Bridges to Better Health and Wellness: A Health Care Manager Intervention for Latinos with Serious Mental Illness

Background and Purpose: Improving the health care of Latinos with serious mental illness (SMI; e.g., schizophrenia) is an important public health priority since this population faces serious health disparities. Compared to non-Latino whites with SMI, Latinos with SMI tend to be at increased risk of experiencing cardiovascular-related mortality, negative metabolic abnormalities (e.g., weight gain) associated with antipsychotic treatment, and higher prevalence of diabetes mellitus and metabolic syndrome. These health needs are exacerbated by the structural barriers (e.g., stigmatization, fragmented care) faced by people with SMI when seeking and using primary care services. Latinos with SMI also have to contend with additional obstacles to care including, language barriers, lack of culturally-competent care and mistrust of the health care system due to the legacy of discrimination toward minorities and immigrants in the U.S. These health needs and deficiencies in medical care indicate that Latinos with SMI would benefit from health care manager interventions that focus on improving care coordination and patient-centered care.  This federally-funded study examines the feasibility, acceptability, and initial impact of Bridges to Better Health and Wellness (B2BHW), a 12-month health care manager intervention for Latinos with SMI delivered by social workers employed in public outpatient mental health clinics and focuses on care coordination, patient activation, and receipt of preventive primary care (e.g., screenings, vaccinations).

Methods: Thirty-four Latino adults with SMI and at least one cardiovascular risk factor (e.g., smoking, diabetes, high cholesterol) at a public outpatient mental health clinic were enrolled in the study. A single-group design with assessments (e.g., structured interviews and chart abstractions) at baseline, 6, and 12 months was used to examine the feasibility, acceptability and initial impact of B2BHW.  Mixed linear models were used to examine changes over time on: patient activation, self-efficacy, patients’ ratings of quality of care, receipt of preventive primary care services, and quality of life.

Results:  Participants were mostly female, Dominican, and had a diagnosis of schizophrenia, schizoaffective or bipolar disorder.  On average, participants had 2.8 medical conditions with high cholesterol, hypertension, and diabetes being the most frequent.  On average, participants attended 10 of the 12 sessions and eighty-five percent completed the intervention. Participants found B2BHW helpful, acceptable, and culturally compatible.  Statistically significant improvements from baseline to 12-months were found for patient activation, self-efficacy, and patients’ ratings of quality of care. The receipt of preventive primary care services significantly increased from baseline to 12 months (32% to 54%, p < 0.001).  Improvements in quality of life from baseline to 12 month were observed but were not statistically significant.

Conclusions: B2BHW seems to be an acceptable and feasible health care manager intervention delivered by social workers in public outpatient mental health clinics. Study results indicate that B2BHW is a intervention that can help improve the health care of Latinos with SMI, but more rigorous examinations are needed to confirm its effectiveness.