Evaluating culturally and linguistically integrated care for Latinx adults with mental and substance use disorders

ABSTRACT

Objective: To evaluate changes in health and health care utilization outcomes for Latinx adults with substance use and mental disorders receiving integrated behavioral and primary health care.

Design: Study sample included enrollees who completed baseline, 6-month and 12-month assessments (n = 107). Study outcomes were depression symptom severity, anxiety symptom severity, illicit drug use, emergency department utilization and homelessness status. Pre–post analyses were conducted using paired t-test and McNemar test to examine changes in study outcomes. Multivariable regression model estimated through generalized estimating equations explored the influence of the intervention on study outcomes. Results were presented in adjusted odds ratios (AOR) and 95% confidence intervals (CI).

Results: Participants were less likely to report depressive symptoms (AOR: 0.496, 95%CI: 0.296–0.832), less likely to report anxiety symptoms (AOR: 0.539, 95%CI: 0.329–0.884), and less likely to experience homelessness (AOR: 0.556, 95%CI: 0.328–0.943) at 6-month assessment compared to baseline. Participants were also less likely to report depressive symptoms (AOR: 0.378, 95%CI: 0.209–0.684), less likely to report anxiety symptoms (AOR: 0.471, 95%CI: 0.270–0.821), less likely to experience homelessness (AOR: 0.333, 95%CI: 0.189–0.587), and less likely to utilize the emergency department in the past 30 days (AOR: 0.397, 95%CI: 0.188–0.837) at 12-month assessment compared to baseline.

Conclusions: Integrating culturally responsive behavioral and primary health care services is critical for addressing the needs of Latinx adults with mental and substance use disorders, and other chronic diseases. This initiative has the potential to reduce disparities in access to and engagement in care for Latinx adults.

KEYWORDS:

• Substance use
• mental health
• integrated care
• behavioral health
• homelessness
• Latino

Acknowledgements

The authors thank Yiyang Yuan, M. P. H., M. S. at the Department of Quantitative Health Sciences, University of Massachusetts Medical School for detailed review and constructive feedback on this manuscript; and staff at Casa Esperanza, Inc., Boston Health Care for the Homeless Program, and Boston University’s Center for Addiction Research and Services (BUCARS) for their commitment and dedication to the CasaCare project.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Substance Abuse Mental Health Services Administration (SAMHSA) of the US Department of Health and Human Services (HHS) under Grant SM060845.