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H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM Director

Center for Substance Abuse TreatmentSubstance Abuse Mental Health Services

AdministrationU.S. Department of Health & Human Services

July 10, 2009San Francisco, CA

Movilizandonos por Nuestro Futuro:Strategic Development of a Mental Health

Workforce for Latinos

“Call to Action: Developing a Latino Behavioral Health Workforce”

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Substance Abuse and Mental Health Services Administration/CSAT

Substance Abuse and Mental Health Services Administration/CSAT

SAMHSA’s Mission: • To build resilience and facilitate recovery for

people with or at risk for substance abuse and mental illness.

Center for Substance Abuse Treatment (CSAT) Mission:• To improve the health of the nation by bringing

effective alcohol and drug treatment to every community.

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Past Month Alcohol UsePast Month Alcohol Use

Source: NSDUH

Past Month Alcohol Use

U.S.¹ U.S. – Hispanic Only

Any Use 51% 42.1%

Binge* Use: 23% 23.4%

Heavy Use: 7% 5.5%

* Binge Alcohol Use is defined as drinking 5 or more drinks on the same occasion on at least 1 day in the past 30 days. Heavy Alcohol Use is defined as drinking 5 or more drinks on the same occasion on each of 5 or more days in the past 30 days; all heavy alcohol users are also binge alcohol users.

¹ Annual Averages based on 2005 - 2007 NSDUHs

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Past Month Illicit Drug Use – U.S.Past Month Illicit Drug Use – U.S.12.6%

11.8%

9.5%

8.2%

6.6%

4.2%

0%

2%

4%

6%

8%

10%

12%

14%

AI/AN Two or MoreRaces

Black/AfricanAmerican

White Hispanic/Latino Asian

Pe

rce

nt

Us

ing

in

Pa

st

Mo

nth

Source: NSDUH 2007. It should be noted that, except for the "Hispanic or Latino" group, the racial/ethnic groups discussed in the NSDUH report include only non-Hispanics. The category "Hispanic or Latino" includes Hispanics of any race.

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Concurrent Alcohol & Illicit Drug Use – by Race/Ethnicity

Concurrent Alcohol & Illicit Drug Use – by Race/Ethnicity

11.7%

9.9%

7.4%

5.4% 5.2%4.2%

2.1%

0%

2%

4%

6%

8%

10%

12%

14%

AmericanIndian orAlaskaNative

Black Two orMore Races

Hispanic orLatino

White NativeHawaiian or

OtherPacific

Islander

Asian

Source: NSDUH 2006 and 2007 combined data

Concurrent illicit drug and alcohol use among past month alcohol users aged 12 or older:

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There were 1,817,577 Admissions to Specialty Substance Abuse Treatment

Facilities in 2007

There were 1,817,577 Admissions to Specialty Substance Abuse Treatment

Facilities in 2007

6Treatment Episode Data Set 2007

0.1%

2.2%

0.1%

2.2%

14.3%

5.9%

4.3%

0.2%

3.9%

20.9%

60.1%

White (non-Hispanic)Black (non-Hispanic)Alaska Native

AmericanIndianAsian/PacificIslanderOther

Mexican

Puerto Rican

Cuban

Other/notspecified

Hispanic Origin

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The NSDUH REPORT

July 16, 2009

Substance Use Treatment Need and Receipt among Hispanics

National Survey on Drug Use and Health

Treatment Need for Hispanics aged 12 or Older in the Past Year

Treatment Need for Hispanics aged 12 or Older in the Past Year

• An estimated 8.3 percent (2.6 million) of Hispanics aged 12 or older were in need of alcohol use treatment in past year.

• An estimated 3.4 percent (1.1 million) were in need of illicit drug use treatment in past year.

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Source: 2002 to 2007 SAMHSA National Surveys on Drug Use and Health (NSDUHs)

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Per

cent

Need for Alcohol and Illicit Drug Use Treatment in the Past Year among Hispanics Aged 12 or Older, by Ethnic Subgroup: 2002 to 2007

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Need for Alcohol and Illicit Drug Use Treatment in the Past Year among Hispanics Aged 12 or Older,

by Nativity: 2002 to 2007

Per

cent

Receipt of Treatment for Hispanics aged 12 or Older in the Past Year

Receipt of Treatment for Hispanics aged 12 or Older in the Past Year

• Of the 2.6 million Hispanics in need of alcohol use disorder treatment in the past year, 7.7 percent received alcohol treatment in a specialty facility.

• Of the 1.1 million Hispanics in need of illicit drug use disorder treatment in the past year, 15.1 percent received illicit drug use treatment in a specialty.

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Source: 2002 to 2007 SAMHSA National Surveys on Drug Use and Health (NSDUHs)

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Received Substance Use Treatment at a Specialty Facility in the Past Year among Hispanic Aged 12 or Older in Need of Treatment, by Ethnic Subgroup: 2002-2007

Per

cent

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Received Substance Use Treatment at a Specialty Facility in the Past Year among Hispanics Aged 12 or Older in

Need of Treatment, by Nativity: 2002 to 2007P

erce

nt

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Meeting the Needs of a Changing Population

Meeting the Needs of a Changing Population

• According to the U.S. Census Bureau, between 2008 and 2050 the Hispanic population is expected to double. (15% to 30%)

• Other studies have reported that 28% of Latinos have little or no choice in where to seek health care – compared to 15% of whites.

• Cultural competency needs to be integrated into every program – treatment providers must speak the language and understand the culture of the changing population.

• Provider networks need to be expanded through outreach and recruitment activities, making sure that faith based and other community based providers are included.

Sources: Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, Institute of Medicine, 2002; Schmidt, L. et al (2006) Unequal treatment: Racial and ethnic disparities in alcoholism treatment services, Alcohol Research and Health, 29(1), 49-54;

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Ongoing Challenges of the Addictions Workforce

Ongoing Challenges of the Addictions Workforce

• Although minorities make up approximately 30% of the U.S. population, they currently account for only– 24.3% of all psychiatrists,

– 5.3% of psychologists,

– 14.9% of social workers,

– 20% of counselors,

– 8.5% of marriage and family therapists,

– 4.9% of school psychologists, and

– 9.8% of psychiatric nurses (Duffy et al., 2004).

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Behavioral Health Workforce ChallengesBehavioral Health Workforce Challenges

• Challenges facing today’s behavioral health workforce include:– Labor shortage and geographic distribution of

workforce– Diversity and cultural expertise– Education and training – Consistent and high-quality implementation of

prevention programs, practices, and policies

• These challenges – and more – need to be addressed in a strategy for increasing the number of Hispanics/Latinos in the behavioral health workforce.

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Is there a place for me here…?Is there a place for me here…?

“…in class we were supposed to look at [TV] cartoons to see how realistic they were [in relation to families]. I told my classmates that my cartoon was pretty much a White family, Anglos, so it was not realistic at all. The teacher kind of looked at me, and I thought, ‘Great, so what’d I say?’”

-- Hispanic/Latino Nursing Student

Source: Evans, B. PhD,RN (2008) Attached at the Umbilicus: Barriers to Educational Success for Hispanic/Latino and American Indian Nursing Students. Journal of Professional Nursing. 24:4. pp. 205-217. Retrieved 6/26/09 from Elsevier.com

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..and when I graduate do I fit here….?..and when I graduate do I fit here….?

…or here?

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Or do I fit here…?Or do I fit here…?

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Sullivan Commission on Diversity in the Healthcare Workforce

Sullivan Commission on Diversity in the Healthcare Workforce

• According to the Sullivan Commission on Diversity in the Healthcare Workforce, to increase diversity in the health professions:– Schools must examine the practices of their

own institutions and change their cultures accordingly.

– New and nontraditional paths to the health professions must be explored.

– Commitments must be made at the highest levels.

Source: Missing Persons: Minorities in the Health Profession (2004) Sullivan Commission on Diversity in the Healthcare Workforce as cited in U.S. Health Care Professions Separate and Unequal (7 October, 2004) Black Issues in Higher Education. Research Library, p. 11

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SAMHSA’s ResponseSAMHSA’s Response• SAMHSA works to increase the number of

minorities in the behavioral health field through:– Youth Scholar & Workforce Development Initiative –

introducing Hispanic/Latino high school students to a behavioral health career,

– The Minority Fellowship Program – encouraging more minority students to enter the field,

– Workplace Development /Professional Training – focusing on retaining current members, recruiting new members, and ensuring quality of care is maintained, and

– Screening, Brief Intervention, Referral to Treatment Medical Residency Program – encouraging the further integration of SBIRT into primary care settings.

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Youth Scholar & Workforce Development Initiative


Purpose:• To encourage high school students to consider becoming

mental health and addiction treatment practitioners through exposure to information and mentors in the addiction and behavioral health fields,

• To develop a support system for Hispanics/Latinos through high school and college to help them secure degrees and entrance into the addiction and behavioral health workforce, and

• To increase the knowledge in the addiction and mental health fields on strategies and methodologies to treat Hispanic/Latino clients who have addiction and mental health problems.

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• Since August 2008, the Initiative has held two Latino Youth Institute programs in collaboration with Hispanic/Latino health conferences:– Latino Behavioral Health Institute Conference,

September 2008 – 21 students recruited– Illinois Alcohol and Other Drug Abuse

Professional Certification Association’s conference in Chicago, March 2009 – 15 students recruited.

• At both events students participated in specially designed workshops & were assigned mentors.

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SAMHSA’s Minority Fellowship Program (MFP)

SAMHSA’s Minority Fellowship Program (MFP)

• Purpose: to facilitate the entry of ethnic minority students into mental health careers and – increase the number of psychologists,

psychiatric nurses, psychiatrists, and social workers trained to teach, administer, and provide direct mental health and substance abuse services to ethnic minority groups.

• Since 1973, the MFP has helped to support doctoral-level training of almost 1000 ethnic minority psychiatrists, psychologists, psychiatric nurses, and social workers.

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SAMHSA Support of Minority Fellowship Program

SAMHSA Support of Minority Fellowship Program

• There are currently 135 sponsored fellows across the five grant organizations:– American Association for Marriage and Family Therapy– Council on Social Work Education– American Nurses Association– American Psychological Association– American Psychiatric Institute for Research & Education

• A quarter to one-third of the current fellows are Hispanic/Latino – the second largest minority group in the program.

• 58 of total fellows are in psychology, 26 in social work, 20 in marriage and family counseling, 16 in psychiatry, and 15 in nursing.

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SAMHSA/CSAT’s Workforce Development Strategy

SAMHSA/CSAT’s Workforce Development Strategy

• The Workforce Development Strategy attempts to efficiently promote the use of SAMHSA resources to address a broad range of workforce development needs, including the recruitment and retention of ethnic minorities and other underrepresented populations in the behavioral health workforce.

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SAMHSA Mental Health and Substance Use Workforce Development Resource Center

SAMHSA Mental Health and Substance Use Workforce Development Resource Center• SAMHSA Mental Health and Substance Use

Workforce Development Resource Center will be a robust workforce website, including:– Information on State-specific behavioral health

workforce development information and activities– Recruitment and Retention Toolkit

– Inventory of behavioral health courses (addiction, mental health, prevention) in minority education programs including HBCUs, Hispanic Serving Institutions & Tribal Colleges

• The website is scheduled to launch in August 2009.

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Workforce Development Activities: Addiction Technology Transfer Centers

(ATTC)

Workforce Development Activities: Addiction Technology Transfer Centers

(ATTC)

• The ATTC network was initiated by CSAT in 1993 to enhance the quality of addiction treatment and recovery services by providing policymakers, providers, consumers and other stakeholders with state-of-the art information through technology translation and transfer activities.

• The Workforce Development section on the ATTC Network website includes up-to-date information, tools, links and other resources, as well as information designed to help organizations be successful in recruiting, training, and retaining staff, and developing future leaders.

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Hispanic Leadership InstituteHispanic Leadership Institute

• Housed at the Caribbean Basin and Hispanic ATTC of the School of Medicine at the Universidad Central del Caribe, Bayamon, Puerto Rico.

• Since 2004, four leadership activities have been conducted, with a total of 40 graduates.

• The activities provide interaction with leaders and mentors of the Hispanic community nationwide.

• Activities, materials, and products are in Spanish and English.

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• In partnership with the ATTC network, Partners for Recovery (PFR) conducts Regional Leadership Institutes.– Award-winning program that provides

leadership development training, including self-assessment, immersion training, mentor program, and continuing education for emerging leaders in the addiction field.

– More than 500 individuals have been trained to date.

Workforce Development Activities: Partners for Recovery

Workforce Development Activities: Partners for Recovery

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Strengthening Professional Identity: Challenges of the Addiction Treatment

Workforce

Strengthening Professional Identity: Challenges of the Addiction Treatment

Workforce• PFR has also compiled the report

Strengthening Professional Identity: Challenges of the Addiction Treatment Workforce

• Included in the recommendations are:– expanding recruitment efforts through employing

marketing strategies, particularly to underrepresented groups, and

– supporting academic programs in Historically Black Colleges and Universities (HBCUs), Hispanic Serving Institutions, Tribal Colleges and Universities, and other minority-serving institutions.

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FY 2008 SBIRT Medical Residency Program

FY 2008 SBIRT Medical Residency Program

• Hispanics/Latinos make up an average of 11% of drug-related visits to hospital emergency departments.¹

• Screening, Brief Intervention, Referral to Treatment provides early identification and intervention for clients who exhibit substance misuse symptoms when seeking other services.– Assists to move patients who don’t perceive a need

for treatment into appropriate services.• The SBIRT Medical Residency Program will train medical

physicians to provide SBIRT services.• The goal is to establish SBIRT training as a component of

residency programs in a variety of disciplines, including emergency medicine, trauma, and others.

¹ SAMHSA’s Drug Abuse Warning Network 2003 – June 2009

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FY 2008 SBIRT Medical Residency Grantees

FY 2008 SBIRT Medical Residency Grantees

Two of the 11 FY 2008 SBIRT Medical Residency Grantees are in California:• Natividad Medical Center - The program will implement a

cross-cultural training program to teach medical residents skills to provide screening, brief intervention and

treatment and referral to treatment. • University of California San Francisco - The goals are to

train primary care residents in SBIRT services; integrate SBIRT into the core curriculum; and link SBIRT services with specialty treatment systems. It is expected that 195 residents will be trained over the course of the five year program.

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Mes de la Recuperación – Septiembre 2009Mes de la Recuperación – Septiembre 2009

Metas:• Apoyar las metas administrativas sobre la reducción de

demanda y promover el mensaje de que la recuperación sobre la adicción es posible.

• Generar el impulso para organizar eventos con base comunitaria a nivel local y estatal.

– Aumentar el conocimiento, mejorar el entendimiento y promover apoyo a los servicios de adicción.

• Publicar mensajes que:

– Reduzcan el estigma & discriminación asociada con la adicción.

– Animen a aquellas personas con necesidad de tratamiento a obtener tratamiento.

– Apoyen a aquellos que ya están en el proceso de recuperación.

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Involúcrate en el Mes de la RecuperaciónInvolúcrate en el Mes de la Recuperación

Ayuda a llevar esperanza y salud a otros• Visita el sitio Web del Mes de la Recuperación en:

www.recoverymonth.gov• Utiliza las herramientas para esparcir el mensaje del

Mes de la Recuperación:– Kits, presentaciones, recordatorios, anuncios de

servicio público, y más.• Únete a miles de individuos y organizaciones

organizando eventos del Mes de la Recuperación en tu comunidad.

• Educa a otros sobre la efectividad de tratamiento y la esperanza de la recuperación.

• Para más información llama al 1-800-662-Help

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Recovery Month – September 2009Recovery Month – September 2009

Goals:

• Support the administration’s goal of reducing demand and promoting the message that recovery is possible

• Generate momentum for hosting state and local community-based events

– Enhance knowledge, Improve understanding, Promote support for addiction treatment

• Publicize messages that:

– Reduce the stigma & discrimination associated with addiction

– Encourage those in need to get treatment

– Support those who are already in recovery

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Get involved in Recovery MonthGet involved in Recovery Month

Help bring hope and healing to others• Visit the Recovery Month Web site at

www.recoverymonth.gov• Use the tools to spread the Recovery Month

message:

– Toolkits, presentations, giveaways, public service announcements, and more

• Join thousands of individuals and organizations by hosting a Recovery Month event in your community

• Educate others about the effectiveness of treatment and the hope of recovery

• For more information call 1-800-662-Help

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