The Bienvenido Program incorporates a healing framework that encourages participants to:

1.      Acknowledge possible trauma and distress resulting from immigration and stigmatized social status

1. Identify positive coping strategies
2. Learn about mental health and navigating available services when needed
3. Build social support networks and increase participation in local social and political life

The National Latino Behavioral Health Association (NLBHA) touts evidence based and success-based practices (Community Defined Evidence Project (nlbha.org)) that include the following criteria:

1. clear articulation of practice(s) used with Latinx/Hispanic populations;
2. demonstrated knowledge of the population(s) served;
3. utilization of practice(s) by community;
4. potential for demonstrating outcomes; and
5. potential for sustainability of practice(s).

In 2008, I was part of a workgroup that consisted of four distinct areas of mental wellness. The groups were categorized into adult mental illness, youth wrap around services, smoking cessation, and obesity.

I was incredibly impressed by the workgroup addressing obesity. This group didn’t attend the meetings just because they were invited. They truly embraced the work and dove into one Latinx community specifically. So, I share bits of this case study to emphasis that these principles really do work.

What the workgroup discovered:

First, they walked the streets of the community, talked with the people, observed, and interacted.  This is important to note as no two communities are the same.  While the principles of this work apply, never lose site of your audience, what makes them unique, and what resources are at hand.

Secondly, the workgroup learned this community was somewhat isolated from surrounding neighborhoods. The residents had collectively banded together due to their similar experiences, culture, and language.  What bonded them, also isolated them as providers of medical services, merchants, and residents of surrounding communities referred to this “community” (grouping all people together) and overlooked the “individual”.  When this happens, stigma grows.

In the good work we do, we must never lose sight of the individual. Maslow’s Hierarchy of Human Needs may seem old and so basic, but in the work that we do we can’t lose sight of the social determinants of health and delve into questions that ask how a person is eating or sleeping? What we uncover is paramount to the success of that individual. Yet, are we prepared for the answers?  What supports can we refer to someone who needs shelter, who needs food, or isn’t sleeping because they simply don’t feel safe? We must listen, learn, and partner with others in our communities who can help provide what must come next.

Third, because the workgroup was among the people engaging the community and listening, they uncovered some interesting lifestyles among the residents. One thing they noticed was that nearly all the married men in the community were overweight.  It turns out that their wives were proud of that as it signified they were taking care of their husbands by feeding them well. Upon further investigation, it wasn’t that they were feeding them well, they were feeding them a lot. The wives were unaware of good nutritional facts. So, how was this group going to provide this education? A good thing to remember when working with groups who differ from you with regard to culture or geography is that you are an outsider. Don’t take the cartoon character Underdog’s favorite phrase “Here I am to save the day!” approach! You are an outsider. The education must come from within.

In this case, by reaching out to local restaurants, restaurant owners began to change their menus slightly to include healthier options, state why these were healthier on their menus, and offer nutritional tips on fliers in their windows as well as their menus. This information was shared with the local grocery store which further led to healthier results throughout the community.

Fourth, addressing the language barrier! The conversation with the grocery store unraveled additional “ah ha’s” for the community.  While a prominent grocer served this community as well as more affluent communities surrounding it, there were noticeable differences in this store compared to the other locations. Light bulbs were not changed as often, produce didn’t seem to be tended as well as other stores, the floors were not swept as often, the frozen bins were less tidy, and the food on the shelves was not arranged by expiration dates.

Curiously, this was not the standard of the grocer. When the workgroup brought this to the attention of the regional manager overseeing this store, this is what they discovered. The regional manager made his site visits as he did with his other stores and left his notes and suggestions with the store manager.  In this case, perception and language barriers came in to play. It was translation and translation. Translation from English to Spanish and translation with misinterpretation of what was being said and understood.

The store manager read notes from the regional manager that mentioned something like this, “It is the responsibility of management to…”  Therefore, the store manager assumed some of these items were to be addressed by corporate specifically and, the store manager assumed corporate didn’t care about this store as he assumed his role was reduced to the scheduling of workers.  This all turned out to be a training issue where culturally appropriate communication needed to occur.  Once the conversation was clear, the store met and exceeded the expectations of the grocery chain.

This grocer joined the same efforts of restaurants by posting good nutrition facts, offering cooking and educational classes, and supporting the community in a multitude of other ways.

In everyday life I think we must examine when we give directions. Is telling someone what we expect enough? Or, do we need to take an extra moment to teach it? With a language barrier, we need to ensure we have an appropriate understanding of expectations. When we are clear and concise our expectations have a higher chance of being met. When we are fair and consistent, the chances are even greater. Assume a “team” approach when giving directions.  If everyone feels they are part of the same team, and, most importantly appreciated for their contributions, expectations are often exceeded.  When the person giving the directions is clearly a part of the team, a good leader is present.

An evidence-based practice or success-based practice exists because identified and consistent principles are in place that lead to measured outcomes that have been proven to work.  By engaging Latinx communities with this approach, the Bienvedido Program is helping Latinx communities better understand their mental health concerns and develop a program unique to their needs. We all can learn from this approach. It may not be easy work, but it is work that worth it, and work that will fulfill you the most.