Transcript Document
BieneSTAR
Duke University Medical Center CAC Annual Meeting – Grantee Panel
Session Title: Reducing Stigma and Increasing Access to Care
April 21, 2009
The Partners
Division of Community Health, Duke Durham Public Schools El Centro Hispano Center for Child and Family Health
Duke’s Division of Community Health
Established in 1998 Clinical Services, Disease Prevention and Health Promotion, and Education More than 40 programs Community needs and stakeholders determine the services to be developed Programs are overseen by steering committees composed of community stakeholders/partner organizations, faculty and staff Programs focus on populations facing health disparities Programs are designed to be financially stable Programs are rigorously evaluated
El Centro Hispano
Grassroots Latino community center Created in 1992 for newly arrived immigrants
Services ↔ Education ↔ Community Organizing
Programs for children, youth, and adults Linkages to Community Resources Health Education, Disease Prevention & Access to Care ESL classes Parenting Support Family Literacy Youth Education and Support Leadership and Empowerment Programs
Center for Child & Family Health (CCFH)
Consortium (est. 1996)
Duke University, UNC Chapel Hill, NC Central University, & Child & Parent Support Services, Inc. (United Way non-profit) Mission: … to care for children and families affected by trauma, abuse, and other forms of adversity… by uniquely integrating community based practice and academic excellence.
EBP in mental health for ~2500 children & families Legal advocacy and adjunctive services Dissemination of MH best practices Research related to practice improvement, maltreatment prevention, & treatment effectiveness
Utilizing a School-Base: BieneSTAR Pilot Sites
1. Three Elementary School-Based Health Centers in DPS Operated by the Duke’s Division of Community Health
:
Total Students
African American 28% Hispanic 43% White 21% Multi Racial 4.5% Free/ Reduced Lunch 59.89% LEP 22%
Watts 355 EK Powe
325
Glenn
764 45% 53% 29% 39% 18% 3.7% 6.4% 3.4% 70.64% 81.34% 24% 24%
2. El Centro Hispano: Registration and ESL Testing for DPS
Durham Public Schools, www.dpsnc.net
BieneSTAR Goals
Prevent and reduce exacerbation of mental health disorders of children enrolled in 3 elementary school clinics through the provision of mental health education and outreach to parents and school personnel with special emphasis on immigrant children and families.
Create sustainable mental health services, including early identification and counseling that are accessible, culturally competent, and integrated into school services with special emphasis on immigrant at-risk children enrolled in the SBHCs.
BieneSTAR Team
Bilingual Licensed Clinical Social Worker from Center for Child and Family Health Bilingual, Bi-Cultural Health Educator from El Centro Hispano
Who work with:
SBHC Mid-level practitioners and LCSWs School Guidance Counselors and Social Workers School Classroom Faculty and Administration
BieneSTAR Activities
Education and Training
Parent acculturation to school norms School personnel training Resource connection
Mental Health Service Delivery
Bilingual, culturally competent Evidence based interventions TF-CBT, TFC Resiliency & skills groups 226 assessment; 109 intervention
Evaluation/Quality Improvement
Parent surveys of school-based health centers Pre-post educ. session surveys for parents & teachers In-depth interviews with parents participating in BieneSTAR Survey of educ. session facilitators
Challenges
With 1 full-time mental health staff, need & referral demand exceed community capacity. No Spanish language psychiatric services in Durham County.
National and local political climate regarding immigration policies exacerbates skepticism and fear by some immigrant populations.
When parents will not give consent to pursue mental health evaluations and/or services for their children, it is challenging to provide needed support to these children who struggle in school when they do not have family support/ involvement.
Individual, familial, and cultural loss & bereavement.
Stigma as a barrier to care
Unmet service need Expanding provider capacity Accessing funding streams Enhancing a system of care No consent to treat Linkage to medical care Connecting academic failure to MH status Orientation to school culture Orientation to child traumatic stress Fostering school advocacy Political context Immigration status Law enforcement activity Child protection standards
Successes
In-Service training sessions for school personnel Two types of parent education sessions:
general orientation sessions skill building sessions covered topics such as how to be involved in children’s education process and positive parenting/discipline techniques
Increased access to evidence-based practices Child mental health promotion groups teaching: coping skills, peer support, and cultural understanding Assist in convening a Spanish-speaking provider group to inform and enhance services for the immigrant community