A Promotora-centric Community Collaborative to Improve Connections to Mental Health Services

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PROJECT SUMMARY / ABSTRACT Almost 70% of Latinx people with mental health disorders fail to receive the treatment they need due to various barriers to accessing culturally specific mental health care. We propose that particularly trusted voices might be able to decrease mental health stigma in their communities and strengthen social networks to improve mental health services connections. In Spanishspeaking communities, lay health workers called promotoras fulfill this role: promotoras act as educators, cultural brokers, and bridges between the community and health services. We will engage with a promotora learning collaborative to develop and assess a community-wide mental health education and empowerment campaign to increase culturally specific knowledge of mental health, trauma, and support services and to improve mental health services utilization in the Latinx population of East San José, CA. By collaborating with deep-rooted community partners, we seek to achieve the following specific aims: 1) Map the landscape of and pathways to mental health services within the community; 2) Strengthen promotoras’ capacity to engage their community around mental health services use; and 3) Determine if engaging promotoras in a mental health education and empowerment campaign increases mental health services utilization community-wide. Under the first aim, we will work with community partners and promotoras to create a rich community asset map of culturally specific mental health services, layered with findings from a community-wide assessment of mental health services use, using geographic information system mapping (GIS). Promotoras will then be trained to facilitate Mental Health Education, (self-)Efficacy, and (outcomes) Expectancy (MHE3) gatherings – a co-created culturally specific intervention to improve mental health services use. Finally, in the third aim, we will implement MHE3 as a cluster randomized trial and determine its impact at the individual, interpersonal, and community levels. Beyond self-reported outcomes, we will investigate the impact on social networks used to identify and choose mental health services. We will combine findings from existing facility-based and claims data with the results of a newly collected annual cross-sectional survey of the community to determine broader community-level impact on mental health services use. Understanding how promotoras help overcome barriers to mental health and services use will deliver insights that inform collaboration with and integration of promotoras into care pathways and delivery strategies to decrease mental health disparities among Latinx communities more widely. Furthermore, we believe this work can also serve as a template for how to conduct outreach to other underserved populations. Finally, the proposed research will further NIMH’s mission to strengthen the public health impact of research by testing innovating approaches to reduce disparities in care access.