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La cocina de abuela: eradicating social isolation with Latino older adults

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La cocina de abuela: eradicating social isolation with Latino older adults

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Content Capstone
La Cocina de Abuela:
Eradicating Social Isolation with Latino Older Adults
by

Lizeth Moreno
Doctor of Social Work
Suzanne Dworak-Peck School of Social Work
University of Southern California
August 2020
PROTOTYPE 2
Table of Contents
Executive Summary…………………………………………………3
Conceptual Framework……………………………………………...8
Social Innovation………………………………………….……….15
Methodology…………………………………………………….…22
Conclusion…………………………………………………………34
References…………………………………………………………36
Appendix 1 Logic Model………………………………………….45
Appendix 2 Startup Budget……………………………………….46
Appendix 3Operating Budget……………………………………..47
Appendix 4 Questionnaire………………………………………..48
Appendix 5 Timeline of the project………………………………49
Appendix 6 Flyer…………………………………………………51
Appendix 7 Prototype……………………………………………52

PROTOTYPE 3
Executive Summary
The aging community is growing, but the resources, support, and financial availability
are limited. Latino older adults over the age of 65 will increase from the current 8% of the US
population to 22% by 2060 (Larson, 2017). It is estimated that 25% of the overall aging
population is suffering from isolation. Latino older adults suffer from isolation, but they are
underrepresented, and data is limited (Miyawaki, 2015). Some causes for isolation for Latino
older adults are acculturation, stress, language barriers that limit communication, and the
possibility of receiving adequate or necessary resources (Larson, 2017). Those that are isolated
have higher risks of cardiovascular disease, strokes, dementia, depression, anxiety, and suicidal
ideation (Meinert, 2018). Isolation can also lead to lower physical activity, weight gain, high
smoking levels, and alcohol consumption (Meinert, 2018). Having these changes can lead to
frequent visits to the Emergency Room or regular hospital stays.
Due to concerns of isolation, some programs are tackling the problems that are causing
isolation. Some of the most common deviants among mental illnesses are medication and
psychological interventions like cognitive therapy or problem-solving therapy (Leggett, 2014).
Innovations create opportunities to help provide mental health services at any time with the
availability of the internet (Leggett, 2014). It’s incredible how many changes the internet has had
within therapy
Some mental health program focused on aging is a stepped-care program in which a
nurse visits the patient for three months and evaluate whether the patient needs to extend the
additional treatment or has met the goal (Leggett, 2014). Healthy IDEAS is a program focused
on older adults that identify depression and empowers seniors and provides different activities
they need (Healthy IDEAS, 2017). PEARLS is another program for depressed seniors and
PROTOTYPE 4
provides counseling services that can encourage active and productive lives (PEARLS program,
2019). Lastly, Esperanza is another program that provides education to the Spanish community
about mental health (Compartiendo Esperanza: Speaking With Latinos About Mental Health,
2019). The program works with a person that has a mental health diagnosis or a family member
that lives with a person who has a mental illness. They provide the material that they need to
educate the community. Mental illnesses influence sleep deprivation, so a program called sleep
problem prevention helps clients inhibit and promote healthy sleeping (Leggett, 2014).
Studies have also demonstrated that exercise has helped minimize mental illness
(Leggett, 2014). Lastly, Reminisce encouraged older adults to provide a life review through
storytelling, sensory recall, or other activities that remind them of the past (Leggett, 2014). This
intervention helped minimize symptoms of anxiety and depression (Leggett, 2014). It is difficult
to show the effectiveness of these innovations because there was no follow-up treatment, so
additional research needs to support the innovation.
There are various traditional mental health programs available for the aging population,
but because of the stigma, not many people use the service available (Campbell, 2017).
Technology has had an impact on how the community communicates outside of their home. A
phone program creates a phone meeting for older adults to communicate with others in their area
(Alibhai, 2017). There is also a program that uses stuffed animals that act and look like a pet
without worrying about feeding them or taking them out for walks (Innovation, 2018).
Latinos are not using many of these programs because of the barriers they encounter
when trying to obtain or use needed services (Pagano, 2014). The less of the services they use,
the less attention they receive for themselves. They struggle with the language barrier and not
understood from a cultural perspective (Pagano, 2014). Various non-traditional programs can
PROTOTYPE 5
cater to the Latino older community that could help with accessibility. Storytelling and cooking
are integral to the Latino community and becomes a form of communication within the
community (Zamudio, 2017). It is essential to create an environment in which older adults have
people they can trust to feel comfortable sharing. Family members, church, at times their medical
practitioner, and social media are sources that Latino’s use frequently.
La Cocina de Abuela is a program that creates a space for Latino older adults in which
cooking, and storytelling is a means to deliver needed mental health support in an informal
format. The program is for Latino older adults between the ages of 65 and 75 who have
symptoms of isolation. It uses experiential techniques with cooking as a tool to facilitate
storytelling. The program provides tools that help them build conversations with their friends,
family members, and other members they meet within the program. The program meets in a
group of a minimum of 8 to a maximum of 10 participants. A Spanish speaking therapist will
lead the session. During the 90-minute sessions, the participants cook and share on a specific
theme that the therapist provides. After each session, the participants prepare the meal and share
it. Once the ten weeks are complete, they have the option of obtaining additional support
through individual therapy.
The group sessions have demonstrated a different perspective of therapy and have
become the gateway to educate the Latino aging population of the meaning of treatment. It
provides participants the opportunity to receive individual treatment. They will meet with a
Spanish speaking therapist weekly at the convenience of their home for ten weeks. Each session
will be an hour-long, and they will work on specific issues the participant is interested in
tackling.

PROTOTYPE 6
The program has had to make changes since COVID19 because people have had to stay
home and have increased social isolation among the aging population (Holt-Lunstad, 2020). The
program will have to temporarily move online to provide the needed support during these
difficult times. During COVID19, the participants will have an iPad and the necessary groceries
that they can use to cook their meals their home. The participants will meet with the therapist and
other participants to share their meals and a guided story behind the cooking. Once the food is
cooked, the participants will have the opportunity to stay online and have a meal and discussion
with the other participants.
The location of the implementation of the pilot program will begin at Saint Augustine
Catholic Church in Culver City, CA, 3850 Jasmine Ave, Culver City, CA 90232. Still, due to
COVID 19, the program will launch online by January 2021. The lead priest of the Church Fr.
Christopher Fagan is interested in collaborating and providing the service to the Latino aging
population. The priest shared a large aging Latino population that suffers from isolation, and
family members and friends are calling the office asking for support. The program is piloted with
Latino older adults between the age of 65 and 75.
La Cocina de Abuela creates a space where older adults share their stories and come to
terms with the causes of isolation. The program encourages older adults to build other
relationships within the group within the community and nurture the links within the family,
which something that has not occurred before. They will be able to build new stories and tackle
new challenges.
The program will help older adults learn the support mental health can provide, build
relationships within the group, and their community. They will be able to embrace their
independence and explore other methods that can eliminate the feelings or symptoms of
PROTOTYPE 7
isolation. The goal is that within the next five years, that program will be expanding to other
cities in Los Angeles county where there is a large population of Latino older adults and are
experiencing symptoms of isolation. The project will help build relationships and encourage
older adults to volunteer in areas that they never thought they could and embrace the changes in
their lives.

PROTOTYPE 8
La Cocina de Abuela
Grand Challenge
Society is being affected by social isolation, and it is having an impact on the
aging population. There are various reasons older adults are becoming isolated, and those reasons
are loss of loved ones, retirement, loss of mobility, and decline in health (Stevenson, 2019). The
first reason is that older adults build relationships in the workplace, and when they stop working
relationships end; as a result, older adults have to be intentional in keeping relationships going,
or they can become isolated from their peers. Secondly, the death of family members or friends
(Stevenson, 2019), which may leave older adults grieving and alone. The third reason is due to
age and decline in health. A number of older adults begin to lose their loved ones and are forced
to isolate because their social network does not exist anymore. Stevenson (2019) shared that
older adults who are socially isolated have higher rates of facing poverty and poor health
outcomes. As a result of isolation, many older adults do not have the motivation to have a
healthy lifestyle.
Along with the general population of the aging community, Latino older adults are also
growing in the United States. They make up eight percent of the population, and the numbers are
expected to increase by 22% by the year 2060 (Mata, 2016). In California, Latino older adults
make up seven percent of the population (Mata, 2016). Compared to other older adults, the
Latino population is prone to have limitations with education, income, and health decline (Mata,
2016). They are considered to be the worst off compared to other seniors from different ethnic
backgrounds (Mata, 2016). In California, Latino older adults are a vulnerable population and are
having challenges with finances, food, housing, and accessing the programs that they need
(Larson, 2017).
PROTOTYPE 9
Older adults require attention from various providers; however, these places encourage
isolation due to the lack of support or experienced exclusion. Interpreters are available for older
adults but are limited, and their concerns get lost in translation (Larson, 2017). Older adults
living in rural areas are at higher risk of not receiving help because most agencies have the
“English only” workplace, which also increases their chances of discrimination and discourages
them from obtaining assistance (Larson, 2017).
Problem
There is a large aging population of Latino older adults who need resources. If the funds
are not available, then it discourages them from asking for assistance and, as a result increasing
the symptoms of isolation (Abedini, 2019). Latino older adults struggle with language barriers,
issues with acculturation, limitations in social support, the decline in health, non-compliance
with medical appointments, misdiagnosis, economic insecurity, and mental health disorders
(Bakhshaiea,2018). Having adequate support or resources can help minimize or eliminate some
of the obstacles. Still, there needs to be an understanding of the environmental factors that
influence the problem.
Within the systems perspective, there is a better understanding of a broader framework of
the problem, behavior, and how the environment affects specific populations (Greene, 2009). The
Latino older adults who immigrate to the United States have different perspectives on life
(Eldred, 2018). They have to build a community, create a family, or leave a family in their home
country (Heisel, N.D.). They are faced with trauma, have issues of acculturation, believe
spirituality is essential and part of life, and are affected by policies that impact the lives of Latino
Older Adults (Larson, 2017). Having an understanding of the various systems can help better
assist the aging population
PROTOTYPE 10
In the United States, the baby boomer population defines the one that has impacted
history and continues to make an impact today (Hayes, 2019). They are such a large population
that they have influenced housing, education, and opened various employment opportunities
(Stevenson, 2019). Today, they are changing the issues in retirement, health concerns, social
security, and isolation (Stevenson,2019). There is a belief that 11 million people over the age of
65 find it challenging because they do not have the social support they need (Stevenson, 2019).
Resources for the aging population are becoming limited and sometimes difficult to obtain
(Pearson, 2019). The United States expects the population over the age of 65 to increase at
approximately 78 million by the year 2035 (Meiner, 2018). With such population growth, there is
growing concern that they are becoming isolated, and it increases their chances of a chronic
condition minimizing the quality of life they want (Esposito, 2015). Older adults who are
separated have higher rates of developing chronic diseases affecting their health and leading
them to death (Esposito, 2015). Those experiencing symptoms of hypertension, physical activity
limitations, and the increase of depression have had symptoms of loneliness and isolation
(Esposito, 2015). Besides, they are also experiencing mental health disorders and cognitive
decline because they are not socializing or interacting as they were used to (Esposito, 2015).
These issues continue to be a concern among the aging population, and they must be addressed
because the resources are difficult to obtain.
Latinos in the United States are a diverse population because the people living in the
United States have a different country of origin and the number of years that they have lived in
the United States (Garcia, 2017). Latinos are becoming a growing population in the United
States. Still, one of the most vulnerable people is the senior Latino population, and with an
increasing population, there is also a growth in the demand for specific resources (Garcia, 2017).
PROTOTYPE 11
There is limited information on how Latinos immigrated to the United States, but what is
available demonstrates that Latinos from Mexico has been living in California and various areas
that lead to Texas since the mid-1800s (Thompson, 2001). The reason is that after the Mexican
war, the United States took the territories that belonged to Mexico. Puerto Ricans immigrated
from the 1950s to the 1960s due to the increase in unemployment rates (Thompson, 2001).
Cubans migrated to the United States in the 1960s when Fidel Castro became the country's
leader, and they were given refugee asylum (Thompson, 2001). Lastly, Central Americans
immigrated to the United States from the 1970s to the 1990s because of war-related trauma and
terror. Even though they have endured all the trauma, they have never been considered political
refugees (Thompson, 2001). Now, those that immigrated during that era as adults are over the
age of 65. In California, Latino older adults are one of the most vulnerable populations,
specifically when it deals with retirement income, hunger, health, housing, and accessing
programs, which leads to isolation (NHCOA, 2016). In California, twenty percent of the Latino
population will be considered over 64 by 2060 (Caucus, 2017). In 2019 it was recorded that Los
Angeles County had 4.9 million Latinos in the county, which is the largest than any other in the
country (Bustamante, 2020). This large population have various health issues they must tackle.
Latino older adults are facing challenging health outcomes because they have a diagnosis
of various chronic conditions. Some of the most common conditions are heart disease, malignant
neoplasm, cerebrovascular disease, diabetes, Alzheimer’s disease, chronic lower respiratory
disease, influenza and pneumonia, nephritis, and chronic liver disease. The health conditions
demonstrate the health disparities they have. In California, it is documented that 21% of the older
Latino population feel they are not receiving the quality health care they deserve. When they do
receive the attention, they need it is often too late. If they are not provided with adequate
PROTOTYPE 12
healthcare, it becomes a burden for the government because of the additional expenses that an
Emergency Room visit can have. These are situations that can be prevented if adequate health
care support and education is provided.
There are higher rates of older adults who have a mental illness than previous aging
generations. Over 20% of older adults are diagnosed with a mental or neurological disorder
(Mental Health of Older Adults, 2017). Latino older adults have a history of not using the mental
health resources available because of the stigma that follows (Llorente, 2019). It is more
common for male immigrants to not receive adequate mental health support because of the
cultural influences and the belief that if they need mental health support because they are crazy.
There has been a 107% increase in Alzheimer’s Disease in older Latino adults between
1999 and 2014 (Latinos Against Alzheimer’s, 2019). Due to the dramatic rise of Latino older
adults diagnosed with Alzheimer’s, it is going to have a toll on the patient and the family as well
because of the financial hardship it can cause (Latinos Against Alzheimer’s, 2019). Even though
Latinos make up 17% of the United States population, less than one percent are part of the
clinical health trials (Latinos Against Alzheimer's, 2019). It is a concern because there can be
limitations in the type of support and resources they receive.
Older adults tend not to receive adequate substance abuse treatment because of
misdiagnosis for another behavioral disorder (Juergens, 2019). Sometimes health-related or a
dramatic altering life event can encourage older adults to lead a life of substance abuse
(Juergens, 2019). Specific symptoms that can describe substance abuse a physician can
misdiagnose as old age. Prescription drugs like Benzodiazepines are used for anxiety, pain, or
insomnia, and it is becoming a drug used frequently (Juergens,2019). Older adults are becoming
PROTOTYPE 13
addicted to the medication (Juergens, 2019). Older adults face drastic changes, and sometimes it
can be easier to resort to substance abuse.
Older adults who face depression might be difficult to diagnose because symptoms are
different than what you would usually see in a younger adult (Depression and Older adults,
2017). Depression occurs when life-altering events happen in a person’s life (Depression and
Older Adults, 2017). If they do not have a period of adjustment to regain their emotional balance,
then it can lead to depression and can sometimes be difficult for them to go back to the routine
they use to have (Depression and Older adults, 2017). Creating an environment in which they
can have a culturally safe space for them to share can help minimize the symptoms of
depression.
Older adults struggle with their mental health, but they also have to struggle with the
burden of the cost of housing (Living, 2019). Older adults are faced with the weight of having to
pay a lot of money for housing, especially when the money they receive is not enough (Living,
2019). They fall under the worst possible housing scenario and live in poor conditions (Living,
2019). They are paying more than 50% of the income they are receiving (Living, 2019). Some of
them are working extra hours to pay for their primary necessities. The worst-case needs have
gotten worse from 2003 to 2013 (Living, 2019).
Latino older adults over the age of 65 have a median income of $40,512 (ACL, 2019).
For male Latino older adults, the median salary is $19,179, and for Latino older women, it is
$12,758 (ACL, 2019). Latino older adult’s poverty rate is documented at 17%, which is higher
than any older Americans, which is recorded at 9.2% (ACL, 2019). The statistics demonstrate the
inequality older adults face, the limitations in resources, and difficulty accessing the available
resources.
PROTOTYPE 14
Sometimes income or limitation of income can lead to elder abuse, and it doesn’t have to
be physical, but it can be emotional and financial damage (NHCOA, 2016). Latino older adults
in Los Angeles reported that 40% of them had experienced some abuse (NHCOA, 2016). They
shared that 10.7% have been physically abused, 9% have been sexually abused, 16.7% have
suffered from financial abuse, and 11% suffered from neglect (NHCOA, 2016). Those who
suffer from abuse have experienced an injury, pain, sleep disturbance, psychological
consequences, and premature death (NHCOA, 2016). Latino older adults have experienced and
continue to experience so many issues that can hinder their overall being, leading to isolation
(HHCOA, 2016).
Various programs are trying to tackle the issues Latino older adults are facing (Eldred,
2018). More hospitals are hiring Spanish speaking staff and marketing to the population, but it
seems as though it isn’t enough because of the stereotypes and the support they receive (Eldred,
2018). Latino older adults need mental health support (Eldred, 2018). Didi Hirsch, Los Angeles
County of mental health, other private therapists, and nonprofit organizations provide mental
health support, but there is a long waitlist to receive help (Eldred, 2018). Some might not know
or understand the impact mental health can have on the activities of daily living and do not seek
support (Health, 2016). For those struggling with housing, there is section 8, LAHSA, and senior
housing assistance, but once aging, there is a long waitlist, or the support is closed because of the
high need (Padgett, 2020). Those that are struggling with financial hardship also have the
opportunity to obtain assistance with meals (Caucus, 2017). Still, Latino older adults are not
receiving the support because they are scared of the consequences it might bring, or they are not
aware of the support (Caucus, 2017).

PROTOTYPE 15
Through the systems theory, there is a better understanding of the struggles older adults
have faced and continue to meet, which are life changing. The program gives Latino Older adults
the space they need to share their efforts and concerns. They have not had adequate education
and support to have an understanding of the available resources. La Cocina de Abuela will
provide them with a team that will provide mental health support, but they will be able to relate
to them culturally. They will have the expertise and understanding to assist them better and lead
them to socialize with others. The logic model in appendix 1 provides a better understanding of
the goal and outcome of the program. The program will have adequate equipment and bilingual
staff that will be able to communicate with the aging population. For the older Latino adults who
are experiencing isolation symptoms, they will qualify to participate in group sessions that
consist of cooking with storytelling. If additional support is needed, they will have the
opportunity to receive individual therapy.
Solutions/Innovation
The innovation is a program called La Cocina de Abuela. The program will tackle social
isolation for Latino older adults by using narrative group therapy in an environment they are
comfortable with, cooking, and storytelling (Morgan, 2000). Narrative therapy is a form of
treatment that uses a non-blaming approach and focuses on the person as an expert in their lives
(Morgan, 2000). The problems are separate from the person and assume that they have skills,
competencies, beliefs, values, commitments, and abilities that will help reduce the issues the
person is facing in their lives (Morgan, 2000). This program allows Latino older adults to share
their struggles, traumas, and concerns in a safe environment. It will be an environment that they
can relate to. They would meet with others who might have similar experiences and share the
same language. Group therapy can help open the door to individual treatment if they feel they
PROTOTYPE 16
need additional support. Once they have completed the group sessions and think they need
further assistance, they will have the opportunity to receive additional support in individual
therapy.
The program will improve with the Grand challenge eradicating social isolation because
Latino older adults will have the opportunity to address the issues that are leading to social
isolation. The program will give them the space to solve the underlying problems that address
isolation. It will allow them to explore and learn about the person they are, talk about their grief
and losses, address any trauma, and try to find healing and meaning within their story. The
program will help Latino older adults socialize with family members, build relationships within
their community, and new relationships within the group sessions.
Stakeholders perspective.
Stakeholders are considered those who might be interested in people who can influence
or affect a company or people (Chen, 2019). Some stakeholders for Latino older adults are health
care providers, family members, close friends, immigration communities, caregivers, and
insurance companies.
Health care providers are having difficulty providing adequate care (Zamudio, 2017).
They have difficulty obtaining a full medical history (Zamudio, 2017). Healthcare providers have
difficulty communicating with older Latino patients (Zamudio, 2017). Because of the patient
caseload and documentation, they do not have time to build rapport (Zamudio, 2017). Medical
providers are also having difficulty providing care because older Latino adults who are living in
poverty, Latino older adults are exposed to environmental problems (Mandal, 2019). Maintaining
their health is the last thing on their mind until they have severe pain that they have to be taken to
PROTOTYPE 17
the emergency room (Mandal, 2019). Often, those brought to the emergency room have more
extended hospital stays because of the critical condition they might be in.
Health care providers struggle to provide adequate care, but the staff at nursing homes
have a high turnover rate and have difficulty building rapport with their patients (Kashi, 2017).
They are frequently understaffed and find it challenging to give adequate time and care they need
(Kashi, 2017). Documentation has demonstrated that patients are usually over medicated with
antipsychotic medication and do not have the opportunity to socialize with others because of the
drug they are receiving (Kashi, 2017). Older adults in nursing homes have a history of isolation
because of the limitations in activity and staff (Kashi, 2017).
Being a caregiver can be difficult, and times decisions are made that they have to place a
loved one in an assisted living facility or nursing home. Older Latino adults can be an essential
part of family life, but due to the caregivers being compromised in the sandwich generation, they
are forced to be isolated (Rodriguez-Chamussy, 2018). Sandwich generation means that they are
caring for an older adult and their children (Rodriguez-Chamussy, 2018). It is a stressful situation
because it is difficult to care for various people and not have enough time to care for themselves.
Due to the stressors, caregivers face isolation because they have difficulty being involved in
social activities or routines that build self-care (Rodriguez-Chamussy, 2018). Caring for older
adults and family is a difficult task and identifying and asking for help is very important to
maintain their well-being (Rodriguez-Chamussy, 2018).
Policies
History has demonstrated that older adults have not been given resources because they
have never really been a priority and are not living as long as they live today (Achenbuam,
2014). The aging population is dramatically growing, and it can have detrimental effects on the
PROTOTYPE 18
economy and the people (Markwood, 2018). There is even a conversation that social security
might not have enough funding for the aging population because such a large population will
need those benefits (Gusmano, 2018). Baby boomers have made changes along the way, and now
that they are aging, they are making an impact in various areas because the demand is high
(Gusmano, 2018). Aging agencies are working closely with Congress to create policies that can
help the aging community (Markwood, 2018). Some changes are continually being made with
the Patient Protection and Affordable Care Act, Medicaid, and Medicare (Markwood, 2018).
These programs and insurances have a significant influence on the aging population. They
impact the care and support they receive if it weren’t for these programs, then it would be
difficult for them to receive adequate care and pay for housing and utilities. There are various
available programs and can be an excellent resource for the Latino population, but unfortunately,
Latinos are underrepresented and present a small percentage in specific clinical trials (Perez,
2018).
The Patient Protection and Affordable Care Act was created to allow citizens to receive
adequate health care (EP, 2019). It took years for the act to get approved, but many gaps were not
evident after it was passed (EP,2019). Today congress continues to make changes that can
provide adequate support (EP, 2019). Health care plays a vital role in Latino older adults and
social isolation (EP, 2019). Those who are socially isolated have been diagnosed with a chronic
condition that limits their activity and can sometimes make it difficult to attend the doctor's
appointments (EP, 2019). Providing the population with adequate support and resources can
encourage less spending (EP,2019). If a patient is not provided with the appropriate treatment,
then there is a higher possibility of the patient going to the emergency room, costing more
money (EP,2019).
PROTOTYPE 19
Medicaid is an insurance that is federally and state-funded for low-income people of all
ages (Medicaid and Long Term Care for the Elderly, 2018). Medicaid covers physician visits,
non-medical support services, home personal care assistance, and nursing home care (Medicaid
and Long Term Care for the Elderly, 2018). Medicaid can also cover long term care, but they
have to qualify for that service, and every state has its criteria (Medicaid and Long Term Care for
the Elderly, 2018). The benefits of the program being presented encourage older adults to share
their concerns with Medicaid and address any questions (Medicaid and Long Term Care for the
Elderly, 2018). Navigating the Medicaid process can be difficult, and the program's support can
alleviate the stressors and address the issues they are facing with Medicaid (Medicaid and Long
Term Care for the Elderly, 2018).
Medicare is a health insurance program that is geared for the population over the age of
65(James, 2019). One in four beneficiaries who receive Medicare has $15,000 in savings and has
some debt (James, 2019). White Medicare beneficiaries have more considerable savings than
black or Hispanic beneficiaries (James, 2019). Their savings and debt demonstrate that the
minority population would not be at a loss with Medicare. Even though Medicare covers a large
portion of the medical costs, some beneficiaries have to pay a significant part for an out of
pocket cost that they still cannot afford, especially medication they need for their medical
condition (James, 2019). Creating guidelines that can lower prescription drugs' costs can help
save money that can be used for food, housing, and other needs that the aging population needs
(James, 2019). Medicare can be confusing, and at times, trying to understand and have a team
that can provide the assistance and advocates for the patient's needs is essential to ensure they
can receive adequate care.
Opportunities for innovation
PROTOTYPE 20
The programs that tackle isolation issues for the aging population are growing and
building opportunities for older adults to socialize. Some examples of the current plans are
mobile technologies, internet, videoconferencing, online games, and social networking sites that
provide opportunities for older adults to connect with family, friends, and people in their
communities (Alibhai, 2017). Technology offers the opportunity to create a connection and help
decrease feelings of isolation, loneliness, depression, and anxiety (Alibhai, 2017). A great
example of innovation for older adults is Joy For All(Innovation, 2018). This company creates
pets that look, sound, and feel like an actual cat or dog, depending on their preference
(Innovation, 2018). The stuffed animal has sensors that respond to motion and touch (Innovation,
2018). This specific innovation provides a companion for an older adult who can help with
socialization. Another innovative program is the Senior Centre Wall program (Sutcliffe, 2014).
The program's goal is to create a conference call between seniors without the use of equipment
except for the telephone (Sutcliffe, 2014). Each phone session is between 30 and 60 minutes, and
each course consists of 10 to 15 participants (Sutcliffe, 2014). This program allows others to
create relationships within their community and socialize with people within their age group.
Some of the resources may not be readily available for Latino older adults because of the
limitations in income and deficiencies in education (Pray, 2010). At times, technology is not
sufficient because there are emotional barriers that limit them from interacting with others
(Anderson J. R., 2018). Creating a program that takes away the stigma of mental health provides
emotional support and provides the necessary tools to not regress to isolation. Once the
emotional issues are addressed, then using the technology that is being offered can help the aging
population socialize with others in the community (Anderson J. R., 2018).
Innovation aligns with the theory of change
PROTOTYPE 21
La Cocina de Abuela aligns with the systems theory of change because it tackles many of
the issues Latino older adults are facing. It allows older Latino adults to build relationships with
their health care providers, nursing staff, and caregivers. Latino older adults will advocate for
themselves when faced with questions they might have concerning their medical condition.
During the group sessions, they will be provided with education regarding self-care and how to
ask their primary physician the critical questions. The program is easily accessible, and even
nursing homes can apply for the program to provide the mental health support the Latino aging
population needs. It could also benefit the staff by providing the needed support. It would help
the medical team and nursing team, but it would give relief to caregivers who are struggling with
burnout.
Success
The innovation aligns with the logic model as it creates an opportunity for Latino older
adults facing social isolation and is trying to find healing and meaning within their story
(Morgan, 2000). It has been proven to be useful for all ethnicities and economic backgrounds
(Morgan, 2000). It’s an opportunity for the participant to overcome what they need to overcome
(Morgan, 2000). It demonstrates the beauty in their story and problem outside of themselves
(Morgan, 2000). Integrating the cooking aspect of therapy combines the cultural perspective of
how cooking influences older adults and provides them with independence and clarity through
the cooking process (Andrews, 2015). Having a bilingual team can create rapport and educate on
the importance of socializing by adding a support group and including food and activities that
can generate socialization and discuss topics of concern (Andrews, 2015). This program is likely
to succeed because it builds on creating an environment in which older adults feel comfortable
storytelling and cooking food. Food within the Latino culture carries its history, and families can
PROTOTYPE 22
share that while talking about a recipe or sharing and making the recipe (Thrussell, 2015). The
program is an opportunity to engage older adults in an environment that allows them to share
their stories in a culturally acceptable way.
Methodology
The population of Latino older adults is growing, and it is expected to increase at least 20
percent by the year 2060 (Bustamante, 2020). With the growing population, some concerns are
not addressed (Bustamante, 2020). Latino older adults suffer from limited education, the decline
in income, diagnosis of more than one chronic health condition, grief and loss, smaller social
networks, and through statistical standards, they are the worst in comparison to other aging
groups (Bustamante, 2020). Latino older adults struggle to access the resources they need
because of not being able to speak the English language, discrimination, and limitations to
adequate interpreters that can better assist them (Larson,2017). Latino Older adults who are
socially isolated have many issues to address (Esposito, 2015). They have faced trauma in their
home country and the country they live in today (Heisel, N.D.). There are so many issues that
Latino older adults have faced and continue to struggle with (Esposito, 2015). The program
being proposed will have a Spanish speaking team that will provide the needed support. The
group sessions combine cooking, and storytelling gives the clients the opportunities to help them
face the issues that might be triggering social isolation.
For the program to be successful, an initial referral must be made. The office staff will
process the paperwork and set up an appointment with the participant. A Spanish speaking
therapist will meet with the participant for an introduction and explanation of the program. If the
participant agrees, then the initial assessment will be completed. Part of the evaluation will
include completing confidentiality forms, treatment goals, and a pretest, which is the geriatric
PROTOTYPE 23
depression scale are provided in the curriculum. If the participant's symptoms are severe, and
they do not qualify for the program, then other resources will be provided. Once the assessment
is complete, the therapist will give a date of the initial group session.
Once all paperwork and assessment are submitted, the participant will attend the ten-
week cooking and storytelling sessions. Each week the participants will focus on a particular
theme. The themes that will be discussed are country of origin, present life and day to day
activities, skills and abilities, hopes and goals, essential people in their lives, gifts from
influential people, and challenges. Since cooking and storytelling are an integral part of the
Latino culture, the participants will cook or share a recipe that tells a story of a question the
therapist will provide (Kitada, 2016). After the ten weeks, each participant will be able to go
home with a book of recipes they shared, a gift card to encourage them to complete the group
sessions, and a post-test to see if there have been changes with their symptoms.
After the participants have been exposed to a non-traditional form of therapy, they may
be more inclined to explore additional support with individual treatment. The therapist will visit
the client weekly for a total of ten weeks. If restrictions due to current global pandemic, COVID-
19, are t still in place, then the visits will be conducted virtually. During the ten-week session,
the therapist will work with the client to address the issues triggering socially isolating behaviors
of the client and minimize any mental health concerns and possible disorders that have
developed due to the social isolation. For a detailed description and outline, please refer to
Appendix 7.
Analysis of the market
Various programs provide support for the aging Latino population. Some of the most
common programs among mental illnesses are medication and psychological interventions like
PROTOTYPE 24
cognitive therapy or problem-solving therapy (Leggett, 2014). Innovations are being created to
help provide mental health services in the convenience of the home (Leggett, 2014). Treatment
can now be delivered online and easily accessed at any time with access to the internet (Leggett,
2014). Some mental health programs focused on the aging population have stepped into the
program called CARE program. The program uses an RN to visit the patients for three months,
and after that period, they evaluate and assess the needs of the patients (Leggett, 2014). Healthy
IDEAS is another program that identifies depression and provides tools that empower seniors
with various activities that might interest them (Healthy IDEAS, 2017). PEARLS is a program
that offers counseling services that encourage active and productive lives, specifically for seniors
that are depressed (PEARLS program, 2019). Lastly, Esperanza is a program that focuses on the
Spanish community with education on mental health (Compartiendo Esperanza: Speaking With
Latinos About Mental Health, 2019). The program works with a person diagnosed with a mental
illness or a family member who lives with a person who has a mental illness. They are provided
with the material that they need to educate the community (Compartiendo Esperanza: Speaking
With Latinos About Mental Health, 2019). Mental illnesses are also influenced by sleep
deprivation, so a program called sleep problem prevention helps clients with inhibiting and
promoting healthy sleeping (Leggett, 2014).
Not only are mental health programs helpful, but some studies have also demonstrated
that exercise has helped minimize the symptoms of mental illness (Leggett, 2014). Lastly, a
program called Reminisce encourages older adults to provide a life review through storytelling,
sensory recall, or other activities that remind them of the past (Leggett, 2014). This intervention
helped minimize symptoms of anxiety and depression (Leggett, 2014). It is difficult to show the
PROTOTYPE 25
effectiveness of these innovations because there was no follow-up treatment after the programs
were provided, so additional research needs to support the innovation.
The program Reminisce is an innovation that helps older adults with depression because
it encourages conversations and activities that support older adults to discuss their life and helps
them explore symptoms that can cause depression and anxiety (Sauer, 2019). Therapy can also
help with minimizing the symptoms of depression (Sauer, 2019). Lastly, the Fisher Wallace
Simulator helps with depression symptoms because it stimulates the brain to release serotonin
and dopamine (Utley, 2016). The beautiful part of this simulator is that it can be done at the
convenience of the home. Native Americans have used storytelling to keep their culture and
beliefs for future generations (Hodge, 2002). A storytelling program was created for Native
Americans and Alaskan Natives to provide education and encourage healthy behaviors (Hodge,
2002). The plan proposed creating talking circles where the clients meet weekly for 12 weeks in
tribal health clinics or tribal buildings (Hodge, 2002).
Community members are trained to facilitate the sessions and provide clients with the
needed support (Hodge, 2002). These programs reclaim the importance of storytelling and
wellness in tribal communities (Hodge, 2002). Storytelling has been used for generations and has
created reflection and changes with Native American communities when they have not read or
write (Hodge, 2002). Lastly, various cooking programs are being used in multiple communities.
The first one is Dinner for 30; this program uses storytelling explicitly and cooking for
community building (Lane, 2017). A specific guest that is invited will cook while sharing a story
and allows for the additional guests to engage and share the meal, which supports the idea of
community d (Lane, 2017). Lastly, Chef Serenity Wood is another engaging cooking program
that uses culinary cooking and storytelling to understand the food consumed (Woods, 2018).
PROTOTYPE 26
These programs focus on cooking and storytelling, but it does not cater to the Latino aging
population's needs.
Program implementation
The location of the implementation of the pilot program will be done at Saint Augustine
Catholic Church in Culver City, CA, 3850 Jasmine Ave, Culver City, CA 90232; however, due
to COVID-19, the goal will be to launch the program online by January 2021. The lead priest
and collaborator, Father Christopher Fagan, will help collaborate with the program. Father Chris
has been the lead priest of the church for over 12 years and is very involved with the community.
Due to the large aging population in the parish, specifically Latino older adults, there is a need
for support. Many families contact the main church office, asking for help. The program is being
piloted with the Latino older adults that are between the ages of 65 to 75.
La Cocina de Abuela was introduced to Father Chris when he reached out, asking for
support and wanting to know more about the aging population and its benefits. Father Chris
shared that many Latino older adults are struggling with symptoms of isolation, and family
members have called Father Chris asking for advice and support because they do not know how
to support them. Father Chris wants to use the resources that are available from the volunteers in
the church. The beginning phase is complete, as Father Chris has agreed to implement the
church's pilot at the beginning of January 2021. The program's continued plan of implementation
is to promote within the parish and enroll a maximum of 20 participants for the pilot program
within the first three weeks of promotion. A flyer is provided (Appendix 6) to use as a
promotion. Education to the staff at the parish about the program is essential to provide reliable
information for those that are calling to ask for more information. For those that are interested,
an appointment will be made to schedule an initial assessment. Once the evaluation is completed,
PROTOTYPE 27
they will be provided with a date and time of the sessions. Those that do not qualify for the
program will be given resources to assist them better. Having a Spanish speaking team will help
increase communication and help build rapport, trust, and understanding.
Some obstacles that the program can face will be that older adults might be hesitant to be
part of the program because they are not familiar or feel comfortable sharing their feelings,
specifically with people in the community. Family members might not trust a therapist providing
therapy because of the stigma that mental health has within the Latino population. There is also
the possibility that there are many participants interested in the program, but there is not enough
space or funding to provide the service.
Some alternative pathways that can help the implementation process will be to provide
educational workshops on various topics that give an insight into possible experiences older
adults having to support the community in maintaining the aging population within their
families. There is also the flexibility of integrating family members into the group sessions to
support the rapport building by having familiar individuals present, such as family members or
close friends. Lastly, additional research into other facilities that might be able to accommodate
space and a kitchen to conduct the group sessions.
Financial Plans
The program's long-term vision is to open the doors of the program over the next five
years to various cities in Los Angeles County that have a growing ratio of Latino Older adults.
The organization will be receiving an annual fund of $2 million to maintain the program. The
program will provide culturally sensitive bilingual staff that can address the needs of older
adults. They will be able to speak the participants' language and provide them with the needed
support through a combination of cooking and storytelling, which is an unconventional method
PROTOTYPE 28
that they might not have seen before. The number of participants enrolling, and the positive
outcome of the group therapy will demonstrate the program's success. Social isolation is a
common issue and having the resources in place can provide a better quality of life. The sector
La Cocina de Abuela will apply for the nonprofit organization 501c3 by the summer of next year.
The pilot program will have been concluded, and adjustments made based on outcomes to
support success. Funding will go directly to programs that will open up additional possibilities
for the organization to receive state funding, federal funding, and private funding. The program
will be tax-exempt, which can be used for the needs of the clients. The final authority will be the
board of directors; they will have the final say in the program and the financing aspect of it.
Scope of Pre-Operation Start-Up Plans
For the program to be successful, there are a few things that need to be in place. Office
space is necessary as it will be a place where staff and clients can share and feel they are a part of
a community. There is an open office space in the Crenshaw Medical Arts Centre that is easily
accessible for the aging Latino community in an area beneficial. The initial startup cost of the
office space rental is $4,400.00 for the first month. After the first month, rent will be $2200 per
month. Part of the office maintenance will have electricity and water bills. The initial startup of
installing the water and power will cost $1,000.00 and an additional $500 every other month.
Janitorial service will be needed to clean the office daily and cost an additional $26,000 a year.
The initial cost of installing a telephone system and a cell phone will have a cost of $5,000.
Having liability insurance and business insurance will cover any lawsuits that will have an initial
fee of $1,000.00. Creating a marketing team that will outreach physicians, senior centers, nursing
homes, board, and cares, assisted living families, churches, and any other community outreach
programs that could benefit from this program will cost $100,000 a year. An Executive Director
PROTOTYPE 29
who manages the program's business and clinical aspect will have a salary of $160,000.00 a year.
The Chief Financial officer will manage all finances and will have a salary of $110,000 a year.
Two administrative assistants will help with the office duties, and each of their yearly salaries
will be $50,000. The Director will also hire three Licensed Clinical Social Workers who will
each have an annual salary of $100,000. The duties will include completing initial assessments,
conducting group therapy, and visiting clients in their homes if there is a need. Two MSW
therapists will also be hired to assist in the field, and their yearly salary will be $85,000. Every
staff member that is employed is required to receive training on confidentiality, documentation,
and online database training, which will cost $10,000. The field staff will also be required to
obtain training in substance abuse, physical and sexual abuse, and Narrative therapy training.
The cost of this training will be an additional $10,000. An initial startup of office equipment and
office supplies will have a cost of $9,000. Having a reliable internet network, adequate laptops,
desktop for the staff, and iPad for the clients will cost $40,000. Participants will all receive an
iPad to engage in group therapy or individual therapy during the current global pandemic,
COVID-19. Having a kitchen with all the cookware and equipment will cost approximately
$17,650.00. Additional costs will arise with groceries at $600 a month, which the clients will
need for therapy. Having adequate space, resources, and the team is detrimental for the program
to become successful. The program will be launching once the proper staff is hired and
adequately trained, which would take approximately three months. A detailed budget plan
(Appendix 2) provides additional and accurate information.
Scope of First-Full-Year-of-Operations
The expectation of the program is to start with 50 clients in the South Los Angeles area
during the first full year of operation. The therapist will be hosting group meetings every day
PROTOTYPE 30
with a maximum of 10 participants per meeting and a minimum of 8 participants per meeting.
The group meetings will be held in the office, where a kitchen will be set for the group sessions.
In order to encourage the participants to attend the meeting, the staff will be providing the
participants with gifts cards once the sessions have been completed. The staff in the field will be
working closely with each other and the office staff to provide adequate care the clients will need
in the home. In order for the program to be exposed in the neighborhood, the office will hold
luncheons and activities where older adults and family members are able to join. The program
will also buy pens, notepads, mugs with the name of the agency. These marketing strategies can
help spread the word of the program through word of mouth. This is an opportunity in which
they will feel that they are part of the community, and they are celebrated. An itemized budget
(See Appendix 3) provides additional information on materials needed for a successful program.
Evaluation
To demonstrate the impact of the program, the Geriatric depression scale will be provided
as a pre and post (Appendix 4). The Geriatric depression scale is frequently used among the
aging population, and it appears to have a positive outcome, specifically when the short form is
provided (Krishnamoortyhy, 2020). The scale has been translated into Spanish and is easily
understood by the participants (Krishnamoortyhy, 2020). In the initial assessment, a Geriatric
Depression scale will be used as a pretest, and once the participants have completed the group
session or individual therapy, they will complete the Geriatric Depression Scale as a posttest to
assess the improvements and the impact the program has had on the participants. The EPIS
model provides an opportunity to create a visual in regard to the process of implementation and
impact the program is having on the community (Moullin, 2001). The EPIS framework focuses
on the exploration phase, preparation phase, implementation phase, and sustainment phase
PROTOTYPE 31
(Moullin 2001). In having a visual of the process of implementation and the impact of the
program, using the EPIS framework, the implementation timeline is documented and depicts the
process and overlaps (Moullin, 2001). The exploration phase, preparation phase, implementation
phase, and sustainment phase have some areas of overlap as these phases are constantly changing
and adapting to the needs of the Latino older adults (Moullin, 2001). The timeline in Appendix 5
provides a better understanding of how long each phase will take and can be altered if needed.
Having adequate documentation can help assist in educating on the success of the program to
possible stakeholders and people interested in providing funding.
Stakeholders
Stakeholders have an essential role in how successful the program can be. Health care
providers, nursing home staff, caregivers, family, and friends must be aware of the program's
support and services. One way to keep them involved is by providing volunteer workshops and
having staff help healthcare providers if they need assistance. Nursing homes would have staff
visit patients and schedule the sessions in the nursing home. Lastly, involving family members
and friends by having workshops for them and meeting the team that is assisting the Latino Older
adult. The critical internal stakeholders involved in the program are the management team, the
therapist, the office staff, the board members, and the owner. In order to maintain the internal
stakeholder's happy, management will have weekly meetings to address any concerns; the team
may have, lunch will be provided, they will be paid higher than the average rate, and they will
have training and workshops so they can have a better understanding on how to treat the
participants. The internal key stakeholders are an essential asset to the organization because they
are the ones who keep the program moving. They help address any issue the program is facing,
and they help the clients with the plan of care. If there is a high turnover rate with the employees,
PROTOTYPE 32
then it begins to affect the clients. The external stakeholders are an essential asset to the
organization because the program needs the clients to keep open. If there is no funding available
for the program, then the program is forced to close because it cannot maintain the necessary
expenses to keep the program flowing.
Some considerations to be aware of are that older adults might have sudden changes in
their overall health condition, which can increase their chances of having a frequent illness,
resulting in a barrier to documenting the outcome of the program. Clients might also have stayed
in the hospital or might die, which can also lead to limited documentation of how effective the
program can be.
Impact on the audience
The program will impact the participants because a nontraditional format of mental health
will be used (Morgan, 2000). Storytelling has been a tradition that has been used in various
cultures and served for multiple purposes (Tobin, 2007). Storytelling provides education,
political mobilization, and entertainment, and it allows others to share their point of view (Tobin,
2007). In narrative therapy, the participants will have the opportunity to find meaning and
healing within their story, as there is evidence of its effectiveness in all ethnicities and economic
backgrounds (Morgan, 2000). This type of therapy helps the participants look at the beauty of
their stories outside of themselves (Morgan, 2000). Lastly, in addition to narrative therapy,
cooking provides its form of treatment. It will help the participant slow down and focus on the
task (Andrews L., 2015). If they are focusing on the moment, there is no room to think about
worrying about any future problems that can arise (Andrews L., 2015). Cooking helps provide
mindfulness, reduce stress, and creativity (Andrews L., 2015). When a person cooks, it helps
them center themselves and focus on the actual and the process that it has when cooking, there is
PROTOTYPE 33
difficulty (Andrews L., 2015). These forms of interventions will help older adults share the
struggles and concerns that are causing them to isolate.
Capstone components, as a collection
The capstone components that will address the stated problem will be a Spanish speaking
and culturally sensitive to the needs of the aging population (Zamudio, 2017). The therapeutic
team will provide mental health interventions that will address the issues causing older adults to
isolate. During the cooking process and storytelling, they will be able to navigate and find
solutions that can encourage them to receive the support and resources they need (Morgan,
2000). Lastly, during group therapy, the participants would build relationships with each other
because they have spent time with each other and have shared intimate moments that might not
be easy to share.
Ethical Consideration
Latino older adults have various beliefs concerning mental health and might find it
embarrassing to accept help (Campbell, 2017). There is also a lot of misinformation that older
adults might have regarding mental health symptoms (Campbell, 2017). They might feel like
those symptoms might be part of the aging process and that there is no need for interventions
(Caplan, 2019). Some ethical considerations to keep in mind will be that some family members
and participants might not feel comfortable being part of the program because of the fear that
they might be taken advantage of (Campbell, 2017). There might also be possibilities that
participants might not be able to complete the program because of changes in their overall health
or unpredictable hospitalizations. Lastly, there might be a large population of Latino older adults
seeking services, and the program might not have enough support staff and material to meet their
PROTOTYPE 34
need for support. Los Angeles County Mental Health and county contracted programs usually
have a long waitlist and may take a significant amount of time to service, if at all (DMH, 2014).
Conclusion
La Cocina de Abuela is a program that provides mental health support to Latino older
adults who are suffering from social isolation. Latino older adults are faced with struggles and
obstacles and find it difficult to ask for help or needed resources that will cater to their needs
(Caballero, 2017). The program would educate the population and their relatives on the
importance of mental health and the type of support. Providing a mental health team that is
culturally sensitive and can address their need in their language can have an impact on their
treatment and life. Aging adults can have so many changes, and sometimes it can be hard for
them to process the changes they face, which leads to social isolation (Caballero, 2017). Having
a program that can give them the space to share and grieve in a non-formal way can provide
healing and opportunities for them to socialize not only within the support group but with family
members, longtime friends, and communities they live in.
They have to struggle with trauma, but late in age, they have to struggle with
socioeconomic inequality, housing, and health decline (NHCOA, 2016). Being part of the
program will help Latino older adults build rapport, ask questions, and address any needs they
will have. They would have created a rapport with the staff that they would be comfortable
asking the hard questions. Since older adults have built rapport and a relationship with the team,
they will feel comfortable to ask questions and build relationships with others who are going or
have gone through similar experiences.
Aging adults can have so many changes, and sometimes it can be hard for them to
process the changes they face, which leads to social isolation (Caballero, 2017). Having a
PROTOTYPE 35
program that can give them the space to share and grieve in a non-formal way can provide
healing and opportunities for them to socialize not only within the support group but with family
members, longtime friends, and communities they live in (Depression and Older adults, 2017).
Creating environments that will limit isolation symptoms can have an impact on the community
(Esposito, 2015).
The goal within five years is to expand the program to other cities in Los Angeles county
that have a high population of Latinos and need support. Some limitations that the program will
have will be funding and making sure that the census is available to maintain the staff. There
must be a marketing and funding team that will be able to promote, fundraise, and apply for the
needed funding. The program can be shared with other programs that cater to the Latino
community. But there would need to be a Spanish speaking team that can provide them the
needed support in their language and understands their cultural perspective.

PROTOTYPE 36
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PROTOTYPE 40
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PROTOTYPE 41
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PROTOTYPE 42
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PROTOTYPE 43
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PROTOTYPE 45
Appendix 1 Logic Model

1
NIH – National Networks of Library of Medicine
Logic Model Template
1

Program: La Cocina de Abuela

Goal: Minimize symptoms of social isolation and increase the social skills among Latino older adults
INPUTS ACTIVITIES OUTCOMES
What we invest What we do Who we reach
Why this project: short-
term results
Why this project:
intermediate results
Why this
project: long-
term results

• Spanish speaking
Office Staff
• Spanish speaking
Management
• Spanish speaking
field staff
• Technology
• Office equipment
• Office supplies
• Marketing
• Food
• cookware

• Train staff
• Conduct meetings
• Provide group therapy
through cooking and
storytelling
• Provide individual
therapy if additional
support is needed
• Provide any needed
resources
• Provide phone calls
• Market the program
• Provide culturally
sensitive information
and support

• Latino older adults
between the ages of
65 to 75
• Family members
• Case managers
• Senior centers
• Medical providers
• Health fairs
• Mental health
providers
• Participants

Learning

• Awareness of the
issues that are causing
isolation
• Provide emotional
support
• Explore tools that can
minimize the
symptoms of isolation
• Learn advocacy tools
during the process

Action

• Participant will be
socializing with others
in the groups
• Participant will be
practicing the social
skills learned
• Participant will become
social within the
community and the
family.

Conditions

• The
participants
health will
improve
because they
will make an
effort to visit
the doctor
• Participant
will build with
other
participants
and through
the community
• The program
will expand to
other cities

Assumptions
-You don’t need therapy you just need to go to church
- Therapy is for people with mental issues
External Factors
• Family can approve or decline the support for the family
member
• The need for funding.

PROTOTYPE 46
Appendix 2 Start Up Budget

Name: La Cocina de Abuela

FY 2020-2021 Start Up Operating Budget

Category

------------ $'s (000's) ------------

REVENUE

Foundation funding

100,000,000.00

State and Federal Funding

200,000

Private funding

800,000

X______

______

Total REVENUE

2,000,000.00

EXPENSES

Personnel Exp

Wages/Salaries

Executive Director

160,000

Chief Financial Officer

110,000

Licensed Clinical Social Worker-3

300,000

MSW therapist-2

170,000

Marketer-3

300,000

Administrative assistants

100,000

Sub-Total

1,140,000

Benefits (@ _40_%)

508,000

Total Pers. Exp

1,648,000

Other Operating Exp

Occupancy/Rent

28,600

Furn & Eqpt

7800

Tech/Computers

10,000

Tel/Cell

5,000

Comm & Mat'ls

1000

Trng/Prof Dev

20,000

Travel & Enter.

7000

Laptop, desktop, Ipad and interne

40,000

Groceries

7200

Kitchen and cookware

18,362

Water and electricity

3,000

Insurance

1000

Cleaning

26,000

Total Other Op Exp

174,962

Total EXPENSES

1,858,962

SURPLUS/DEFICIT

141,038

PROTOTYPE 47
Appendix 3 Operating Budget

Name: La Cocina de Abuela

FY 2020-2021 Operating Budget

Category

------------ $'s (000's) ------------

REVENUE

Foundation funding

100,000,000.00

State and Federal Funding

200,000

Private funding

800,000

X______

______

Total REVENUE

2,000,000.00

EXPENSES

Personnel Exp

Wages/Salaries

Executive Director

160,000

Chief Financial Officer

110,000

Licensed Clinical Social Worker-3

300,000

MSW therapist-2

170,000

Marketer-3

300,000

Administrative assistants

100,000

Sub-Total

1,140,000

Benefits (@ _40_%)

508,000

Total Pers. Exp

1,648,000

Other Operating Exp

Occupancy/Rent

28,160

Gift Cards

600

CompTech/Computers

1,000

Tel/Cell

1,000

Comm & Mat'ls

1,000

Trng/Prof Dev

3,000

Travel & Enter.

7,000

Laptop, desktop, Ipad and internet

0

Groceries

7,200

Kitchen and cookware

100

Water and electricity

3,000

Insurance

1000

Cleaning

26,000

Total Other Op Exp

79,060

Total EXPENSES

1,763,060

SURPLUS/DEFICIT

236,940

PROTOTYPE 48
Appendix 4: Questionnaire for Pre and Post
Escala de Depresión Geriátrica (Forma Corta)

16. Que parte del servicio sintio que le ayudo?

Short Geriatric Depression Scale (Spanish
version for BRITE)

Evaluación: Acredite 1 punto por cada respuesta en mayúscula
acentuada en negro
0-4 puntos - Sugiere ninguna o leve depresión
5-9 puntos - Sugiere depresión moderada; requiere más investigación
10 -15 – Alta indicación de depresión. Requiere ser referido para más
evaluación

Piense en como se ha sentido usted durante la ultima semana y responda
si o no alas siguientes preguntas:

1. ¿En general, se siente usted satisfecho/a con su vida? Si  NO �
2. ¿Ha abandonado usted actividades o cosas de interés personal?
SI  No  �
3. ¿Siente usted que su vida está vacía?
SI  No  �
4. ¿Se siente usted con frecuencia aburrido/a?
SI  No  �
5. ¿Se siente usted de buen ánimo la mayor parte del tiempo?
Si  NO �
6. ¿Tiene usted temor de que algo malo le vaya a pasar?
SI  No  �
7. ¿Se siente usted feliz la mayor parte del tiempo?
Si  NO �
8. ¿Se siente usted a menudo desamparado/a?
SI  No  �
9. ¿Prefiere usted estar en casa, en vez de salir y hacer nuevas cosas?
SI  No  �
10.¿Siente usted que tiene más problemas de memoria que la mayoría de las
personas?
SI  No  �
11.¿Piensa usted que es maravilloso estar con vida?
Si  NO �
12.¿Se siente usted que no vale nada en la condición en que está viviendo?
SI  No  �
13.¿Se siente usted lleno de energía?
Si  NO �
14.¿Se siente usted en una condición sin remedio?
SI  No  �
15.¿Siente usted que la mayoría de las personas están mejor que usted?
SI  No  �

PROTOTYPE 49
Stage
Task

Target
(Measure to
indicate task is
completed)
Appendix 5
Activity by Quarters from the start of the project for La Cocina de
Abuela

Spring
2020
Summer
2020
Fall 2020 Winter 2020 Spring 2021
Summer
2021
E
Identify the
need for the
community,
location,
participants,
supporting staff
Secure a location to
hold the pilot group
sessions

E
Meet and
discuss
program,
progress with
stakeholders
Meet with the staff
that was hire

P
Funding,
network with
community
agencies,
identify staff
roles
Obtain funding for
the program

I
Set
implementation
goals, ensure
process and
materials are
culturally
appropriate,
Before and during the
pilot program there will
be revisions that will
address the needs of the
population.

I
Monitoring of
the success of
the program
Provide
participants with the
Geriatric Depression
form in Spanish

S
Ensure
continued
funding is
readily available
for the program

PROTOTYPE 50

S
Maintain roles
and continue with
exploring the
needs of the
Latino older adult
population

PROTOTYPE 51
Figure 5 Flyer

PROTOTYPE 52
Figure 6 Prototype

A training Manual for Clinicians and Staff
Lizeth Moreno, DSW(c), MSW
Creating a sense of belonging for Latino Older Adults

PROTOTYPE 53

Introduction

La Cocina de abuela a non-profit organization that provides a safe space for older Latino adults
that need mental health support through cooking and storytelling

Mission: Provide mental health support in a cultural conscience environment that older adults are
familiar with and can empower them to eliminate isolation

Vision: Latino older adults can thrive and have an impact within their community and their
family

Values:
- Acceptance
- Respect
- Cultural sensitivity

Purpose

Latino Older Adults makeup 8% of the population and the expectation is that by 2060 there
will be a 22% increase (Mata, 2016). Latino older adults suffer from limited education, they
struggle with income, they are known to be diagnosed with more than one chronic health
condition, they experience loss of loved ones, their social network is smaller, and through
statistical standard they are the worst in comparison to other aging groups (Mata, 2016).
Latino older adults are struggling to access the resources they need because of not being able
to speak the English language, discrimination, and limitations to adequate interpreters that
can better assist them (Larson,2017). Latino older adults are experiencing so many barriers
that it is becoming easier to isolate themselves than to persist through the barriers.

In order to provide older adults with the needed mental health support “La Cocina de
Abuela” will create an environment they are familiar with and encourages a conversation.
Cooking and food are a reflection of the persons upbringing, it is a form of bringing people
together through a meal (Saldana, 2011). The type of food and cooking is a part of a person’s
identity and lets others know who they are (Saldana, 2011). Through storytelling Latino older
adults feel there is a representation of themselves and are able to express themselves in a
larger social structure and feel like there is a sense of place and identity for them (Flores,
2018). Using these two models will help provide healing and meaning to their life. It will
help tackle the symptoms of isolation for Latino older adult.

Audience:

The primary audience for this curriculum is Latino older adults between age of 65 to75 who are
suffering from social isolation.
PROTOTYPE 54

Goal of this program:

The focus of the program is to provide Latino older adults with mental health support while they
enjoy cooking and storytelling. When they complete the program, they should be able to find
healing and meaning to their life. The program will encourage socialization with others in the
community and their family.

Theoretical Approaches used in this program:

- Culturally sensitive Therapy
- Narrative Therapy
- Culinary Therapy
- Experiential Therapy

Delivery methodologies

The curriculum information will be delivered using these methodologies:
• Group therapy with cooking and storytelling
• Individual therapy if participant request additional support

The curriculum was created to provide guidance and structure for the important information that
will be needed to better assist Latino older adults who are suffering from social isolation.

Assessment of learning objectives:

A geriatric depression scale will be provided as a pre and post – survey questionnaire. The
survey will be provided at the initial assessment and at the conclusion of group therapy or
individual therapy. The survey will measure the progress the participant has once they complete
the program.

Equipment needed
Kitchen
Groceries
Screen
Projector
Pens
Paper
Handouts

PROTOTYPE 55

Incentives to provide participants upon completion of the training:

• Recipe book of the dishes they have shared
• Gift card once the sessions are completed

Initial assessment

Initial assessment will be conducted in the convenience of the home confidentiality forms and
plan of care will be provided in the visit. The therapist will assess if the participant will be able
to benefit from the program. If the participant qualifies for the program the therapist will provide
a date and time of first initial session.

Group sessions are 90 minutes on a weekly basis for 10 weeks. There will be 8 to 10 participants
per session. Workshops will be conducted by a therapist and a co-facilitator.

The group session will be conducted in an equipped office that has a kitchen. The setting should
include chairs, tables, cookware, kitchen, and groceries.

Group sessions will be conducted in the Spanish Session

Group Session #1 – Overview
Objective:
• Have an understanding of the outcome of the group session
• Gain understanding on the meaning of cooking and storytelling in their life.
• Provide a safe environment where they share their feelings and experience
Welcome and introduction:
• Provide introduction of the therapist and participants
• Review goal of the group sessions and confidentiality
- Therapist will provide a meal to demonstrate how the sessions will be
- Once meal is done everyone will share the meal together
Homework
• Provide therapist with the groceries they will need for their dish

Group Session #2 – Country of Origin
Objective:
• Gain understand of how their country of origin has shaped who they are
• Gain understanding how their perception of their country has changed overtime
Welcome
Check-in/review from last workshop, Q&A
• Introduction to topic –Country of origin
PROTOTYPE 56
o Create a dish or provide recipe that describes their country of origin and explain
how that has influenced who they are today.
• Once meal is done everyone will share the meal together
Homework
- Provide therapist with a grocery list and write the process of how the dish was made
today

Group Session #3 – Family
Objective:
• Gain understanding of how family has influenced who they are today
• Gain understand how their perception of family has changed over time
Welcome
Check-in/review from last workshop, Q&A
• Introduction to topic – Family
• Activity – Create a dish that reminds them of what family means to them and how that
has made an impact in their life
• Once meal is done everyone will share the meal together
Homework
- Provide therapist with a grocery list and write the process of how the dish was made
today

Group Session #4 – Present life
Objective:
- Explore what life looks like today
- Explore what influences their daily lives
- Explore those who influences them on a daily basis
- Gain understanding of how they tackle challenges on a daily basis
Welcome
Check-in/review from last workshop, Q&A
• Introduction to topic – Present life
• Activity- Create a dish that is normally made in the home as part of their routine and how
it has influenced them
• Once meal is done everyone will share the meal together
Homework
- - Provide therapist with a grocery list and write the process of how the dish was made
today

Group Session #5 – Skill and abilities
Objective:
• Gain understanding of what their talents look like
• Explore their faults
• Learn what coping strategies they have used and how it influences them
• Explore how others view them
PROTOTYPE 57
Welcome
Check-In/review from last workshop, Q&A
• Introduction to topic – Skills and abilities
• Activity- Create a dish that they enjoy making and explore the skills they use while
making the dish
• Once meal is done everyone will share the meal together
Homework
- Provide therapist with a grocery list and write the process of how the dish was made
today

Group Session #6 – Grief and loss
Objective:
• Gain understanding of grief and loss
• Provide support when discussing losses, they have experienced
Welcome
Check-in/review from last workshop, Q&A
• Introduction to topic – Grief and loss
• Activity- Create a dish or recipe of someone you have lost in the past that has made an
impact in your life
Homework
- Provide therapist with a grocery list and write the process of how the dish was made
today

Group Session #7 –Goals and hopes
Objective:
• Gain understand that they can still create goals in this stage of their life
• Creating a healthy lifestyle
Welcome
Check-in/review from last workshop, Q&A
• Introduction to topic –Goals and hopes
• Activity- Create a healthy dish that influences the new journey they might want to make
in their life
Homework
- Provide therapist with a grocery list and write the process of how the dish was made
today

Group Session #8 – Important people in their life
Objective:
• Gain understanding of how important people in their life influences who they are
• Explore if they need to make changes or show appreciation for what they have done
• Explore their support system
• Explore relationships in the future that can make an impact
Welcome
Review from last workshop, Q&A
PROTOTYPE 58
• Introduction to topic – Important people in their life
• Activity- Create a dish that the important person in their life enjoys and the reasons they
like this dish
Homework
- Provide therapist with a grocery list and write the process of how the dish was made
today

Group Session #9 – Challenges
Objective:
- Have the understanding of how they manage stress
- Discuss their challenges
- Discuss their future challenges
Welcome
Review from last workshop, Q&A
- Introduction to topic – Challenges
- Activity- Create a dish that they have never made before and explore the challenges they
had while making the dish
Homework
Review handout with information

Group Session #10 – Conclusion
Objective:
- Address any additional concerns the participants will have
- Review plan of care
- Discuss new tools and behaviors the participants have learned
- Terminate session
Welcome
Check-in/review from last workshop, Q&A
• Introduction to topic – Conclusion
• Activity- Review plan of care and explore how they will apply the new tool they learned
during the sessions
• Create dish that everyone enjoyed
Review
- Provide post survey and gift card for those that have completed the sessions

Individual therapy

- Therapist will provide therapy in the home or through telehealth for additional support
and it will be done for ten weeks. Sessions will be 60 minutes on a weekly basis.

PROTOTYPE 59
Initial Assessment
Date of first assessment contact: ______________

ASSESSING PRACTITIONER (NAME AND DISCIPLINE): _____________________________________
Client/Others Interviewed:
________________________________________________________________
I. Demographic Data and Special Service Needs:
DOB: ______ GENDER: ______ ETHNICITY: ____________ Marital Status: ____________________
Referral Source: ________________________________________
Non-English Speaking, specify language used for this interview: _______________________________
Were interpretive services provided for this interview? Yes No

Cultural Considerations, specify: ______________________________________________
Physically challenged (wheelchair, hearing, visual, etc.) specify: ________________________
Access issues (transportation, hours), specify: ________________________________________
II. Reason for Referral/ Chief Complaint
PRECIPITATING EVENTS(S)/REASON FOR REFERRALCURRENT SYMPTOMS AND BEHAVIORS
(INTENSITY, DURATION, ONSET, FREQUENCY) and IMPAIRMENTS IN LIFE FUNCTIONING caused
by the symptoms/behaviors (from perspective of client and others):

SUICIDAL THOUGHTS/ATTEMPTS: “Columbia Suicide Severity Rating Scale Screener (LACDMH
Version)” Wish to be Dead: Person endorses thoughts about a wish to be dead or not alive anymore, or
wish to fall asleep and not wake
1. Within the past 30 days, have you wished you were dead or wished you could go to sleep and not
wake up?
Yes_________ No ____________
Suicidal Thoughts: General non-specific thoughts of wanting to end one’s life/commit suicide, “I’ve
thought about killing myself” without general thoughts of ways to kill oneself/associated methods, intent,
or plan.
2. Within the past 30 days, have you had any thoughts of killing yourself? Yes ___No ___
If YES to #2, ask questions 3, 4, 5, and 6 If NO to 2, go directly to question 6
PROTOTYPE 60
Suicidal Thoughts with Method (without Specific Plan or Intent to Act): Person endorses thoughts of
suicide and has thoughts of at least one method during the assessment period.

3. Have you been thinking about how you might kill yourself? Yes ____No _______
Suicidal Intent (without Specific Plan): Active suicidal thoughts of killing oneself and patient reports having
some intent to act on such thoughts.
4. Have you had these thoughts and had some intention of acting on them? Yes____ No _____
Suicide Intent with Specific Plan: Thoughts of killing oneself with details of plan fully or partially worked
out and person has some intent to carry it out.

5. Have you started to work out or worked out the details of how to kill yourself and do you intend to carry
out this plan? Yes_____ No_____

Suicidal Behavior

6. Have you done anything, started to do anything, or prepared to do anything to end your life?
Yes___ No____

If yes, how long ago did you do any of these?
III. MENTAL HEALTH HISTORY / RISKS
PSYCHIATRIC HOSPITALIZATIONS:
Yes_____ No______ Unable to Assess ________
If yes, describe DATES, LOCATIONS, AND REASONS

OUTPATIENT TREATMENT:
Yes _____No _____Unable to Assess _____
If yes, describe DATES, LOCATIONS, AND REASONS.

Past Homicidal Thoughts/Attempts (including dates, threat, intent, plan, target(s), access to lethal
means, methods used)

PROTOTYPE 61
TRAUMA or Exposure to Trauma:
Yes _____ No_____ Unable to Assess______
Examples include: (1) physically hurt or threatened by another, (2) raped or had sex against their will, (3)
lived through a disaster, (4) combat veteran or experienced an act of terrorism, (5) severe accident, or
been close to death from any cause, (6) witnessed death or violence or the threat of violence to someone
else, or (7) victim of a crime

IV. MEDICATIONS
Has the client ever taken psychotropic medications? Yes _____No ____Unable to Assess ______
List "all" past and present psychotropic medications used, prescribed/non-prescribed, by name, dosage,
frequency. Indicate from client's perspective what seems to be working and not working.
MEDICATION:

Dosage and Frequency
:

PERIOD TAKEN:

EFFECTIVENESS:
PROTOTYPE 62

RESPONSE:

SIDE EFFECTS:

REACTIONS:
General Medication Comments (include significant non-psychotic medication issues/history):

V. Substance Use/ Abuse Screening and Assessment
Does the client currently appear to be under the influence of alcohol or drugs?
Yes___ No ___Unable to Assess____

When was the last time the client used alcohol or drugs?
Alcohol Screening Questions:
Drink = 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of liquor
1 In the past year, how often did you have a drink containing alcohol?
Never (0): ____ Monthly or less (1): ______ 2-4 times a month (2): ______ 3 times a week (3): _____
4 times a week (4) ______
If “Never”, proceed to Drug Screening Questions.
1a. In the past year, how many drinks containing alcohol did you have on a typical day when you are drinking
1 or 2 (0): ____ 3 or 4 (1): ______ 5 or 6 times a month (2): ______ 7 to 9(3): _____
10+(4) ___
1b. In the past year, how often did you have six or more drinks on one occasion?
Never (0): ____ Monthly or less (1): ______ 2-4 times a month (2): ______ 3 times a week (3): _____
4 times a week (4) ______
Alcohol screening score: ____________ Low risk/abstain=score of 0-3: Moderate/high risk=
score3-7score (women)and score of 4-7(men) Severe risk (provide brief intervention) = score of
8 or more
Was brief intervention provided: yes____ no_____
PROTOTYPE 63
B. Drug Screening Questions (“Yes” to any of the questions below indicates a positive screening)
1. Have you used nicotine products? (Cigarettes, cigars, electronic cigarettes, smokeless tobacco)
Ever used: Yes____ No______ Recently Used (Past 6 months) Yes____ No_______
2. Do you use products containing caffeine, such as tea, coffee or high-caffeine energy drinks? (Such as AMP,
Monster, Red Bull or 5 Hour Energy)
Ever used: Yes____ No______ Recently Used (Past 6 months) Yes____ No_______
3. Have you used opioids? (Heroin, opium, non-prescribed pain medications)
Ever used: Yes____ No______ Recently Used (Past 6 months) Yes____ No_______
4. Have you used prescription medications, over the counter medications, and/or non-?
prescription supplements in a manner other than prescribed? (For example, to get high)
Ever used: Yes____ No______ Recently Used (Past 6 months) Yes____ No_______
5. Have you used stimulants, such as cocaine or methamphetamine?
Ever used: Yes____ No______ Recently Used (Past 6 months) Yes____ No_______
6. Have you used marijuana? (smoked, edibles, wax, or other)
Ever used: Yes____ No______ Recently Used (Past 6 months) Yes____ No_______
7. Have you used hallucinogens? (MDMA or Ecstasy, LSD, PCP, mushrooms, or psilocin)
Ever used: Yes____ No______ Recently Used (Past 6 months) Yes____ No_______
8. Have you used drugs intravenously?
Ever used: Yes____ No______ Recently Used (Past 6 months) Yes____ No_______
9. Have you used other substances of abuse?
Ever used: Yes____ No______ Recently Used (Past 6 months) Yes____ No_______

C. Are you interested in changing your substance use patterns?
Yes _____. No ______. N/A ______
Assessment/Additional Information (answer only if screening is positive)
PAST AND PRESENT USE OF TOBACCO, ALCOHOL, CAFFEINE, CAM (COMPLEMENTARY AND
ALTERNATIVE MEDICATIONS) AND OVER THE COUNTER, AND ILLICIT DRUGS, if not determined by screener.
Be sure to include route of administration, frequency (amount), withdrawals, etc.
VI. MEDICAL HISTORY
PROTOTYPE 64
MD NAME: ______________________ MD PHONE: ___________________
Date of Last Physical Exam: _____________
Major medical problem (treated or untreated)
(Indicate problems with Y or N for client, Fam for family history)
Seizure/neuro disorder:
Head trauma:
Cardiovascular disease/symp:
Thyroid disease/symp:
Asthma/lung disease:
Liver disease:
Renal disease/symp:
Hypertension:
Diabetes:
HIV Test
If yes, date: __________
Diarrhea:
Cancer:
Sexual dysfunction:
Sexually trans disease:
Pregnant
If yes, due date: __________
Sleep disorder:
Weight/appetite change:
Blood disorder:
Sensory/Motor Impairment (If Yes, specify):
ALLERGIES (If Yes, specify):
Pap smear If yes, date: __________
Mammogram If yes, date: __________
PROTOTYPE 65
Comments on above medical problems, other medical problems, and any hospitalizations, including dates
and reasons.
VII. PSYCHOSOCIAL HISTORY
Please state specifically how mental health status directly impacts each area below. Be sure to
include the client’s strengths in each area.
Education/School history
Special education: Yes____ NO_____ Unable to assess _______
Learning disability: Yes____ NO___ Unable to assess________
Describe motivation, education goals, literacy skill level, general knowledge skill level, math
skill level, school problems, etc.:

Employment History, Readiness for Employment and Means of financial support
Current Paid Employment: Yes___ No ____Unable to Assess____
Military Service: Yes____ No _____Unable to Assess_____
Describe work related problems, volunteer work, money management, source of income, longest period
of employment, etc.:

LEGAL HISTORY AND CURRENT LEGAL STATUS: Describe any arrests/DUI, probation, convictions,
divorce, conservatorship, parole, child custody, etc.:

CURRENT LIVING ARRANGEMENT and Social Support Systems: Describe type of living setting,
problems at setting, community, religious, government agency, or other types of support, etc.:
Is the client homeless? Yes____ No______ Unable to Assess ______
If yes, when did the client become homeless (estimated date)? __________________________
DEPENDENT CARE ISSUES
PROTOTYPE 66
Number of Dependent Adults: ______ Number of Dependent Children: _______
Describe ages of children, school attendance/behavior problems of children, special needs of
dependents, foster care/group home placement issues, child support, etc.:

FAMILY HISTORY / RELATIONSHIPS:
History of Mental Illness in Immediate Family: Yes_____. No_______. Unable to Assess_____

Alcohol/Drug Abuse in Immediate Family: Yes_____. No_______ Unable to assess_______

History of Incarceration in Immediate Family: Yes____ No_______ Unable to assess_________

Describe family constellation, family of origin, family dynamics, cultural factors, nature of relationships,
domestic violence, physical or sexual abuse, home safety issues, family medical history, family
legal/criminal issues

VIII. MENTAL STATUS EXAM
Instructions: Check all descriptions that apply
General description:
Grooming & Hygiene: Well groomed: _____ Dirty: ______ Odorous: ______ Disheveled: ______
Bizarre: _____
Comments: ______________________
Eye Contact: Normal for culture: ______ Little Avoids: ________ Erratic: ______ Comments:
____________
Motor Activity: Calm: _______ Restless: _______ Agitated: ________ Tremors/Tics: _______
Posturing_____ Rigid: _____
Retarded: _______ Akathesis: _______ E.P.S: _______ Comments: _________________
PROTOTYPE 67
Speech: Unimpaired: ____ Soft: _______Mute: _______ Pressured: _____ Loud: _______ Slowed:
________ Excessive: ____
Slurred: _____ Incoherent: _____ Poverty of Content: ____. Comments:
_________________________________
Intellectual Functioning: Unimpaired: ________ Impaired: _______ Comments:
______________________________
Memory: Unimpaired: ______ Impaired: ______ re: Immediate: ______ Remote: ______ Recent: ____
Amnesia: _______
Comments: _________________________________________________________
Fund of Knowledge: Average: ______ Above average: _______ Below average: ___________
Mood and Affect:
Mood: Euthymic:_____ Dysphoric:_____ Tearful :_____ Irritable:_____ Lack of pleasure:____
Hopeless:______ Worthless:_____ Anxious :______Known Stressor:_______ Unknow
stressor:________ Comments:
Affect: Appropriate: _____ Labile: _____ Expansive: _______ Constricted: ______ Blunted: _____ Flat:
_____ Sad: ____ Worried: ____
Comments:
Perceptual Disturbance: None Apparent_____
Hallucinations: Visual: ____ Olfactory: ______Tactile: _____ Auditory: ____ Command: ______
Persecutory: _____ other: ____ Comments:
Self-perception: Depersonalization: _______ Ideas of reference: _______ Comments: _________
Thought Process Disturbances
None Apparent: ______
Associations: Unimpaired: _______ Loose: ____ Tangential: ____ Circumstantial: _____ Confabulous:
____ Flight of ideas: ____ Word salad: ____
Concentration: Intact: ______ Impaired by: _______ Rumination: _____ Thought Blocking: ______
Clouding of Consciousness: ____ Fragmented: _____ Comments:
Abstraction: Intact: ____ Concrete: ___ Comments:
Judgments: Intact: ____
Impaired: Minimum: ___ Moderate: ___ Severe: ____
Insight: Adequate: ____ Minimum: ___ Moderate: ___ Severe: ____
Serial 7s: Intact: ___ Poor: ____
PROTOTYPE 68
Thought Content Disturbances:
None apparent: ____
Delusions: Persecutory: ______ Paranoid: _____ Grandiose: ______ Somatic: _____ Religious: _____
Nihilistic: _____ Being controlled: _____ Comments:
Ideations: Bizarre: ____ Phobic: ____ Suspicious: ____ Blames others: ______ Persecutory: _______
Assaultive ideas: ____ Magical thinking: _____ Irrational/Excessive Worry: _____ Sexual Preoccupation:
__
Comments:
Behavioral disturbances: None: ___ Aggressive: ____ Demanding: _____ Demeaning: ____ Other:
______
Comments:
Suicidal/Homicidality
Suicidal: Denies___ Ideation only____ Threatening: ___ Plan: _____
Homicidal: Denies: ___ Ideation only: __ Threatening: ___ Plan: _____
Other:
Passive: A motivational: ____ Apathetic: _____ Isolated: ____ Withdrawn: ____ Evasive: ____
Dependent: ___ Comments:
Other: Disorganized: _____ Bizarre: _____ Obsessive: _____ Compulsive: ____ Ritualistic: ____
Excessive: ____ Inappropriate crying: ______ Comments:
IX: Summary and Diagnosis
CLIENT’S STRENGTHS (to assist with achieving treatment goals)

CLINICAL FORMULATION AND DIAGNOSTIC JUSTIFICATION Summarize/conceptualize all clinical
information to determine the client’s diagnosis and include initial proposal(s) for treatment. Be sure to
PROTOTYPE 69
identify any impairments in life functioning due to the client’s diagnosis (Medical Necessity). Formulation
should include risk factors as well as any significant strengths that can assist the client with treatment.

DIAGNOSTIC DESCRIPTOR _______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

This confidential information is provided to you in accord with State and Federal laws and regulations including but not limited to applicable Welfare and Institutions
code, Civil Code and HIPAA Privacy Standards. Duplication of this information for further disclosure is prohibited without prior written authorization of the
client/authorized representative to whom it pertains unless otherwise permitted by law. Destruction of this information is required after the stated purpose of the
original request is fulfilled.

PROTOTYPE 70

Spanish Consent Forms

El suscrito cliente* o adulto responsable** consiente y autoriza los servicios de salud mental por
parte de:_______La Cocina de Abuela________________
Estos servicios pueden incluir pruebas psicológicas, psicoterapia/orientación, servicios de
rehabilitación, medicamentos, gestión de casos, pruebas de laboratorio, procedimientos
diagnósticos y otros servicios apropiados. Si bien los servicios se pueden prestar en diferentes
lugares, todos los servicios del sistema de salud mental del condado de Los Ángeles serán
coordinados por el personal de una sola institución.
El suscrito comprende que:
1. Tiene derecho a recibir información y participar en la elección de los servicios que se le
presten;
2. Tiene derecho a recibir cualquiera de los servicios antes mencionados sin estar
obligado a recibir otros
servicios del sistema de salud mental del condado de Los Ángeles;
3. Todos los servicios son voluntarios y tiene derecho a solicitar un cambio de proveedor
de servicios (institución
o personal) y a cancelar este consentimiento en cualquier momento;
4. Como condición de empleo, todos los empleados de la institución firman cada año un
juramento de
confidencialidad que les prohíbe dar a conocer información sobre los clientes, excepto
en los casos permitidos
por las leyes, políticas y procedimientos de privacidad federales, estatales y del
Departamento;
5. Toda la información que se comunique a los empleados y sea importante para la
atención, debe incluirse en la historia clínica para asegurar que todo el personal que
participe en el tratamiento tenga a su disposición información completa sobre el cliente
al decidir qué tratamiento será́ apropiado para sus necesidades y
brindarle atención de calidad.
6. En una base de información computarizada se registra el nombre de todos los clientes y
los programas que les
brindan servicios, y que, sin requerirse su autorización, todos los empleados del sistema
del Departamento, ya
PROTOTYPE 71
sea directos o de servicios contratados, acceden a esta información;
7. La información de la historia clínica de los clientes sobre sus necesidades de servicios
puede ser compartida
dentro de la institución o dentro del sistema de salud mental del condado de Los
Ángeles (directamente o a través de servicios contratados).

Firma del cliente: ____________________________________________________
Firma del adulto responsable: ___________________________________________
Firma del testigo/intérprete: ____________________________________________
Fecha: ______________ _________________
Relación con el cliente Fecha: ________________
Fecha:

PROTOTYPE 72

Progress Notes

Date:

Activity Type:

Initial Assessment: _______
Individual Therapy: _______
Group therapy: ___________
Phone Call: ______________
Other activity: Describe: __________________
Length of service in minutes:

Therapist 1: Print Name: __________________ Signature: __________________

Therapist 2: Print Name: __________________ Signature: ____________________

Outcome of the session:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

What goals were met: (Make sure to update plan of care)

PROTOTYPE 73

Pre- Test will be provided in Spanish

PROTOTYPE 74

Post Test will be provided in Spanish
Question: What part of the group session has been helpful to you?
PROTOTYPE 75
Geriatric Depression Scale (GDS) Scoring
Instructions
Instructions:
Score 1 point for each bolded answer. A score of 5 or more suggests depression.
1. Are you basically satisfied with your life? Yes. no
2. Have you dropped many of your activities and interests? yes no
3. Do you feel that your life is empty? yes no
4. Do you often get bored? yes no
5. Are you in good spirits most of the time? yes no
6. Are you afraid that something bad is going to happen to you? yes no
7. Do you feel happy most of the time? yes no
8. Do you often feel helpless? yes no
9. Do you prefer to stay at home, rather than going out and doing things? yes no
10. Do you feel that you have more problems with memory than most? yes no
11. Do you think it is wonderful to be alive now? yes no
12. Do you feel worthless the way you are now? yes no
13. Do you feel full of energy? yes no
14. Do you feel that your situation is hopeless? yes no
15. Do you think that most people are better off than you are? yes no

A score of > 5 suggests depression Total Score ___________
Ref. Yes average: The use of Rating Depression Series in the Elderly, in Poon (ed.): Clinical Memory Assessment of Older
Adults, American Psychological Association, 1986

PROTOTYPE 76
Sample of Spanish Geriatric Scale Short Form
Piense en como se ha sentido usted durante la ultima semana y responda si o no
alas siguientes preguntas:
1. ¿En general, se siente usted satisfecho/a con su vida?
2. ¿Ha abandonado usted actividades o cosas de interés personal?
3. ¿Siente usted que su vida está vacía?
4. ¿Se siente usted con frecuencia aburrido/a?
5. ¿Se siente usted de buen animo la mayor parte del tiempo?
6. ¿Tiene usted temor de que algo malo le vaya a pasar?
7. ¿Se siente usted feliz la mayor parte del tiempo?
8. ¿Se siente usted a menudo desamparado/a?
9. ¿Prefiere usted estar en casa, en vez de salir y hacer nuevas cosas?
10. ¿Siente usted que tiene más problemas de memoria que la mayoría de las
personas?
11. ¿Piensa usted que es maravilloso estar con vida?
12. ¿Se siente usted que no vale nada en la condición en que está viviendo?
13. ¿Se siente usted lleno de energía?
14. ¿Se siente usted en una condición sin remedio?
15. ¿Siente usted que la mayoría de las personas están mejor que usted?

PROTOTYPE 77
Consentimiento de Servicio de Salud Mental Por Medio De Tecnología
Comprendo que:
1. Tengo la opción de rehusar mi consentimiento en este momento o cancelarlo en cualquier
momento, incluso en cualquier momento durante una sesión, sin afectar mi derecho a
recibir atención o tratamientos en el futuro, ni arriesgarme a perder ningún beneficio del
programa al que tenga derecho.
2. Un beneficio posible de los servicios de salud mental por medio de tecnología es que
podré conversar hoy mismo con el personal de salud mental desde este lugar para que
evalúen mis necesidades. De ser apropiado, podré recibir hoy mismo servicios de salud
mental, comenzar a tomar una medicación o seguir tomando mis medicamentos sin
interrupciones.
3. Un riesgo posible de los servicios de salud mental por medio de tecnología es que haya
una falla total o parcial del equipo que haga que el personal de salud mental no pueda
terminar la evaluación, los servicios de salud mental y/o la prescripción de
medicamentos.
4. Los registros de imagen o voz de la sesión de servicios de salud mental por medio de
tecnología no se conservan.
5. Se aplican todas las normas de protección de la privacidad.
6. Se cumplen todas las leyes sobre el acceso de los clientes a información de la salud
mental y copias de los registros de salud mental.
7. Sin el consentimiento del cliente, no se comunicarán a investigadores ni otras
instituciones imágenes o información de los servicios de salud mental por medio de
tecnología que permitan identificar al cliente.
8. Yo, ________________________________, acepto recibir servicios de salud mental por
medio de tecnología cuando el personal de salud mental más apropiado para mis
necesidades no esté disponible. Mi proveedor de servicios de salud mental me ha
explicado la información que antecede. He tenido oportunidad de formular preguntas
sobre esta información y se les dio respuesta a todas mis preguntas. Comprendo la
información escrita que antecede.
Firma del cliente: ________________________________________
Firma del adulto responsable: __________________________________
Firma del testigo/interprete: ____________________________________
Relación con el cliente: ________________________________________
Fecha: _____________________________________________________
Al cliente y/o adulto responsable se le tradujo verbalmente el presente Consentimiento a
[idioma] ________.
El firmante recibió se rehusó a recibir una copia de este Consentimiento. Fecha: _____ Iniciales
del empleado: __
PROTOTYPE 78
Client Treatment Plan
Client Treatment Goals: (Use direct quote)

Short -Term goals: Must be SMART: Specific, Measurable/Quantifiable, Attainable within the
Treatment Plan review period, Realistic, and Time- bound. Must be linked to the client’s
functional impairment and diagnosis / symptomatology as documented in the Assessment.
Objective 1:

Clinical Interventions: Must be related to the objective and achievable within the time frame of
this Plan. Describe proposed intervention and duration (specify if time frame is less than 1 yr.).
Client Involvement:
Client agrees to participate by:

Family Involvement: Biological_____ Other: Please specify: ________
Family is available: Yes_____ No_____
Client consents to family participation: Yes___ No_____ N/A_____
Family Agrees to Participate: Yes_____ No____ (If yes please specify):

Short -Term goals: Must be SMART: Specific, Measurable/Quantifiable, Attainable within the
Treatment Plan review period, Realistic, and Time- bound. Must be linked to the client’s
functional impairment and diagnosis / symptomatology as documented in the Assessment.
Objective 2:

Clinical Interventions: Must be related to the objective and achievable within the time frame of
this Plan. Describe proposed intervention and duration (specify if time frame is less than 1 yr.).
Client Involvement:
Client agrees to participate by:

Family Involvement: Biological_____ Other: Please specify: ________
Family is available: Yes_____ No_____
Client consents to family participation: Yes___ No_____ N/A_____
Family Agrees to Participate: Yes_____ No____ (If yes please specify):

PROTOTYPE 79
PhD/PsyD, LCSW, MFT, RN, CNS:_________________________________________
Date:__________________

All Other Staff/Title:
_______________________________________________Date:________________

Client:_____________________________________________________
Date:___________________________
Client
Collateral:____________________________________________Date:_____________________
______

Client was offered a copy of this objective: Accepted____ Declined_______ Staff
initials_________ Date: _______

PROTOTYPE 80

References

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Abstract (if available)

Abstract Due to the large percentage of growing older adults their limitations in the service being provided is limited. Especially during COVID 19 a lot of the services for older adults are becoming harder to obtain because of the large need they have. Having a program that will be able to provide the needed support is important. La Cocina de Abuela will create a space where older adults will share their stories and come to terms with the issues that are causing isolation. Providing other opportunities for them to build other relationships within the group, within the community, and nurture the relationships within the family. They will be able to build new stories and tackle new challenges.

Linked assets

University of Southern California Dissertations and Theses

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Asset Metadata

Creator Moreno, Lizeth (author)

Core Title La cocina de abuela: eradicating social isolation with Latino older adults

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Publication Date 09/24/2020

Defense Date 08/06/2020

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Latino older adults,OAI-PMH Harvest,older adults,social isolation,Storytelling

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Enrile, Annalisa (committee chair)

Creator Email lizethRmoreno@gmail.com,lizethru@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-380506

Unique identifier UC11666343

Identifier etd-MorenoLize-8944.pdf (filename),usctheses-c89-380506 (legacy record id)

Legacy Identifier etd-MorenoLize-8944.pdf

Dmrecord 380506

Document Type Capstone project

Rights Moreno, Lizeth

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA