Multicultural patients face multiple barriers to receiving care for depression such as scant referral options.
A Virginia-based health center's quality improvement project was able to significantly improve depression care for a vulnerable multicultural population, research shows.
Annual societal costs associated with depression are estimated at $210 billion, and depression is the top cause of disability globally. For minority, immigrant, or refugee patients, cultural factors often impede depression treatment.
"Improving depression screening should lead to measurable outcomes for those who screen positive, including referral to mental health specialists, prescription of appropriate medications, and perhaps most importantly, scheduling of follow-up appointments to monitor signs and symptoms of depression," said Ann Schaeffer of the Harrisonburg Community Health Center.
"There are multiple barriers. These include clinics not prepared with screening tools in multiple languages; providers not culturally aware of the stigma attached to depression; lack of provider confidence in client engagement; and few referral options for multicultural populations."
The HCHC initiative made significant progress. Evidence-based care practice increased to 71.4 percent, adherence to follow-up care increased from 33 percent to 60 percent, and the rate of screening in patients' preferred language increased to 85 percent.
To topple barriers to care, HCHC implemented a four-part intervention.
Starting with Language, One Woman Is Helping Latino Patients Get Better Care
After her mother was diagnosed with breast cancer, Carla Echeveste was inspired to change the entire course of her life. She turned down an accounting job at her dream financial firm and went back to school to study medicine. Today, she researches and advocates for equity on behalf of Milwaukee’s Latino community.
After she learned her mother was sick, she made it a priority to take care of her and attend all of her doctor’s appointments. Those appointments would inspire Echeveste to sideline her future in accounting to re-enroll into a pre-medicine program.
Those appointments with her mother were crucial in her decision. Echeveste quickly observed how language could be a barrier between Latino patients and their doctors. “Six percent of doctors in the country are Latino,” said Echeveste. This leaves room for error and disconnect between Spanish-speaking patients and their doctors.
People Are Holding Onto Their Native Languages Longer in Canada
Canada has always been a country of immigrants who came to this country speaking their mother tongue and, in most cases, having some knowledge of English or French. For the 2011 Census, more than 200 languages were reported as a mother tongue or home language. The Census also noted that one in five persons (6.6 million) reported speaking a language other than English or French in the home.
It now appears that newer immigrant groups to Canada are holding onto their languages longer than their predecessors.
Studies show that while immigrant groups of European origin have had more difficulty preserving their mother tongue in Canada over time, more recent immigrant groups, such as those who speak Spanish, Chinese or Punjabi, are generally more likely to maintain theirs. The most important factor is the extent to which children are exposed to those languages within the family or through contact with other people with the same mother tongue.
FYI: English Is Not the Official Language of the United States
Numerous multilingual countries promote an official language, but the United States has never done so with English. Nothing in the Constitution or any federal law supports the comment that someone “should be speaking English” because “this is America.”
“The Founding Fathers didn’t see a need to declare (an official language),” Dr. Wayne Knight, a professor of language and literacy at Purdue University, told CNN.
People in the United States have been speaking languages other than English since before the founding of the republic. Common languages spoken throughout the 13 colonies included Dutch, French, and German, not to mention the many languages spoken by Native Americans.
New Language Access Law Makes Strides But Comes Up Short
Andrea Tacconi remembers a day when a young girl could not get medical treatment at school because her family only spoke Spanish. In her written testimony to the D.C. Council in April 2017, she recounted the incident, which occurred when she worked for Teaching for Change, an educational non-profit based in the District. To receive treatment for the girl’s fever, her family would have had to fill out English-language forms. When the girl’s mother approached the school to seek a translation from English to Spanish, the school did not have enough Spanish-speakers on its staff to help the family provide documentation for their child, leading her to be denied treatment by the school.
This story is one of many that have inspired a decade-long struggle to lower the daily barriers for non-English speakers in Washington, D.C. The campaign reached an important milestone last month, when the D.C. Council officially passed the Language Access for Education Amendment Act.
The fight in the District for language access rights is a microcosm of a larger, nationwide push for greater accommodation of non-English speakers. Unfortunately, evidence and trends from the past few decades suggest a greater need for language access in the District and throughout the United States.
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