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Building bilingual behavioral health care in NC
Every few months, nonprofit mental health provider El Futuro invites teenagers and their parents to drive a go-kart that is designed to simulate driving under the influence of alcohol or marijuana.
As the teens struggle to make clean turns and drive in a straight line – with a parent cringing and gripping anything they can grab hold of in the passenger seat – they come to an epiphany, says Pablo Silva Ortiz, a licensed clinical addiction specialist (LCAS) and therapist at El Futuro.
“We call it ‘simulacro,’ or simulation, and I remember the first time we did one. One kid said, ‘Wow, I don’t know how my dad drives under the influence of alcohol. This is really difficult,’” Ortiz says. “From just one experience on the go-kart, they get it.”
The go-kart is part of a substance-abuse counseling program called Sin Ataduras, or No Strings Attached, which incorporates a wide range of techniques, experiences, and resources to help those with substance-use disorders and their families break the cycle of addiction. With the use of virtual-reality devices, children get to experience go-karts, playing sports, and even doing basic school activities, such as math problems, under the influence.
Sin Ataduras is among many examples of the multifaceted approach to mental health counseling that Durham-based El Futuro has embraced ever since its founding in 2001.
El Futuro serves more than 2,000 Hispanic / Latino people – including those who don’t have health insurance – in 30 North Carolina counties. The organization offers in-person and virtual bilingual counseling for people battling depression, anxiety, substance-use disorder (SUD), and other mental health challenges. By training mental health providers to be culturally responsive to the needs of Hispanic / Latino patients, the staff are helping reduce barriers to access.
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is a longtime supporter of El Futuro, providing funding to the organization as part of the goal to improve access to behavioral health in rural and underserved communities.
Creating connections
More than half of Hispanic / Latino people between the ages of 18 and 25 who have mental illnesses are unlikely to be treated, according to the National Alliance on Mental Illness. Each year, 35.1% of Hispanic / Latino adults in the US with mental illnesses are treated, compared to the national average of 46.2%.
Youth and adolescents are particularly vulnerable when it comes to mental illness. A study conducted by Salud America! showed that 22% of Hispanic / Latino youth have symptoms of depression, higher than any other minority group other than American Indians.
Rachel Siegel, one of El Futuro’s outpatient therapists working with youth and families, says the combination of where adolescents are developmentally, what is happening in their personal lives, and cultural norms can dramatically influence their sense of stability.
“Adolescents are in a time of a lot of change, and we expect there to be an intensity of emotions, which can create stress, anxiety, and uncertainty. Depending on where they are in the immigration cycle, you can see acculturation stress,” she says. “In this culture, there's a lot of emphasis on working hard and just pushing forward no matter what the obstacles are. And that's a really beautiful thing. And at the same time, it can create some harm when we think about youth who are experiencing mental health crises and how likely they're going to be to admit that that's what's happening and seek help.”
Even though Hispanic / Latino people suffer mental illnesses at about the same rate as the general population, they face significant barriers when it comes to treatment. These barriers include job instability, being uninsured or under-insured, a shortage of Spanish-speaking counselors, and a general cultural stigma surrounding mental health in Hispanic / Latino communities.
“As with our larger community, the Hispanic / Latino residents of North Carolina are also suffering from isolation and loneliness, but it’s often more intense for immigrants because they have migrated away from their home and culture,” says Dr. Luke Smith, executive director of El Futuro.
“Many of the programs of El Futuro address issues such as depression, anxiety, and substance use, but we are also intentionally working to build community. This happens through an array of different events that help connect Hispanic / Latino immigrants to their families, culture, and neighbors.”
El Futuro treated 2,409 community members during the fiscal year that ended in June 2023, up from 2,192 people in fiscal 2022. About 19% of the patients it serves are children between the ages of 6 and 14, 26% are 15- to 24-year-olds and the rest are adults over 25. SUD is among the top diagnoses El Futuro sees, along with depression, trauma, anxiety, and stress.
El Futuro’s approach includes traditional cognitive and behavioral therapy, as well as a variety of programs aimed at strengthening social connections, building resilience, and improving family dynamics among people facing mental health challenges. The organization offers classes for parents of children with depression or attention deficit disorder, a therapeutic garden in Durham’s Lakewood neighborhood that hosts volunteer events and cultural celebrations, and a support group for women who have experienced trauma. El Futuro also provides patients with access to community resources to help them solve issues such as homelessness, food insecurity, and unemployment.
In 2019, Ortiz was working as a substance-abuse counselor in Florida when he received a call from Smith, who asked him to join his team.
“I had never heard of El Futuro, but when I talked to Dr. Smith, I fell in love with his vision to serve the Hispanic / Latino community and to nurture stronger families,” Ortiz recalls.
Since joining the organization, he has been instrumental in broadening its family-centered approach to treating SUD, including with the Sin Ataduras program. El Futuro board chair Rosa Gonzalez-Guarda, associate professor and assistant dean at Duke University School of Nursing, says hands-on experiences that pull in the whole family, coupled with counseling, are key to keeping patients engaged in their treatment.
“El Futuro delivers evidence-based treatments in ways that are also aligned with the preferences and culture of the Hispanic / Latino community,” she says. “The activities that promote our communities’ cultural heritage and pride are also very powerful in promoting both mental and physical health, and support well-being more broadly. All these activities combined help establish a strong relationship with patients, their families, and our entire community, helping to increase the probability of better outcomes.”
Expanding to underserved communities
With the help of Blue Cross NC, El Futuro has been expanding its holistic approach to counseling to more communities in the state.
In 2019, Blue Cross NC provided $250,000 to help El Futuro expand its La Mesita pilot program to reach rural and underserved areas. And in 2022, Blue Cross NC provided $200,000 so the organization could expand its workforce of bilingual and bicultural counselors.
El Futuro was also a stop on the Blue Cross NC Extra Miles Tour (EMT) in March 2021. This statewide listening tour enables company leaders to meet with local organizations and hear firsthand about the challenges they face in order to find meaningful ways to support their missions.
During the EMT stop in Chatham County, Smith moderated a panel discussion about the growing Hispanic / Latino community across North Carolina and the need for health care organizations to adapt to this population’s diverse challenges.
El Futuro Executive Director Dr. Luke Smith, center, at a Blue Cross and Blue Shield of North Carolina Extra Miles Tour event in Chatham County in March 2021.
For Blue Cross NC, partnering with El Futuro is part of a broader push to improve mental health access across the state. In addition to addressing disparities in access to behavioral health care, Blue Cross NC is working toward the integration of mental health into primary care for both children and adults, and we’re working to destigmatize mental health so more people who need support will be encouraged to seek it.
“Expanding access to evidence-based treatment for adults and children in North Carolina who are dealing with behavioral health challenges is a priority for Blue Cross NC,” says Ellyn Saren, vice president of behavioral health at Blue Cross NC. “We admire El Futuro’s innovative whole-person, whole-family approach to care, and its progress in expanding access to behavioral health services throughout the Hispanic / Latino community.”
The demand for El Futuro’s services skyrocketed during the COVID-19 pandemic and continues to be high, which Ortiz attributes largely to an uptick in alcohol use, as well as abuse of stimulants like cocaine and methamphetamines among young Hispanic / Latino individuals.
“It was a result of the isolation, the stress and the fear of what would happen in the future,” Ortiz says. He adds that he’s grateful that Blue Cross NC is helping El Futuro expand its outreach. “With this support, we are able to deliver our services to more people who need us.”
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