Transcript La Frontera - Texas Department of State Health Services

“La Frontera”- DDRAC
8/4/09
Susan M. Gallego, LCSW
DSHS MH/SA – Program
Implementation
Border Programs Coordinator
Texas Border: Colonia
Texas Border Health
US-Mexico Border
Sister Cities and Population
California
Baja
California
Norte
ran
de
Arizona
New Mexico
Rio G
San Diego
1,223,400 Calexico Yuma
27,109
77,515
Tijuana Mexicali
San
Luis
1,148,681 549,873
Rio Colorado
126,645
Nogales
20,878
Nogales
156,854
Columbus
1,765
El Paso
563,662
Texas
Puerto Palomas Ciudad Juarez
5,210
1,187,275
Presidio
4,167
Ojinaga
20,371
Sonora
Chihuahua
Baja
California
Sur
Sinaloa
Durango
Del Rio
Ciudad 33,867
Acuña
Eagle Pass
108,159
22,413
Piedras Negras
Laredo
126,386
176,576
McAllen
Nuevo
Coahuila
106,414
Laredo
Brownsville
308,828
139,722
Nuevo
Leon Reynosa Matamoros
403,718
376,279
Tamaulipas
Population Data Sources:
US Census Bureau, 2000
Instituto Nacional de Estadística, Geografía, e Informática (INEGI), 2000
August 2003
Borderlands – “La Frontera”
• 32 Texas Border counties in 4 MH/SA regions
with approx. 4.1 million people.
• 68% of legal truck crossings between US and
Mexico come through Texas (Laredo).
• 48% of legal crossings of people between the
US and Mexico come through Texas.
• El Paso/Ciudad Juarez is the largest TX border
community, and the busiest crossing.
Population increased by 38% from 1990-2000.
• McAllen/Reynosa is the 4th fastest growing
metro area in US. Population increased by 38%
from 1990 -2000.
“If the Texas Border counties made up a
“51st” state, it would rank last in per capita
personal income and first in poverty and
unemployment.”
Texas Borderlands: Frontier to the Future, February 2007, State of
Texas, Eliot Shapleigh
Texas Border Health:
DSHS Office of Border Health
Binational “Sister-Cities” Health Councils
held a Strategic Planning Meeting, 6/08,
sponsored by USMBHA and TX OBH, and
identified the top five border-wide health
priorities:
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2.
3.
4.
5.
Diabetes/obesity/nutrition
Tuberculosis
Dengue fever
EDIDS/EPI
Mental Health/Substance Abuse/Domestic
Violence
Substance Abuse Prevention - Six
Effective CSAP Strategies
• Prevention Education/Skills
Training
• Alternative Activities
• Problem Identification & Referral
• Information Dissemination
• Community-Based Process
• Environmental/Social Policy
Youth SA Prevention Programs
Border Region 8 (Eagle Pass, Uvalde)
Community/School SA Prev. =
19
Border Region 9 (Pecos,Terrell Co.)
Community/School SA Prev. =
6
Border Region 10 (El Paso)
Community/School SA Prev. =
11
Border Region 11 (Brownsville, Laredo)
Community/School SA Prev. =
31
Purpose & Goals of the Texas Rural
Border Intervention (RBI) Projects
PURPOSE:
To develop and implement a comprehensive behavioral
health model that promotes and embraces culturally
competent prevention, intervention, and treatment for
youth and adults in rural border areas (including
Colonias) of the State.
GOALS:
• Increase access to health and social services
• Increase substance abuse awareness and prevention
• Decrease risk factors and strengthening protective
factors.
• Promote recovery and improve quality of life for
community members
• Increase the number of people receiving services
• Enhance motivation for change related to substance
use/abuse.
The 5 RBIs currently serve the following 20
counties along the Texas – Mexico border
(Regions 8, 10, 11):
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Hudspeth
Culberson
Jeff Davis
Brewster
Presidio
Maverick
Val Verde
Edwards
Kinney
Real
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Uvalde
Dimmit
Zavala
Frio
La Salle
Zapata
Starr
Duval
Jim Hogg
Brooks
Counties Targeted by RBI
Land Area
42,220 mi2
Estimated
Population
303,648
Texas Border Health:
Substance Abuse Clinics
Recent Anecdotal Findings 2/09 – 5/09
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Increases in:
– Fear, trauma, stress for border residents
– demand for SA treatment services
– Heroine use (adults)
– Heroine, speed and cocaine use (youth) Increasing fear and mental
health issues.
– Truancy
– Youth involved in drug trafficking
– Referrals from JPs in rural border counties for youth at risk
– Fear and barriers to asking for SA/MH services for immigrants
Decreases in:
– Ability to collaborate and coordinate across borders.
Families and support systems are more broken.
Community level responses seem weaker.
Homeless shelters and domestic violence shelter in the border areas
are full (fuller) more often.
Growing concerns about providing group SA prevention services in
communities experiencing increase in violence and crimes related to
drugs.
Fear that “addictive tendencies” may develop into “addiction” to
violence.
Increased poverty due to global economics.
Exodus of upper and upper middle class Mexicans to Texas (San
Antonio).
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Recommendations for our work on
“La Frontera”
Adopt a Borderlands (an “across”) mindset for joint
strategies and programs.
Build on the willingness of the border population to get
involved with programs that relate to the well-being of
children
Support and grow current binational initiatives.
Increase youth community counseling, MH and SA
treatment programming and facilitate access.
Increase focus on community based outreach models
and services provided by Community Health Workers
or Promotoras(es) and other para-professionals.
Develop and support new evidence-based
interventions that are culture-informed
Evaluate community-developed, grass roots
interventions to determine efficacy and possibility of
replication
Recommendations cont’d
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14.
Fund and support new services/programs targeting
out-of-school youth and violence prevention.
Create bilingual multi media campaigns, social
marketing.
Develop creative and responsible strategies to
increase bilingual and bicultural work force
Make an effort to integrate trauma knowledge into
service delivery systems
Support and fund mechanisms that increase the
number of bilingual mental health and substance
abuse counselors.
Increase support for integrated behavioral health
services within medical clinics.
Utilize creative approaches to target resources to the
32 Border counties, such as directing a % of seized
money towards SA/MH prevention, intervention and