Latino/a immigrants in the United States may face any number of common acculturative stressors including a lack of stable employment, discrimination, legal difficulties, or not speaking English, among others. Resulting behavioral and emotional health issues often go unaddressed due to a lack of specialist mental health providers available to this community.
Uninsured, largely undocumented, Spanish-speaking immigrants in the Fair Haven community now have improved access to much-needed mental health services thanks to the HAVEN Free Clinic Behavioral Health Program for Depression. The program is a model for integrating mental health interventions into the services of a student managed free clinic.
Utilizing Spanish-speaking student volunteers who are supervised by a team of psychiatrists and psychologists, the program provides free first-line services for mild-to-moderate depression including mental health education, social services, and modified behavioral activation exercises.
"The immigrant community has limited access to mental health services because of barriers within the health care system," said Marco Ramos, an MD/PhD student at Yale School of Medicine and the program's coordinator. "At HAVEN, we often see how the social stress of immigrating to the United States has negatively impacted the health of our patients. These stressors can make life extremely difficult."
Program volunteers administer an individualized psychoeducational curriculum based on the promotora (community health worker) model developed at the University of California, Berkeley. Medical student facilitators promote patient behaviors (e.g. exercise) that are associated with psychological health and volunteers in the clinic's Social Services Department connect patients with community resources.
To prepare the volunteers, Yale School of Medicine psychologists and psychiatrists train medical students in the principles of motivational interviewing and common strategies for engagement, population health, quality improvement methods, and mental health education.
"The program serves as a model for expanding access to mental health services by rational task shifting," said Andres Barkil-Oteo, MD, MSc. "The program is a hands-on introduction to the field of public psychiatry and the challenges of providing culturally-competent care with limited resources."
Task-shifting, as defined by the World Health Organization, is the rational reassignment, as appropriate, of tasks from highly qualified health workers to health workers who have less extensive training in order to make more efficient use of the available workforce. Experience with both rational task-shifting and the promotora model of care serve as useful preparation for students interested in the practice of medicine in a global context.
Barkil-Oteo is a faculty advisor to the program, along with Michelle Silva, PsyD. Both Barkil-Oteo and Silva are assistant professors of psychiatry at Yale School of Medicine.
Robert Rohrbaugh, MD, professor of psychiatry and deputy chair for education and career development in psychiatry, and Peter Ellis, MD, MPH, assistant professor of medicine, serve as senior advisors to the program.
The Behavioral Health Program began in 2012 with the assistance of a Helping Hands Grant from the American Psychiatric Foundation.
The HAVEN Free Clinic is a student-run primary care clinic partnered with Fair Haven Community Health Center (FHCHC) and Yale University. The clinic is unique in its inclusion of students across the disciplines of medicine, nursing, physician’s associates, and public health.