Reducing Disparities in Identification
and Treatment of Mental Health Disorders
of Latino and Russian-speaking
Primary Care Clients:
a Community Health Work approach
Multnomah County, OR
Sergiy Barsukov, BA, CHW, Marcela Dixon, CHW, and Graham
Harriman, MA, LPC
A Project Supported by the Center for Mental Health Services of the
Substance Abuse & Mental Health Services Administration (SAMHSA)
Multnomah County Health
Department
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County-run system of primary care safety net
clinics – part of public health department
Portland, Oregon and suburbs – 675,000
7 clinics serving approximately 26,000
patients/year, 99% below 200% of poverty
• 44% Hispanic
• 11% identify Russian as their first language
Environment
Primary care clinics under-diagnosing
mental disorders in Latino and Russianspeaking patients
 When mental disorders identified, barriers
connecting to community system of care
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Utilization of Community Health
Worker Approach
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Use of CHWs effective at reaching clients
• Empower community members to identify own needs
and help them to find solutions to their problems
• Relationship based on common culture, language
• Located in primary care setting for ease and availability
MH Disparity Project CHW Tasks
Act as cultural mediator between provider
and patient
Screening and education with patients
Lead Chronic Disease Self Management
Groups (Lorig)
Assist with problem solving, referrals
Prepare clients for referral to mental health
specialists
Community Health Work
with Russian Clients
Russian/ Ukrainians in Portland, OR
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Immigration increase began in 1988
Currently 60,000 Russian speaking
immigrants in Portland metro area
First group of immigrants came to the US
due to religious persecution in former
Soviet Union
Majority of these immigrants are
Pentecostal Christians
Common Themes of Russian Speaking
Clients
Acculturative Stress
 Religion
 Mental Health Stigma
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Chronic Disease Self Management
(Lorig et al) in Russian
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Two Pilot Groups
Client evaluation –verbal and written
Pre/Post group assessments
Patient Satisfaction
Patient Self Reported Results
Community Health Work
with
Latino Clients
Latino Clients in Portland, OR
87% increase in Latino population in
last 10 years
 50,000 Latinos in Portland metro area,
approximately 62% are of Mexican
origin
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Common Themes of Latino Clients
Many Latinos are living binational lives
 Poverty, acculturation, domestic violence
isolation are common issues
 Language issues are common barrier to
care
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McGlade, M, Dahlstrom, M. Salir Adelante: A needs and assets
assessment of the Hispanic community of Multnomah County(2000)
Tomando Control de Su Salud
(Lorig)
How is it helpful?
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Teaches self care management through the
use of popular education tools.
• appropriate use of medication
• effective communication with friends/ health
professionals
• CHW empowers the client by helping them to
manage and foster a better understanding of
chronic disease without limitations of language
barriers and cultural competency
Behavior Changes
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Eating habits
Exercise routines
Self initiated health interventions
Increased patient/physician communication
skills
Increased management of acculturation
Increased confidence engaging new people
and supporting one another with their
chronic condition
Less inhibition to search for services that
will help them feel better
Learnings
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Religious/cultural beliefs create special
challenges to delivering mental health treatment
which CHWs can address effectively
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Providing mental health services in primary
care clinics produce clinically significant results
for Latino patients and Russian-speaking
refugees diagnosed with depression
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Community Health Workers are a recognized
and valued component of clinical support –
especially their ability to do outreach,
education, referral and assistance services