Integrated Care Among Latine's in Treatment for Co-Occurring Disorders

Background: Integrated health care is the most effective treatment for individuals with co-occurring disorders. Using this treatment model has been successful in treating mental illness and substance use disorders, which has been shown to improve health outcomes for clients (Goldman et al., 2021). Individuals with marginalized identities who are substance users are more likely to experience several barriers when seeking healthcare from different locations. Treatment organizations that offer integrated healthcare reduce the mental and physical conditions among this population, making healthcare more accessible (Brooner et al., 2013) and reducing the use of emergency services (Gourevitch et al., 2007). Few studies have explored if participation in integrated treatment for behavioral health, primary care, and social determinants supports improved social factors such as employment, education, housing stability, and criminal legal system involvement in Latine individuals in treatment for mental health and substance use disorder.

Methods: Bivariate statistics and bi-nominal logistic regression were used to analyze assessment and reassessment data on 331 adults, the majority of whom were Latine (91%), receiving substance use treatment services at a bilingual/bicultural integrated behavioral health facility serving Latine communities in Massachusetts. We examined the relationship between social factors such as employment, education, housing stability, criminal legal system involvement, and the intersections of Puerto Rican ethnicity among Latine individuals with substance use.

Results: Data from baseline assessment and six months follow-up identified that participation in an integrated care treatment resulted in significant increases at the bivariate level in employment, education, housing stability, criminal legal system involvement, mental health functioning, quality of life, and social connectedness. However, the logistic regressions identified that PR ethnicity and a trauma history posed significant risks for both continued unemployment and housing instability, while being older posed a significant risk for continued unemployment. PR clients were 2.3 times more likely to be unemployed and 1.8 times more likely to be unhoused than non-Puerto Rican clients at reassessment. Clients with a trauma history were 1.8 times more likely to be unemployed and 2.3 times more likely to be unhoused compared to clients with no trauma history. There were no gender differences in outcomes at the six-month reassessment.

Conclusion and Implications: Even though the majority of clients in treatment experienced significant improvements in employment, housing, social connectedness, and education, clients identifying as PR and reporting a trauma history resulted in lower rates of positive outcomes at reassessment. It is important to remember that Latine individuals are not homogenous, and the cultural stigma around substance use can hinder engagement and retention in treatment. A collaborative approach between treatment organizations and social work researchers is vital to address these obstacles. This collaboration provides an opportunity to significantly improve the effectiveness of service delivery and develop a scientific basis for treating substance use and co-occurring disorders among Latine individuals by considering cultural nuances and health behaviors. Collaboration can improve integrated care models to be more culturally appropriate for Latine individuals dealing with mental health and substance use disorders.