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New residency program providing mental health care for Spanish-speaking Missourians

July 7, 2018 | By Christie L.C. Ellis

Newlywed psychology doctoral students Daymarie Rivera-Morales and Luis Lopez-Rodríguez are about to make another big change this year: They, along with fellow student Nicole Ryan-Nolla, will move 2,000 miles from Puerto Rico to Missouri to join a new residency program based out of a campus in downtown St. Louis.

The program will provide mental health care services in Spanish through a partnership between Ponce Health Sciences University in Puerto Rico and Compass Health Network, a nonprofit with health care facilities serving rural residents across Missouri.

Given the dearth of mental health professionals in the state, along with its steadily growing Hispanic and Latino population, the two organizations — and the program’s first residents — see big potential for the program.

Spanish is the primary language spoken in 2.6 percent of Missouri households, a number that has more than doubled since 1990, according to the 2010-2014 Missouri Economic Research Information Center survey. In six counties in Missouri, Spanish is the primary language in more than 10 percent of households, most of which are in rural areas that are historically difficult to reach with behavioral health services.

Compass Health Network is the largest community behavioral health provider in Missouri. Paul Thomlinson, executive director of Compass Health Network, said that workforce development is a big issue in behavioral health even for English speakers due to a shortage of therapists, psychologists and psychiatrists.

Very few Missouri clinics have therapeutic staff who speak Spanish, according to the Missouri Coalition for Community Behavioral Healthcare. Compass Health Network clinics provide in-house translators for their Spanish-speaking patients, but many clinics in Missouri turn to over-the-phone translation services or even Google Translate.

Translation services can fall short of meeting patients’ needs because they hinder the development of patient-therapist trust and often omit cultural context, Thomlinson said. “Talk therapy, even if you have a translator… You’re going to miss something. You’re going to miss the idioms, you’re going to miss the cognitive mindset encapsulated in that language.”

Dr. Ninive Sanchez, Assistant Professor of Social Work at the University of Missouri, highlighted the myriad subtleties of treating Spanish-speaking patients, including “cultural beliefs and practices, concerns with immigration status, acculturation, racism, stigma associated with seeking mental health services, and lack of understanding of how to navigate the U.S. healthcare system.”

Ponce Health Sciences University found itself in a unique position to fill an unmet need. The Puerto Rico-based school recently opened a campus in downtown St. Louis and was looking for opportunities for their doctor of psychology and clinical psychology students that could have a positive impact on their new community. The chance to place their Spanish-fluent students in one of the largest clinic networks in the state, especially at Compass Health Network’s rural locations with the highest concentration of Spanish-speaking residents, was what Thomlinson called a “hand in glove fit.”

Residency programs give students or recent graduates specialized training in a particular medical field in a real-world clinic or hospital setting.

“You change lives, not only of these students, but the lives of those they serve,” said Ken Dobbins, the chancellor of Ponce’s St. Louis campus, who initiated the partnership by reaching out to Compass, about the impact of the program for both the Ponce students and Missouri residents.

Daymarie Rivera-Morales, 24, and her husband Luis Lopez-Rodríguez, 25, are two of the three residents in the program. Rivera-Morales, who focuses on treating patients, said she’s excited to meet the needs of an underserved population.

“People will start coming and getting the help they need in a way that will actually work for them,” she said.

Lopez-Rodríguez will conduct research on how effective different therapy methods are for different groups of patients in addition to treatment. “What we do know is not all models of therapy work on the whole population,” he said. “When you’re open to multiple aspects of psychology and how that type of therapy benefits that patient, and the needs of the human being as a patient and as a part of the culture… That’s one of the things we’re most excited about, that we can help different types of people.”

The residency program will begin this August at Compass Health Network clinics in Rolla, Windsor, and Clinton, Mo. If successful, Ponce is evaluating expanding the program next year from three residents to 25.

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