Abriendo Caminos: Engaging Latinx Communities Through Culturally Responsive Peer Delivered Motivational Interviewing

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Program Summary/Abstract People with serious mental illness (SMI; psychotic and major affective disorders) experience significantly higher rates of morbidity compared with individuals of similar ages without these conditions. Among this broad population, the most vulnerable are Latinxs living with SMI who are not engaged in treatment. Further, trauma among people with SMI, in general, is four to five times higher than for the general public, with highest rates among Latinxs in comparison to other racial and ethnic groups. Despite the availability of effective mental health treatment interventions, approximately 47% of Latinx adults with SMI are not engaged in treatment. Those who are engaged have significantly lower rates of treatment adherence, retention, and satisfaction than White people. Barriers to treatment engagement for Latinxs include lack of bilingual and bicultural clinical providers, the absence of culturally responsive interventions, lack of access to specialty services in Latinx neighborhood, self-reliant attitudes, and cultural differences that impact the recognition of mental health concerns. Some evidence suggests that culturally tailoring interventions to Latinxs may improve treatment engagement. The proficient use of Motivational Interviewing (MI), an evidence-based and person-centered treatment approach, has been shown to predict behavior change, such as treatment engagement, greater medication adherence and reductions in alcohol consumption, and additional outcomes among Latinxs. However, no research to date has examined the cultural adaptation of the MI spirit or the full approach. To fully integrate Latinx cultural values and MI, we need to pay attention not just to the intervention, but also to the method of service delivery. Latinx peers may be in the best position to deliver MI to Latinxs with SMI, given their lived experience with both the culture and the illness. Of the available research on Latinx peers in recovery from SMI, evidence suggests that Latinx peer navigators appear to enhance service engagement, recovery, and quality of life for Latinxs in recovery from a SMI. Therefore, the overall objective of this career development proposal is to culturally adapt MI to integrate Latinx cultural relational values and trauma informed care for delivery by peers in recovery from SMI to engage Latinxs with SMI in mental health treatment. Specifically, the proposed research will 1) identify social and cultural factors that contribute to mental health treatment hesitancy and engagement among Latinxs with SMI; 2) culturally adapt an MI treatment engagement intervention that is trauma informed and peer delivered for Latinxs with SMI; and 3) provide evidence of the feasibility, acceptability, and engagement of target mechanisms associated with the intervention. My mentors, in combination with a world-class training environment at Yale University, will guide me towards my goal of becoming an independent bicultural and bilingual investigator of multi-level influences on mental health inequities, with expertise in designing and conducting rigorous, pragmatic research aimed at improving engagement, care, and clinical outcomes for Latinxs and other racial and ethnic communities.