Abriendo Caminos: Engaging Latino Communities Through Culturally Responsive Peer Delivered Motivational Interviewing

Yale University, New Haven CT

Investigators

Linked publications, trials & patents

Abstract

People with serious mental illness (SMI; psychotic and major affective disorders) experience significantly higher rates of morbidity compared with individuals of similar ages without these conditions. Among this broad population, the most vulnerable are Latinos living with SMI who are not engaged in treatment. Further, trauma among people with SMI, in general, is four to five times higher than for the general public, with the highest rates among Latinos in comparison to other racial and ethnic groups. Despite the availability of effective mental health treatment interventions, approximately 47% of Latino adults with SMI are not engaged in treatment. Those who are engaged have significantly lower rates of treatment adherence, retention, and satisfaction than White people. Barriers to treatment engagement for Latinos include lack of bilingual and bicultural clinical providers, the absence of culturally responsive interventions, lack of access to specialty services in Latino neighborhood, self-reliant attitudes, and cultural differences that impact the recognition of mental health concerns. Some evidence suggests that culturally tailoring interventions to Latinos may improve treatment engagement. The proficient use of Motivational Interviewing (MI), an evidence-based and person-centered treatment approach, has been shown to predict behavior change, such as treatment engagement, greater medication adherence and reductions in alcohol consumption, and additional outcomes among Latinos. However, no research to date has examined the cultural adaptation of the MI spirit or the full approach. To fully integrate Latino cultural values and MI, we need to pay attention not just to the intervention, but also to the method of service delivery. Latino peers may be in the best position to deliver MI to Latinos with SMI, given their lived experience with both the culture and the illness. Of the available research on Latino peers in recovery from SMI, evidence suggests that Latino peer navigators appear to enhance service engagement, recovery, and quality of life for Latinos in recovery from a SMI. Therefore, the overall objective of this career development proposal is to culturally adapt MI to integrate Latino cultural relational values and trauma informed care for delivery by peers in recovery from SMI to engage Latinos with SMI in mental health treatment. Specifically, the proposed research will 1) identify social and cultural factors that contribute to mental health treatment hesitancy and engagement among Latinos with SMI; 2) culturally adapt an MI treatment engagement intervention that is trauma informed and peer delivered for Latinos with SMI; and 3) provide evidence of the feasibility, acceptability, and engagement of target mechanisms associated with the intervention. My mentors, in combination with a world-class training environment at Yale University, will guide me towards my goal of becoming an independent bicultural and bilingual investigator of multi-level influences on mental health disparities, with expertise in designing and conducting rigorous, pragmatic research aimed at improving engagement, care, and clinical outcomes for Latinos and other racial and ethnic communities.