Transcript Tennessee - Addiction Technology Transfer Center

Substance Use and Hispanic/Latinos, Tennessee:
Implications for Work
Round Table Discussion
June, 2015
Introduction and Presentations
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Welcome
Purpose
Goals
Roles and Responsibilities
General Presentation
Ground Rules
Questions and Discussion
Closing and Evaluation
Icebreaker
Name
Name of Organization
Position/Role
Location
Why did you decide to participate on this meeting
and what would you expect to gain?
Purpose
• Meet with stakeholders serving Hispanic and Latinos in need of
substance use disorder treatment and recovery support services
to gather information on how the National Hispanic and Latino
ATTC can support the work and strengthen the workforce
capacity.
Goals
• Identify available resources and needs regarding training and
capacity building of culturally appropriate services for Hispanic
and Latino populations requiring substance abuse treatment
and recovery services.
• Ensure that Hispanic and Latino populations in need of
substance abuse treatment and recovery services are seen as
a priority among stakeholders.
• Broaden the Regional ATTCs scope on implementation
practices and system transformation focusing on Hispanic and
Latino effective and culturally competent practices.
What is the National Hispanic and Latino ATTC?
ATTC Network Model of Technology
Transfer in the Innovation Process
Copyright 2010 ATTC Network
Vision and Mission
• Serve as the national subject matter expert and key resource
Strategic
Plan: Goals
for the workforce
providing substance abuse treatment and
recovery support services in order to reduce health disparities
among Hispanic and Latino populations.
• Develop and strengthen the workforce that provides substance
abuse treatment and recovery support services to Hispanic
and Latino populations throughout the United States by
maintaining relevant and up-to-date information and resources
to be used for the provision of training and technical
assistance.
Strategic Plan: Goals
• Identify available resources and needs.
Strategic Plan: Goals
• Ensure that Hispanic and Latino populations are seen as a priority.
• Broaden the ATTCs’ scope on implementation practices and
system transformation.
• To develop and strengthen the skills and capabilities of the
workforce.
• Build a collaborative and communication relationship.
These goals will be accomplished by …
These
goals
will
be
accomplished
by
• Building a collaborative and communicative relationship.
…
• Identifying regional differences and commonalities.
• Identifying training needs and assessing capacity building needs.
• Developing and implementing the strategic plan.
These goals will be accomplished by …
• Developing and disseminating educational products and
trainings.
• Supporting the effective utilization of culturally competent
practices.
• Promoting collaboration and maintaining effective
communication.
Workflow of Services
Assessment
Curriculum
and Education
Stakeholders
FactsheetWebinars
TOT
Training
Sustainability
Substance Use and Hispanic/Latinos, Tennessee:
Implications for Work
Miguel A Cruz-Feliciano, PhD
Associate Director
June, 2015
Unnatural Causes – Becoming American
Source: Unnatural Causes, http://www.unnaturalcauses.org/episode_descriptions.php?page=3
Hispanic vs. Latino
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Relation with Spain (territory, culture, colonization)
Language (Brazilians are Latinos but not Hispanics)
Identity (Caribbean and South America vs. Mexican)
Inclusiveness
East vs. West
Preference
Operational Definition
Individuals of Cuban, Mexican, Puerto Rican,
South or Central American or other Spanish
culture or origin regardless of race (US Bureau of
Census).
Percent of Hispanic Population in the
United States: Trends and Projections
35%
30%
25%
17%
20%
13%
15%
10%
19%
22%
25%
28%
31%
6%
9%
5%
0%
1980 1990 2000 2013 2020 2030 2040 2050 2060
Population as of April 1
Projections for Population as of July 1
Source: US Census Bureau. (2013). 2012 National population projections.
Hispanic or Latino by Origin
United States, 2011-2013
Guatemalan,
2.4
Dominican,
3.1
Salvadoran,
3.7
Colombian,
2.0
Other
Central/South
American/
Hispanic
descents, 11.4
Cuban, 3.7
Puerto Rican,
9.5
Mexican, 64.3
Source: US Census Bureau (2014). FactFinders, 2011-2013 American Community Survey 3- Year Estimates
Hispanic Population – Concentration by States
• Arizona, California, Colorado, Florida, Illinois, New Jersey, New
York, and Texas
– States with more than 1 million Hispanics
• California, Florida, and Texas
– Represents 55% of Hispanics in United States
• Arizona, California, Colorado, Connecticut, Florida, Idaho, Illinois,
Iowa, Kansas, Massachusetts, Nebraska, Nevada, New
Hampshire, New Jersey, New Mexico, New York, Oregon, Rhode
Island, Texas, Utah, Washington, and Wyoming
– 22 States where Hispanic are the largest minority.
Source: US Census Bureau. (2014, September). Hispanic Heritage Month 2014: Sept. 15-Oct. 15. Washington,
DC: US Department of Commerce.
Hispanic and Latinos as Group vs. non-Hispanic Whites
• Younger (median age 27.8 vs. 37.5 Years)
• Less educational attainment
– (27% High School vs. 29%)
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Low median income ($21K vs. $32K)
Higher poverty levels (25.6% vs. 11%)
Less health insured (29% vs. 11%)
Speak other language than English (38 million)
Source: U.S. Census Bureau, 2011-2013. 3-Years American Community Survey.
Language
• Speak Spanish at home: 38 million
– 58% speak English very well
• One-third of all Hispanics (33%) do not speak English
very well
• Immigrants Latinos that speak only English or English
very well
– Children (5-17 years) : 70%
– Adults : 32%
Source: U.S. Census Bureau, 2011-2013. 3-Years American Community Survey.
Persons Below Poverty Level by Race and Hispanic Origin
United States, 2012
15.0
All races
11.7
Asian
12.7
White
27.2
Black or African American
25.6
Hispanic or Latino
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Source: National Center for Health Statistics (2014). Health, United States, 2013: With special feature on
prescription drugs. Hyattsville, MD.
Health Uninsured Percentage by Race/Ethnicity
United States, 2013
Asian, 14.5%
Latinos, 24.5%
US-born Latinos, 17.0%
Black, 15.9%
Foreign born Latinos, 39.0%
White, 9.8%
Sources: Krogstad, J. M., & Lopez, M. H. (2014). Hispanic immigrants more likely to lack health insurance than U.S.-born. Retrieved from
http://www.pewresearch.org/fact-tank/2014/09/26/higher-share-of-hispanic-immigrants-than-u-s-born-lack-health-insurance/
Smith, J. C., & Medalia, C. (2014). Health Insurance Coverage in the United States: 2013. Washington, DC: U.S. Government Printing Office.
Life Expectancy by Race and Hispanic Origin
United States, 2010
Total
HISPANIC OR LATINO
BLACK, NOT HISPANIC
WHITE, NOT HISPANIC
78.5
83.8
81.2
71.4
77.7
74.7
76.4
81.8
78.8
Male
Female
Source: National Center for Health Statistics (2014). Health, United States, 2013: With special feature on
prescription drugs. Hyattsville, MD.
Why do Hispanic and Latinos live longer?
• Hispanic Epidemiological Paradox
– Refers to the contradictory finding that indicates Hispanics in the
United States tend to have significantly better health and mortality
outcomes than the average population despite generally low
socioeconomic status.
• Salmon bias or return-immigrant effect (equally represented by Hispanic group?)
• Healthy immigrant effect
• Social construct and artifact of research
• Cultural factors
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Diet
Support network
Smoking
Identity
Birth and Fertility Rates by Race and Hispanic Origin
United States, 2012
Fertility
Birth
0
10
20
30
Black not Hispanic
40
50
White not Hispanic
60
70
80
Hispanic or Latina
Source: National Center for Health Statistics (2014). Health, United States, 2013: With special feature on
prescription drugs. Hyattsville, MD.
Distribution of Hispanics by ATTC Region
R10: 12.4%
R5: 8.0%
R8: 15.0%
R7: 6.8%
R1: 10.4%
R2: 19.3%
R9: 37.2%
R3: 7.7%
R4: 12.1%
R6: 30.3%
Source: US Census Bureau (2014). FactFinders, 2011-2013 American Community Survey 3- Year Estimates
Distribution of Hispanic and Latinos: Tennessee
N=6,402,387 (M=48.7% : F=51.3%)
Total:
• Mexican
• Puerto Rican
• Guatemalan
• Cuban
• Honduran
• Salvadoran
• Colombian
• Spaniard
• Other SA/CA/Sp
4.7%
64.3%
7.3%
4.9%
2.7%
3.3%
3.0%
1.3%
1.1%
12.1%
Source: US Census Bureau, 2009-2013 5-Year American Community Survey
Distribution of Hispanic and Latinos: Tennessee
Source: U.S. Census Bureau, 2010 Census. 2010 Census Summary File 1, Tables P5 and P8.
H/L Total:
Foreign born
Spanish Language
18-64
4.7%
45.6%
3.9%
71.9%
Geography
• Bedford
• Hamblen
• Davidson
• Crockett
• Warren
• Montgomery
• Loudon
• Rutherford
• DeKalb
• Robertson
• Shelby
• Putnam
• Sevier
Foreign born
7.2%
7.0%
11.7%
4.9%
5.1%
5.3%
5.6%
7.0%
5.7%
3.7%
6.2%
5.0%
5.2%
Total
11.3%
10.7%
9.8%
8.7%
8.1%
8.0%
7.0%
6.7%
6.6%
5.9%
5.6%
5.3%
5.3%
Distribution of Persons Below 125% Poverty Level
Tennessee
45
Hispanic/Latino, 43.9
40
35
30
25
Overall, 23.1
White n/H/L, 18.8
20
15
10
5
0
OVERALL
HISPANIC/LATINO
WHITE N/H/L
Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey.
Distribution of Persons Health Uninsured
Tennessee
50.0%
46.2%
45.0%
40.6%
40.0%
35.0%
30.0%
25.0%
20.0%
15.0%
13.9%
12.3%
11.6%
10.0%
5.0%
0.0%
Overall
White n/H/L
Hispanic/Latino
US-born
Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey.
Foreign born
Substance Use Distribution by Race/Ethnicity: 2013
25
24.1
24
20.1
20
14.9
15
12.4
12.3
9.5
10
10.5
8.8
8.4
7.3
4.5
5
2.5
5.8
7.5
4.8
8.6
4.6
2
3.1
0
Binge Drinking
White
Black
Heavy Alcohol
Use
Illicit Drug Use
American Indian/Alaska Natives
Substance Use
Disorder
Hispanic
Asian
Source: Substance Abuse and Mental Health Services Administration [SAMHSA]. (2014). Results from the 2013 National Survey on
Drug Use and Health: Summary of national findings. Rockville, MD: Author. NSDUH Series H-48, HHS Publication No. (SMA) 144863.
Abuse/Dependence of Illegal Drugs by ATTC Region
R10: 9.0%
R5: 7.0%
R8: 13.0%
R7: 4.5%
R1: 10.1%
R2: 19.7%
R9: 32.9%
R3: 4.7%
R4: 7.5%
R6: 27.0%
Source: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for
Behavioral Health Statistics and Quality (2014). National Survey on Drug Use and Health: 2-Year R-DAS (2002 to 2003, 2004 to 2005, 2006 to
2007, 2008 to 2009, and 2010 to 2011). ICPSR 34482. Retrieved from: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/sda
Prevalence of Alcohol Abuse or Dependence in
Tennessee by Hispanic Origin
10
8
6.1
5.8
6
4
2
0
Not Hispanic
Hispanic
Source: National Survey on Drug Use and Health: 2-Year R-DAS (2002 to 2003, 2004 to 2005, 2006 to 2007, 2008 to 2009, 2010 to 2011,
and 2012 to 2013). Analysis ran on 2015-05-13 (11:08 AM EDT) using SDA 3.5: Tables
Prevalence of Illicit Drug Abuse or Dependence in
Tennessee by Hispanic Origin
5
4
2.9
3
0.9
2
1
0
Not Hispanic
Hispanic
Source: National Survey on Drug Use and Health: 2-Year R-DAS (2002 to 2003, 2004 to 2005, 2006 to 2007, 2008 to 2009, 2010 to 2011,
and 2012 to 2013). Analysis ran on 2015-05-13 (11:08 AM EDT) using SDA 3.5: Tables
Lifetime Prevalence of Psychiatric Disorders by White not Latino
and Latinos
60
52.5
50
37.1
40
30
20
30.8
27.6
19.8
14.8
26.4
18.9
15.2
20.4
9.5
10
24.9
5.9 4
7
0
Any Depressive
Disorder
Any Anxiety
Disorder
White, not Latino
PTSD
Latino US-born
Any Substance
Disorder
Any Disorder
Latino immigrant
Source: Alegria, M., Canino, G., Shrout, P.E., Woo, M., Duan, N., Vila, D., Torres, M., Chen, C.N., & Meng, X.L. (2008). Prevalence of mental
illness in immigrant and non-immigrant U.S. Latino groups. The American Journal of Psychiatry 165(3):359–369.
doi:10.1176/appi.ajp.2007.07040704
Past Month Substance Use among Hispanics by Nativity:
2008-2012
57.3
60
50
37.1
32.8
40
30
21.7
20
12.2
3.2
10
0
Alcohol Use
Binge Drinking
Born in the United States
Illicit Drug Use
Not Born in the United States
Source: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration,
Center for Behavioral Health Statistics and Quality. (2013). 2012 National Survey on Drug Use and Health. Rockville, MD. ICPSR
34933. Retrieved from: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/sda
Lifetime Prevalence of Substance Use Disorders by Hispanic
Subgroup and Immigration Status
Puerto Ricans
Mexicans
25
25
20
20
15
15
10
10
5
5
0
0
Any SUD
Alcohol
Abuse
Alcohol
Drug Abuse
Drug
Dependence
Dependence
Any SUD
Alcohol
Abuse
Other Latinos
Cubans
25
25
20
20
15
15
10
10
5
5
0
Alcohol
Drug Abuse
Drug
Dependence
Dependence
0
Any SUD
Alcohol
Abuse
Alcohol
Drug Abuse
Drug
Dependence
Dependence
Any SUD
Alcohol
Abuse
Alcohol
Dependence
Drug Abuse
Drug
Dependence
Source: Alegria, M., Canino, G., Shrout, P.E., Woo, M., Duan, N., Vila, D., Torres, M., Chen, C.N., & Meng, X.L. (2008). Prevalence of mental
illness in immigrant and non-immigrant U.S. Latino groups. The American Journal of Psychiatry 165(3):359–369.
doi:10.1176/appi.ajp.2007.07040704
Mental Illness Distribution by Race/Ethnicity: 2013
30
26
25
20
19.3
16.9
15
16.9
12.3
10
4.6
5
5.8
2.9
8.9
7.3
3.7 2.9
4.6
5.8
7.4
4
4.1
2.9
4.8
3.6 3.3
3.3 3.3
3.1
1.4
0
Any Mental
Illness
White
Black
Serious
Mental
Illness
Major
Depressive
Episode
Suicide
Thoughts
American Indians/Alaska Natives
Co-occurring
Mental
Illness
Hispanic
Asian
Source: Substance Abuse and Mental Health Services Administration [SAMHSA}. (2014). Results from the 2013 National Survey on
Drug Use and Health: Mental Health Findings. Rockville, MD: NSDUH Series H-49, HHS Publication No. (SMA) 14-4887.
Unmet Need for Substance Abuse Treatment: Hispanics
9.9% Received Treatment vs. 11% Overall
2.2%
2.0%
Didn't feel they needed Tx.
Felt needed Tx. but no
effort
Felt needed Tx. made
effort
United States
95.8%
Source: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration,
Center for Behavioral Health Statistics and Quality. (2014). 2013 National Survey on Drug Use and Health. Rockville, MD. ICPSR
35509. Retrieved from: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/sda
Perception of Need for Treatment
Tennessee by Hispanic Origin
100
90
80
70
60
92.7
99.8
50
40
30
20
10
0
Not Hispanic
Hispanic
Felt Need/Made Effort
Felt Need/Made No Effort
Felt No Need for TX
Source: National Survey on Drug Use and Health: 2-Year R-DAS (2002 to 2003, 2004 to 2005, 2006 to 2007, 2008 to 2009, 2010 to 2011, and
2012 to 2013). Analysis ran on 2015-05-13 (11:08 AM EDT) using SDA 3.5: Tables
Spanish Service Indicator, Substance Abuse Treatment
ATTC Region 4
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•
•
•
•
•
•
•
State
Alabama
Florida
Georgia
Kentucky
Mississippi
North Carolina
South Carolina
Tennessee
Total
123
427
259
282
405
329
92
163
Spanish
10
175
43
14
36
45
24
16
(8.1%)
(41.1%)
(16.6%)
(5.0%)
(8.9%)
(13.7%)
(26.1%)
(9.8%)
Source: Substance Abuse and Mental Health Services Administration (2015). Behavioral Health Treatment
Services Locator. Retrieved from: https://findtreatment.samhsa.gov/locator?sAddr=&submit=Go
Treatment Admissions by Hispanic Population and ATTC Region
R10: 10.2%
R5: 4.9%
R8: 19.1%
R7: 4.8%
R1: 12.4%
R2: 19.0%
R9: 33.2%
R3: 5.5%
R4: 5.8%
R6: 20.2%
Source: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration,
Center for Behavioral Health Statistics and Quality (2014). Treatment Episode Data Set -- Admissions (TEDS-A), 2010-2012. ICPSR
25221. Retrieved from: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/sda
Treatment Episode Data Set-Admission
Why Tennessee?
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Alabama
Florida
Georgia
Kentucky
Mississippi
North Carolina
South Carolina
Tennessee
0.8%
11.6%
2.5%
1.0%
No inf. (1% in 2005-09)
2.0%
2.5%
17.5%
Source: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration,
Center for Behavioral Health Statistics and Quality (2014). Treatment Episode Data Set -- Admissions (TEDS-A), 2010-2012. ICPSR
25221. Retrieved from: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/sda
Treatment Admission Characteristics, Tennessee 2012
Latinos, n= 2,056
• Male: 65.7%
• Age Median: 34
• Service
– Rehab/Res Short Term 30D or fewer: 34.0%
– Ambulatory, Intensive : 25.7%
• Referral
– Criminal Justice: 46.9%
– Individual: 35.3%
– Other Health Care Provider: 10.1%
• No prior TX: 52.1%
• Primary Substance (Alcohol: 37.8% / Other
opiates and synthetics: 19.9%)
• Secondary Substance (Marijuana: 12.7%)
Not Latinos, n= 11,070
• Male: 64.5%
• Age Median: 32
• Service
– Rehab/Res Short Term 30D or fewer: 28.3%
– Ambulatory, Intensive : 24.7%
• Referral
– Criminal Justice: 47.2%
– Individual: 32.4%
– Other Health Care Provider: 12.9%
• No prior TX: 49.2%
• Primary Substance (Other opiates and
synthetics: 33.1% / Alcohol: 28.1%)
• Secondary Substance (Marijuana: 16.1%)
Source: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health
Statistics and Quality (2014). Treatment Episode Data Set -- Admissions (TEDS-A), 2010-2012. ICPSR 25221. Retrieved from:
http://www.icpsr.umich.edu/icpsrweb/SAMHDA/sda
Treatment Admission Characteristics, Tennessee 2012
Latinos
Substance Reported
• Alcohol: 53.4%
• Cocaine: 28.6%
• Marijuana: 35.6%
• Heroin: 5.4%
• IDU: 22.9%
Substance Abuse Type
• Alcohol Only: 21.2%
• Other Drugs Only: 46.6%
• Alcohol and Other Drugs: 32.2%
Co-occurring condition: 36.1%
Health Insurance (None: 89.8%)
Not Latinos
Substance Reported
• Alcohol: 46.7%
• Cocaine: 21.3%
• Marijuana: 41.4%
• Heroin: 3.2%
• IDU: 14.1%
Substance Abuse Type
• Alcohol Only: 18.7%
• Other Drugs Only: 35.6%
• Alcohol and Other Drugs: 45.7%
Co-occurring condition: 45.3%
Health Insurance (None: 86.3%)
Source: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health
Statistics and Quality (2014). Treatment Episode Data Set -- Admissions (TEDS-A), 2010-2012. ICPSR 25221. Retrieved from:
http://www.icpsr.umich.edu/icpsrweb/SAMHDA/sda
Treatment Discharge Characteristics, Tennessee 2011
Latinos n= 1,944
• Reason
–
–
–
–
Treatment completed: 58.6%
Left against advise: 25.4%
Transferred: 2.3%
Terminated: 9.7%
Not Latinos n= 9,802
• Reason
–
–
–
–
Treatment completed: 49.1%
Left against advise: 23.8%
Transferred: 2.3%
Terminated: 21.7%
Source: United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health
Statistics and Quality (2014). Treatment Episode Data Set -- Discharges (TEDS-D), Concatenated, 2006-2011. ICPSR 30122. Retrieved from:
http://www.icpsr.umich.edu/icpsrweb/SAMHDA/sda
Implications for service
• Service availability
• Service accessibility
• Representation
– Data, research, workforce, policy
• Language/Communication
– Generational differences (conflict resolution)
• Inclusion
• Assessment and screening
Ground Rules
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•
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Respect each other
One person at a time
No right or wrong answers
Turn off or in vibration mode your cellphone
Taking notes and recording
You are the experts
Question 1
• Based on your experience, what are the major
issues/situations service providers face while
working with H/L populations?
Question 2
• What are the training needs faced by service
providers to deliver culturally appropriate service
and treatment for H/L?
Question 3
• What strengths can you mention from providers
of your organization to deliver specific services to
H/L?
Question 4
• What does the recovery culture look like for H/L
in your area?
Question 5
• Is your organization currently involved with any
Training Center of particular aspects of workforce
development with specific orientation towards
H/L? What about behavioral health?
Question 6
• Based on what you have learned today, how the
NHL ATTC and the ATTC in general can be an
integral part of your workforce development?
Question 7
• Has Health Care Reform affected or influenced
the way you are currently delivering treatment
services?
Closing and Evaluation
National Hispanic and Latino ATTC
http://attcnetwork.org/hispaniclatino
Tel. 787-785-5220
Fax 787-785-4222