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Program Details


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Practice Type: Model
Program Name: Mente y Cuerpo/Mind and Body: Integrating mental health and primary care services
Organization: Boston Public Health Commission
Web site:
Overview: Mente y Cuerpo/Mind and Body: Integrating mental health and primary care services
Year Submitted: 2011
Responsiveness and Innovation: The National Institutes of Health defines health disparities as “the differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions that exist among specific population groups in the United States”. These population groups can represent geographic areas, socioeconomic status levels, race, ethnicity, education level and other social and geographic demographics. Health inequities differ from health disparities in that they refer to differences in health outcomes that, in addition to being unnecessary and avoidable, are unfair and unjust. For example, in Boston, Black babies are three times more likely to die within the first year of life than White babies; this is an inequity because it is avoidable, unfair, and unjust. Mind and Body/Mente y Cuerpo is focusing on disparities in mental and behavioral health and chronic disease treatment and outcomes among Latina women, specifically, depression, substance use and domestic violence. Our project is also addressing the multiple problems that contribute to that overall problem including language and cultural barriers, lack of specific provider training to address these issues, lack of adequate systems to track patients and facilitate and maintain engagement in care, and lack of adequate resources, including non-traditional resources to promote mental well-being. This project hopes to improve chronic disease outcomes by addressing mental health concerns through screening, case management and social support. Mente y Cuerpos/Mind and Body focuses on Latina women in Boston who are at risk for mental health concerns. Our geographic focus is on two Boston neighborhoods, the South End and Jamaica Plain, both of which have a large Latino population. Our local need assessment indicated that Latinas in Boston are twice as likely as White women to report poor mental health, but much less likely to seek professional help for it. Among 1600 women screened at two Boston community health centers serving predominantly Hispanic populations during 2004-2006, 23% screened positive for risk for depression. Consumer focus groups and provider interview underscored the need for culturally-specific mental health services in the community, along with the challenges posed by stigma, language barriers and lack of culturally appropriate care.
Agency and Community Roles: The Boston Public Health Commission, the city’s health department, continues a commitment to public health that dates back to the establishment of Boston’s first health department in 1799. Our mission is to protect, preserve and promote the health and well-being of Boston residents, particularly those most vulnerable. The Commission works with academic medical centers, community health centers, federal and state agencies and a broad spectrum of community agencies and leaders to plan urban health policy, conduct research related to the health of the city’s neighborhoods and provide residents with access to health promotion and disease prevention. Through community-based health improvement projects in chronic disease prevention and treatment, cancer, infant mortality, elder health and other areas, the Boston Public Health Commission is seeking to restructure and transform public health and health care delivery systems to reduce the burden of disease and eliminate racial disparities in health outcomes. A key component of this effort is the Mayor’s Task Force to Eliminate Racial and Ethnic Health Disparities, led by the Boston Public Health Commission. This blue ribbon Task Force spent two years assessing health disparities in Boston and issued a Blueprint report in June 2005, with wide-ranging recommendations for addressing racial and ethnic health disparities in health and health care for Bostonians. Specific recommendations included: Patient education Develop programs that build the skills of community members to become better informed and equipped patients, able to effectively navigate through the health care system. Such efforts should include the use of population-specific and/or disease-specific training and educational tools. Health systems Develop programs that identify and address specific obstacles to overcoming disparities. Such components should include mechanisms for patient input and feedback, specialized outreach and patient support efforts. Cultural Competence: Provide cultural competence education and training, including educational components on racism and other social determinants of health, as part of the training of all health professionals. Training should focus on eliminating health disparities and pay particular attention to eliminating invalid assumptions that lead them to provide different treatment for people of color.
Costs and Expenditures: There are marked differences in the distribution of mental disorders by gender, race/ethnicity, socioeconomic status, and neighborhood of residence. For example, females are more likely to suffer from depression. Blacks and Latinos are less likely to have a lifetime prevalence of mental disorders compared with Whites; however, they are more likely to have a longer course of persistent and disabling disorders. By accessing appropriate care, people with mental health disorders can improve their quality of life. Treatment for disorders may involve receiving psychotherapy, supportive counseling, or medication. Evidence suggests that less than one-third of adults and one-half of children with a diagnosable mental disorder receive mental health services annually. Furthermore, access to mental health care remains a challenge for many people. In some communities, barriers such as availability, accessibility, stigma, and misunderstanding surrounding mental health contribute to the unmet needs for treatment and counseling. Cultural influences, language barriers, institutionalized racism, and self reliance also may prevent Asians, Blacks, and Latinos from seeking mental health services. Mente y Cuerpo / Mind and Body, is a bilingual/bicultural program which seeks to address the area of mental health for Latina women 18 and older for whom limited English proficiency is a barrier to effective prevention and care. Partners seek to demonstrate that: mental health screening, referrals and education can be effectively integrated into primary care. The program seeks to improve the prevention and treatment of chronic diseases such as diabetes, asthma and cardiovascular disease by addressing depression and other mental health concerns which may contribute to disease and interfere with treatment compliance. The project partnership consists of the Boston Public Health Commission which is the city’s health department serving as the lead agency, two community health centers (South End Community Health Center and Southern Jamaica Plain Health Center) serving high percentage of Latino’s and Pathways to Wellness, a neighborhood-based holistic health care facility. Provider staff participates in training sessions on utilizing the assessment tool, attend feedback sessions and focus groups in order to understand and promote cultural competence in the health workforce. The link between mind and body in illness and wellness is well established. This link has not been fully exploited in strategies to address disparities in incidence and outcomes of chronic disease, among people of color. Latina women suffer a disproportionate burden of both depression and diabetes. Risk factors in these conditions are synergistic – and mutually contribute to poorer outcomes in both. In Mente y Cuerpo we seek to increase awareness of health disparities among patients and providers, improve patient and provider interaction in areas of care that are salient to patients and enhance cultural competence among providers and patient care systems that will have sustainable impact. The project began in September of 2007. The above project objectives have been met. Further evaluation is underway to understand its impact on diabetes, cardiovascular disease and other chronic diseases by addressing mental health concerns through the supportive services of case managers. The project is funded through August 31, 2011. About 3,000 Latina women have received a comprehensive behavioral health screening. Baseline data was obtained from providers regarding their understanding and ability to address cultural competency and health disparities as they relate to their clinical practice, knowledge and skills to integrate screening for depression, stress management into their primary care practice in the aggregate, both sites scored in the middle range of knowledge. Based on project participant focus groups and provider feedback, the following factors contributed to the success of this project: 1) case managers have the time to spend with patients to talk about their concerns, 2) participants feel listened too and cared for by the case manager, 3) participants appreciate the opportunity to talk to other women with similar concerns in a group not labeled as for those “with mental health problems”, and 4) participants enjoy stress reduction activities such as psycho educational groups, yoga, and acupuncture.
Implementation: The National Institutes of Health defines health disparities as “the differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions that exist among specific population groups in the United States”. These population groups can represent geographic areas, socioeconomic status levels, race, ethnicity, education level and other social and geographic demographics. Health inequities differ from health disparities in that they refer to differences in health outcomes that, in addition to being unnecessary and avoidable, are unfair and unjust. For example, in Boston, Black babies are three times more likely to die within the first year of life than White babies; this is an inequity because it is avoidable, unfair, and unjust. Mind and Body/Mente y Cuerpo is focusing on disparities in mental and behavioral health and chronic disease treatment and outcomes among Latina women, specifically, depression, substance use and domestic violence. Our project is also addressing the multiple problems that contribute to that overall problem including language and cultural barriers, lack of specific provider training to address these issues, lack of adequate systems to track patients and facilitate and maintain engagement in care, and lack of adequate resources, including non-traditional resources to promote mental well-being. This project hopes to improve chronic disease outcomes by addressing mental health concerns through screening, case management and social support. Mente y Cuerpos/Mind and Body focuses on Latina women in Boston who are at risk for mental health concerns. Our geographic focus is on two Boston neighborhoods, the South End and Jamaica Plain, both of which have a large Latino population. Our local need assessment indicated that Latinas in Boston are twice as likely as White women to report poor mental health, but much less likely to seek professional help for it. Among 1600 women screened at two Boston community health centers serving predominantly Hispanic populations during 2004-2006, 23% screened positive for risk for depression. Consumer focus groups and provider interview underscored the need for culturally-specific mental health services in the community, along with the challenges posed by stigma, language barriers and lack of culturally appropriate care.
Sustainability: Both partnering sites recognize the benefit of integrating mental health screening and assessment into primary care. Participants in the project have spoken to the positive impact of this project on their lives as well as the gains providers have seen from case manager support to patients. Both sites have been exploring reimbursement for case management services. At this point, none of the services provided by case managers are reimbursable via public or private insurance. The Boston Public Health Commission and it’s project partners are committed to the Mente y Cuerpo project. At this time, fiscal constraints will dictate in what capacity the project will remain. Working with our partners, this initiative enhances existing capacity by integrating vital mental health and chronic disease services for Latina women into primary care. The case management support is vital to patients as it provides support via resource finding, advocacy, general support, and other none reimbursable services. Provision of these services allows for medical and mental health providers to focus on direct care services. Evaluation data from this project will demonstrate the effectiveness and cost savings of integrating health screening, referrals, education, case management and advocacy into existing services. The findings will provide support for expansion of the project to other healthcare sites. Funding from the Office of Minority Health for this project plays a key role in providing leverage to secure additional funding support. Office of Minority Health, our current funder cannot support this project beyond its current extension. At this time, funding beyond July 31, 2011 has not been secured for this project. Both project partners have contingency plans in place to support the continued work of case managers. Some of this funding has been secured by the partners. The project lead and partners continue to seek funds to support this work beyond July 2011.
Lessons Learned:

 

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