U.S. Department of Health and Human Services

Office of Minority Health and 

Hogg Foundation for Mental Health

Enhancing the Delivery of Health Care: 

Eliminating Health Disparities through 

a Culturally & Linguistically Centered 

Integrated Health Care Approach

Consensus Statements and Recommendations

June 2012
2

Prepared by:

Authors: 

Katherine Sanchez, LCSW, PhD;

Teresa Chapa, PhD, MPA; 

Rick Ybarra, MA; and 

Octavio N. Martinez, Jr., MD, MPH, MBA

This publication is based on research conducted by the Hogg Foundation for Mental 

Health and proceedings from the 2011 national consensus meeting titled: Eliminating 

Behavioral Health Disparities through the Integration of Behavioral Health and 

Primary Care Services for Racial and Ethnic Minority Populations and Those with 

Limited English Proficiency.

The views, opinions and content expressed in this publication are those of the authors 

and conference participants and do not necessarily reflect the views, opinions or 

policies of the Office of Minority Health, the U.S. Department of Health and Human 

Services, or the Hogg Foundation for Mental Health.

This document is in the public domain and may be used and reprinted without 

permission except for noted copyrighted materials for which further reproduction is 

prohibited without the specific permission of copyright holders. Appropriate citation is 

requested by the authors when the document is cited.
3

Acknowledgements

We would like to thank everyone who assisted in the research, planning and execution of the 

expert consensus meeting, as well as with the writing and editing of this document. 

National experts meeting participants 

Henry Acosta, MA, MSW, LSW

Luis Añez, PsyD

Teddy Chen, PhD, LCSW

Miriam Delphin-Rittmon, PhD

Gayle Dine-Chacon, MD

Daniel Fisher, MD, PhD

DJ Ida, PhD

Theopia Jackson, PhD

Parinda Khatri, PhD

Pierluigi Mancini, PhD

LaVerne D. Miller, Esq

Myechia Minter-Jordan, MD, MBA

Martín Ornelas

Tassy Parker, PhD, RN

Gilberto Pérez, Jr., MSW, ACSW

Joe Powell, LCDC, CAS

Kathy Reynolds, LMSW, ACSW

Jürgen Unützer, MD, MA, MPH

Jorge Wong, PhD, CCEP, CHC

Special recognition

Event Facilitator: 

Jamie Hart, PhD, MPH

Event Scribe: 

Mary Held, LCSW

Project Staff:

Teresa Chapa, PhD, MPA

Octavio N. Martinez, Jr., MD, MPH, MBA

Lynda E. Frost, JD, PhD

Rick Ybarra, MA

Meagan A. Longley, LMSW

Science Writer: 

Katherine Sanchez, LCSW, PhD
4

Table of contents

I. Acknowledgements..............................................................................................................................3

II. Introduction and Background.............................................................................................................5

III. The Consensus Process and Outcomes .............................................................................................7

IV. Recommendations ................................................................................................................................9

a. Patients/Consumers ........................................................................................................9

 b. Practice.............................................................................................................................10

c. Communities...................................................................................................................11

d. Health Care Systems ......................................................................................................12

e. Workforce ........................................................................................................................13

V. Conclusion...........................................................................................................................................15

VI. References ...........................................................................................................................................16

VII. Appendices ..........................................................................................................................................21

a. Integration Framework .................................................................................................21

b. National Consensus Meeting Participant List ...........................................................22

c. National Consensus Meeting Agenda.........................................................................25

d. Glossary ...........................................................................................................................27
5

Introduction and Background

INTEGRATION: 

The Future of Health Care in America

Research shows that treating behavioral health 

conditions as early as possible, holistically, close to 

a person’s home and community, and in a culturally 

and linguistically appropriate manner leads to the best 

health outcomes. Integrated behavioral and physical 

health care is gaining significant momentum across the 

nation as a preferred approach to providing optimal 

care for behavioral health conditions. This approach is 

more accessible and less stigmatizing than referral to 

specialty behavioral health care settings. 

The World Health Organization (2011) has 

recommended integrating mental health services into 

primary care as the most viable way of closing the gap 

in prevention and treatment of mental illness. Primary 

care settings are often the first point of contact for all 

health issues and therefore, the gateway to identifying 

undiagnosed or untreated behavioral health conditions. 

A successful approach would require primary care 

settings to incorporate early screening, identification 

and treatments for behavioral health disorders, while 

ensuring the presence of a culturally diverse workforce 

that treats the whole health patient/consumer.

Providing health care to the community at the “point of 

entry” in the system is the key to wellness. In particular, 

racial and ethnic minority populations and individuals 

with limited English proficiency (LEP) are more likely to 

seek and receive behavioral health care in primary care 

settings. Many reasons have been cited for this trend, 

including lack of access to mental health specialists, 

income and insurance issues, stigma surrounding 

mental illness, the level of trust in the relationship with 

the family physician, language and cultural barriers 

that hinder communication and delivery of services 

(President’s New Freedom Commission on Mental 

Health, 2003). Integrated health care approaches must 

respect the whole person, work across the life span, 

include prevention and early intervention methods, 

and be person centered, strength based and recovery 

focused. Providers that respect the cultures, languages 

and world views of the people they serve are more 

successful in engaging and activating individuals, 

families and communities to be an active participant in 

their own health care.

HEALTH EQUITY:

The Role of Integration in Eliminating 

Health Disparities

In a strategic effort to improve the health status of 

populations most impacted by disparities, in 2010, 

the U.S. Department of Health and Human Services’ 

Office of Minority Health (OMH) entered into a 

collaborative agreement with the Hogg Foundation 

for Mental Health in Austin, Texas to investigate the 

role and impact of integrated care in promoting health 

equity and eliminating behavioral health disparities. 

The scope of the collaboration was to identify and 

recommend culturally and linguistically competent 

elements, strategies and practice innovations to be 

incorporated into current models and approaches of 

integrated health care. Additional goals were to identify 

effective strategies for implementing those changes and 

to create a new knowledge base for this paradigm. Key 

activities and work products were defined and aligned 

strategically to provide the greatest impact when 

promoting and implementing integrated health care 

in culturally and linguistically diverse communities, 

including persons with LEP. A literature review was 

conducted to examine the evidence base and literature 

of integrated health care regarding racial and ethnic 

minorities and populations with LEP. This literature 

review was then disseminated to a select group of 

leading national experts for review and consideration, 

setting the stage for a robust dialogue to take place at a 

national consensus meeting.

OMH and the Hogg Foundation convened a two-day 

expert panel meeting in Austin, Texas on November 
6

7-8, 2011, “Eliminating Behavioral Health Disparities 

through the Integration of Behavioral Health and 

Primary Care Services for Racial and Ethnic Minority 

Populations and Those with Limited English 

Proficiency.” 

Recognized experts in the fields of health, mental 

health and addictions, integrated care, and cultural and 

linguistic competency met to share best practices, offer 

insights and provide recommendations to help create 

national models to improve integrated health care for 

racial and ethnic minority and LEP populations.

This report contains the consensus statements and 

recommendations from the experts meeting and is 

the fourth in a series of OMH-sponsored projects to 

address specific areas of need for underserved, targeted 

communities. The other three reports are available 

online at http://minorityhealth.hhs.gov/ or http://

www.hogg.utexas.edu/.

•	 Movilizandonos por Nuestro Futuro: Strategic

Development of a Mental Health Workforce for Latinos

(2010) 

•	 Pathways to Integrated Health Care: Strategies for African

American Communities and Organizations (2011)

•	 Integrated Care for Asian American, Native Hawaiian

and Pacific Islander Communities: A Blueprint for Action

(2012)

LITERATURE REVIEW:

An Analysis of Evidence-Based Studies 

and Reports

Katherine Sanchez, LCSW, PhD, the project’s science 

writer, prepared a technical report, “Eliminating 

Disparities through the Integration of Behavioral 

Health and Primary Care Services for Racial and Ethnic 

Minority Populations and Persons with Limited English 

Proficiency: A Review of the Literature.” 

The technical report provides a comprehensive 

summary of literature on the state of integrated care 

for racial and ethnic minority and LEP populations, 

highlighting cultural and linguistic competency and 

best practices in integrated health care. The report also 

examines highly relevant materials including reports 

and articles from both peer and non-peer reviewed 

publications; compiles the available evidence from 

practice; and summarizes the knowledge base of 

cultural and linguistic competence in the delivery of 

primary health and behavioral health care. 

A key purpose of the report was to provide a context 

for the expert panel meeting, setting a platform of 

identifying best practices in integrated health care 

while examining approaches on key elements needed 

to improve overall health outcomes and reduce health 

and behavioral health disparities. Experts invited to the 

meeting received the draft report in advance.
7

The Consensus Process and Outcomes

FOCUS ON THE ISSUES: 

Outcomes of the National Experts Meeting

The goal of the national experts meeting was to 

convene a panel of national experts to advance the 

understanding of optimal integrated care and best 

practices for traditionally underserved communities. 

The meeting opened with welcoming remarks from 

Teresa Chapa, PhD, MPA, senior policy advisor for 

Mental Health at OMH, and Octavio N. Martinez, 

Jr., MD, MPH, MBA, executive director of the Hogg 

Foundation for Mental Health. 

Dr. Chapa provided background on the collaboration 

with the Hogg Foundation and prior activities and 

reports sponsored by OMH to enhance behavioral 

health equity among racial and ethnic minorities, 

including the integration of behavioral health and 

primary care. She described the objectives of the 

meeting as follows:

1. Identify promising and practice-based 

approaches for delivering integrated 

health care to racial and ethnic minorities 

and populations with LEP. 

2. Define and recommend key components 

of ideal models and approaches to 

delivering integrated health care to racial 

and ethnic minorities and populations 

with LEP.

3. Discuss implementation, assessment and 

future research considerations related to 

delivering integrated health care to racial 

and ethnic minorities and populations 

with LEP.

Dr. Sanchez provided an overview of the technical 

report and responded to questions and comments. 

Meeting participants provided extensive feedback and 

offered suggestions for enhancing content and other 

considerations relevant to care for racial and ethnic 

minority and LEP populations. A final version of this 

technical report will become available in summer 2012.

Topics for discussion were identified from the 

technical report and participants were asked to offer 

practice recommendations from the field that have 

demonstrated success and hold promise for improving 

access, treatment and health outcomes for racial 

and ethnic minorities. Issues discussed included: 

language accessibility and linguistic competency in the 

screening; diagnosis and treatment of mental health and 

substance use disorders and comorbidities; preference 

for treatment in primary care for racial and ethnic 

minorities; methods to strengthen the quality of primary 

care, access to care and continuity of care for LEP 

populations. 

The experts developed consensus statements to 

inform the governance and operations of clinical 

and community practice, research, evaluation and 

policy. The governance structure and organizational 

culture of a system or organization set the tone for 

clinical and community practices that are sensitive and 

responsive to the needs of racial and ethnic minorities. 

Practice-based research and continuous comprehensive 

evaluation are critical to examining organizational 

efforts and implementing effective policy. 

The experts also made recommendations that are 

centered on key integrated health care strategies 

relevant to racial and ethnic minority populations and 

are outlined in five essential areas of care: 1) patient, 2) 

practice, 3) community, 4) system and 5) workforce.

The consensus statements and recommendations are 

intended to inform a broad audience of health and 

behavioral health care providers, educators, advocates, 

patients/consumers and their families, researchers and 

policy makers. The goal of integrated care for racial and 

ethnic minority and LEP populations is to eliminate 
8

health disparities by improving health and behavioral 

health status. Suggested strategies will require broad 

support from the public health, behavioral health and 

medical sectors in general. Strategies to improve the 

health status of our diverse communities must also 

include workforce diversification and approaches 

designed to enhance engagement and adherence to 

treatments.

Consensus Statements

A framework (see Appendix A) for improving access 

to care for traditionally underserved racial and ethnic 

minority communities requires expanding services 

beyond the traditional domains of health and behavioral 

health care delivery systems. Treatment planning must 

be person-and family-centered in order to increase 

engagement in the elements of integrated care. 

Efforts to eliminate health disparities must incorporate 

strategies for addressing social determinants of health, 

such as location of the integrated health care center, 

availability of transportation, hours of operation, 

and levels of acculturation, socioeconomic status, 

community centeredness and health literacy. The 

development of a multidisciplinary, culturally and 

linguistically competent workforce is essential.

Specifically, the group of experts collectively agreed to 

the following five statements that define a culturally 

and linguistically competent approach to integrated 

health care.

1. Integrated care organizations and 

teams will be culturally and linguistically 

competent and responsive to the needs 

of the communities they serve, including 

being located in reasonably accessible 

areas and providing flexible hours of 

service. 

2. Integrated care teams will actively 

engage with patients/consumers, their 

family members, and their community 

across the lifespan. The team must be 

multidisciplinary and cross-trained in 

health and behavioral health, thereby 

leveraging the strengths of the team. 

3. Integrated care teams will recognize and 

incorporate the strengths of patients/

consumers, their family members and 

their cultures, permeating all levels of 

assessment, diagnosis and intervention.

4. Integrated care organizations will 

ensure one health and behavioral health 

history and treatment plan for each 

patient/consumer, under one roof, with 

a wellness component and a focus on 

health promotion, prevention and personcenteredness across the life-span.

5. Integrated care organizations will 

participate as a member of a learning 

community in which health and behavioral 

health professionals gain knowledge, 

develop data collection plans, and foster 

the growth of an ethical workforce that 

represents the diversity of the community 

with language and cultural competency.
9

Recommendations

Seamless integrated health and behavioral health care 

offered in a culturally and linguistically competent, 

person-centered framework that adequately reduces 

barriers will require implementation of certain best 

practices in integrated health care at the individual, 

community, practice, system and workforce level. 

The following recommendations represent key 

strategies and examples from practice for better 

dissemination and implementation of integrated health 

care to meet the needs of racial and ethnic minority 

populations.

PATIENTS/CONSUMERS

Language accessibility and linguistic sensitivity 

are essential elements to the treatment of mental 

and physical health conditions. Accurate screening, 

diagnosis and treatment are entirely dependent on a 

linguistically accurate interview that acknowledges 

cultural values, spirituality and community/family 

beliefs about behavioral health and medicine.

Additionally, access to information on the Internet 

has dramatically changed the role of the patient/

consumer and has provided new opportunities for 

true partnership and collaboration between patients/

consumers and providers. Health care should have 

a particular focus on linking problem-solving skills 

and patient/consumer education to disease selfmanagement and socioeconomic stressors created by 

an illness.

Key Strategies Identified

•	 Conduct comprehensive assessments

that are culturally and linguistically 

competent to understand cultural values, 

beliefs and constructs and how they may 

inform the symptom picture, diagnosis 

and treatment.

•	 Develop patient/consumer-driven

treatment plans that activate patients/

consumers in their own health care.

EXAMPLE: Charles B. Wang Community 

Health Center

The Mental Health Bridge Program at the Charles B. 

Wang Community Health Center in New York City 

integrates mental health services in a primary care 

setting. This was designed to address and reduce 

the stigma attached to mental health services that 

is deeply rooted within the Chinese community. A 

bilingual and bicultural mental health team consults 

with primary care providers through assessment, 

medication recommendations, and counseling to adults, 

children and families. With no distinction between 

treatment rooms for primary and mental health care, 

providers have open communication in a combined 

electronic health record and informal communication 

is encouraged. To increase patient/consumer trust 

and reduce fears of seeking mental health services in a 

medical setting, records are strictly confidential. Only 

those staff directly involved in treating the patient/

consumer may gain access to mental health information. 

The program has successfully reached its original goal 

of providing mental health treatment to a population 

that traditionally stigmatizes mental health conditions 

and has a limited understanding of Western concepts of 

mental health and mental illness. 

http://www.cbwchc.org 
10

EXAMPLE: Atlanta Clinic for Education, 

Treatment and Prevention of Addiction

The Atlanta Clinic for Education, Treatment and 

Prevention of Addiction (CETPA) in Atlanta, Georgia 

is a full-service behavioral health agency, providing 

services in English and Spanish to their diverse Latino 

community. Their specialty includes cultural and 

linguistic competency in mental health and substance 

use assessments and treatments. One practice example 

is from a monolingual Spanish-speaking Latino client 

seeking help for his substance abuse and medical 

problems. He believed his problems were caused by a 

curse placed on him by an ex-girlfriend. The bilingual 

and culturally competent clinicians demonstrated 

a deep understanding and respect of the client’s 

presenting problem and cultural beliefs. In order to 

engage him fully in treatment, the clinician helped him 

also understand the problem from a behavioral health 

perspective. A curandero, or indigenous healer, was 

added to complement the evidence based treatments.

http://www.cetpa.org/

EXAMPLE: Mile Square Health Center

The University of Illinois Hospital & Health Sciences 

System – Mile Square Health Center (MSHC) is 

a federally qualified health center (FQHC) that 

provides comprehensive health care services to the 

predominantly African American residents of the 

Chicagoland area at multiple locations throughout 

the city. Integration of behavioral health services into 

a primary care setting, coupled with staff possessing 

both expertise in behavioral health and experience 

working in African American communities, careful 

matching of provider and patient, and utilization of 

culturally sensitive engagement processes results in 

increased patient engagement. Examples of behavioral 

health/substance use services embedded at MSHC 

include specialized and intensive care for patients with 

severe and persistent mental illness, a communitybased substance use organization that provides peer 

counseling services led by African Americans in 

recovery and/or with a personal history of substance 

use to enhance patient activation and advance recovery 

and wellness, and a research project funded by the 

Robert Wood Johnson Foundation to provide behavioral 

health services to ethnic minority youth (adolescents). 

http://hospital.uillinois.edu/Patients_and_Visitors/

Mile_Square_-_Federally_Qualified_Health_Center.

html

PRACTICE

At the practice level, patients/consumers should be 

offered their preferred choice of first-line treatment 

options, including information, education and 

psychotherapy in place of or in addition to psychotropic 

medication. Family members including extended 

kinships and significant others should be included in 

treatment if preferred by the patient/consumer. The 

emphasis in many ethnic cultures is on interdependency, 

the importance of relying on one another in times of 

need. Patient/consumer education and homework 

materials should be culturally, linguistically, 

idiomatically and literacy-level appropriate to be 

consistent with language access competency.

Key Strategies Identified

•	 Develop and share appropriate tools that

go beyond just the standard measurement 

of symptoms. 

•	 Build understanding by cross-training

providers and exposing them to other 

systems.

EXAMPLE: Center for Native 

American Health

For the Native American community in New Mexico, 

the Center for Native American Health (CNAH) strives 

to improve the overall health of Native Americans 

in New Mexico. CNAH began by establishing strong 

networks with tribal communities, based on principles 

of consultation and collaboration in all aspects of public 

health policy, research and service provision. CNAH has 
11

also been a vigorous advocate of tribal and indigenous 

values and perspectives, including Native American 

student development in the health professions. In an 

attempt to create culturally respectful mental health 

services, CNAH found that the use of focus groups 

and vignettes were beneficial to patients/consumers 

in improving access to services for understanding 

depression and other mental health concerns. The 

women in the focus group wanted a community health 

worker to make home visits and help inform and 

educate them about depression from a layperson’s 

perspective. Men, however, expressed the desire to meet 

and talk with other Native American men at a neutral 

location instead of a primary care or mental health 

service setting. Hearing the case vignette was critical 

to opening the door to discussion, leading to improved 

diagnosis, engagement and treatment. http://hsc.unm.

edu/community/cnah/

EXAMPLE: New York State 

Psychiatric Institute

The Center of Excellence for Cultural Competence at 

the New York State Psychiatric Institute developed 

the “Depression Fotonovela,” a culturally and 

linguistically appropriate health literacy tool designed 

to raise awareness, provide education and reduce 

barriers to depression care in the community. These 

commonly known soap opera stories are published in 

the commonly used popular style of a comic book, to 

inform and educate Latinos about depression and to 

eliminate powerful negative connotations associated 

with the treatment of mental health conditions. 

http://nyspi.org/culturalcompetence/what/project_

summary.html

EXAMPLE: Proyecto Nueva Vida

Proyecto Nueva Vida (PNV), with seven locations in 

Bridgeport, Conn., is a multi-provider collaborative 

program that addresses cultural and gender-specific 

needs of Latino men and women with behavioral health 

conditions, criminal backgrounds, at-risk medical 

issues and vocational needs. PNV employs culturally 

and linguistically competent practitioners who are 

aware of how belief systems play an important role in 

the way behavioral health and physical illnesses are 

perceived, understood and treated. These practitioners 

also incorporate other Latino-oriented services into the 

recovery process including, churches, spiritual healers 

and community leaders. PNV’s model builds on the 

recognition that there is a deep cultural sense of family 

commitment, obligation and responsibility and thus 

engages family members (including extended family 

and those not related by blood or marriage) who are 

identified by Latino program participants in their 

treatment and recovery process. http://www.casaincct.

org/proyectonuevavida.html

COMMUNITIES

Academic-community partnerships, in which 

community agencies collaborate with research experts, 

can examine implementation strategies for underserved 

populations, offer inclusion of diverse perspectives 

to address stigma, and implement community-based 

participatory research initiatives. Strategies for outreach 

and engagement of hard-to-reach populations are 

essential to convey the importance of screening for 

mental health issues and inform them of their role in 

chronic disease management.

Key Strategies Identified

•	 Create culturally responsive, asset-based

environments where the innate strengths 

of the community are being tapped.

•	 Use community-based participatory

approaches to help communities define 

the parameters and evidence.

•	 Identify and empower leaders from within

the community.

•	 Provide health/behavioral health

education wherever people are in the 

community.
12

EXAMPLE: Project Brotherhood

Project Brotherhood in Chicago provides free health 

care without appointments and during evening clinic 

hours to make integrated care more available to African 

American men. The project hired and trained a barber 

to provide health education, to serve as an advocate for 

African American men without access to health care, 

and to create a male-friendly environment to reduce 

mistrust of the health care system. They also provide 

fatherhood classes and produced a comic book, “County 

Kids,” that discourages violence and teaches children 

how to deal with conflict without resorting to violence. 

http://projectbrotherhood.net

EXAMPLE: University of California at Irvine

The “Reducing Racial Disparities in Diabetes: Coached 

Care Project” at the University of California at Irvine 

is designed to reduce disparities in health care for 

Latinos and Asian Americans with diabetes. Care is 

provided in a community setting and teaches ethnically 

diverse patients to take an active role in designing their 

treatment regimen in a way that is consistent with their 

preferences, culture and lifestyle. Community-based 

ethnic minority coaches who themselves have diabetes 

are recruited from the target communities, trained 

and monitored for quality of services. http://www.

medicine.uci.edu/r2d2c2 

EXAMPLE: Bienvenido Program at 

Northeastern Center

The Bienvenido Program at Northeastern Center in 

Kendallville, Ind., provides prevention, treatment and 

inpatient care to people in northeastern Indiana. After 

a large influx of Latino immigrants in the 1990s, the 

Northeastern Center found that local Latinos had a high 

incidence of depression and substance abuse and a very 

low usage of mental health services. The Bienvenido 

Program is a prevention and intervention program that 

addresses the migration experience and acculturative 

stressors encountered by Latino immigrants. The 

program trains and empowers local facilitators in a 

strengths-based mental health promotion curriculum 

that focuses on building the emotional and behavioral 

health of Latinos and helps reduce the risk of reliance on 

substance abuse due to potentially living in an ongoing 

marginalized social status. The Bienvenido curriculum 

has become a dual vehicle to build facilitator knowledge 

and enhance protective factors in the Latino immigrant.

http://www.necmh.org

HEALTH CARE SYSTEMS

Health care system factors that result in barriers to 

health and behavioral health care for racial and ethnic 

minorities include: limited provider access; lack of 

health insurance; poor-quality patient education 

and understanding of their condition; and large, 

cumbersome health systems that intimidate and bar 

easy access. Limited English-language proficiency, 

limited medical literacy, geographic inaccessibility 

and lack of medical insurance are all more common 

among immigrants, minority populations, and people 

living in rural, frontier and U.S.-Mexico border areas. 

At the system level, a supplemental patient/consumer 

navigation intervention can address clinic and system 

communication barriers, facilitate access to community 

resources, and locate patients/consumers who miss 

appointments. 

Key Strategies Identified

•	 Provide services where needed.

•	 Ensure institutions reflect the populations

they serve.

•	 Address cultural and linguistic diversity,

including professional culture.

•	 Evaluate practice for efficacy.

EXAMPLE: Children’s Hospital & Research 

Center Oakland

The Comprehensive Sickle Cell Center at Children’s 

Hospital & Research Center Oakland in Oakland, Calif., 

is based on a co-location model that applies holistic 
13

principles to the care and treatment of individuals with 

sickle cell disease and related conditions. The center 

operates from an integrative health perspective for both 

inpatient and outpatient care. In addition, the children’s 

care team interfaces with an adult multidisciplinary 

team to improve patient/consumer transition and 

coordinate services throughout the health care system 

for patients/consumers whose illness impacts several 

family members across the lifespan. The center also 

partners with community-based nonprofit organizations 

and endeavors to ensure that all patients/consumers 

with sickle cell disease have a medical home and 

primary care interface with behavioral health, education 

and vocational components. http://www.chori.org/

Centers/Sickle/Sickle_Main.html

EXAMPLE: Connecticut Latino Behavioral 

Health System

The Connecticut Latino Behavioral Health System 

initiative integrates a comprehensive qualitative 

and quantitative evaluation designed to assess the 

program at three levels: organizational, staff and 

patient/consumer. Evaluation at the organizational 

level included the development and preliminary pilot 

implementation of a new instrument, The Cultural 

Competency Index. The instrument was designed to 

evaluate culturally responsive clinical services and is 

being measured at three time points. Evaluation at the 

staff level includes pre- and post-training evaluations, 

satisfaction with trainings, and random tape ratings 

to assess for language fluency and the integration of 

Latino cultural values in treatment. Data from the 

organizational and staff measures currently are being 

analyzed. http://www.ctlbhs.org

EXAMPLE: Dimock Center

The Dimock Center in Boston, founded in 1862, was 

the first hospital in New England opened and operated 

by women for women and holds a significant place in 

the history of women in medicine. Dimock provides 

programs and services that are all carefully designed, 

monitored and integrated to meet an individual or 

family’s health and human service needs. It provides 

comprehensive health services including substance 

abuse and mental health. The center has two mental 

health clinicians, a pediatric social worker, and a child 

and adolescent psychiatrist. The clinicians operate in 10 

schools during the day and in the clinic after hours to 

maximize availability and access. The Dimock Center 

practices a “warm hand-off” approach with a multidisciplinary health and behavioral health team. http://

dimockcenter.org

WORKFORCE

Interdisciplinary mental and behavioral health training 

programs that focus on models of integrated primary 

care are examples of partnerships designed to reduce 

minority health disparities. Examples of these include 

medical homes, team management of chronic disease 

and specific models that integrate physical and mental 

health services. Other workforce development strategies 

include racial/ethnic minority patient/consumer 

navigators, community health workers/promotores 

de salud, and health advocates that reach out to the 

community to provide education, self-management 

skills, support and empowerment. 

Key Strategies Identified

•	 Build a diverse multidisciplinary

workforce.

•	 Attract and retain bilingual/bicultural

providers.

•	 Identify and engage individual health care

workers early in their studies/career.

•	 Provide in-culture and in-language

supervision.

•	 Build and support diverse, empowered

leadership.
14

EXAMPLE: Connecticut Latino Behavioral 

Health System

The Connecticut Latino Behavioral Health System is 

a collaborative of 13 behavioral health and primary 

care providers. The system employs unique strategies 

to successfully recruit and retain bilingual/bicultural 

professionals and provide ongoing training and 

consultation on topics related to Latino mental health, 

addictions and co-occurring conditions. The system 

created a training academy to enhance the knowledge 

base, skill set and attitudes of the behavioral health 

workforce at all levels of the organizational spectrum 

(administrative, management and clinical). Training 

topics have included current issues in Latino behavioral 

health including engagement strategies, clinical 

interviewing and assessment, Latino cultural values, 

and the impact of immigration and acculturation. 

http://www.ctlbhs.org/training.html

EXAMPLE: Cherokee Health Systems

Cherokee Health Systems (CHS) in east Tennessee 

continuously seeks to expand its capacity and diversity 

though ongoing recruitment strategies for multilingual 

staff from all cultural backgrounds. CHS employed 

a full-time Burundi interpreter to work at the front 

desk of their largest inner city clinic, which serves the 

local African refugee population. They also retained a 

multilingual psychologist who speaks Spanish, French 

and Portuguese who works via tele-health technology 

from her home in Miami, Florida.

CHS ensures that job advertisements reflect a desire 

to hire a diverse multilingual staff by using targeted 

techniques to recruit particular population groups. To 

recruit Latino staff, CHS targets specific community 

locations and publications, as well as works with 

existing bilingual staff to assist in recruitment efforts. 

Another effective retention strategy has been to offer 

advanced training, such as certified nursing assistant or 

other health-related courses, to bilingual staff. http://

www.cherokeehealth.com

EXAMPLE: Hogg Foundation for 

Mental Health

In an effort to increase the number of highly trained, 

culturally and linguistically diverse and consumeroriented mental health workers in Texas, the Hogg 

Foundation for Mental Health launched the Bilingual 

Scholarship for Mental Health Workforce Diversity 

initiative. This program offers full-tuition scholarships 

for Spanish-speaking graduate social work students 

at twelve Texas universities accredited by the national 

Council on Social Work Education. Upon graduation, 

the recipients commit to working in Texas providing 

mental health services for a period equal to the 

timeframe of the scholarship. As the largest category of 

mental health service providers in the country, masterslevel trained social workers can help close the workforce 

and language gap between supply and demand for 

mental health services. A total of 109 scholarships have 

been awarded to students at twelve Texas graduate 

schools through the spring 2012 semester. http://www.

hogg.utexas.edu
15

Conclusion

Based on the most current and relevant literature, a 

panel of national experts has clearly concluded that the 

improvement of behavioral health and physical health 

outcomes and the elimination of disparities for racial 

and ethnic minority and LEP populations can best be 

addressed by the integration of behavioral health and 

primary care services. The panel’s consensus statements 

and recommendations presented in this document 

are intended to improve health status for traditionally 

underserved populations. They describe key strategies 

already in place and successfully being used by 

integrated health and behavioral health care practices.

Future efforts must focus on the specific behavioral 

health care needs of populations who prefer treatment 

from their primary care physician and for whom 

disparities in behavioral health care prohibit access 

and result in poorer quality of care. Of absolute 

importance is a linguistic and culturally competent, 

patient/consumer-centered framework that adequately 

addresses barriers. 

The suggested strategies outlined in this report will 

require the comprehensive, persistent commitment 

of local, state and national leaders, especially as they 

relate to funding mechanisms, barriers that impede 

implementation, policies that help grow and sustain 

integrated health care programs, and data collection and 

research that enhance our knowledge base of how best 

to improve America’s health care system. 
16

References

Alliance for Health Reform. (2006). Racial and Ethnic Disparites in Health Care. from http://www.allhealth.org/

publications/pub_38.pdf

Bao, Y. H., Alexopoulos, G. S., Casalino, L. P., Ten Have, T. R., Donohue, J. M., Post, E. P., Schackman, B. R., & Bruce, 

M. L. (2011). Collaborative Depression Care Management and Disparities in Depression Treatment and Outcomes. 

Archives of General Psychiatry, 68(6), 627-636.

Bauer, A. M., Chen, C.-N., & Alegría, M. (2010). English language proficiency and mental health service use among 

Latino and Asian Americans with mental disorders. Medical Care, 48(12), 1097-1104.

Bazargan, M., Bazargan-Hejazi, S., & Baker, R. S. (2005). Treatment of self-reported depression among Hispanics and 

African Americans. Journal of Health Care for the Poor and Underserved, 16(2), 328-344.

Betancourt, J. R. (2006). Improving Quality and Achieving Equity: The Role of Cultural Competence in Reducing Racial

and Ethnic Disparities in Health Care: The Commonwealth Fund.

Bower, P., & Gilbody, S. (2005). Managing common mental health disorders in primary care: conceptual models and 

evidence base. British Medical Journal, 330(7495), 839-842.

Brach, C., & Chevarley, F. M. (2008). Demographics and Health Care Access and Utilization of Limited-English-Proficient and

English-Proficient Hispanics. Rockville, MD: Agency for Healthcare Research and Quality.

Bravemen, P., & Egerter, S. (2008). Overcoming Obstacles to Health. Princeton, N.J.: Robert Wood Johnson Foundation.

Butler, M., Kane, R., McAlpine, D., Kathol, R., Fu, S., Hagedorn, H., & Wilt, T. (2008). Integration of Mental Health/

Substance Abuse and Primary Care. Rockville, MD: Agency for Healthcare Research and Quality. Cabassa, L. J., Molina, 

G. B., & Baron, M. (2010). Depression Fotonovlea: Development of a Depression Literacy Tool for Latinos With 

Limited English Proficiency. Health Promotion Practice, Epub ahead of print.

Centers for Disease Control and Prevention. (2010). Current depression among adults - United States, 2006 and 2008. 

MMWR, 59(38), 1229-1235.

Centers for Disease Control and Prevention. (2011). Public Health Action Plan to Integrate Mental Health Promotion and

Mental Illness Prevention with Chronic Disease Prevention, 2011–2015. Atlanta: U.S. Department of Health and Human 

Services.

Centers for Disease Control and Prevention. (updated 2011). Racial and Ethnic Approaches to Community Health 

(REACH). from http://www.cdc.gov/reach/

Changing Minds Advancing Mental Health for Hispanics. (2002). Comprehensive In-Depth Literature Review and Analysis

of Hispanic Mental Health Issues with Specific Focus on Members of the Following Ethnic Groups: Cubans, Dominicans,

Mexicans and Puerto Ricans. Mercerville, N.J.: New Jersey Mental Health Institute, Inc.

Chapa, T., & Acosta, H. (2010). Movilizandonos por nuestro futuro: Strategic development of a mental health workforce for

Latinos: Consensus statements and recommendations. Rockville, MD: U.S. Department of Health and Human Services, 

Office of Minority Health and the National Resource Center for Hispanic Mental Health.
17

Cooper, L. A., Gonzales, J. J., Gallo, J. J., Rost, K. M., Meredith, L. S., Rubenstein, L. V., Wang, N. Y., & Ford, D. E. 

(2003). The acceptability of treatment for depression among African-American, Hispanic, and white primary care 

patients. Medical Care, 41(4), 479-489.

Davis, K. (2011). Pathways to integrated health care: Strategies for African American communities: Consensus statements and

recommendations. Rockville, MD.: U.S. Department of Health and Human Services, Office of Minority Health.

DeNavas-Walt, C., Proctor, B. D., & Smith, J. C. (2010). Income, Poverty, and Health Insurance Coverage in the United

States: 2009. Washinton, D.C.: U.S. Census Bureau.

Doty, M. M., & Ives, B. L. (2002). Quality of Health Care for Hispanic Populations: A Fact Sheet: The Commonwealth Fund.

Dwight-Johnson, M., Lagomasino, I. T., Hay, J., Zhang, L., Tang, L. Q., Green, J. M., & Duan, N. (2010). Effectiveness of 

Collaborative Care in Addressing Depression Treatment Preferences Among Low-Income Latinos. Psychiatric Services,

61(11), 1112-1118.

Ell, K., Katon, W., Cabassa, L. J., Xie, B., Lee, P. J., Kapetanovic, S., & Guterman, J. (2009). Depression and diabetes 

among low-income Hispanics: Design elements of a socio-culturally adapted collaborative care model randomized 

controlled trial. International Journal of Psychiatry in Medicine, 39(2), 113-132.

Ell, K., Katon, W., Xie, B., Lee, P. J., Kapetanovic, S., Guterman, J., & Chou, C. P. (2010). Collaborative Care 

Management of Major Depression Among Low-Income, Predominantly Hispanic Subjects With Diabetes A 

randomized controlled trial. Diabetes Care, 33(4), 706-713.

Eschbach, K., Ostir, G. V., Patel, K. V., Markides, K. S., & Goodwin, J. S. (2004). Neighborhood context and mortality 

among older Mexican Americans: Is there a barrio advantage? American Journal of Public Health, 94(10), 1807-1812.

Fernandez, A., Schillinger, D., Warton, E. M., Adler, N., Moffet, H. H., Schenker, Y., Salgado, M. V., Ahmed, A., & 

Karter, A. J. Language Barriers, Physician-Patient Language Concordance, and Glycemic Control Among Insured 

Latinos with Diabetes: The Diabetes Study of Northern California (DISTANCE). Journal of General Internal Medicine,

26(2), 170-176.

Fiscella, K., Franks, P., Doescher, M. P., & Saver, B. G. (2002). Disparities in health care by race, ethnicity, and language 

among the insured - Findings from a national sample. Medical Care, 40(1), 52-59.

Flores, G. (2005). The impact of medical interpreter services on the quality of health care: A systematic review. Medical

Care Research and Review, 62(3), 255-299.

Flores, G., Fuentes-Afflick, E., Barbot, O., Carter-Pokras, O., Claudio, L., Lara, M., McLaurin, J. A., Pachter, L., Gomez, 

F. R., Mendoza, F., Valdez, R. B., Villarruel, A. M., Zambrana, R. E., Greenberg, R., & Weitzman, M. (2002). The health 

of Latino children - Urgent priorities, unanswered questions, and a research agenda. Jama-Journal of the American

Medical Association, 288(1), 82-90.

Fort, J. G., & McClellan, L. (2006). REACH-Meharry community-campus partnership: Developing culturally 

competent health care providers. Journal of Health Care for the Poor and Underserved, 17(2), 78-87.

Galea, S., Tracy, M., Hoggatt, K. J., DiMaggio, C., & Karpati, A. (2011). Estimated Deaths Attributable to Social Factors 

in the United States. American Journal of Public Health, 101(8), 1456-1465.
18

Gelberg, L., Andersen, R. M., & Leake, B. D. (2000). The behavioral model for vulnerable populations: Application to 

medical care use and outcomes for homeless people. Health Services Research, 34(6), 1273-1302.

Gonzalez, H. M., Tarraf, W., Whitfield, K. E., & Vega, W. A. (2010). The epidemiology of major depression and 

ethnicity in the United States. Journal of Psychiatric Research, 44(15), 1043-1051.

Goode, T. D., Dunne, M. C., & Bronheim, S. M. (2006). The Evidence Base for Cultural and Linguistic Competency in Health

Care: The Commonwealth Fund.

Heckler, M. M. (1985). Report of the Secretary’s Task Force on Black and Minority Health. Retrieved. from http://

minorityhealth.hhs.gov/assets/pdf/checked/1/ANDERSON.pdf.

Heron, M., Hoyert, D. L., Murphy, S. L., Xu, J. Q., Kochanek, K. D., & Tejada-Vera, B. (2009). Deaths: final data for 2006. 

Atlanta: Centers for Disease Control and Prevention.

Hogg Foundation for Mental Health. (2007). The Mental Health workforce in Texas: A snapshot of the issues. 

Retrieved March 15, 2011, from http://www.hogg.utexas.edu/

Ida, D., & SooHoo, J. (2011). Integrated care for Asian American, Native Hawaiian and Pacific Islander communities: A

blueprint for action: Consensus statement and recommendations. Rockville, MD: U.S. Department of Health and Human 

Services, Office of Minority Health and the National Asian American Pacific Islander Mental Health Association.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, D.C.: 

National Academy Press.

Institute of Medicine. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, D.C.: 

The National Academies Press.

Interian, A., Ang, A., Gara, M. A., Rodriguez, M. A., & Vega, W. A. (2011). The long-term trajectory of depression 

among Latinos in primary care and its relationship to depression care disparities. General Hospital Psychiatry, 33(2), 

94-101.

International City/County Management Association. (2006). Community Health and Food Access: The Local Government

Role. Washington, D.C.

Jackson-Triche, M. E., Greer Sullivan, J., Wells, K. B., Rogers, W., Camp, P., & Mazel, R. (2000). Depression and healthrelated quality of life in ethnic minorities seeking care in general medical settings. Journal of Affective Disorders, 58(2), 

89-97.

Kaiser Family Foundation. (2011). Health Reform Source. from www.kff.org

Kaplan, K. (2011). Stress and aggressive breast cancer go together, study finds. Los Angeles Times, from http://www.

latimes.com/health/boostershots/la-heb-breast-cancer-stress-20110919,0,6194939.story

Katon, W., Russo, J., Lin, E. H. B., Heckbert, S. R., Ciechanowski, P., Ludman, E. J., & Von Korff, M. (2009). Depression 

and Diabetes: Factors Associated With Major Depression at Five-Year Follow-Up. Psychosomatics, 50(6), 570-579.

Katon, W., Unutzer, J., Wells, K., & Jones, L. (2010). Collaborative depression care: history, evolution and ways to 

enhance dissemination and sustainability. General Hospital Psychiatry, 32(5), 456-464.
19

Katon, W. J. (2008). The Comorbidity of Diabetes Mellitus and Depression. American Journal of Medicine, 121(11), 8-15.

National Alliance on Mental Illness. (2007). Cultural Competence: A key for success. from http://www.nami.org/

Content/NavigationMenu/Find_Support/Multicultural_Support/Cultural_Competence/Cultural_Competence.htm

National Asian American Pacific Islander Mental Health Association. (2011). Improving care for Asian American 

Native Hawaiian Pacific Islanders. from http://naapimha.org/

Ngo-Metzger, Q., Sorkin, D. H., & Phillips, R. S. (2009). Healthcare experiences of limited English-proficient Asian 

American patients: A cross-sectional mail survey. The Patient: Patient-Centered Outcomes Research, 2(2), 113-120.

NORC at the University of Chicago. (2010). Trends In U.S. Public Awareness of Racial And Ethnic Health Disparities (1999-

2010) U.S. Department of Health and Human Services Office of Minority Health.

Office of Minority Health. (2001). National Standards for Culturally and Linguistically Appropriate Services in Health Care,

Final Report. Washington, D.C.: U.S. Department of Health and Human Services.

Oxman, T. E., Dietrich, A. J., & Schulberg, H. C. (2003). The depression care manager and mental health specialist as 

collaborators within primary care. American Journal of Geriatric Psychiatry, 11(5), 507-516.

Oxman, T. E., Dietrich, A. J., & Schulberg, H. C. (2005). Evidence-based models of integrated management of 

depression in primary care. Psychiatric Clinics of North America, 28(4), 1061-+.

Pippins, J. R., Alegria, M., & Haas, J. S. (2007). Association between language proficiency and the quality of primary 

care among a national sample of insured Latinos. Medical Care, 45(11), 1020-1025.

President’s New Freedom Commission on Mental Health. (2003). Achieving the promise: transforming mental health care

in America. Final report. Washington, D.C.: U.S. Department of Health and Human Services.

Ramirez, L., Baker, E., & Metzler, M. (2008). Promoting health equality: A resource to help communities address social

determinates of health. Atlanta: Centers for Disease Control and Prevention.

Smedley, B. D. (2008). Moving Beyond Access: Achieving Equity In State Health Care Reform. Health Affairs, 27(2), 

447-455.

Taylor, P., Kochhar, R., Fry, R., Velasco, G., & Motel, S. (2011). Wealth Gaps Rise to record highs between whites, blacks, and

Hispanics. Washington, D.C.: Pew Research Center.

Technical Assistance Partnership for Child and Family Mental Health. (2011). Closing the Gap: Cultural Perspectives on

Family-Driven Care. Washington, D.C.

The Annapolis Coalition on the Behavioral Health Workforce. (2007). An Action Plan for Behavioral Health Workforce 

Development: A Framework for Discussion. from http://www.annapoliscoalition.org/download_actionplan.aspx 

Thielke, S., Vannoy, S., & Unutzer, J. (2007). Integrating mental health and primary care. Primary Care, 34(3), 571-+.

U.S. Department of Health and Human Services. (1999). Mental Health: a report of the Surgeon General. Washington, D.C.

U.S. Department of Health and Human Services. (2001). Mental Health: Culture, Race, and Ethnicity: A Supplement to

Mental Health: A Report to the Surgeon General. Rockville, MD.
20

University of California Irvine. (2009). The Coached Care Project: Reducing Racial Disparities in Diabetes. from 

http://www.medicine.uci.edu/r2d2c2/

Unutzer, J., Schoenbaum, M., Druss, B. G., & Katon, W. J. (2006). Transforming Mental Health care at the interface with 

general medicine: Report for the President’s Commission. Psychiatric Services, 57(1), 37-47.

Vega, W. A., Karno, M., Alegria, M., Alvidrez, J., Bernal, G., Escamilla, M., Escobar, J., Guarnaccia, P., Jenkins, J., 

Kopelowicz, A., Lagomasino, I. T., Lewis-Fernandez, R., Marin, H., Lopez, S., & Loue, S. (2007). Research issues for 

improving treatment of US Hispanics with persistent mental disorders. Psychiatric Services, 58(3), 385-394.

Vega, W. A., Kolody, B., Aguilar-Gaxiola, S., Alderete, E., Catalano, R., & Caraveo-Anduaga, J. (1998). Lifetime 

prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California. Archives of

General Psychiatry, 55(9), 771-778.

Vega, W. A., Kolody, B., Aguilar-Gaxiola, S., & Catalano, R. (1999). Gaps in service utilization by Mexican Americans 

with mental health problems. American Journal of Psychiatry, 156(6), 928-934.

Velez-Ibanez, C. G. (2004). Regions of refuge in the United States: Issues, problems, and concerns for the future of 

Mexican-Origin populations in the United States. Human Organization, 63(1), 1-20.

Warden, D., Trivedi, M. H., Wisniewski, S. R., Davis, L., Nierenberg, A. A., Gaynes, B. N., Zisook, S., Hollon, S. D., 

Balasubrarnani, G. K., Howland, R., Fava, M., Stewart, J. W., & Rush, A. J. (2007). Predictors of attrition during initial 

(Citalopram) treatment for depression: A STAR*D report. American Journal of Psychiatry, 164(8), 1189-1197.

Weinick, R. M., Jacobs, E. A., Stone, L. C., Ortega, A. N., & Burstin, H. (2004). Hispanic healthcare disparities - 

Challenging the myth of a monolithic Hispanic population. Medical Care, 42(4), 313-320.

Wilson, E., Chen, A. H., Grumbach, K., Wang, F., & Fernandez, A. (2005). Effects of Limited English Proficiency and 

Physician Language on Health Care Comprehension. JGIM: Journal of General Internal Medicine, 20(9), 800-806.

World Health Organization. (2009). Improving health systems and services for mental health. Geneva.

World Health Organization. (2011). Face the Problem: Invest in Mental Health. from http://www.who.int/mental_

health/publications/mentalhealthday_brochure_2011.pdf

Wu, C. H., Erickson, S. R., & Kennedy, J. (2009). Patient characteristics associated with the use of antidepressants 

among people diagnosed with DSM-IV mood disorders: results from the National Comorbidity Survey Replication. 

Current Medical Research and Opinion, 25(2), 471-482.
21

Appendix A: Framework for the Integration of Behavioral Health and Primary Care Services for Racial and Ethnic 

Minority Populations and Those with Limited English Proficiency 

Cultural & Linguistic Scope of Influence

COMMUNITY 

Patient/Consumer

Family

Social Determinants: 

Examples = 

transportation

geographic location of health services

health literacy

levels of acculturation

socioeconomic status

housing

safety

healthy food options

Engagement

Across the 

lifespan

OBJECTIVES:

↓Health disparities

 Behavioral health & 

physical health 

outcomes 

INTEGRATED CARE ORGANIZATION that is 

culturally and linguistically competent, responsive to 

the community, resides in a reasonable location, and 

has flexible Hours of operation. Member of a learning 

community committed to addressing the social 

determinants that cause health disparities.

Integrated Care Team (ICT)

Multidisciplinary & cross-trained in physical 

health and behavioral health

Development and use by the ICT of one health 

and behavioral health history.

One Treatment Plan

Patient/family centered with a wellness 

component and focus on health promotion 

and prevention, across the lifespan.

GOAL:

Improved individual, 

Family & community 

quality of life
22

Appendix B: Participant List

National Consensus Meeting Participants

Henry Acosta, MA, MSW, LSW

Executive Director

National Resource Center for Hispanic Mental Health 

3575 Quakerbridge Rd., Suite 102

Mercerville, NJ 08619

hacosta@nrchmh.org

Luis Añez, PsyD

Director Hispanic Services of the Connecticut 

Mental Health Center

Associate Professor

Yale Department of Psychiatry

300 George St.

New Haven, CT 06511

luis.aneznava@yale.edu

Teddy Chen, PhD, LCSW

Director of Mental Health Bridge Program 

Charles B. Wang Health Clinic

268 Canal St.

New York, NY 10013

tchen@cbwchc.org

Miriam Delphin-Rittmon, PhD

Assistant Professor, Department of Psychiatry

Director, Cultural Competence & Health Disparities 

Research & Consultation

Yale School of Medicine

319 Peck St., Bldg. One

New Haven, CT 06513

miriam.delphin@Yale.edu

Gayle Dine-Chacon, MD

Associate Professor, Family & Community Medicine

Director, Center for Native American Health

Surgeon General, Navajo Nation

University of New Mexico

P.O. Box 865

Corrales, NM 87048

gdchacon@salud.unm.edu

Daniel Fisher, MD, PhD

Executive Director 

National Empowerment Center 

599 Canal St.

Lawrence, MA 01840

daniefisher@gmail.com

DJ Ida, PhD 

Executive Director 

National Asian American Pacific Islander Mental Health 

Association

1215 19th St., Suite A

Denver, CO 80202

djida@naapimha.org

Theopia Jackson, PhD

Staff Psychologist

Children’s Hospital & Research Center Oakland

Department of Psychiatry

Assistant Chair of Psychology

Saybrook University

747 52nd St. 

Oakland, CA 94609

thjackson@mail.cho.org; tjackson@saybrook.edu 

Parinda Khatri, PhD

Director of Integrated Care

Cherokee Health Systems

2018 Western Ave.

Knoxville, TN 37921

parinda.khatri@cherokeehealth.com

Pierluigi Mancini, PhD

Chief Executive Officer

CETPA

6020 Dawson Blvd, Suite I 

Norcross, GA 30093

pmancini@cetpa.org
23

LaVerne D. Miller, Esq

Policy Research Associates

166-15 111th Ave.

Jamaica, NY 11433

lmiller@prainc.com

Myechia Minter-Jordan, MD, MBA

Chief Medical Officer

The Dimock Center

55 Dimock St.

Roxbury, MA 02119

mminterj@dimock.org

Martín Ornelas

Director

Transportation Coordination Network

of the Coastal Bend

Jim Wells County Public Transportation Dept.

200 N. Almond St.

Alice, TX 78332

martin.ornelas@tcncb.org 

Tassy Parker, PhD, RN

Associate Professor

Department of Family & Community Medicine

Acting Director

Center for Native American Health

University of New Mexico

MSC09 5040, 1 University of New Mexico

Albuquerque, NM 87131

taparker@salud.unm.edu

Gilberto Pérez, Jr., MSW, ACSW

Bienvenido Program Director

Northeastern Center

206 S. Main St., Suite 1

Goshen, IN 46526

gperez@nec.org

Joe Powell, LCDC, CAS

National Leadership Council on African American 

Behavioral Health

P.O. Box 191186

Dallas, TX 75219

joep2722@aol.com

Kathy Reynolds, LMSW, ACSW

Vice President, Health Integration and Wellness

National Council for Community Behavioral Healthcare

Director, SAMHSA/HRSA Center for Integrated Health 

Solutions

2615 Ellis Rd.

Ypsilanti, MI 48197

kathyr@thenationalcouncil.org

Jürgen Unützer, MD, MA, MPH

Professor and Vice-Chair 

Department of Psychiatry and Behavioral Sciences

University of Washington 

Chief of Psychiatric Services, UW Medical 

Center

University of Washington School of Medicine

1959 NE Pacific St., Box 356560 

Seattle, WA 98195

unutzer@u.washington.edu

Jorge Wong, PhD, CCEP, CHC

Director of Behavioral Health Services 

Asian Americans for Community Involvement

2400 Moorpark Ave., Suite 300

San Jose, CA 95128

jwong@paloaltou.edu

jorge.wong@aacl.org

Jamie Hart, PhD, MPH

Facilitator

Senior Vice President

Atlas Research

3240 Prospect St. NW

Washington, DC 20005

jhart@atlasresearch.us 

Katherine Sanchez, LCSW, PhD

Science Writer

Assistant Professor

The University of Texas at Arlington

School of Social Work

211 S. Cooper St.

Arlington, TX 76019 

ksanchez@UTA.edu 
24

Teresa Chapa, PhD, MPA

Federal Project Officer

Senior Policy Advisor, Mental Health

U.S .DHHS, Office of Minority Health

1101 Wootton Parkway, Suite 600

Rockville, MD 20852

teresa.chapa@hhs.gov

Octavio N. Martinez, Jr., MD, MPH, MBA

Principal Investigator

Executive Director

Hogg Foundation for Mental Health

Associate Vice President, Division of Diversity and 

Community Engagement

Clinical Professor, School of Social Work

The University of Texas at Austin

3001 Lake Austin Blvd., Fourth Floor

Austin, TX78703

HOGG-ED@austin.utexas.edu

Rick Ybarra, MA

Project Director

Program Officer

Hogg Foundation for Mental Health

3001 Lake Austin Blvd., Fourth Floor

Austin, TX 78703

rick.ybarra@austin.utexas.edu 

Lynda Frost, JD, PhD

Director of Planning & Programs

Hogg Foundation for Mental Health

3001 Lake Austin Blvd., Fourth Floor

Austin, TX 78703

lynda.frost@austin.utexas.edu

Meagan A. Longley, LMSW

Mental Health Fellow

Hogg Foundation for Mental Health

3001 Lake Austin Blvd., Fourth Floor

Austin, TX 78703

meagan.longley@austin.utexas.edu
25

Appendix C: Consensus Meeting Agenda

National Consensus Meeting Agenda

Meeting Objectives

1. Identify promising and practice-based approaches for delivering integrated health care to 

racial and ethnic minorities and populations with limited English proficiency (LEP).

2. Define and recommend key components of ideal models and approaches to delivering 

integrated health care to racial and ethnic minorities and populations with LEP.

3. Discuss implementation, assessment, and future research considerations related to delivering 

integrated health care to racial and ethnic minorities and populations with LEP.

Agenda

Day One Monday, November 7th 

8:00 am Breakfast

9:00 am Welcome, Remarks and Introductions

Octavio Martinez, Teresa Chapa

9:30 am Announcements & Meeting Packet Review

Meagan Longley

9:40 am Overview of Meeting Context and Rationale: Setting the Stage

Teresa Chapa, Rick Ybarra, Jamie Hart (facilitator)

• Overview of Hogg Foundation and OMH Collaborative Effort

• Meeting Objectives, Agenda and Norms

10:00 am Examining the Field: An Overview of Integrated Care

Katherine Sanchez

What does the literature tell us about the integration of healthcare (health, mental health 

and substance use/abuse), for racial and ethnic minorities and populations with LEP? 

Note: Addressing this correctly will include cultural and linguistic competence, workforce, 

transportation, hours of operation, and social determinants of health.

10:45 am Break
26

11:00 am Identification of Promising and Practice-Based Models and Approaches: 

Highlighting What Works 

• Based on your experience, what does integrated health care look like for racial and 

ethnic minorities and populations with LEP?

• What are examples of current practices or practice-based models and approaches? Are 

there successful models or promising practices? 

12:30 pm Lunch

1:30 pm Identification of Key Components: Developing Ideal Models of Integrated Care

• Based on today’s discussion of promising and practice-based models, what are the key 

components of effective models and approaches of integrated care? 

• What would an ideal model or approach to integrated health care for racial and ethnic 

minorities and populations with LEP look like?

3:00 pm Break

3:15 pm Identification of Key Components: Developing Ideal Models of Integrated Care (Continued)

5:00 pm Summary of Day One and Preparation for Day Two

5:15 pm Adjourn

Day Two Tuesday, November 8th 

8:00 am Breakfast

9:00 am Reflections and Review of Findings from Day One 

9:15 am Identification of Key Components: Integrating Models and Approaches of Cultural and 

Linguistic Competence Into Integrated Care (Continued)

10:15 am Feedback on Implementation, Assessment, and Future Research: Applying the 

Recommendations 

• What is needed to ensure that integrated health care is provided in a culturally and 

linguistically appropriate way – in terms of training, policy, research / evaluation, and 

other strategies?

• How will we know that integrated health care is impacting health disparities for racial and 

ethnic minorities and populations with LEP?

• How do we build new evidence on what works? 

11:30 am Next Steps: Moving Forward

Rick Ybarra, Octavio Martinez, Teresa Chapa

12:00 pm Adjourn
27

Appendix D: Glossary

Integrated Health Care Glossary

Behavioral health – A term used to refer to both mental 

health and substance use.

Behavioral health specialist – A mental health 

or substance abuse treatment provider, such as a 

psychiatrist, social worker, psychologist, licensed 

chemical dependency counselor or psychiatric nurse.

Care management – A set of evidence-based integrated 

care practices in which patients are educated about their 

behavioral health problems and regularly monitored for 

their response and adherence to treatment.

Clinical barriers – Obstacles to integrating care that 

stem from how treatment traditionally is provided and 

how providers traditionally are trained in different 

fields.

Co-location – An integrated health care approach in 

which both physical and mental health providers are 

located in the same building or on the same premises 

to increase access to those services and to reduce the 

stigma of seeking mental health treatment. Also spelled 

collocation.

Comorbidity – The co-existence of two or more illnesses 

at the same time.

Embedded primary care – An integrated health 

care approach in which primary care providers and 

behavioral health providers are located in the same 

practice or clinic to improve clients’ physical health 

outcomes. Also called co-location.

Evidence-based – A treatment practice or approach 

that is backed by a strong body of research evidence.

Facilitated referral – An approach in which nursing 

staff assist clients with accessing referrals to primary 

care and help coordinate their care. Also called 

enhanced referral.

Health promotion – The provision of informa¬tion and 

education to empower people to increase control over 

and improve their health.

Integrated health care – The coordination of physical 

and behavioral health care.

Managed care – An approach to paying for health 

care in which a payer controls the costs and quality of 

services through a variety of techniques.

Medical model – An approach to treatment in 

which recovery from a mental illness is defined as 

the reduction of symptoms and a reduced need for 

treatment, as contrasted with the recovery model.

Organizational barriers – Obstacles to integrating care 

that stem from how physical and behavioral health care 

organizations traditionally are structured.

Patient registry – A log or database of all patients 

in a clinic or practice who have a particular illness or 

condition.

Policy barriers – Obstacles to integrating care that 

stem from laws and regulations on how physical and 

behavioral health care organizations can provide 

services and share information.

Recovery model – An approach to treatment in 

which recovery from a mental illness is defined as the 

improvement of a person’s quality of life and level of 

functioning despite the illness, as contrasted with the 

medical model.

Serious emotional disturbance – Mental health 

problems that severely limit children’s ability to 

function at school, at home and in the family.

Severe mental illness – Term used to refer to 

psychiatric disorders like schizophrenia and bipolar 

disorder that are associated with greater disruptions in 

people’s ability to function.

Treatment guidelines – Descriptions of best practices 

for assessment or management of a health condition.

Warm hand-off – An approach in which the primary 

care provider does a face-to-face introduction of a 

patient to the behavioral health specialist to which he or 

she is being referred.

Wellness – A state of physical, mental and spiritual 

well-being.
28

Culturally and Linguistically Competent Care: Glossary

Collecting Culturally- and Linguistically-Specific 

Patient Data – Under the Affordable Care Act, to the 

extent practicable, federal health data collections will 

include culturally- and linguistically-specific data on 

populations served. Guidance and tools have yet to be 

developed. This information is included as an advisory 

for program planners. 

Culture – Attitudes and behaviors that are characteristic 

of a group or community.

Cultural Competence – A set of congruent behaviors, 

attitudes and policies that come together in a system, 

agency, or among professionals that enables effective 

work in cross-cultural situations.

Culturally Competent Community Engagement – The 

practice of working in conjunction with natural, informal 

support and helping networks within culturally diverse 

communities, encouraging communities to determine 

their own needs and community members to be full 

partners in decision making. Community engagement 

should result in the reciprocal transfer of knowledge 

and skills among all collaborators and partners with 

communities benefitting economically from the 

collaboration.

Culturally Competent Organization – An organization 

that embraces the principles of equal access and nondiscriminatory practices in service delivery.

Culturally Competent Practice and Service Design – 

The implementation of a service model that is tailored 

or matched to the unique needs of individuals, children, 

families, organizations and communities served. 

Practice is driven in service delivery systems by client 

preferred choices, not by culturally blind or culturally 

free interventions. The service delivery model recognizes 

that mental health is an integral and inseparable aspect 

of primary health care.

Disparity – The state or condition of being unequal or 

different.

Family and Consumers – The recognition that family 

is defined differently by different cultures. Family as 

defined by each culture is usually the primary system of 

support and preferred intervention. Family/consumers 

are the ultimate decision makers for services and 

supports for their children and/or themselves.

Health Disparities – The differences in the overall rate 

of disease incidence, prevalence, morbidity, mortality or 

survival rates in a population as compared to the health 

status of the general population.

Language Access – The provision of services, supports, 

and written material in the preferred language and/

or mode of delivery or the use of interpretation and 

translation services that comply with all relevant 

Federal, state and local mandates governing language 

access.

Linguistic Competence – The capacity of an 

organization and its personnel to communicate 

effectively, and convey information in a manner that 

is easily understood by diverse groups including 

persons of limited English proficiency, those who have 

low literacy skills or are not literate, individuals with 

disabilities, and those who are deaf or hard of hearing. 

Linguistic competency requires organizational and 

provider capacity to respond effectively to the health 

and mental health literacy needs of populations served. 

The organization must have policy, structures, practices, 

procedures, and dedicated resources to support this 

capacity.

Health Literacy – The degree to which individuals 

have the capacity to obtain, process and understand 

basic health information and services needed to make 

appropriate health decisions. 

Plain Language – Writing that is clear and to the point, 

which helps to improve communication and takes less 

time to read and understand.