Listening to his Spanish-speaking clients at the Fair Haven Community Health Center in New Haven, Dr. Francisco Lopez hears a lot of stories about trauma.
Trauma is an underlying factor in many behavioral health disorders; its destructive impact on a person’s life can be compounded by neglect and isolation. But thanks to the Connecticut Latino Behavioral Health System (LBHS), Dr. Lopez’s clients—and many others like them—are able to access the high quality, culturally and linguistically appropriate care they need.
LBHS is a network of eight providers anchored at the Hispanic Clinic of the Connecticut Mental Health Center (CMHC) and supported by the Connecticut Department of Mental Health & Addiction Services (DMHAS). CMHC, a longstanding partnership between the Yale Department of Psychiatry and DMHAS, is dedicated to providing recovery-oriented services to uninsured or underinsured people.
As a community-academic partnership, LBHS offers more than a referral system: it’s a collaborative of professionals working together, supporting each other, and sharing expertise. The Hispanic Clinic manages the day-to-day operation including recruitment, training, and consultation. The well-constructed network creates the context for first-rate care.
In the United States, the Latino population is growing steadily but the number of behavioral health professionals who identify themselves as Latino is relatively small (in 2012, only 4.3% of psychiatrists; 6.2% psychologists; 10.4% counselors; 11.6% social workers). At one time, the Hispanic Clinic was the only place in the south central region of Connecticut where monolingual Spanish speakers could receive culturally appropriate mental health care in their own language. By 2005, the demand for services had grown so quickly that the clinic could not keep up.
Faced with long waiting lists, leaders in the Hispanic Clinic and CMHC came together with other community providers to design a new organizational framework to help address the unmet need for behavioral health services. The effort was led by Yale Psychiatry faculty members Luis Añez, Manuel Paris, Michelle Silva, Esperanza Diaz, and Robert Cole, CMHC’s chief operating officer. Cole notes that the State legislature was extremely supportive of the effort from the beginning: the initiative was championed by State Representatives from the New Haven delegation Pat Dillon and Juan Candelaria, and it enjoyed the strong support of former DMHAS commissioner Thomas Kirk and his leadership team at DMHAS. For years, Connecticut has been in the vanguard of public mental health services; LBHS is one example of the State’s continuing commitment to innovation within the sector.
This article, published in Psychological Services, the journal of the American Psychological Association, outlines the history and success of LBHS.
LBHS services are provided in Spanish. Language is a cornerstone of all medical care; in behavioral health, with its reliance on narrative and conversation to create the therapeutic alliance, it’s a critical factor in every patient-provider relationship. LBHS follows the model of the CMHC Hispanic Clinic, where monolingual Spanish speakers are cared for in Spanish and clinical providers come from many different countries and cultures.
The collaborative nature of LBHS is no accident. It stems from organizers’ conscious effort to identify and adhere to a set of cultural values. “We wanted to develop a system that would be responsive to those values at every level,” says Manuel Paris, PsyD, who explains that research on Latino behavioral health clearly demonstrates “the importance of integrating cultural values into whatever kind of treatment you’re providing.”
For LBHS, one such value, "familismo,” roughly translates “we’re all in this together”; another, “personalismo,” refers to an individual’s ability to collaborate with others. “Confianza” means trust and respect. “Humilidad” recognizes that each person has a role to play and that no one individual is more important than any other. Patients, providers, administrators, support staff, family members—all are equally valued for their contributions to the whole.
“LBHS is not a success because of any one person,” says Dr. Paris. “It's truly a collective effort.”
Behind the scenes, LBHS maintains a contract with each agency in the network. Individual behavioral health providers are employees of their agencies; funding for their positions comes from the State of Connecticut. CommuniCare, a local agency, is the fiduciary agent. Providers receive regular support and supervision. Michelle Silva, PsyD, oversees the administrative side of the LBHS, making sure clinical care meets multiple standards and adheres to fidelity measures.
“Sharing information is a big part of what we do,” notes Dr. Silva. “Because we’re part of the university, we are fortunate to have access to resources that many of the community providers may not hear about. We share what we know with our colleagues.”
Monthly case conferences with a supervising psychologist help LBHS clinicians strategize about their most complex and challenging cases. Everyone on the team is part of the learning process.
Dr. Lopez, a clinical psychologist, works at the Fair Haven Community Health Center, a federally qualified clinic and one of the LBHS partner agencies. The clinic is located in Fair Haven, a predominantly Latino neighborhood in New Haven. Born in Puerto Rico to parents from the Dominican Republic, Dr. Lopez came to Yale for his post-doctoral training at the Hispanic Clinic.
“In graduate school, I became interested in doing community mental health with Latinos,” he says. “There really isn’t any other place in the country quite like the Hispanic Clinic, where you can see Spanish-speaking clients and receive training from Latino professionals. It is a special place.”
Dr. Lopez stayed in New Haven to practice in the community and says he enjoys being part of LBHS. “You feel like you’re part of a bigger system,” he explains. “It’s good to be connected with Yale and continually learn from the people there.”
While every patient is unique, he says, the majority have experienced trauma caused by a wide range of factors including loss, sexual or intimate partner violence, or interactions with police. His clients struggle with poverty-related problems that impact their health. In addition to providing behavioral health counseling, Lopez runs a chronic pain management program at the clinic.
Dr. Silva says access is the key objective of LBHS and its most important contribution. Without LBHS, many individuals would likely receive no care at all.
In lost earnings, hospitalizations, loss of educational opportunity and more, the cost of untreated mental health disorders to individual, family, and society is great. “It’s all about serving people,” says Robert Cole. “The numbers are impressive. This is the fastest growing population in our community and the amount of trauma that needs to be addressed is quite striking. It’s really a privilege to be able to extend these services.”