Multnomah CountyMultnomah CountyHealth DepartmentHealth Department

Presented by:Consuelo Saragoza, Director, Community Health

Promotion, Partnerships and PlanningLinda Castillo, Bienestar de la Familia, Clinical &

Program SupervisorRuby Ibarra, La Clinica de Buena Salud, Community

Health Specialist

Neighborhood Revitalization Neighborhood Revitalization

StrategiesStrategies

Identified NeedIdentified Need Build PartnershipsBuild Partnerships Long Term CommitmentLong Term Commitment

DemographicsDemographics

The Hispanic community in Multnomah The Hispanic community in Multnomah County is now the largest group of color, County is now the largest group of color, representing almost 9% of the population in representing almost 9% of the population in 2002 2002

The Hispanic community has also been the The Hispanic community has also been the fastest growing group in the County fastest growing group in the County

The Hispanic population grew 78% between The Hispanic population grew 78% between 1990 and 2002, when they numbered close to 1990 and 2002, when they numbered close to 59,000 59,000

Hispanics have among the lowest incomes in Hispanics have among the lowest incomes in Multnomah CountyMultnomah County

DemographicsDemographics According to the 2000 Census, Hispanics had a According to the 2000 Census, Hispanics had a

median annual household income of just $32,244 in median annual household income of just $32,244 in 2000, $11,000 below that of White non-Hispanics 2000, $11,000 below that of White non-Hispanics ($42,947)($42,947)

In addition, 26% of Hispanics in Multnomah County In addition, 26% of Hispanics in Multnomah County lived in poverty in 2000, compared with only 10% for lived in poverty in 2000, compared with only 10% for White non-Hispanics White non-Hispanics

Along with African Americans, they have the highest Along with African Americans, they have the highest poverty rate of all racial / ethnic groups in the Countypoverty rate of all racial / ethnic groups in the County

Despite their poverty, the Hispanic population Despite their poverty, the Hispanic population nationally and in Multnomah County is healthier nationally and in Multnomah County is healthier overall than the White non-Hispanic population, and overall than the White non-Hispanic population, and does much better than White non-Hispanics on many does much better than White non-Hispanics on many health measureshealth measures

Health Status IndicatorsHealth Status Indicators

Examination of the 17 health status indicators for Examination of the 17 health status indicators for Hispanics, compared to White non-Hispanics, Hispanics, compared to White non-Hispanics, shows that in the 1990-1994 period, statistically shows that in the 1990-1994 period, statistically significant health disparities (p<0.05) were found significant health disparities (p<0.05) were found for seven measures: homicide, low birth weight for seven measures: homicide, low birth weight babies, lack of early prenatal care, teen births, babies, lack of early prenatal care, teen births, syphilis, gonorrhea, and chlamydia syphilis, gonorrhea, and chlamydia

The largest health disparities in the 1990-1994 The largest health disparities in the 1990-1994 period were for syphilis cases (almost 14 times period were for syphilis cases (almost 14 times higher for Hispanics than for White non-Hispanics), higher for Hispanics than for White non-Hispanics), gonorrhea (eight times the White non-Hispanic gonorrhea (eight times the White non-Hispanic rate), and homicide (almost triple the White non-rate), and homicide (almost triple the White non-Hispanic rate)Hispanic rate)

Health Status IndicatorsHealth Status Indicators

Of the seven health disparities found in 1990-Of the seven health disparities found in 1990-1994, significant disparities persisted for six 1994, significant disparities persisted for six indicators in the 1998-2002 period. The indicators in the 1998-2002 period. The disparity for low birth weight babies disparity for low birth weight babies disappeared in 1998-2002. disappeared in 1998-2002.

For the period 1998-2002, the largest disparities For the period 1998-2002, the largest disparities occurred in the teen birth rate, which was occurred in the teen birth rate, which was almost five times the White non-Hispanic rate, almost five times the White non-Hispanic rate, and for syphilis, which was close to four times and for syphilis, which was close to four times higher than White non-Hispanichigher than White non-Hispanic

Health Status IndicatorsHealth Status Indicators

Examining indicators individually, health disparities Examining indicators individually, health disparities between Hispanics and White non-Hispanics between Hispanics and White non-Hispanics significantly worsened (at p<0.05) over time for three significantly worsened (at p<0.05) over time for three indicators: overall mortality, early prenatal care, and indicators: overall mortality, early prenatal care, and teen birth rates teen birth rates

The highest significant increase in health disparities The highest significant increase in health disparities occurred for teen birth rates, which increased by 87% occurred for teen birth rates, which increased by 87% between the 1990-1994 period and 1998-2002 between the 1990-1994 period and 1998-2002

Disparities for overall mortality and lack of early Disparities for overall mortality and lack of early

prenatal care grew 23% and 21%, respectivelyprenatal care grew 23% and 21%, respectively

La Clinica de Buena SaludLa Clinica de Buena Salud

StrategiesStrategies

OutreachOutreach Community CollaborationCommunity Collaboration Culturally Appropriate Health, Mental Culturally Appropriate Health, Mental

Health and Social ServicesHealth and Social Services

Bienestar de la FamiliaBienestar de la Familia

StrategiesStrategies

Identified NeedIdentified Need Culturally Appropriate Service DeliveryCulturally Appropriate Service Delivery Integrated Physical and Mental Health Integrated Physical and Mental Health

ServicesServices

Bienestar de la FamiliaBienestar de la Familia (Well-being of (Well-being of the Family). Multnomah County, the Family). Multnomah County,

Office of Mental Health and Addiction Office of Mental Health and Addiction ServicesServices

Program and Clinical supervisor, Linda Castillo, Program and Clinical supervisor, Linda Castillo, MS. (503) 988-3999 x28814MS. (503) 988-3999 x28814

The team consists of mental health professionals, The team consists of mental health professionals, drug and alcohol evaluation specialist, case drug and alcohol evaluation specialist, case managers, and social service resource specialists.managers, and social service resource specialists.

The Bienestar de la Familia Team promotes the The Bienestar de la Familia Team promotes the well-being of Latinos, in Multnomah County, by:well-being of Latinos, in Multnomah County, by:

Respecting values, language, culture, and Respecting values, language, culture, and experiences.experiences.

Providing and facilitating culturally competent Providing and facilitating culturally competent services.services.

Advocating, educating, and supporting community Advocating, educating, and supporting community leadership.leadership.

Physical

Mental Emotional

Spiritual

Concept of Health

Hispanic Values and BeliefsHispanic Values and Beliefs

FamilismoFamilismo Respeto y la Buena Respeto y la Buena

EducacionEducacion La ComidaLa Comida Harmony/ArmoniaHarmony/Armonia

(simpatia)(simpatia)

PersonalismoPersonalismo Time Orientation or Time Orientation or

PresentismoPresentismo Concepts of HealthConcepts of Health Spirituality/ReligionSpirituality/Religion

(fatalism)(fatalism)

Mental Health Status Mental Health Status IndicatorsIndicators

Studies have found that adult Mexican Americans Studies have found that adult Mexican Americans and Whites have similar rates of psychiatric and Whites have similar rates of psychiatric disorders.disorders.

However, in the Hispanic group, when subdivided However, in the Hispanic group, when subdivided into those born in Mexico and those born in US, the into those born in Mexico and those born in US, the US born have higher rates of depression and US born have higher rates of depression and phobias.phobias.

Hispanics born outside US had lower prevalence Hispanics born outside US had lower prevalence rates of any lifetime disorders than there US born rates of any lifetime disorders than there US born counterparts.counterparts.

Immigrants who live in US 13 years+ have higher Immigrants who live in US 13 years+ have higher prevalence of disorders than those who lived in US prevalence of disorders than those who lived in US fewer than 13 years.fewer than 13 years.

Mental Health Status Mental Health Status IndicatorsIndicators

Rate differences suggest acculturation may lead to Rate differences suggest acculturation may lead to increased risk of mental disorders; changing values increased risk of mental disorders; changing values & practices, stressors associated with change, & practices, stressors associated with change, negative encounters with American institutions, etc.negative encounters with American institutions, etc.

Latino youth experience significant number of Latino youth experience significant number of mental health problems; anxiety-related, mental health problems; anxiety-related, delinquency-type problem behaviors, reported more delinquency-type problem behaviors, reported more depressive symptoms. Related to higher rates of depressive symptoms. Related to higher rates of depression, drug use, and suicide.depression, drug use, and suicide.

For older adults, 26% had major depression or For older adults, 26% had major depression or dysphoria. 5.5% reported depression if w/o physical dysphoria. 5.5% reported depression if w/o physical health complications.health complications.

Mental Health ProblemsMental Health Problems

Sx may reflect actual disorders, general distress Sx may reflect actual disorders, general distress associated with social stressors may not necessarily associated with social stressors may not necessarily be associated with disorders. Overall, Latinos report be associated with disorders. Overall, Latinos report higher levels of depression and distress than whites.higher levels of depression and distress than whites.

Mexican American women, esp. over 40 y/o, tend to Mexican American women, esp. over 40 y/o, tend to report somatic symptoms.report somatic symptoms.

Latinas have highest lifetime prevalence of Latinas have highest lifetime prevalence of depression at 24%. Latinas are more likely to to depression at 24%. Latinas are more likely to to experience severe depression than Caucasian experience severe depression than Caucasian women (53% vs. 37%).women (53% vs. 37%).

Latino patients half as likely to receive depression Latino patients half as likely to receive depression dx or medication. dx or medication.

Culture Bound SyndromesCulture Bound Syndromes

Concept of illness is culture bound, Concept of illness is culture bound, these may differ from anxiety these may differ from anxiety disorders or DSM classification.disorders or DSM classification.

Ataque de Nervios (attack of nerves)Ataque de Nervios (attack of nerves) Nervios (nerves or nervousness)Nervios (nerves or nervousness) Susto or Perdida del Alma (fright or Susto or Perdida del Alma (fright or

soul loss).soul loss).

Bienestar Lessons learnedBienestar Lessons learned

Know your population, community, and Know your population, community, and acknowledge and prepare for change in acknowledge and prepare for change in outreach and care. Consult with community outreach and care. Consult with community specialists/experts. (what to know)specialists/experts. (what to know)

Holistic and Cultural assessment is crucial.Holistic and Cultural assessment is crucial. Beware of disparities in health care and assist Beware of disparities in health care and assist

patients to receive appropriate care. (what to patients to receive appropriate care. (what to ask)ask)

Cultural competency is necessary in all Cultural competency is necessary in all industries. Be aware of stereotypes, biases, industries. Be aware of stereotypes, biases, and assumptions. (and assumptions. (What to be aware ofWhat to be aware of))

Bienestar Lessons learnedBienestar Lessons learned

Communities respond to advocacy and Communities respond to advocacy and activism.activism.

There are not enough programs (funding) to There are not enough programs (funding) to meet the needs.meet the needs.

Evidence based practices are not normed on Evidence based practices are not normed on immigrant populations, we are pioneering immigrant populations, we are pioneering practice based evidence programs.practice based evidence programs.

Welcoming,culturally/linguistically specific, Welcoming,culturally/linguistically specific, consistent, reliable, and episodic care is the consistent, reliable, and episodic care is the most successfulmost successful..

“La Promesa de un Futuro Brillante”

“The Promise of a Bright Future”