Building Bridges between Primary and Mental Health Care for Latino/a/e Youth 

Summary

Despite experiencing higher levels of depressive symptoms, Latino/a/e teens are less likely to begin and stay engaged in treatment for depression than non-Latino/a/e white peers.^1–3 In 2021, both Latino male teens (30%) and Latina female teens (62%) reported a higher prevalence of depressive symptoms than their non-Latino White male (28%) and female counterparts (55%).¹ Similar patterns are also present for inequities in access to mental health services. In 2023, only 44% of Latino/a/e teens experiencing major depression received treatment compared to 54% of non-Latino/a/e White peers.³ When left untreated, depression can lead to a variety of consequences, such as suicidality, behavioral health issues, and physical health problems, and perpetuate health inequities throughout the lifespan.⁴ 

Healthcare-system level factors, such as cost, lack of bilingual and bicultural providers, and waitlists for therapy, are some of the most impactful barriers Latino/a/e teens face when trying to get treatment for depression.^5,6 In partnership with Latino/a/e teens, parents, and community health advocates, our team is co-developing both family- and healthcare system-level interventions to address these barriers and bridge gaps between primary care and mental health services for teens in Spanish-speaking families. Our family-focused intervention will provide one-on-one support from a community health worker (CHW) to address barriers to depression treatment access. Our healthcare-level intervention will include trainings for both primary care providers and interpreters on how to facilitate conversations about adolescent depression in Spanish-speaking families. Both are designed for implementation in primary care settings, where most teens are diagnosed with depression. Providers in these settings often lack the time and resources to fully address mental health concerns.^6,7 

Significance

The goal of our research is to eliminate inequities in depression treatment access faced by Latino/a/e teens in the U.S. We intend to achieve this goal through developing and disseminating family- and healthcare-team focused interventions across healthcare settings that serve populations of Latino/a/e adolescents. Through promoting Latino/a/e teens’ access to treatment for depression, we hope to promote lifelong wellbeing, productivity, and positive quality of life for this population. In the future, we hope to expand our projects to other populations facing similar inequities in accessing mental health services. 

Our research directly tackles mental health inequities faced by U.S. Latino/a/e adolescents. Specifically, our project enables healthcare providers and interpreters to provide more culturally and linguistically sensitive mental health screening, referral, and treatment to Latino/a/e teens. Our project also aims to improve access to mental health care for Latino/a/e youth by providing one-on-one support from a community health worker to address barriers to care faced by the family. 

Benefits

Demonstrated benefits are those that have been observed and are verifiable.

Potential benefits are those logically expected with moderate to high confidence.

Community & public health benefits

Provide training to community health workers (CHWs) in community organizations to address mental health needs of Latino/a/e teens. potential.

Community health services

Co-developed psychoeducation materials to address mental health promotion and resources with Latino/a/e families. demonstrated.

Health education resources

Increase access to mental health treatment for depression among Latino/a/e teens through healthcare team education and family support. potential.

Health care accessibility

Disseminate CHW-led methods of delivering care navigation to Latino/a/e teens with depression. potential.

Health care delivery

Developed training modules for providers and interpreters to improve ability to provide culturally and linguistically appropriate mental health screening and referral. potential.

Health care quality

Contribute to the prevention of the consequences of untreated depression (e.g., suicidality, productivity losses, reduced QoL, physical health ailments) and the perpetuation of health inequities throughout the lifespans of Latino/a/e teens through our interventions. potential.

Life expectancy & quality of life

Economic benefits

Save costs relative the common practice of provider follow–up visits. potential.

Cost effectiveness

Prevent negative health and social outcomes associated with untreated depression and perpetuation of health inequities throughout the lifespan of young Latino/a/es. potential.

Societal & financial cost of illness

Policy & legislative benefits

Contribute to a body of research demonstrating the value of CHWs in addressing health inequities, justifying reimbursement for their services. potential.

Scientific research reports

Justify the reimbursement of CHW care navigation services. potential.

Policies

This research has community, economic, and policy implications. The framework for these implications was derived from the Translational Science Benefits Model created by the Institute of Clinical & Translational Sciences at Washington University in St. Louis.⁸

Community

We hope to make an impact on community health through the development and dissemination of resources to community and healthcare organizations to equip service providers to deliver culturally- and linguistically-appropriate mental health care to Latino/a/e teens with depression. In the short term, these projects will increase the quality of care provided to Latino/a/e teens and their families and, in the long term, will result in increased access to depression treatment among Latino/a/e youth.

Economic

Untreated depression is associated with a variety of social and health consequences among adolescents, such as academic difficulties, substance use, and suicidality.^9–11 Through ensuring that Latino/a/e teens are able to receive treatment for depression, our research will contribute to breaking the cycle of the consequences of untreated depression among Latino/a/e teens⁴ which contributes to increased healthcare and non-healthcare costs. 

Policy

In the long term, we hope to contribute to a body of evidence demonstrating the impact of community health workers in improving quality of and access to mental health care for Latino/a/e populations. We want to translate this into impact through scientific reports which make way for legislative change to reimburse CHW services within healthcare settings. 

Lessons Learned

Strong partnerships with Latino/a/e teens and families, Federally Qualified Health Centers, and community leaders have been crucial to the development of our interventions to ensure that they meet the needs of Latino/a/e teens and families and can be feasibly implemented in primary care settings. Of note, drawing from the User Centered Design process, we were able to rapidly prototype our family-focused intervention with Latino/a/e teens and families, which was a useful method to ensure the acceptability and feasibility of our intervention.