Overcoming Language Barriers in Mental and Behavioral Health Care for Children and Adolescents—Policies and Priorities

Abstract

It isn't a good fit." The patient, a child who had fled armed conflict and persecution, had been diagnosed with a severe behavioral health problem. The family was overwhelmed. On behalf of the family, we sought help from multiple behavioral health services and heard the same thing: "Therapy won't work with an interpreter." "We don't know how to complete intake for a child who doesn't speak English." "We can't start treatment until we hire a bilingual therapist." Our health system failed this family, and the social and emotional consequences were devastating.In retrospect, we should not have been shocked. Since entering health care, we have been aware that children and adolescents with limited English proficiency (LEP) have been subtly and less subtly deterred from seeking mental and behavioral health care by the health system itself. Despite federal regulations rooted in the Civil Rights Act that require recipients of Medicaid or Medicare to take reasonable steps to address language barriers, children with LEP are nonetheless stymied while seeking routine outpatient services for conditions such as depression, when trying to enroll in early intervention services for children with disabilities, and when seeking help for addiction. In general, the barriers that patients face are rooted in good intentions. One health care professional has never been trained to work with children with LEP and feels that someone with more experience would offer better care. Another with strong beliefs in evidence-based therapies is reluctant to treat because "we don't know if these therapies are effective with interpreters." Other barriers are more prosaic or are simply oversights. One clinic is contracted for inperson but not telephonic interpretation and thus is unable to schedule appointments because office staff cannot talk to parents on the phone. Another program developed a protocol for communicating with parents with LEP but not with children with LEP.Our anecdotal experiences are consistent with research on access to mental and behavioral health care for patients with LEP across North America. 1 Sentell et al 1 found that among adults with LEP in California, the odds of receiving needed mental health services were less than half those of English-proficient adults, even after adjusting for insurance status. Similarly, Fortuna et al 2 found that among immigrant Latino adults who had been exposed to political violence in their home countries, English proficiency was associated with mental health service use in the prior 12 months. Although most research has focused on adults rather than on children, a large study from Canada found that among children and adolescents referred for mental health care, patients with

“We Need Health for All”: Mental Health and Barriers to Care among Latinxs in California and Connecticut

“…The findings of this study affirm existing research that links structural factors affecting Latinx migrant communities to mental health outcomes and access to services [4][5][6][7]35,[64][65][66][67][68][69][70][71].…”

“…Further, even when immigrants do access services, they face discrimination that can further activate mental health trauma [35,64]. The provision of services in English only also creates major barriers for communities that speak Spanish [65][66][67][68], or any number of non-English and Indigenous languages. Beyond that, Latinx migrant communities are often economically exploited, and therefore face barriers at disparately high rates, including the cost of services themselves, access to childcare, transportation, and the inability to take time off from work [5,6,[69][70][71].…”

Association of Youth Suicides and County-Level Mental Health Professional Shortage Areas in the US

“…42 Investments are also needed to build a diverse mental health workforce that is adept at delivering culturally and linguistically relevant care. 43 Improving reimbursement rates for mental health services may further aid in rec ruitment and retention of mental health professionals. 44 Additionally, mental health capacity can be increased through integration of mental health care into primary care settings and schools and through expansion of telehealth services.…”

“…For instance, several programs funded by HRSA focus on workforce development in underserved and rural communities . Investments are also needed to build a diverse mental health workforce that is adept at delivering culturally and linguistically relevant care . Improving reimbursement rates for mental health services may further aid in recruitment and retention of mental health professionals .…”

Disparities in Mental and Behavioral Health Treatment for Children and Youth in Immigrant Families

“…Notable barriers to MBH care for CIF include lack of accommodation for language barriers (56% of CIF have at least one parent with limited English proficiency), lower rates of diagnostic screening, a paucity of culturally or linguistic-concordant providers, stigma, provider racial/ethnic biases, and distrust of providers. [4][5][6][7][8][9][10][11][12] Recent studies of children with Autism Spectrum Disorder (ASD) exemplify these barriers. In qualitative interviews, Hispanic/Latinx immigrant parents report lack of empowerment, language barriers, stigma, and a delayed process of diagnosis as reasons for delays In ASD care.…”