Meeting the Linguistic Service Needs of Latinos in Substance Abuse Treatment

Background and Purpose: Latino clients entering outpatient substance abuse treatment (OSAT) in the U.S. has doubled in the past 10 years going from six to 12 percent. This mostly bilingual/bicultural population has reported lack of services in Spanish as one of the most significant barriers to access OSAT. Even in California where Latinos are highly represented, services in Spanish may be scattered. This study explores the geographic location, as well as the organizational factors associated with availability of Spanish speaking services in the OSAT system in California.

Methods: This analysis utilized two sources of data to map out service availability and to identify providers' organizational structure. The 2000 U.S. Census tract assisted this research in determining the Latino representation in counties across California, while data collected from 2005for the National Survey on Substance Abuse Treatment Services (NSSATS) provided information about the location and structure of SAT facilities and whether or not they offered services in Spanish. Information collected from both sources was then consolidated and analyzed with Geographic Information System (GIS) software. The spatial analysis mapped, in three layers, existing facilities, their availability of Spanish speaking services and the low to high Latino presence in different communities. A follow up statistical analysis was conducted using NSSATS to determine to what extent facilities' characteristics, such as service resources, regulation and facility type associate with offering Spanish speaking services. The analytical approach included multiple imputation to respond to missing data (8%) and a logistic regression approach was conducted to model the dichotomous outcome.

Results: The GIS analysis revealed that availability of services in Spanish, while certainly more pronounced in urban settings with high representation of Latinos (e.g. Los Angeles), other counties in the state with moderate to high representation did not make these services readily available or were located at greater distance from Latino communities. Even within Los Angeles County where Latinos account for nearly half (47.3%) of the population, the accessibility of SAT services overall were scattered. Furthermore, the statistical analysis showed that public facilities and those with state license were three and four times more likely to provide services in Spanish compared with non profit and private or non-license facilities respectively.

Conclusions and Implications: Overall, these results suggest that the SAT system in California, which is comprised mainly of non-profit and private facilities (82%), is challenged to meet the Linguistic services needs of Latinos. Regulation through state licensing seems to play a major role in ensuring compliance with federal requirements to offer these services, yet providers still struggle to have bilingual counselors and or use translators, let alone ensure Spanish proficiency. As health reform seeks to increase accessibility of services to a significant number of people, which may be represented by native Spanish speakers, it is important that California's SAT system builds capacity to meet the linguistic, as well as the cultural services needs of its largest ethnic minority population.