A GIS analysis of Latino communities in Los Angeles County, California

BackgroundThe percentage of Latino clients entering outpatient substance abuse treatment (OSAT) in the United States has increased significantly in the past 10 years. Evidence suggests that a lack of services in Spanish is a significant barrier to treatment access among Latinos.MethodsUsing a geographic information system (GIS) approach, data from the U.S. Census Bureau and the National Survey of Substance Abuse Treatment Services (N-SSATS) were analyzed to determine the geographic distance between OSAT facilities with services in Spanish and Latino communities throughout Los Angeles County, CA. Data from N-SSATS were also analyzed using logistic regression models to examine organizational characteristics and their association with offering services in Spanish. Our GIS methods are tested in their ability to provide baseline measures to inform future analysis comparing changes in demography and service infrastructure.ResultsGIS analysis revealed cold spots representing high-density Latino communities with extensive travel distance to facilities offering services in Spanish. The average linear distance between Latino communities and facilities offering Spanish-language services ranged from 2 to 6 miles, while the location of the cold spots pointed to a need for services in Spanish in a particular subregion of the county. Further, secondary data analysis revealed that, on average, being privately owned (OR = .23, 95% CI = 0.06-0.90) was associated with a lower likelihood of providing services in Spanish compared to public facilities. Additionally, a facility with a state license (OR = 2.08, 95% CI = 1.12-3.88) or a higher number of Medicaid recipients (OR = 2.98, 95% CI = 1.76-5.05) was twice as likely to offer services in Spanish.ConclusionDespite the significant presence of Latinos in L.A. County in 2000, low capacity was found in discrete Latino communities in terms of offering OSAT services in Spanish. Funding and regulation play a significant role in facilities' capacity to offer these services. Future studies should build from our multi-method approach to compare changes in population demography and system infrastructure and inform health care policy that seeks to improve providers' capacity to provide linguistically competent care.

Level of Acceptance of a Clinical Solid Organ Xenotransplantation Program Among Personnel in Organ Transplant-Related Services in Spanish, Mexican, and Cuban Hospital Centers

Introduction Xenotransplantation is far from becoming a clinical reality. However, in vital organs it could be used as a bridge until a human organ becomes available, in an emergency situation. We analyzed the attitude toward xenotransplantation among personnel in transplant-related services in several hospitals in Spain and Latin America. Methods A random sample stratified by type of service and job category ( n = 738), in transplant-related services (procurement units, transplant units, and transplant patient follow-up units) was examined in eight hospital centers from three different countries: Spain ( n = 349), Mexico ( n = 269), and Cuba ( n = 120). A self-administered validated questionnaire was completed anonymously. Results Based on the assumption that all the results of xenotransplantation were similar to those achieved with human donors, most respondents [66% ( n = 484)] would be in favor. The employees from Cuban centers had the most favorable attitudes (72% in favor), followed by the Spanish (64%) and the Mexicans (61%; P = .013). However, the differences were mainly determined by job category: Physicians showed the most favorable attitudes and auxiliary staff the least (67% vs 40%; P = .010). Attitudes were significantly related to beliefs about different types of human donation [deceased ( P < .001) and living ( P < .001)], the possibility of needing a transplant for oneself ( P < .001), and a favorable attitude toward donating the organs of a deceased family member ( P = .004). Conclusions Currently, a third of health care employees working in transplant-related services are not in favor of xenotransplantation. More information should be provided about the subject, especially in centers with preclinical xenotransplantation programs.