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BieneSTAR

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.

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BieneSTAR

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  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 • 1. Three Elementary School-Based Health Centers in DPS Operated by the Duke’s Division of Community Health: 2. El Centro Hispano: Registration and ESL Testing for DPS 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. 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 Team

  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

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