Substance Use and Hispanic/Latinos, Tennessee: Implications for Work Round Table Discussion June,...

Substance Use and Hispanic/Latinos, Tennessee: Implications for Work

Round Table Discussion

June, 2015

Introduction and Presentations

• 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

Strategic Plan: Goals• Serve as the national subject matter expert and key resource

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.

Vision and Mission

Strategic Plan: Goals• Identify available resources and needs.

• 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.

Strategic Plan: Goals

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.


• Developing and disseminating educational products and trainings.

• Supporting the effective utilization of culturally competent practices.

• Promoting collaboration and maintaining effective communication.


Assessment

Curriculum and Education

TOT

SustainabilityTraining

Factsheet-Webinars

Stakeholders

Workflow of Services

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

• 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

Source: US Census Bureau. (2013). 2012 National population projections.

1980 1990 2000 2013 2020 2030 2040 2050 20600%

5%

10%

15%

20%

25%

30%

35%

6%9%

13%17%

19%22%

25%28%

31%

Population as of April 1 Projections for Population as of July 1

Hispanic or Latino by OriginUnited States, 2011-2013

Source: US Census Bureau (2014). FactFinders, 2011-2013 American Community Survey 3- Year Estimates

Mexican; 64.3Puerto Rican; 9.5

Cuban; 3.7

Salvadoran; 3.7

Dominican; 3.1

Guatemalan; 2.4 Colombian; 2.0 Other Central/South American/ Hispanic descents; 11.4

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%)

• 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 OriginUnited States, 2012

Source: National Center for Health Statistics (2014). Health, United States, 2013: With special feature on prescription drugs. Hyattsville, MD.

Hispanic or Latino

Black or African American

White

Asian

All races

0.0 5.0 10.0 15.0 20.0 25.0 30.0

25.6

27.2

12.7

11.7

15.0

Health Uninsured Percentage by Race/EthnicityUnited States, 2013

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.

Latinos, 24.5%

White, 9.8%

Black, 15.9%

Asian, 14.5%

US-born Latinos, 17.0%

Foreign born

Latinos, 39.0%

Life Expectancy by Race and Hispanic OriginUnited States, 2010


White , not Hispanic

B lack, not His panic

Hispanic or Lati no

Male Female

83.8

77.7

81.8

78.5

71.4

76.4

81.2

74.7

78.8

Total

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– Diet– Support network– Smoking – Identity

Birth and Fertility Rates by Race and Hispanic OriginUnited States, 2012


0 10 20 30 40 50 60 70 80

Black not Hispanic White not Hispanic Hispanic or Latina

Birth

Fertility

Distribution of Hispanics by ATTC Region

R1: 10.4%

R2: 19.3%

R3: 7.7%

R4: 12.1%

R6: 30.3%

R7: 6.8%R8: 15.0%R10: 12.4%

R9: 37.2%

R5: 8.0%

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: 4.7%• Mexican 64.3%• Puerto Rican 7.3%• Guatemalan 4.9%• Cuban 2.7%• Honduran 3.3%• Salvadoran 3.0%• Colombian 1.3%• Spaniard 1.1%• Other SA/CA/Sp 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: 4.7% Foreign born 45.6% Spanish Language 3.9% 18-64 71.9%

Geography Total Foreign born• Bedford 11.3% 7.2%• Hamblen 10.7% 7.0%• Davidson 9.8% 11.7%• Crockett 8.7% 4.9%• Warren 8.1% 5.1%• Montgomery 8.0% 5.3%• Loudon 7.0% 5.6%• Rutherford 6.7% 7.0%• DeKalb 6.6% 5.7%• Robertson 5.9% 3.7%• Shelby 5.6% 6.2%• Putnam 5.3% 5.0%• Sevier 5.3% 5.2%

Distribution of Persons Below 125% Poverty LevelTennessee

Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey.

Overall Hispanic/Latino White n/H/L0

5

10

15

20

25

30

35

40

45

Overall; 23.1

Hispanic/Latino; 43.9

White n/H/L; 18.8

Distribution of Persons Health UninsuredTennessee

Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey.

Overall White n/H/L Hispanic/Latino US-born Foreign born0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

13.9%11.6%

40.6%

12.3%

46.2%

Substance Use Distribution by Race/Ethnicity: 2013

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) 14-4863.

Binge Drinking Heavy Alcohol Use Illicit Drug Use Substance Use Disorder

0

5

10

15

20

25 24

7.39.5

8.4

20.1

4.5

10.5

7.5

2.5

5.8

12.3

14.9

24.1

4.8

8.8 8.6

12.4

23.1

4.6

White BlackAmerican Indian/Alaska Natives HispanicAsian

Abuse/Dependence of Illegal Drugs by ATTC Region

R1: 10.1%

R2: 19.7%

R3: 4.7%

R4: 7.5%

R6: 27.0%

R7: 4.5%R8: 13.0%R10: 9.0%

R9: 32.9%

R5: 7.0%

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 inTennessee by Hispanic Origin

Series10

2

4

6

8

106.1 5.8

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 inTennessee by Hispanic Origin

Series10

1

2

3

4

52.9

0.9

Not Hispanic Hispanic


Lifetime Prevalence of Psychiatric Disorders by White not Latino and Latinos

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

Any Depressive Disorder

Any Anxiety Disorder

PTSD Any Substance Disorder

Any Disorder0

10

20

30

40

50

60

27.630.8

9.5

26.4

52.5

19.8 18.9

5.9

20.4

37.1

14.8 15.2

47

24.9

White, not Latino Latino US-born Latino immigrant

Past Month Substance Use among Hispanics by Nativity: 2008-2012

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

Alcohol Use Binge Drinking Illicit Drug Use0

10

20

30

40

50

6057.3

32.8

12.2

37.1

21.7

3.2

Born in the United States Not Born in the United States

Lifetime Prevalence of Substance Use Disorders by Hispanic Subgroup and Immigration Status

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

Any SUD

Alcohol A

buse

Alcohol D

epen

dence

Drug A

buse

Drug D

epen

dence

0

5

10

15

20

25

Any SUD

Alcohol A

buse

Alcohol D

epen

dence

Drug A

buse

Drug D

epen

dence

0

5

10

15

20

25

Any SUD

Alcohol A

buse

Alcohol D

epen

dence

Drug A

buse

Drug D

epen

dence

0

5

10

15

20

25

Any SUD

Alcohol A

buse

Alcohol D

epen

dence

Drug A

buse

Drug D

epen

dence

0

5

10

15

20

25Puerto Ricans

Cubans

Mexicans

Other Latinos

Mental Illness Distribution by Race/Ethnicity: 2013

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.

Any Mental Il

lness

Serio

us Mental Il

lness

Major Depressi

ve Episo

de

Suicid

e Thoughts

Co-occurri

ng Mental Il

lness0

102030

19.3

4.6 7.34.1 3.3

16.9

2.9 4.6 2.9 3.3

26

5.88.9

4.8 7.4

16.9

3.7 5.8 3.6 3.1

12.3

2.9 4 3.3 1.4

White BlackAmerican Indians/Alaska Natives HispanicAsian

Unmet Need for Substance Abuse Treatment: Hispanics

95.8%

2.2% 2.0% Didn't feel they needed Tx.

Felt needed Tx. but no ef-fort

Felt needed Tx. made effort

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

9.9% Received Treatment vs. 11% Overall

United States

Perception of Need for TreatmentTennessee by Hispanic Origin

Not Hispanic Hispanic0

10

20

30

40

50

60

70

80

90

100

92.7 99.8

Felt Need/Made Effort Felt Need/Made No EffortFelt No Need for TX


Spanish Service Indicator, Substance Abuse TreatmentATTC Region 4

State Total Spanish• Alabama 123 10 (8.1%)• Florida 427 175 (41.1%)• Georgia 259 43 (16.6%)• Kentucky 282 14 (5.0%)• Mississippi 405 36 (8.9%)• North Carolina 329 45 (13.7%)• South Carolina 92 24 (26.1%)• Tennessee 163 16 (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

R1: 12.4%

R2: 19.0%

R3: 5.5%

R4: 5.8%

R6: 20.2%

R7: 4.8%R8: 19.1%R10: 10.2%

R9: 33.2%

R5: 4.9%

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-AdmissionWhy Tennessee?

• Alabama 0.8%• Florida 11.6%• Georgia 2.5%• Kentucky 1.0%• Mississippi No inf. (1% in 2005-09)• North Carolina 2.0%• South Carolina 2.5%• Tennessee 17.5%


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%)

Treatment Admission Characteristics, Tennessee 2012Not 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%)


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%)

Treatment Admission Characteristics, Tennessee 2012

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%)


Latinos n= 1,944• Reason

– Treatment completed: 58.6%– Left against advise: 25.4%– Transferred: 2.3%– Terminated: 9.7%

Treatment Discharge Characteristics, Tennessee 2011

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

Not Latinos n= 9,802• Reason

– Treatment completed: 49.1%– Left against advise: 23.8%– Transferred: 2.3%– Terminated: 21.7%

Implications for service

• Service availability• Service accessibility• Representation

– Data, research, workforce, policy

• Language/Communication– Generational differences (conflict resolution)

• Inclusion• Assessment and screening

Ground Rules

• 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. 787-785-5220Fax 787-785-4222



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