1. BieneSTAR Duke University Medical Center CAC Annual Meeting – Grantee Panel Session Title: Reducing Stigma and Increasing Access to Care April 21, 2009

2. The Partners  Division of Community Health, Duke  Durham Public Schools  El Centro Hispano  Center for Child and Family Health

3. 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

4. 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

5. 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

6. Utilizing a School-Base: BieneSTAR Pilot Sites Total Students African- American HispanicWhiteMulti- Racial Free/ Reduced Lunch LEP Watts 355 28%43%21%4.5%59.89%22% EK Powe 325 45%29%18%6.4%70.64%24% Glenn 764 53%39%3.7%3.4%81.34%24% 2. El Centro Hispano: Registration and ESL Testing for DPS 1. Three Elementary School-Based Health Centers in DPS Operated by the Duke’s Division of Community Health: Durham Public Schools, www.dpsnc.net

7. 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.

8. 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

9. 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

10. 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.

11. 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

12. 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

13. Contact Michelle.lyn@duke.edu Robert.murphy@duke.edu