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Acculturation team-based clinical program: pilot program to address acculturative stress and mental health in the Latino community
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Acculturation team-based clinical program: pilot program to address acculturative stress and mental health in the Latino community

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Content ACCULTURATION TEAM-BASED                                                                                            1






Acculturation Team-based Clinical Program: Pilot Program to Address Acculturative Stress and
Mental Health in the Latino Community
Jacqueline Guevara
University of Southern California
December 7, 2018  
ACCULTURATION TEAM-BASED                                                                                            2
Executive Summary
Center for Empowerment and Change (CFEAC) is an innovative non-profit whose
mission is to change behavioral care in the Latino community and to be the leading expert in
creating frameworks for addressing the specific mental health needs of minority
communities.  The Acculturation Team-based Clinical Program’s (ATBCP) goal is to increase
the creation and use of culturally inclusive treatment in minority communities while providing
hope for Latino families who have a youth suffering from mental illness. In particular, CFEAC
has created the ATBCP to address the identified gaps found within traditional evidenced based
practices (EBP) that do not address specific cultural barriers found in the Latino community.
This program would be the first of its kind in the proposed area of Virginia as most programs in
the area do not use specific theories or team-based models when addressing unique barriers
found in Latino communities. Only by addressing these barriers through culturally sensitive
interventions do Latino youth and their families have a chance at living productive lives free of
stigma and with tools to better manage their mental health.  
As the Latino population increases, so do the potential issues which not only impact the
Latino community, but the United States as well. By 2050, the Latino population in the United
States will increase to 119 million with Latino youth making up an estimated one third of this
increase (Smokowski & Bacallao, 2011). Given that Latino youth are diagnosed with serious
mental illness 22 % more than other minority groups and white peers (Ramirez, Gallion, Aguilar,
& Dembeck, 2017), are more likely to live in poverty (estimated five million as of 2015) and
face up to 70 % higher levels of acculturative stress than any other minority group (Flores,
Lopez, & Radford, 2017), the impact on our future economic and social environments could be
detrimental and cost taxpayers millions. In addition, despite these issues increasing, Latino youth
are less likely than their peers to access mental health treatment because treatment does not
ACCULTURATION TEAM-BASED                                                                                            3
address their specific cultural needs (Alexandre, Martins, & Richard, 2009). In 2010, it was
estimated that the economy lost $2.5 trillion due to mental disorders (Trautmann, Rehm, &
Wittchen, 2016). Not addressing the mental health needs of Latino youth who are becoming the
United States majority could increase the economic loss. Acculturation in particular plays a
significant role in Latino youth adapting to two cultures and can become a barrier to accessing
mental health care and adapting to their community if not addressed by appropriate interventions.
This challenge is specific to Latino youth in comparison to their non-Latino peers as youth are
left to establish their own identities and beliefs while balancing their two cultural systems
(Jagger & Gordon, 2015).
ATBCP was developed in an effort to address one of the 12 Grand Challenges identified
by the American Academy of Social Work & Social Welfare. This program focuses on the Grand
Challenge Ensuring Healthy Development for all Youth which looks at “unleashing the power of
prevention through widespread use of proven approaches” which looks to interventions capable
of preventing behavioral health problems in youth (American Academy of Social Work and
Social Welfare, n.d.). The importance of prevention or early intervention to stop maladaptive
behaviors becomes key in decreasing mental health issues in communities of color. As an early
intervention program, ATBCP is a person-centered approach provided by a licensed clinician
and Master of Social Work family support worker who are both assigned to an identified family
tasked with helping parents and youth combat stigma, address mental illness, and become one
with their community. By targeting these three specific areas, ATBCP uses approaches to
prevent acculturative stress from negatively impacting youth and their family. The clinician
would provide therapeutic interventions using Cognitive Behavioral Therapy such as the
challenging of distorted thinking and using coping skills to manage negative emotions along with
components from a promising acculturation stress intervention known as Entre Dos
ACCULTURATION TEAM-BASED                                                                                            4
Mundos/Between Two Worlds (Smokowski & Bacallao, 2009). The family support worker
through case management would help the parent(s) or guardians incorporate the skills learned
from treatment to build connections in the community, understand their roles, rights and
responsibilities, as well as support their youth through treatment. This clinical program varies
significantly from other programs in Virginia due to the use of a team-based clinical program
using evidence-informed practices to address acculturative stress and lack of community
connections as an early intervention approach. There are agencies well known in the community
that specifically work with the Latino community, but do not offer programs or frameworks
addressing acculturative stress and its impact on mental health. As there is no data describing the
specific interventions and outcomes of acculturation based interventions in Virginia, interviews
with multiple county professionals (both in and outside of the social work field) and community
members were conducted to determine the need for an acculturation based program. Results
indicated immense support for the ATBCP noting an urgency in implementing such a program.  
CFEAC will primarily focus on Latino middle school students in two schools within
Fairfax County, Virginia. School settings were chosen given that most behavioral changes are
first noted by school staff while the youth is attending school. Youth and their families will be
referred by school staff after the youth has experienced at least one offense such as defiance or
rule breaking that resulted in school-based discipline (e.g. suspension) or clinical interventions
by school staff such as suicide assessments or frequent counseling sessions where it has been
determined that interventions outside the school are needed. This program will consist of eight to
ten therapy sessions that occur in the home, school, and/or community setting. A family support
worker will meet with the parent(s) once a week to reinforce clinical interventions and will be
imperative peer support for the parent. Implications for establishing the proposed program
include influencing funding streams that would support more prevention and early intervention
ACCULTURATION TEAM-BASED                                                                                            5
programs such as the ATBCP versus reactive programs. In addition, additional frameworks to
address the specific cultural needs of other minority groups can be researched and explored
based on the data and overall functioning of the program. The need to identify more
acculturation based interventions and collect data to show its effectiveness could help change the
way policies are formed as well as reduce the potential impact on a community’s economic and
social wealth.  
This paper will explore the problem, current research, as well as discuss a proposed
acculturation team-based clinical program to address acculturative stress and unique barriers
faced by the Latino community when engaging in mental health services. The Exploration,
Preparation, Implementation, and Sustainment (EPIS) framework will be utilized to ensure
fidelity of the program and effectiveness evaluated using the Global Appraisal of Individual
Needs Short Screener (GAIN SS), clinical interviews, and assessments. The program anticipates
that by adding acculturative interventions to existing EBPs, outcomes will include mental health
symptoms amongst Latino youth decreasing, parent support and understanding of mental health
increasing, and family engagement in community increasing. A first year budget to implement
the program, potential barriers and solutions are also discussed.
ACCULTURATION CLINICAL PROGRAM                                                                             6
Conceptual Framework
Racial and ethnic disparities are present throughout research in evidenced based practices
(EBP) for mental health services among underserved minority communities. For example, one
study showed that not only were Latino youth less likely than their White peers to access mental
health treatment, they were also less likely to participate in an adequate number of treatment
sessions (Alexandre, Martins, & Richard, 2009). Unfortunately, the consequences for untreated
mental illness in the Latino community are predicted to have alarming outcomes given the
population’s estimated growth. One study estimates that by the year 2050, Latinos will make up
approximately one third of the United States population with Latino youth being the majority of
this growth, greatly impacting the future of the United States workforce, education and health
systems (Smokowski & Bacallao, 2011). As the Latino population increases, mental health needs
could also increase. In 2016, 72 percent of Latino youth were more likely to be diagnosed with
Posttraumatic Stress Disorder (PTSD) in comparison to their White peers (Archuleta &
Lakhwani, 2016). Researchers believe the high prevalence is due to many factors including
decreased educational opportunities, discrimination, cultural differences between their
environment and family (acculturation), as well as a higher likelihood of poverty and lack of
access to resources such as adequate mental health services. Identified issues such as these
become concerning given that mental health disorders have been identified as the most
debilitating illness negatively impacting society’s social and economic factors (Lopez, 2002).
With this estimated growth, it is predicted that the impact Latinos not receiving adequate mental
health services will have on society includes less qualified or available workforce, higher
likelihood of involvement with government agencies such as social services or law enforcement,
and further strain on a community’s economic availability.  

ACCULTURATION CLINICAL PROGRAM                                                                             7
Literature Review
Probable societal consequences display what is lacking the most in current EBPs which
include acknowledging culturally specific interventions that include the family’s beliefs. By not
including the family’s beliefs and not addressing unique barriers found in the Latino community
including discrimination, immigration status, insurance accessibility, misdiagnosis, acculturation,
and stigma, Latinos are far less likely to engage in or complete treatment
(Cook, Liu, Lessios, Loder, & McGuire, 2015). This also includes barriers specific to values
found in the Latino community. Some additional and prominent values that have not been
included when implementing EBPs in behavioral health services for Latinos include familism
(needs of family over individual needs), machismo (strong masculine pride), marianismo (female
gender role in machismo), respeto (respect), personalismo (acknowledging value of each person
with utmost politeness), collectivism, and religion and spirituality (Merianos, Vidourek, & King,
2017). Addressing and creating programs that identify and provide solutions for such unique
issues would most likely increase the utilization of mental health services in the Latino
community.  
It is hypothesized that unfamiliarity with resources and their community, mental health
issues being attributed to American or “White” culture, and limited knowledge of behavioral
care, contribute to disengagement and lower success rates of treatment completion. Acculturation
plays a significant role in Latino youth adapting to two cultures and can become a barrier to
addressing mental health issues and acclimating to their community if not addressed by
appropriate interventions. Although acculturative stress is experienced by multiple minority
groups, researchers have indicated that Latinos are 70 percent more likely to experience higher
levels of acculturative stress than any other group (Ramirez, Gallion, Aguilar, & Dembeck,
2017). The higher acculturative stress levels are also due to unique biopsychosocial needs that
ACCULTURATION CLINICAL PROGRAM                                                                             8
are culturally specific. Factors include the Latino population being younger than most other
groups, being less likely to be educated, language barriers and commitment to the Spanish
language, immigration status and experience, historical presence and consequences of war, focus
on physical labor, dedication to family ties and values, and significantly noticeable differences in
societal and family relationships when comparing Latino and American culture (Smart & Smart,
1995). Recognizing these circumstances highlights possible issues that can occur when
attempting to become a part of their host community or engage in services such as mental health
care.  
The difficulty of learning and adapting to their host country can become even more
difficult for youth. For example, youth who live in bicultural homes might face issues such as
adjusting to social demands in their community and its cultural norms while also learning and
understanding their parents’ home countries traditions and beliefs. The voyage of immigration
becomes an event that both child and parent need to process and adjust to even if the youth was
born and raised in the United States (Jaggers & Gordon, 2015). In other words, youth must battle
with what their parents want them to absorb from their culture while attempting to understand
and navigate their new surroundings such as culture in an American school. How well a youth
and family adjust to transitions and changes of balancing two cultures can greatly impact the
success or failure of acculturating or what is also known as acculturative stress (Smokowski &
Bacallao, 2009). It is a challenge specific to Latino youth in comparison to their non-Latino
peers and compared to their parents, who arrived in the United States with lived experiences and
already set values of their culture. Youth are left to establish their own identities and beliefs
while balancing their two cultural systems (Jagger & Gordon, 2015). Recognizing how
acculturation impacts the overall development of Latino youth could help researchers and
practitioners better respond with much needed interventions.  
ACCULTURATION CLINICAL PROGRAM                                                                             9
The program’s innovation is being proposed to better understand whether addressing the
cultural gaps (in particular, acculturative stress) found within EBPs increases behavioral care
completion amongst Latino adolescents and their families. A study completed by the National
Latino and Asian American Study showed remarkable results regarding untreated acculturative
stress. This study included 581 Latino adults, average age 35, and measures including exposure
or history of acculturative stress and environmental factors (Guarnaccia, Pincay, Alegria, Shrout,
Lewis-Fernandez, & Canino, 2007). Multiple scales were administered to the participants
including three item subscales measuring language proficiency, questionnaire measuring
acculturative stress, scale on ethnic identity including a Likert scale, four-point scale to
determine family cohesion, six-point Likert scale to examine experiences with discrimination,
and checklists based on Diagnostic and Statistical Manual of Mental Disorders 4th edition,
(DSM IV) criteria to examine mental health symptoms. Results indicated that participants were
more likely to suffer from mental health issues if the acculturative stress was high and family
cohesion and understanding of American culture and mental health were low (Guarnaccia, et. al.,
2007). Creating programs like the proposed pilot to address the two cultures and
family/community dynamic could potentially decrease the number of Latino youth who grow to
become adults with untreated mental health.  
Current research highlights the importance of supporting the acculturation process and
providing culturally sensitive interventions to increase the likelihood that Latinos will engage in
and complete mental health treatment. Multiple theories have been identified explaining
acculturation. Studies showing implementation of adaptions have been initiated, and have shown
promising results. One study found that implementing culturally sensitive interventions that cater
to the specific need of the population not only achieved treatment effectiveness, but were more
valuable than non-adapted interventions (Parra Cardona, Domenech‐Rodriguez, Forgatch,
ACCULTURATION CLINICAL PROGRAM                                                                             10
Sullivan, Bybee, Holtrop, & Bernal, 2012). Unfortunately, research documenting outcomes of
such interventions and the actual development of frameworks to address acculturation are
minimal. Though theories have been identified such as assimilation and alternation theory,
neither address cultural idiosyncrasy which could impact how well a person acculturates
(Smokowski & Bacallao, 2011). Not addressing cultural idiosyncrasy poses an issue when
attempting to look at the long-term effect of an intervention and whether or not the person
received what they needed. In addition, research has also noted how acculturation interventions
are mostly examined through group variances instead of through the individual during
immigration and data not captured because of lack of longitudinal studies to track important
outcomes (Smokowski & Bacallao, 2011). In other words, the problem has been identified and is
understood, yet appropriate studies have not been conducted to examine effectiveness nor the
need for culturally sensitive practices.  
While research is limited regarding acculturation based interventions, there is some data
to show how promising these specific interventions can be. Findings have shown that by
incorporating culturally explicit interventions with Latino families, parents increased the use of
positive communication and parenting skills while behavioral care issues decreased amongst
their youth (Williams, Ayers, Garvey, Marsiglia, & Gonzalez Castro, 2012). However, what is
(or isn’t) being utilized has done little to assist with this need. Systems put in place to address
mental health issues have done the opposite of supporting Latino youth as most constructed
frameworks have supported majority culture leading to Latino youth feeling alienated, declining
in academic performance, increased instances of disciplinary action in school, and quashing of
the Latino youths’ identity and beliefs (Gutierrez, 2014). Without remedying the lack of support
for the Latino community’s specific needs in mental health treatment, rates of success will
remain low.  
ACCULTURATION CLINICAL PROGRAM                                                                             11
Capstone Logic Model
Given the lack of culturally sensitive EBPs and the need for additional interventions, the  
proposed Acculturation Team-based Clinical (ATBCP) program was designed. The program’s
design was created using Cognitive Behavioral Therapy and Entre Dos Mundos/Between Two
Worlds (a promising acculturative stress prevention model) in an effort to address mental health
stigma, lack of quality culturally sensitive treatment, and lack of connection to community
resources. ATBCP was developed in an effort to address one of the 12 Grand Challenges
identified by the American Academy of Social Work & Social Welfare. This program focuses on
the Grand Challenge Ensuring Healthy Development for all Youth which looks at “unleashing
the power of prevention through widespread use of proven approaches” while providing
interventions capable of preventing behavioral health problems in our youth (American
Academy of Social Work and Social Welfare, n.d.). The importance of preventing or intervening
early enough to stop maladaptive behaviors becomes key in addressing the increase of mental
health issues. As an early intervention program, ATBCP is a person-centered approach provided
by a licensed clinician and Master of Social Work family support worker who are both assigned
to an identified family tasked with helping parents and youth combat stigma, address mental
illness, and become one with their community. By targeting these three specific areas, ATBCP
uses approaches and tools to prevent illness and acculturative stress from any further negative
impact on the youth and their family. Refer to Appendix A Acculturation Team-based Clinical
Program Logic Model for program development. This model includes inputs such as staff, first
year funding, outputs divided by activities the Center will be implementing, participation from
consumers and stakeholders, and outcomes for short, medium, and long-term events that describe
overall impact.

ACCULTURATION CLINICAL PROGRAM                                                                             12
Problem of Practice and Solution/Innovation
With such unique barriers to adequate mental health treatment in the Latino community,
programs and interventions may fall short if culturally sensitive support is not considered. In
addition to the gaps found within these frameworks, environmental factors can also contribute to
failed acculturation and engagement in treatment. Some of these factors include Latino youth and
their families more likely living in neighborhoods with high crime rates, limited access to
transportation, and lack of Latino mental health professionals which can result in increased
chances for chronic mental health issues and poor quality of life (Isasi, Rastogi, & Molina,
2016). Incorporating interventions that could provide tools on how to successfully navigate or
challenge such barriers could further support the development of frameworks and success of a
culturally sensitive EBP. With lack of transportation and lower socio-economic status, it is
indicated that receiving services in the home from a bicultural practitioner and incorporating
person centered care, could potentially increase success rates for completing mental health
treatment. Latino youth are more likely to engage and complete behavioral treatment if made
available in non-conventional settings such as schools, homes, or churches (Merianos, Vidourek,
& King, 2017). In addition, providing services in the home (i.e. homebased counseling) could
also increase the likelihood that treatment will be completed. There is a higher likelihood of
minority and impoverished families accessing and completing mental health services when the
services are provided in the home (Tate, Lopez, Fox, Love, & McKinney, 2014). Using language
that the family understands (literally and figuratively) as well as delivering services based on
person-centered needs (location of services, beliefs, etc.), may help in decreasing avoidance of
treatment. All these factors were taken into consideration when creating the ATBCP.  


ACCULTURATION CLINICAL PROGRAM                                                                             13
Innovation - Acculturation Team-based Clinical Program
In an effort to address barriers unique to Latinos, the pilot program ATBCP would be
implemented to decrease barriers through therapeutic interventions, psycho-education, and case
management in an eight to ten treatment session format. A clinician and family support worker
would be assigned to each family. The clinician would provide therapeutic interventions using
Cognitive Behavioral Therapy (CBT) tools such as the challenging of distorted thinking and
using coping skills to manage negative emotions with components from the promising
acculturation-based psycho education curriculum Entre Dos Mundos (Smokowski & Bacallao,
2009). While delivering the ATBCP curriculum, clinicians are to provide all therapeutic
interventions in clinical sessions ranging from 50-60 minutes long and provided in the home,
school, or other setting of family’s choice. The first 15 minutes are used to set the agenda as well
as review material from the previous session. Then the material for the session is presented and
worked through, as well as anything else the family and/or youth would like to discuss. The final
5 minutes of the session are used to assign the family homework/tasks that serve to reinforce
what was discussed during the session.
The family support worker serves as peer support helping to reinforce skills learned
throughout treatment, keeping the family motivated to stay in treatment through encouragement
and helping build the family’s capacity to connect with their community. While adhering to the
same ATBCP curriculum, family support workers also work to support the youth and family
through case management, navigating systems such as the public school system, understanding
their roles, rights and responsibilities as parents and community members, as well as supporting
their youth through treatment. They also assist the parent and youth in completing therapeutic
assignments as needed. Examples of providing case management and support include reviewing
basic human rights related to immigration status, rights as parents of a child in public school,
ACCULTURATION CLINICAL PROGRAM                                                                             14
local medical resources, local churches, food assistance, etc. This role becomes crucial in
increasing the chances of the family staying in and completing treatment. As noted by Claudia
Schlosberg, former Senior Deputy and Medicaid Director for the Department of Healthcare
Finance in Washington D.C., having peer support or a similar role in the implementation of
mental health care in minority communities is not only encouraged, but desperately needed to
ensure minorities stay in mental health treatment (Schlosberg, personal communication, 2018).
Having the support from a person not directly providing clinical services could really impact
how minority family’s challenge stigma, manage their mental health, and complete treatment.  
The clinician and family support worker also engage in ongoing collaboration to avoid
duplication of work and to ensure appropriate and person-centered services. The pilot program
would work with students who have committed their first offense while at school. An offense is
defined as defiance or rule breaking that resulted in school-based discipline (e.g. suspension) or
clinical interventions by school staff such as suicide assessments or determination that
interventions outside the school setting are needed. Each session would be structured to address
different issues surrounding acculturative stress, familial issues, and mental health while
incorporating assignments to be completed outside of the treatment session with assistance from
the family support worker. Each session is structured to allow the clinician and family support
worker to address the specific needs of the family while providing psycho-education and
preparedness skills to be used in daily living. Refer to Appendix B Acculturation Team-based
Clinical Program Step by Step Curriculum which includes directions on what to present during
the clinical session and Appendix C Referral Form – English and Spanish.  
The pilot ATBCP would be the first of its kind in the proposed area of Virginia. This
clinical program varies significantly from other programs in Virginia due to the use of a team-
based clinical program using evidenced informed practices to address acculturative stress and
ACCULTURATION CLINICAL PROGRAM                                                                             15
lack of community connections as an early intervention approach. There are agencies well
known in the community that specifically work with the Latino community, but do not offer
programs or frameworks addressing acculturative stress and its impact on mental health. As there
is no data describing the specific interventions and outcomes of acculturation-based interventions
in Fairfax County, interviews with Fairfax County professionals and community members were
conducted to determine the need for an acculturation based program. Many of the interviewees
agreed that solutions to acculturative stress were greatly lacking in the community and a need for
programs to address this, urgently wanted. Refer to Appendix D – Interviews with Community
Members and Potential Stakeholders for additional information.  
Comparative Analysis
A comparative analysis of similar programs in the proposed area were examined to
determine the need for a program such as ATBCP. In Virginia alone, there are more than 20
organizations that provide in home counseling and similar services, yet team-based models are
not used unless multiple siblings need different services or the youth needs most-restrictive
services such as residential treatment (Holmes, personal communication, 2017). The
organization Youth for Tomorrow (YFT), offers a team-based approach where a clinician and
case manager are assigned to a youth. However, the clients are unaccompanied immigrant youth
who are in the custody of the Federal Administration for Children and Families Office of
Refugee and Resettlement and YFT’s main goal is to reunify the client with their parent or
guardian in the United States while connecting them to their community (Prince William County,
2014). Another team-based approach used in Fairfax County is the Intensive Care Coordination
unit (ICC) which uses the Wraparound Model to work with families (Fairfax County
Government, n.d.). However, this intervention is used with youth and families who have failed at
ACCULTURATION CLINICAL PROGRAM                                                                             16
multiple other community-based services and are severe enough to be considered for residential
placement or foster care.  
Despite the efforts of all these programs, there is no evidence that these programs have
attempted to address acculturative stress or add acculturation like interventions to existing EBPs.
In addition, local government community mental health settings assign up to 40 cases per
clinician and that one clinician is assigned to work with the family providing individual therapy,
family therapy, and case management for the family unit (Bernard, personal communication,
2017). Balancing all three roles could impact the quality of care and fidelity to treatment as the
focus must be split amongst all tasks. The services offered are also on an outpatient basis only.
Case management becomes mostly administrative (e.g. report writing, documentation) which
could negatively impact therapeutic time that a clinician would have with the youth and family.
Within local child welfare and non-profit settings, only case management services are offered
and any mental health needs are referred to an outside agency. This could impact progress
especially if the family does not consent for exchange of information amongst providers, there
are lengthy waitlists, or the family decides that seeking services from multiple providers is
difficult to manage.  
Existing programs that provide case management and therapeutic interventions in the
home usually include home-based agencies. According to local social services workers, all
services are delivered by one counselor and primary focus becomes work with the parent(s) and
the five to ten hours approved for interventions must be split amongst case management,
multiple family members, crisis intervention, therapeutic interventions, and documentation
(Sanders, personal communication, 2017). This limits the counselor with providing one
intervention to its fullest capacity and most times, the counselor must prioritize and primarily
respond to crisis. Having a clinician provide all therapeutic interventions while a family support
ACCULTURATION CLINICAL PROGRAM                                                                             17
worker provides reinforcement and peer support through case management, could decrease the
likelihood of burnout from balancing multiple roles and increase fidelity of treatment.
Homebased therapists felt they needed co-therapists to be able to not only feel safe, but
adequately do their jobs to the best of their ability (Christensen, 1995). Additionally, specific
clinical frameworks in the community mental health outpatient clinics and home-based agencies
do not specify explicit interventions to address acculturative stress or the unique barriers that
impact the Latino community.  
Methodology
Methods of Project Implementation  
Creating cultural inclusive treatment modalities and interventions such as the ATBCP
become critical in keeping our society ahead of what could be potential negative consequences
that impact many. In an effort to implement the proposed pilot program, the Exploration,
Preparation, Implementation, and Sustainment (EPIS) framework will be utilized to aid in
executing this intervention. The EPIS framework was created to improve the implementation of
EBPs and services offered within public divisions, including mental health services for minority
populations (SAMHSA, n.d.). This framework has four stages, Exploration, Preparation,
Implementation, and Sustainment, and includes factors that support and hinder the
implementation of interventions known as inner and outer planes (Aarons, Hurlburt, & Horwitz,
2011). These factors vary from staff morale to political climate, and contribute to the fidelity of
programming and its continued existence. Given existing cultural gaps in treatment,
incorporating guiding frameworks such as EPIS could potentially increase the likelihood that
underserved communities will receive the services they need. For interventions to be effective,
the problem and possible solutions need to be investigated. The first stage, Exploration,
examines both the problem and need for an intervention and explores what EBP would best fit
ACCULTURATION CLINICAL PROGRAM                                                                             18
the need identified (Aarons et. al., 2011). In other words, the problem is identified and succinctly
defined, people taking on the intervention are selected, and the possibilities of implementing the
solutions are surveyed. Outer and inner planes are also identified such as current funding, federal
policies, who to hire, and readiness to follow the intervention with fidelity (Aarons et. al., 2011).
This ensures that the intervention is appropriate, meets the needs of the community, and could
solve the identified problem.    
With any intervention, step-by-step procedures need to be identified to increase the
likelihood of success when implementing. The second stage, Preparation, begins to create a road
map for how the intervention will be introduced and made part of the current organization
(SAMHSA, n.d.). This stage formulates steps in starting the program, taking the temperature of
consumers and stakeholders, the organization’s culture and staff, as well as training for staff and
stakeholders. Other inner and outer contexts include support for the program, availability of
funding and its stipulations, convincing community partners of the importance of a new
intervention, and using networks to establish a referral stream or awareness of the program
(Aarons, et. al., 2011). The importance of this stage prepares those implementing an intervention
to consider potential obstacles, additional needs of the intervention, and strengthening support
from stakeholders and community members. With these details identified, the success of the
intervention is more likely to run effectively and serve the identified population with fidelity.  
Once a plan is in place, the guidelines developed begin the implementation of the
ATBCP curriculum. The third stage, Implementation, starts the intervention and includes
completion of staff training, referral process, monitoring of the intervention and whether its
followed with fidelity, data collection, and if any additional adaptations are needed (SAMHSA,
n.d.). Other components during this stage include metrics such as pretest and posttest data
collection or interviews with consumers and/or stakeholders. This stage confirms if the plan
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created is accurate, the intervention itself is producing intended results and serving the identified
population, as well as capturing necessary data to support the need and further development of
the intervention. With any new intervention, implementation must also look at the future and its
livelihood of continuing to meet the needs previously identified. The final stage, Sustainment,
looks at continuing the program as well as examining support from outer and inner planes,
funding needs, training needs, results of data collected, intervention adjustments, and reviewing
referral sources and procedure (Aarons, et. al., 2011). Following these components becomes an
additional step in making sure the intervention’s continuity is stable and serving those who are in
need of modified EBPs.  Implementing the acculturation team-based clinical program will
require ongoing collaborations with multiple people including stakeholders and consumers as
well as completing administrative tasks. Refer to Appendix E – 2019-2020 Acculturation Team-
based Clinical Program Pilot Timeline for estimated timeframe of implementing this program
which predicts approximately six to 12 months.  
As this pilot program’s goal is to serve Latino youth and their families, the pilot will take
place in two middle schools with a predominantly Latino student ratio. The two middle schools
identified are located in Falls Church and Alexandria, both cities located in Fairfax County,
Virginia. A school setting was chosen given information from Fairfax County school social
workers that have expressed the school setting usually being “the first to know” of issues
occurring with the youth (Laso, personal communication, 2017).  They further expressed that
many Latino parents within these school settings tend to reach out to school personnel when
behaviors at home become concerning or request help when contacted over their child’s
disciplinary issues.      
The students referred to the program will be of Latino descent as identified by the family
self-identification form completed when students are first registered to attend school. These
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students will be from all three grade levels (sixth, seventh, and eighth grade) and include their
parents and/or guardians. Criteria for participation in the program includes students who have had
at least one offense such as defiance or rule breaking that resulted in school-based discipline (e.g.
suspension) or clinical interventions by school staff such as suicide assessments or frequent
counseling sessions where it has been determined by school staff, that more intensive interventions
are needed. Exclusion criteria includes students who are already connected to community supports
such as homebased counseling or students being referred to higher levels of treatment such as
residential treatment.  
To recruit for the program two informational sessions will be provided for school
personnel, parents, and community members. One session will introduce the program, criteria, and
referral process to staff who work directly with students in a non-teaching capacity. This includes
counselors, school social workers, school psychologists, parent liaisons, and department chairs
who supervise and can make teachers aware of such an intervention. The second informational
group would be a community forum that introduces the program to parents from the identified
community as well as community members and stakeholders who would be willing to invest and
refer to the program. In addition, the program is planning to become a Children’s Services Act
(CSA) vendor and would promote the program through CSA’s annual symposium and Fairfax
County website. CSA is a Virginia law that sets aside a pool of money designated to support youth
with significant emotional or behavioral needs (Fairfax County Government, n.d.). CSA funding
from this Virginia law would be used to further support the program and potentially expand its
capabilities.  Youth and family who do not wish to participate in this program, but are still
interested in culturally sensitive therapy services will be offered outpatient therapy.  


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Financial Plans
The Center for Empowerment and Change would be structured as a 501(c)(3) and
ATBCP will be a service offered by CFEAC. The Center would be the organization responsible
for the development and implementation of ATBCP. Main sources of revenue include insurance
(private and Magellan/Virginia Medicaid), Children Services Act (CSA) funding,
contracts/grants awarded by Fairfax County leadership, grants from federal government agencies
backing mental health early intervention programs (i.e. SAMSHA), donations, and subletting
office space to other services providers. In an effort to secure additional funding to support the
pilot program, a limited liability corporation (LLC) will also be formed as a
partnering/consultation group under the same name. Given that the Center’s focus is on
providing a range of mental health services, outpatient services (in particular, for those who do
not meet the criteria of ATBCP or do not wish to engage in the pilot program) would be offered
as an alternative with funding ranging from private pay clients to high reimbursing insurance
providers such as Blue Cross Blue Shield. The Center would bill insurance companies for
outpatient services meaning our clinicians will also be providing a diagnosis to ensure correct
payment from accurate medical coding. Additionally, for clients who have Magellan/Virginia
Medicaid, case management will be a service provided with outpatient services for the pilot
program meaning the Center can bill Medicaid on a monthly basis in addition to billing for
outpatient therapy.  
Internal Stakeholders and Sources of Authority
Center for Empowerment and Change’s internal stakeholders would include the founder,
two clinicians, two family support workers, and one administrative assistant. Seeing as staff are
crucial to the success of the Center and ATBCP, it will be imperative that staff continue building
their relationships with clients, stakeholders and each other. This Center and its mission are what
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make the work possible and staff would be delivering direct practice work and building upon the
goals of the Center which impacts how well the program performs. Given that the Center will
require licensed clinicians for the clinician positions, the budget would have to include a salary
commensurate on having a clinical license and experience in providing therapy for youth and
adolescents. Budget for family support workers would be commensurate to master level
experience.  
    Sources of authority would include Fairfax County Board of Supervisors, Children’s Services
Act and regulations put in place to conduct business in Fairfax County, Virginia. If the Center
were to receive funds from investors and to keep the partnership strong, investors contributions
would be subject to any authority/rules by the investors to ensure continued collaboration. This
would affect the budgeting in that the investor may or may not continue to give their
contributions and therefore, not be a huge part of the budget.      
External Stakeholders and Organizations
The Center would have multiple stakeholders that would benefit from the services offered
and include Fairfax County Juvenile Domestic Relations District Court (JDRDC), Fairfax
County Public Schools (FCPS), Fairfax County Department of Family Services (DFS), and
Fairfax County Community Services Board (CSB). These agencies which serve families would
initially identify the need for the Center and refer them for services. Given that a program like
ATBCP does not exist, agencies would have an additional resource to assist families. All
Departments, except for the CSB, do not provide outpatient services and must refer their clients
for home-based work (that does not include acculturation) or trainings for families or community
members. The CSB youth division provides outpatient services and medication management, but
do not provide acculturation related services nor provide any home or school-based work. Other
organizations that would be involved with the Center, whether directly or in indirectly, would be
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National Alliance on Mental Illness (NAMI), home-based service providers, and community
based organizations. The Center would also work to build a partnership with NAMI to ensure an
expansion of psycho educational groups and advocacy for the Latino community by NAMI. In
return, NAMI can refer families they come in contact with to ATBCP since they do not provide
therapeutic services.  
It is also the hope of the Center that as the client base grows, a need for connecting these
youth and families to their community will be grander. It is envisioned that investors will provide
training, internships and/or externships for youth and in return have a trained worker that can be
hired on a part time or full-time basis. In particular, the areas of interest include personal training,
tattooing, landscaping, construction, culinary skills, and business given the interests identified by
local school social workers, clients, and community leaders for the two schools where the pilot
program would be implemented. This would be an additional stream of revenue, but would not be
considered until the Center is financially stable and established. Given that CFEAC will have an
LLC group, the LLC will provide in house trainings and workshops to implement the model,
deliver coaching sessions to insure fidelity of the model, and provide as needed consulting to
stakeholders and agencies billed as fee for service.  
Budget Format and Cycle  
    The Center will follow a Line Item Budget System to ensure a comprehensive review of both
revenues and expenses. It would also allow for easier auditing of inputs and outcomes as well as
units of services that would either need to be increased, decreased, or altogether eliminated. It
will follow the fiscal year time frame similar to the local government the Center would be
working with. Their fiscal year begins July 1
st
and ends June 30
th
of every year. Because the
Center’s main sources for revenue would be insurance and government, it is proposed to follow a
budget cycle geared towards accountability and concrete information.  The Budget Cycle
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proposed would include four key elements described as (1) preparation and submission, (2)
approval, (3) execution, and (4) audit and evaluation (Lee & Johnson, 1998, pg. 53). Although
all elements would be driven and completed by the founder, the four components would be
utilized for ongoing monitoring and review to ensure the Center’s success. This cycle would also
be able to provide clear and concise information on progress, expenses, and services offered for
stakeholders, government contract holders, and potential investors.  
First year operations start-up costs to implement the program come to $400,000. Primary
expenses for the program are for the training and managing of clinicians, family support workers,
founder, and activities related to promoting and implementing the program as well as providing
presentations and workshops for community partners and other stakeholders. Consequently, it
will be imperative that fund allocation be meticulous and an effective communication system
with the Board of Directors be implemented to make needed adjustments to ensure the success of
the program. Collaboration and transparency through data sharing will be key to fostering current
and potential relationships. Refer to Appendix F – Center for Empowerment and Change Line
Item Budget – 1
st
Year for additional information.  
    Revenue and Three Year Projection.
The Center’s expenses and revenues for first year operations include overall
implementation of ATBCP and outpatient services. Private insurance will provide higher rates of
reimbursement for clinical services compared to Medicaid, however Medicaid reimburses for
services that private insurances doesn’t such as case management fees. As the Center grows,
additional case management services such as substance use care coordination and drug testing
can occur which according to Magellan/Medicaid rates (2017) currently reimburse at $243 for
coordination and $19.95 for drug screens per client (Magellan of Virginia, 2017). However, it
should be noted that additional services mentioned are not included in the first-year budget. A
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waitlist will be created to ensure the ongoing flow of clients for both the ATBCP and private
practice. In the area where the Center will be located, private pay clients are less likely than
insurance and CSA funded clients however, most private pay clients can either pay for services
from their own money/savings or flex spending health accounts through their employer. It is
estimated that the Center would be able to acquire 20 private pay clients within its first year
given the ongoing gentrification of the area where the Center is located and increase of military
families relocating to the neighboring military base.  
    It is estimated that the Center will receive 20 CSA funded clients, which has guaranteed
approval for six months’ worth of service revenue with the option to renew for another six
months if deemed the family is still in need of services. These clients will be the clear majority
receiving the pilot program the Center’s mission is built upon. Because CSA pays what the
provider lists their services to be worth, the CSA items as described in Appendix F are rates
similar to those found on Magellan VA rates sheet and other private insurance rates. The Center
will also be working with adjudicated youth. Most of these cases require testimony in court
which the Center has proposed their court testimony fees. Additionally, when students from
Fairfax County Public schools are caught on school grounds with substances or behavior has
deemed the student a risk to themselves or others, an assessment is required to either re-enter
school or complete a court ordered sanction. Therefore, the Center proposes to offer a total of ten
assessments a month at the rate described.
    Government grants for providing such services within school settings and communities have
been known to range from $5,000 to $500,000 per the Department of Procurement and Material
Management (Fairfax County Government, n.d.). Grants are provided for multiple services
including mental health therapeutic services such as what the Center is proposing, consultation
services with schools and other agencies on best practice and psycho-education (which the
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Center will also provide), behavioral care services in schools, juvenile detention centers and
programs, community outpatient youth services, mental health services, and family reunification
programs. There are two items which provide less revenue but could potentially increase as the
Center continues to be in existence. As clinicians work to establish themselves in their respective
fields, some of them wish to pursue private practice. However, leasing office space can become
expensive given the already high cost of living in Fairfax County. The Center would offer
subleasing of their offices to clinicians who wish to see clients during late evening and weekend
hours. The rate of $40.00 per hour was determined based on current subleasing rates in Fairfax
County ranging from $20.00 to $50.00 an hour. Given that minority youth are more like to
complete treatment when provided in non-traditional settings, comprehensive mental health
assessments, especially if the child is detained in a juvenile detention facility or refusing to
attend an outpatient office will be provided as another service. The travel fee would be applied to
these particular clients.  
    The Center’s three-year projection estimates that revenue will increase by five percent each
year given continued dedication to fidelity of the program, careful monitoring of the program
and its needs, meeting and transparency with stakeholders, and continued marketing. It is
estimated that the program will bring $50,499 additional revenue by year three including the
addition of other programs and staff. Refer to Appendix G – Three-year Projection for Center for
Empowerment and Change for additional information. Units of Service that equals revenue will
include number of assessments completed, clients receiving counseling services only, clients
receiving proposed acculturation and therapeutic model services (therapy and case management),
and client transitions such as completing treatment, returning to base line, requiring less or more
services, etc. It is essential to track these items to ensure that the mission of the Center is being
followed, services are being identified as useful or in need of improvement, changes that may or
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may not need to be made regarding the Center’s policies and procedures, and determining if the
Center’s interventions have helped in significantly reducing or eliminating the client’s issues.
This constant monitoring will determine the direction the Center will take once the program is
fully operational while upholding its mission.  
Staffing Plans and Costs      
    As outlined in Appendix F, the Center is hoping to hire two Licensed Clinical Social Workers
and two Master Level Family Support workers. Given that licensure determines the amount to be
reimbursed, licensed workers are more likely to receive higher reimbursement rates for
counseling than non-licensed. Given cost of living and average salary in non-profit settings, the
proposed salary of $60,000.00 has been determined with the opportunity for bonuses and/or pay
increase once the Center begins to have more clientele. Family support workers would receive
$55,000.00. Health benefits would be offered after 90-day probationary period and once the
Center begins to prosper, a retirement plan would be considered. Staff would also be given non-
monetary benefits such as flexible schedules, working from home options, in house trainings
from founder, clinical supervision for licensure for Family Support workers, continued
supervision for licensed clinicians, morale boosting events in and out of the Center, shorter work
hours during summer or holiday seasons (e.g. closing office at 12pm on Fridays during the
summer or day before a major holiday).  
Other Spending Plans and Costs
    It is estimated that the Center will need a suite with a waiting area, office for founder, one
office for two case managers, one office for clinicians, and two rooms where therapeutic services
will be provided. Other costs would include furniture for the offices, rent, utilities, website and
internet services, telephone services, marketing, legal paperwork, business cards, office supplies,
and laptops. Using the Practice of the Practice (Sanok, n.d.) tips in reducing costs for non-profit
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practices, the following would allow the Center to save money. Telephone services would be
reduced by using Grasshopper, a system that allows use of a current cell phone but provides a
custom phone line for 12 dollars a month. This also includes a separate voicemail. Website costs
would also be reduced by using BlueHost which charges a one-time fee of 60 dollars for the first
year and five dollars a month thereafter. In regards to marketing, the founder would use her
connections to market the Center through arranging presentations at staff meetings at multiple
agencies, attending the annual CSA symposium which doesn’t charge for tabling, send fliers to
pediatrician offices and hospitals, network with clinicians who sublease space from the Center,
use social media outlets by creating a social media page specific to the Center, and creating a
profile on Psychology Today that provides six months of advertising for free.  
Methods of Assessment and Program Evaluation  
In order to meet the current needs of youth and their families referred to ATBCP, an
initial comprehensive mental health evaluation will be completed to determine mental health
diagnosis and needs.  This program has identified treatment completion and decrease in mental
health symptoms related to acculturative stress as factors to be continuously assessed through
clinical interviews, ongoing assessments, and data tracking from pre and posttests using the
Global Appraisal of Individual Needs – Short Screener or GAIN SS (Dennis, Feeney, Stevens, &
Bedoya, 2007). The GAIN SS examines the following areas: emotional, behavioral, substance
use, and crime and violence. In addition, this screener has been used as a posttest tool to track
progress and overall outcome of treatment. By introducing this program, the expected outcome is
for Latino youth and family to engage and complete the program while decreasing mental health
symptoms. Clinical interviews with youth, family, and any other professional involved with the
family will include collecting data on the increase or decrease of additional offenses, truancy,
and additional behavioral incidents such as hospitalizations, referral to higher level services
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(intensive outpatient, residential treatment, etc.) or additional agency involvement such as
juvenile court.  
Communication Products and Marketing Possibilities
    The Center plans to promote ATBCP and outpatient services through two different marketing
tactics. First, an infographic was created as a referral tool for stakeholders and investors to entice
support. Secondly, a social media hashtag was generated to reach youth and parents who use
social media on a regular basis to challenge stigma and normalize mental health treatment. The
hashtag #mystorytotell or in Spanish #mihisotoriaparacontar would be used on all of the Center’s
social media outlets which include Facebook, Instagram, and Twitter. This hashtag was chosen
to honor the cultural familiarity of storytelling in the Latino community as well as a way to
empower those dealing with the impact of mental health. Refer to Appendix H – ATBCP
Infographic Referral Source Flyer for visual. As the Center grows, additional marketing tools
will be used such as testimony from clients, videos, and support groups via Facebook for clients
who have completed the program in an effort to continue building community. In addition, the
Center also plans to encourage ATBCP participants to share the program with friends, families,
and neighbors or “word of mouth” phenomena and for the quality of work provided by CFEAC
to stand out as a great resource for the Latino community.  
Possible Ethical Concerns and Solutions
With any program that provides mental health services, ethical concerns will arise and
must be addressed appropriately. Although the following is not an exhaustive list, three potential
ethical concerns have been taking into consideration. First, given that the biggest referral source
would be from the school setting, families and/or clinicians could share too much or too little
information about how the student/family are progressing. Given that the school may want to
keep abreast of what is occurring with the family, they may ask CFEAC and/or the family for
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updates. Although it is important for all to work together to ensure the student receives as much
support as possible, families may or may not feel comfortable having this information shared. It
will be extremely important for boundaries to be set regarding roles of each party member and
confidentiality to be discussed with the school referral staff and the family. Using consent forms
(both in English and Spanish) and training CFEAC staff in confidentiality will be implemented.  
      Another ethical concern noted is receiving services in the home of the client. When a worker
is involved with a family and are brought into a family’s home, the worker could be seen or
treated as family or a friend. It will be extremely important to reiterate the purpose and role of
the worker as well as review boundaries to reinforce the professional relationship. Staff will be
provided training and supervision to minimize blurring of boundaries. The third ethical concern
is receiving court mandated clients. The ATBCP would be considered a voluntary program, yet
given its plans to work with the county’s juvenile court, there is a chance that clients may be
court ordered to complete treatment through a program like ATBCP. It will be imperative to
explain to clients how ATBCP is not associated with the court or a service of court, but a
program that courts refer to. In addition, assuring the client’s limits of confidentiality and what
can and can’t be shared as well as the client having the right to not participate in treatment while
understanding that court actions may be taken against them from someone else not affiliated with
CFEAC.  
Most importantly, all ethical dilemmas will not be dealt with alone. Ongoing trainings,
supervision and consultation will occur on a weekly basis as well as the Center and all employed
by the Center would abide by the National Association of Social Workers Code of Ethics to
remain morally and ethically sound when working with clients, stakeholders, and the
community.
Implication to Practice
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Significance to the Field of Social Work
As our world continues to change, so do the needs of some of our most vulnerable
populations.  The impact that ATBCP is predicted to have could change the way we look at
mental health in minority communities and provide a working solution to the healthy
development of Latino youth. Furthermore, it could strengthen community relationships as well
as help create a balanced environment for front line staff. ATBCP could benefit the social work
field in that the reduction of responsibilities on one sole provider could mean less burnout and
turnover.  
Having a person-centered and culturally sensitive EBP program can provide powerful
guidance in not only how we serve minority communities, but also how we write our policies
and view political arenas for both the client and the worker. If ATBCP is able to impact Latino
youth and their families the way it is meant to, our communities will have contributing members
of society that could positively impact our economy and global markets. Resources could be
allocated to other programs or needs in the community, if programs like ATBCP were to be
implemented and serve its purpose of making culturally sensitive EBPs standard practice.
Stakeholders would have a program they trust and know would address the unique goals of their
clients. Hospitals and other higher level of care facilities wouldn’t be overwhelmed with influx
of clients who could’ve potentially been served in early intervention and prevention programs.
Programs such as ATBCP are another resource that could alleviate the already overwhelmed and
over utilized community programs that aren’t reaching the clients it was meant to, saving
taxpayers money. In all, programs such as ATBCP are meant to intervene before it is too late.
With implementation of new programming, there are certain limitations ATBCP may
face impacting how and where the program can be implemented. Therefore, preparing for
program obstacles by identifying barriers is important to the success of ATBCP. One such
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barrier is the lack of culturally relevant theories. Culturally relevant theories have been scarce
when implementing EBPs and have a great influence on whether Latinos seek and ultimately
complete services (Barrera & Gonzalez Castro, 2006). When EBPs are presented, they are
implemented from start to finish without modifications to ensure fidelity. However, without
modifications to cater specifically to the minority group receiving the intervention, the concepts
may not be understood and the likelihood of disengaging may become higher. Strategies
identified for the lack of culturally relevant theories include the improved use of “selective and
directive adaptations” (Barrera & Gonzalez Castro, 2006, p.312) such as methodically
incorporating well-studied cultural approaches (i.e. acculturation) that replace areas of the EBP
the minority group receiving the intervention may not understand. The Sustainment stage of the
EPIS model addresses this by incorporating fluidity through continuing partnerships with the
participants and stakeholders, continuously monitoring and developing the program, and
integrating mixed practices to meet specific needs (Aarons, et. al., 2014). This was taken into
consideration when developing the ATBCP curriculum which allows the front-line staff to
incorporate tools and interventions as needed.      
The lack of collaboration amongst stakeholders and systems within a community also
becomes a barrier when attempting to spread culturally sensitive interventions. Political context,
an organization’s goals and purpose, or their solution to a community issue, may or may not
impact how everyone works together as some may see the need for partnerships while others
may see the need for overall change in how an organization functions (Aarons et. al., 2011).  
In addition, the meaning of culture becomes central when attempting to increase the use of
culturally inclusive theories. The barriers presented here are a minimal acknowledgement of
subcultures and that interventions require more than speaking the same language, as well as
understanding ethnic individuality (Guarnaccia & Rodriguez, 1996). Without recognizing these
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important differences, interventions may fall short of addressing the individual’s need. One
strategy noted to help with collaboration and understanding is the incorporation of Participatory
Action Research (PAR), which focuses on how the community responds to a problem and the
importance of flexibility when exploring solutions (Aarons et. al., 2011). Understanding the
specific needs and progress of a client can ensure they receive the most appropriate intervention.
By providing this structure, a client’s chance of recovery and understanding of their own needs
may increase.
Four additional barriers have been identified that could greatly impact the
implementation of ATBCP. The current innovation may experience low levels of participation
given the current immigration debate. Latino families may be even more hesitant to engage in
services or their community in fear of being deported or receiving sanctions for participating in a
community program. In addition, the future of Medicaid remains uncertain with talks from
political leaders of cutting funding. The third barrier identified is finding bicultural and bilingual
Spanish speaking professionals who fit the need of the program. The clinician and family support
worker would both need to not only meet the language and bicultural requirement, but also meet
educational requirements (licensed clinician and Master of Social Work recipient). The last
barrier being considered for this program is the view on current interventions versus prevention
and early intervention strategies. Majority of funding is usually designated towards high-risk
populations who have already exhausted multiple resources or become chronically mentally ill.
As a result, less is given to prevention and early intervention strategies. Refer to Appendix I –
Implementation of Acculturation Team-based Clinical Program for additional information.  
In discussing barriers, it is also important to note facilitators as part of the solution.
Facilitators for the proposed program include the Center’s founder having over ten years of
experience in working with the Latino community in Virginia as well as established relationships
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with community stakeholders, consumers, and partners. There are also indications of support for
early intervention and prevention programs to address the growing needs of Latino youth as
evidenced by the increased hiring of Latino staff, non-profits incorporating more Latino based
programs, and systems moving towards culturally sensitive practices. In addition, there has been
a noticeable increase in the establishment of least restrictive interventions such as diversion
programs in the juvenile court system, system of care approaches, and increased collaboration
amongst community mental health clinics and schools. This increase becomes relevant to the
implementation of the proposed program as stakeholders could potentially refer and continuously
support ATBCP that caters specifically to the Latino youth they are attempting to serve through a
team-based approach.  
Strategies to Address Identified Barriers.
The following strategies to promote implementation of the proposed program have been
identified and are based on the six strategies designed for implementing clinical solutions
(Powell, McMillen, Proctor, Carpenter, Griffey, Bunger, & York, 2012). The program would
primarily use planning, educating, restructuring, and quality management strategies to initiate the
program with the long-term goal of sustainment. The idea in using multiple strategies for each
barrier is to build trust amongst potential consumers and stakeholders while addressing person-
centered needs. Refer to Appendix J – Barriers and Strategies for ATBCP Implementation for
additional information.  
Finally, this program will depend on multiple government and insurance structures that
may or may not continue depending on our current government administration. Other plans to
fund this program include collaborating with already existing home-based agencies that would be
willing to incorporate the ATBCP model while reaching out to Latino based organizations that
support the growth of the community such as UnidosUS, Virginia Coalition of Latino
ACCULTURATION CLINICAL PROGRAM                                                                             35
Organizations (VACOLAO), Casa de Virginia, League of United Latin American Citizens
(LULAC), and Hispanic Organization for Leadership and Action (HOLA). By reaching out to
these organizations, they may be able to fund part of the program or at the very least connect the
program to potential funding.  
Conclusion
Receiving culturally inclusive mental health care with an acculturation component, as
well as a strengthened connection to their community, becomes essential in Latino youth and
their families completing treatment and successfully becoming a part of their environment.
Removing unique barriers specific to the Latino community would not only decrease the amount
of youth left without mental health services, but also increase successful acculturation, academic
success, and decrease the likelihood of involvement with juvenile justice systems or worsened
mental health issues. By removing these barriers, the reliance on already strained community
systems would decrease. In an effort to implement this program, the social workers from the
schools where the ATBCP would be piloted, have agreed to use the ATBCP curriculum as part
of their yearly interventions with students. Ongoing collaborations with these social workers will
occur as well as with stakeholders and community partners to meet the needs of the community.
In addition, the private practice LLC has been created and will begin to consult with agencies
who have expressed interest in the ATBCP curriculum. Continued dialogues, data collection, as
well as modifying and/or adding components ATBCP, will also occur.  This includes
consultations as well as training and development of staff, stakeholders, and community partners.
Potential additions to the program once the team-based approach is successful include exploring
and adapting the acculturation based model to other underserved minority populations.
Additional research should focus on the development of culturally sensitive EBPs focusing on
specific barriers found in other minority communities to then that be duplicated nationwide.    
ACCULTURATION CLINICAL PROGRAM                                                                             36
References
Aarons, G. A., Green, A. E., Willging, C. E., Ehrhart, M. G., Roesch, S. C., Hecht, D. B., & Chaffin, M.
J. (2014). Mixed-method study of a conceptual model of evidence-based intervention
sustainment across multiple public-sector service settings. Implementation Science, 9(1), 183.
Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based
practice implementation in public service sectors. Administration and Policy in Mental Health
and Mental Health Services Research, 38(1), 4–23.  
Alexandre, P., Martins, S., & Richard, P. (2009). Disparities in Adequate Mental Health Care for Past-
Year Major Depressive Episodes Among Caucasian and Hispanic Youths. Psychiatric Services :
A Journal of the American Psychiatric Association., 60(10), 1365-1371.
American Academy of Social Work and Social Welfare. (n.d.). 12 Grand challenges for social work.
Retrieved from http://aaswsw.org/grand-challenges-initiative/12-challenges/
Archuleta, A. J., & Lakhwani, M. (2016). Posttraumatic stress disorder symptoms among first-
generation Latino youths in an English as a second language school. Children & Schools, 38(2),
119-127.
Barrera, M., & Castro, F. G. (2006). A heuristic framework for the cultural adaptation of
interventions. Clinical Psychology: Science and Practice, 13(4), 311-316.
Christensen, L. L. (1995). Therapists’ perspectives on home-based family therapy. The American
Journal of Family Therapy, 23(4), 306-314.
Cook, B. L., Liu, Z., Lessios, A. S., Loder, S., & McGuire, T. (2015). The costs and benefits of reducing
racial ethnic disparities in mental health care. Psychiatric Services, 66(4), 389396.
Dennis, M.L., Feeney. T., Stevens, L.H., Bedoya, L. (2007). Global Appraisal of Individual Needs –
Short Screener (GAIN-SS): Administration and Scoring Manual Version 2.0.1. Retrieved from
https://www.assessments.com/assessments_documentation/gain_ss/GAIN-SS%20Manual.pdf
ACCULTURATION CLINICAL PROGRAM                                                                             37
Fairfax County Government. Children Services Act. Retrieved from
https://www.fairfaxcounty.gov/healthymindsfairfax/childrens-services-act
Fairfax County Government. Community Services Board: Children, Youth, and Family Services.
Retrieved from https://www.fairfaxcounty.gov/community-services-board/youth
Fairfax County Government. Wrapround Services. Retrieved from
https://www.fairfaxcounty.gov/community-services-board/services/youth-outpatient-intensive
Flores, A., Lopez, G., Radford, J. (2017). Facts on Us Latinos, 2015 – Statistical Portrait of Hispanics in
the US. Retrieved from Pew Research Center http://www.pewhispanic.org/2017/09/18/facts-on-
u-s-latinos-trend-data/
Guarnaccia, P. J., & Rodriguez, O. (1996). Concepts of culture and their role in the development of
culturally competent mental health services. Hispanic journal of behavioral sciences, 18(4), 419-
443.
Guarnaccia, P. J., Pincay, I. M., Alegria, M., Shrout, P., Lewis-Fernandez, R., & Canino, G. (2007).
Assessing Diversity among Latinos: Results from the NLAAS. Hispanic journal of behavioral
sciences, 29(4), 510-534.
Gutiérrez, Leticia A. (2014). “Youth Social Justice Engagement in the Face of Anti-Latina/o Immigrant
Illegitimacy.” The Urban Review, vol. 46, no. 2, 2014., pp. 307-323. Retrieved from
http://link.springer.com.libproxy2.usc.edu/article/10.1007%2Fs11256-013-0269-y.  
Isasi, C. R., Rastogi, D., & Molina, K. (2016). Health issues in Hispanic/Latino youth. Journal of
Latina/o psychology, 4(2), 67.
Jaggers, J., & MacNeil, G. (2015). Depression in 37merican adults who immigrated as youth: Results
from the national Latino and Asian American study. Best Practices in Mental Health, 11(2), 1.
ACCULTURATION CLINICAL PROGRAM                                                                             38
Kellogg Foundation, W.K. (2004). Using Logic Models to Bring Together Planning, Evaluation, and
Action: Logic Model Development Guide. Retrieved from https://www.wkkf.org/resource-
directory/resource/2006/02/wk-kellogg-foundation-logic-model-development-guide
Lee, R. D., & Johnson, R. W., 1942. (1998). Public budgeting systems (6
th
ed.). Gaithersburg, Md:
Aspen Publishers.
López, S. (2002). Mental Health Care for Latinos: A Research Agenda to Improve the Accessibility and
Quality of Mental Health Care for Latinos. Psychiatric Services, 53(12), 1569-1573.
Magellan of Virginia (2017). Magellan VA Medicaid and DMAS rates. Retrieved from
http://www.magellanofvirginia.com/media/1582053/va_medicaid_dmas_rates_4-1-2017.pdf
Merianos, A. L., Vidourek, R. A., & King, K. A. (2017). Effective prevention strategies for increasing
health services utilization among latino youth. Community Mental Health Journal, 53(1), 79-91.
Retrieved from https://link-springer-com.libproxy1.usc.edu/article/10.1007%2Fs10597-016-
0022-6.
Parra Cardona, J. R., Domenech‐Rodriguez, M., Forgatch, M., Sullivan, C., Bybee, D., Holtrop, K., &
Bernal, G. (2012). Culturally adapting an evidence‐based parenting intervention for Latino
immigrants: The need to integrate fidelity and cultural relevance. Family Process, 51(1), 56-72.
Prince William County. (2014). Prince William County News: Youth for Tomorrow. Retrieved from  
Powell, B. J., McMillen, J. C., Proctor, E. K., Carpenter, C. R., Griffey, R. T., Bunger, A. C., ... & York,
J. L. (2012). A compilation of strategies for implementing clinical innovations in health and
mental health. Medical care research and review, 69(2), 123-157.
Ramirez, G.A, Gallion, K.J., Aguilar, R., Dembeck, E.S. (2017). Mental Health and Latino Kids: A
Research Review. Retrieved from https://salud-america.org/wp-
content/uploads/2017/09/FINAL-mental-health-research-review-9-12-17.pdf
ACCULTURATION CLINICAL PROGRAM                                                                             39
Sanok, J. How to start a private practice in one day. Retrieved from
http://www.practiceofthepractice.com/articles/how-to-start-a-private-practice-in-one-day-for-
less-than-200/
Substance Abuse and Mental Health Services Administration (n.d.). The EPIS model of implementation.
Retrieved from https://nrepp-learning.samhsa.gov/framework/epis-model-implementation.
Smart, Julie F., & Smart, David W. (1995). Acculturative Stress: The Experience of the Hispanic
Immigrant. Counseling Psychologist, 23(1), 25-42.
Smokowski, P., & Bacallao, M. (2009). Entre Dos Mundos/Between Two Worlds Youth Violence
Prevention. Small Group Research., 40(1), 3-27.
Smokowski, P., & Bacallao, M. (2011). Becoming Bicultural: Risk, Resilience, and Latino Youth (1).
New York: NYU Press.
Tate, K., Lopez, C., Fox, R., Love, J., & McKinney, E. (2014). In-Home Counseling for Young
Children Living in Poverty. The Family Journal, 22(4), 371-381.
Trautmann, S., Rehm, J., & Wittchen, H. (2016). The economic costs of mental disorders: Do our
societies react appropriately to the burden of mental disorders? EMBO Reports, 17(9), 1245–
1249. http://doi.org/10.15252/embr.201642951)
Williams, L. R., Ayers, S. L., Garvey, M. M., Marsiglia, F. F., & González Castro, F. (2012). Efficacy
of a culturally based parenting intervention: Strengthening open communication between
Mexican-heritage parents and adolescent children. Journal of the society for Social Work and
Research, 3(4), 296-307.





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Appendices
 
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Appendix A Acculturation Team-based Clinical Program Logic Model

Program:   Center for Empowerment and Change Logic Model
Situation: Hispanic youth are not accessing necessary supports to address behavioral and community needs despite existing interventions. Hispanic youth and their
families are not aware of services, services are not addressing stigma found within the Hispanic community, and behavioral frameworks not addressing
acculturation, immigration, and how to access resources within their community.

Inputs
(What we invest)
Outputs
(What we do and who we do it to )
Outcomes – Impact
(The incremental events/changes that occur as a result of the outputs)
Activities

Participation

Short Medium Long

501(c)(3) status

First year funding
($500,000)

Become paneled with
insurance/CSA

Board of Directors
(potential partners)

Staff (LCSWx2, MSWx2,
Adminx1, Exec Dir.x1,
MSW Internx2)

Job description of board
and staff

Office Space and Office
Furniture

Technology (Internet,
EHR, VM/phone)

Computers (6)

Liability Insurance

Health Insurance for
Employees

Orientation/training
process

Maintenance of Office




 
Hire employees

Train employees

Needs Assessment
(MH/SUD/Community)

Therapeutic Interventions
(homebased and/or
outpatient counseling)

Case management

Action Planning/Roles

Conduct
presentations/workshops
to the Community

Psycho-education

Peer Support Group

Connecting families to
their community

Establish community
partnerships

Marketing (online/in-
person/tabling/community
events)






Consumers  

Agencies that work with
youth (Juvenile Court,
Social Services, Schools,
Mental Health Clinics,
Health Department, Parks
and Rec, Doctor’s office)  

Stakeholders

Advocates (MH/SUD,
Immigration, Civil Rights)


 
All staff trained within first
three months of hire

Community
resources/partners aware
of program

Referral list created of
potential clients

40% of consumers are
aware of the new program



Increase of youth
receiving services

Community
partners/agencies
encouraging participation
in program and referring

Changes in Behaviors

Changes in knowledge
and connection to
community


Greater ability to
participate in all aspects
of life through connection
to their community and
use of therapeutic
interventions  

Decrease in
hospitalizations and/or
incarcerations for youth

Increased school
attendance

Increased use of
community supports



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Appendix B

Acculturation Team-based Clinical Program
Step by Step Curriculum
 
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Training Manual for Clinicians and Staff

Created by: Jackie Guevara, LCSW
Center for Empowerment and Change

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Purpose

Center for Empowerment and Change (CFEAC) is an innovative non-profit whose
mission is to change behavioral care in the Latino community and be the leading expert
in creating frameworks for addressing the specific mental health needs of minority
communities.  The program will address the identified gaps found within traditional
evidenced based practices (EBP) that do not address the specific cultural barriers faced
by the Latino community. CFEAC’s goal is to increase the use and completion of
behavioral care through bicultural treatment while decreasing acculturative stress,
building community connectedness, and providing hope for Latino families who have a
youth suffering from mental illness. Only by addressing these barriers through culturally
appropriate interventions do Latino youth and their families have a chance at living
productive lives free of stigma and with tools to better manage their mental health.  
As the Latino population increases, so do the potential issues which not only impact the
Latino community, but the United States as well. By 2050, the Latino population in the
United States will increase to 119 million with Latino youth making up an estimated 1/3
of this increase (Smokowski and Bacallao, 2013). Given that Latino youth are diagnosed
with serious mental illness 22 percent more times than other minority groups and white
peers (Ramirez, et al., 2017), are more likely to live in poverty – approximately 5 million
as of 2015 – and face up to 70 percent higher levels of acculturative stress than any other
minority group (Flores, Lopez, & Radford, 2017), the impact on our future economic and
social environments could be detrimental and cost tax payers millions. In addition,
despite these issues increasing, Latino youth are less likely than their White peers to
access mental health treatment or participate in an adequate number of treatment sessions
because treatment does not address their specific cultural needs (Alexandre, Martins, &
Richard, 2009).
In 2010, it was estimated that the economy lost 2.5 trillion dollars due to mental disorders
(Trautmann, Rehm,& Wittchen, 2016), imagine how our economy will be impacted when
Latino youth (who shortly will become the majority) are left to navigate and attempt to
contribute to our society while dealing with untreated mental health issues. Acculturation
in particular, plays a significant role in Latino youth adapting to two cultures and can
become a barrier if not addressed by appropriate interventions. This challenge is specific
to Latino youth in comparison to their non-Latino peers as youth are left to establish their
own identities and beliefs while balancing their two cultural systems (Jagger &Gordon,
2015). Therefore, CFEAC is dedicated to meeting this challenge and providing much
needed hope and intervention for the Latino community.



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Table of Contents

Introduction .......................................................................................................................... 46
Note to Clinicians and Staff ................................................................................................... 47
Session Descriptions .............................................................................................................. 48
Session 1 (60-90 minutes) ...................................................................................................... 51
Session 2 (50-60 minutes) ...................................................................................................... 52
Session 3 (50-60 minutes) ...................................................................................................... 53
Session 4 (50-60 minutes) ...................................................................................................... 54
Session 5 (50-60 minutes) ...................................................................................................... 55
Session 6 (50-60 minutes) ...................................................................................................... 56
Session 7 (50-60 minutes) ...................................................................................................... 57
Session 8 (50-60 minutes) ...................................................................................................... 58
Additional Tips ...................................................................................................................... 59
Thank you! ............................................................................................................................ 60
References ............................................................................................................................. 61

 
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Introduction

This curriculum was created to provide treatment and support for Latino youth and their
families by decreasing stigma, acculturative stress, and lack of community connections
through team-based culturally inclusive therapy, case management, and advocacy using
Cognitive Behavioral Therapy (CBT) (Beck, 1995) and Entre Dos Mundo/Between Two
Worlds (Smokowski & Bacallao, 2011). Materials presented in this manual are to be used
within a team-based therapeutic framework while building a strong therapeutic alliance
with the youth and family. The curriculum is built on an 8 session model. However,
additional sessions can be implemented to further address a specific issue or assist the
family in moving towards their goals. Additional sessions can also be used as
continuation of a critical session, youth and/or family resistance (need to further build
rapport) or to address crisis.

Roles:

Clinicians are to provide all therapeutic interventions using CBT and Entre Dos Mundos
interventions. These sessions should range from 50-60 minutes long and provided in the
home, school, or other setting of family’s choice. The first 15 minutes are used to set the
agenda as well as review material from the previous session. Then the material for the
session is presented and worked through, as well as anything else the family and/or youth
would like to discuss. The final 5 minutes should be used to assign the family
homework/tasks that serve to reinforce what was discussed during the session.

Family Support Workers are to support the youth and family through case
management, while helping the parent(s) incorporate the skills learned from treatment to
build connections in the community, successfully navigate systems, understand their
roles, rights and responsibilities, as well as support their youth through completion of
treatment. They also assist the parent and youth in completing therapeutic assignments as
needed. Examples of providing resources and support include reviewing basic human
rights related to immigration, rights as parents of a child in public school, local medical
resources, local churches, food assistance, etc.

...............
.....

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Note to Clinicians and Staff

Use this manual as a guide to address the fundamental issues of stigma,
mental health, and acculturative stress. Each youth and their family’s
situation is different, therefore start where the family is. Person centered
care is at the heart of this model. Become familiar with the curriculum,
but please add your personal style. Being genuine and compassionate
are key! Build rapport and do not be afraid to ask questions to get to
know the family’s culture and traditions. The youth and family are also
part of your team. They are the experts of their family. You are the
expert in providing the intervention. Together the possibilities are
endless. In all, the family is looking to you for help, for understanding,
provide the hope and support they need. Thank you and good luck!

 
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Session Descriptions

Session 1 – Introduction to Treatment and Acculturation

The purpose of session is to build rapport, establish a baseline through use of the GAIN SS,
discuss the youth’s mental health and family’s understanding of mental health, as well as
acculturation. This session will also establish the structure and purpose of future sessions.
Logistics such as rules of treatment and confidentiality (including limits) are also discussed.
Empathy and learning about the family’s culture and traditions will be imperative. The first
session begins a dialogue on mental health, its impact and how the youth and family are feeling.
Prepare for resistance or limited disclosures. Provide psycho education on the condition as well
as introduce CBT basic concepts. Basic acculturation stages are also introduced to align with
family culture and awareness. Homework assignment focuses on ways youth and family have
been impacted by two cultures (US and home country) and what the family has been doing/not
doing to adjust.


Session 2 – Family Culture and American Culture relating to Mental Health  

This session provides the family an opportunity to discuss their cultural beliefs more in depth as
well as the impact of trying to understand American culture. This session is also used to discuss
any concerns or answer questions from previous session. Processing and empathy are major
factors throughout this session. Clinician also introduces automatic thoughts and beliefs relating
to the youth’s mental health. The main purpose of this session is to help the family understand
similarities and differences between the cultures as a way of identifying barriers to progressing in
treatment. An in-session activity is included to provide the family with a visual as well as
provide an opportunity for the youth and parent to work together. Along with the therapist, goals
and understanding of treatment are established to help both youth and parent progress and
remedy behaviors.  Homework assignment focuses on the identification of worries each one has
for the other regarding balancing two cultures and mental health. Encouragement of possible
solutions to support each other is also included.

Session 3 – Distorted Thinking and Identification of Coping Skills

The main purpose of this session is to introduce distorted thinking while identifying coping skills
the family can use to handle acculturative stress and mental health symptoms. Review homework
from previous session and process accordingly. The session serves as a way for the youth and
parent to explore their own distorted thinking and the importance of challenging these thoughts.
Discuss concerns or answer questions from previous session as needed as well as review
automatic thoughts and beliefs if required. In-session activity aides in identifying troubling
thoughts. Processing of emotions from distorted thinking and reactions imperative in this session
as well. Homework assignment focuses on tracking negative thoughts and success or failure of
chosen coping skills (negative thought worksheet).  



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Session 4 – Distorted Thinking Continued, Cultural Transitioning and Grief  

This session continues discussion about distorted thinking to help the family understand how this
contributes to the exacerbation of mental health symptoms. In addition, this session is used to
help the family understand that grief and loss are relevant and just as important when attempting
to deal with acculturative stress. Review homework from previous session and process
accordingly. Introduce Stages of Grief pertaining to acculturation and normalize where the youth
and parent are (especially if in different stages). Provide psycho education on the progress of
grief and emotions related to grief as needed. This session allows the family to feel and
understand how this grief can impact mental health as well as connecting to their community.
Homework assignment helps youth and parent to identify their current stage of grief as well as
ways the two can support each other in their particular stages.  

Session 5 – Coping Skills, Continuing to Manage Grief, and Obstacles

The main purpose of this session is to help the family prepare for cultural obstacles and reinforce
the use of coping skills. Review homework from previous session and process accordingly. In
addition, this session serves to help the family prepare for possible negative interactions within
their community such as discrimination. The use of Socratic Questioning and other CBT
challenging tools are introduced and practiced with the family during the session. Provide
psychoeducation as needed and strength-based approaches to help the family effectively deal
with these obstacles and focus on family strengths. Homework assignment helps youth and
parent explore potential discriminatory acts and ways the youth and parent can support each
other through the experience.  

Session 6 – Review of Skills and Building Community

This session is used to process emotions up to this point of treatment, reinforce and/or reevaluate
current coping skills, review any aspects of acculturation, treatment, or coping skills as needed,
and how to build relationships with non-Latino community members. In-session activity serves
to help youth and/or parent practice speaking to/reaching out to non-Latino Americans; finding
ways to relate and build friendships. Homework assignment not necessary unless clinician
assesses that an assignment is needed to reinforce anything from this session or previous
sessions. Remind family of upcoming termination and process any emotions from pending
termination.  

Session 7 – Long Term Goals, Preparing and Celebration Planning for Termination

This second to last session is to help prepare the family for termination and review the work
family has done while in treatment. The use of SMART goal tools/worksheets can be used as the
in-session activity. This session also serves to provide the family with reassurance of their
capability to adapt to their community, deal with obstacles, and use therapeutic tools to handle
mental health symptoms and other barriers the family may face in the future. Discussion of last
session and how the family would like to celebrate completing treatment is also discussed.
Homework assignment includes youth and parent either writing each other a letter or
appreciation or choosing an object/keepsake that represents appreciation. If family would like to
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include other professionals involved with the family (school social worker, probation officer,
etc.) they may attend last session. Family support worker is included in last session as well.  

Session 8 – Review, Integrate, and Celebrate

This last session is to serve as a celebration of the progress and hard work from the family.
Review of family’s success and review of treatment tools. Letter or object of appreciation are
shared. Traditions or family choice of celebration conclude the session.



 
 
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Session 1 (60-90 minutes)
*Given this is the first meeting with family, clinician may choose to extend session past 90
minutes if deemed clinically necessary


Introduction to treatment and acculturation

• Provide psycho education on youth’s mental health condition
o Emphasize confidentiality and person-centered format
o Discuss ATBCP and answer questions, reassure confidentiality and client rights
o Provide empathy as much as possible  
o Build rapport and focus on the importance of client therapist alliance
o Introduce GAIN SS and walk family through assessment if they do not understand
• Discuss youth and parent’s understanding of mental health
o Answer/discuss questions relating to cultural beliefs
o Empathize with emotions from process or what family has been experienced
o Normalize treatment using examples and relating to family’s cultural beliefs
• Discuss family’s culture, then acculturation and its impact with family culture as origin
o Acculturation
o Enculturation
o Assimilation
o Biculturism
o Deculturation
• Homework – List ways family has been impacted by two cultures (US and home country)
and what the family has been doing/not doing to adjust (Smokowski & Bacallao, 2011)



Family Support Worker’s Role this Week – Introductions, building rapport, reinforcing
confidentiality and structure of the program. Assist parent and youth in completing session 1
homework, discussing concerns, and normalizing emotions
 
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Session 2 (50-60 minutes)

Review of Family Culture and American Culture relating to Mental Health  

• Review anything from previous session if needed
• Discuss emotions from engaging in ATBCP; answer questions from family
• Review homework – process emotions, provide psychoeducation as needed
o Have parent and child share the importance of their culture and what they see as
American culture
• Clinician helps parent and youth complete a Venn Diagram of similarities and differences
between the two cultures followed by processing and normalizing of differences
• Introduce understanding automatic thoughts and beliefs and how related to youth’s
mental health
o Use worksheets or drawings with family
§ Ex: Thoughts à Emotions à Behavior/Action
• Homework – Spend 20 minutes (or more if needed) discussing worries and possible
solutions without judgement – provide support as needed (Smokowski & Bacallao, 2011)
o Youth shares worries they have about their parents (draw, journal, etc.)
o Parent shares worries they have about their youth (draw, journal, etc.)
o What can they do to support each other and possible decrease some of these
worries – (provide family with at least two examples if family has difficulty)



Family Support Workers Role this Week– Mood check, continuing to build rapport, provide
support or community resources as needed. For example, if family is not aware of medical
resources, discuss. Assist parent and youth in completing session 2 homework
 
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Session 3 (50-60 minutes)

Introduce Distorted Thinking and Identification of Coping Skills

• Review anything from previous session if needed
• Review homework – process emotions, empathy, provide psycho education as needed
o Have parent share THEIR own concerns
o Have youth share THEIR own concerns
o Ensure safety, confidentiality, and empathize with sharing
• Mood check and symptoms related to diagnosis
• Introduce concept of distorted thinking (Beck, 1995)
o Review automatic thoughts and beliefs (if needed)
o Negative Thinking Patterns worksheet (English and Spanish)
o Help parent and child identify any distortions followed by processing
o Discuss possible coping skills to challenge
• Homework – Start tracking distorted thinking and practice coping skills identified.
Identify at least three more on your own. Provide family with worksheet or show family
how to build their own sheet



Family Support Workers Role this Week – Mood check, provide support and resources as
needed, assist family with completing homework
 
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Session 4 (50-60 minutes)

Distorted Thinking Continued, Cultural Transitioning and Grief  
• Review anything from previous session if needed
• Review homework – process emotions, provide psycho education as needed
o Discuss coping skills and relate to experiencing transitioning and grief
• Introduce Stages of Grief related to cultural transition (Sanders, 1992)
o Shock – can also discuss depression, anger, etc.
o Awareness – “pain too real” strong emotions, separation anxiety
o Conservation – Withdrawal, less social interactions, etc.
o Healing – Acceptance, Understanding both cultures
o Renewal – living for oneself and balancing cultures
• Normalize that parent and youth may be in different stages and coping differently
• Homework – Chart/draw what stage youth and parent are in – discuss ways parent and
youth can support each other in their stages even if a cultural difference between the two
exists (Smokowski & Bacallao, 2011)



Family Support Workers Role this Week – Mood check, provide support and resources as
needed, assist family with completing homework
 
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Session 5 (50-60 minutes)

Coping Skills, Continuing to Manage Grief, and Obstacles
• Review anything from previous session if needed
• Review homework – provide psycho education as needed
o Discuss coping skills and ways to support each other during transitioning and
grief
§ Provide examples as needed, introduce coping skills list if needed
• Explore Potential Obstacles to Successful Acculturation
o From parent view
o From youth view
o From world view (i.e. what obstacles others might bring)
• Explore ways to overcome obstacles using Socratic Questioning/CBT challenging (Beck,
1995)
• Homework – Role play ways to handle discrimination at school and work based on
exploration of obstacles and list ways family can support each other from these
experiences (Smokowski & Bacallao, 2011)



Family Support Worker ‘s Role this Week – Mood check, provide support and resources
as needed, assist family with completing homework
 
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Session 6 (50-60 minutes)

Review of skills and building community
• Review anything from previous session if needed
• Review homework – provide psycho education as needed
o Empathy and discussing discrimination; problem solving
o Normalize emotions invoked from experiencing discrimination and how to handle
• Reassess skills used for current symptoms and progress
o Discuss skills that worked and reinforce
• Introduce building relationships within the community, in particular with non-Latino
Americans (Smokowski & Bacallao, 2011)
o Obstacles and solutions
o Addressing culture shock if needed
o Review of compare/contrast of culture if needed
• Homework – Role play using empty chair technique ways of speaking to/reaching out to
non-Latino Americans; finding ways to relate and build friendships (Smokowski &
Bacallao, 2011) – demonstrate during end of session if needed



Family Support Worker ‘s Role this Week– Mood check, provide support and resources as
needed, assist family with completing homework

 
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Session 7 (50-60 minutes)

Long Term Goals, Preparing and Celebration Planning for Termination
• Review anything from previous session if needed
• Review homework – provide psycho education as needed
o Discuss fears and provide reassurance of ways to build relationships with Non-
Latino Americans; use challenging of negative thoughts to ease doubts of building
relationships
• Explore long term goals regarding acculturation and identity (Smokowski & Bacallao,
2011)
o What does the family want and need to accomplish this?
o Chart long term goals using SMART technique
• Discuss what termination session will look like
• Have client complete GAIN SS
• Homework – Write each other a letter of appreciation and decide how to celebrate end of
treatment incorporating any tradition family wishes (food, prayer, meditations, etc.)



Family Support Worker’s Role this Week – Mood check, provide support and resources as
needed, assist family with completing homework, and discuss transitioning out of
treatment/celebration
 
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Session 8 (50-60 minutes)
*Final session – however as mentioned, clinician and family support worker
may extend sessions as needed

Review, Integrate, Celebrate (Smokowski &Bacallao, 2011)
• Review overall progress (Family Support Worker joins session)
o Provide reassurance and discuss support group
o Review of resources and clinical tools
o Review of community connections
• Review integration and process as well as moving forward
• Celebrate!  
o Share letters, food, or whatever tradition family has decided to close their journey



If family is open to connecting with other families who have completed the
program, they are added to the Center’s support group list. Support group to
be scheduled and planned accordingly.



 
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Additional Tips  

• Plan adequate time for termination
o Use additional sessions if more than 8 sessions are needed (no more than four
additional sessions is recommended). Regardless, last session should be a review
of treatment, discussion of progress, and celebration. Do not introduce new
concepts during the final session.
• Address any concerns brought on by client as treatment ends
o Provide a “confidence booster” and remind family of their progress, walk them
through challenging negative thoughts associated with terminating treatment.  
• Discuss possible booster session if needed
o Appointment can occur a month after completion of treatment
• Write Down Tips for Yourself  
o As social work professionals, we constantly grow in our profession and recognize
the importance of continued training and our own well-being. Below, jot down
what tips you have after completing a cycle of ATBCP

TIPS FOR ME





















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Thank you!

Providing services and hope to some of our most vulnerable citizens is no easy feat but choosing
to implement ATBCP shows your dedication to serving your community. It is our belief that we
can impact the lives of many and leave quite the impression for a better tomorrow. If you have
any questions, suggestions, or feedback about this pilot, please do not hesitate to reach out to  

Jackie Guevara, Founder at jguevaralcsw@gmail.com

Or you may also email empowermentandchangellc@gmail.com or call us at (240) 392-1684.

Best of luck and thank you for being such a powerful change agent!
 
ACCULTURATION CLINICAL PROGRAM                                                                             61
References  

Beck, J.S., (1995). Cognitive Therapy: Basics and Beyond. The Guilford Press  
Sanders C. (1992) Surviving Grief and Learning to Live Again. John Wiley & Sons, N.Y.
Smokowski, P., & Bacallao, M. (2011). Becoming Bicultural: Risk, Resilience, and Latino
Youth (1). New York: NYU Press
 
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Appendix C
Referral Form – English and Spanish
 
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Acculturation Clinical Program Referral Form  


The Acculturation Clinical Program is a team-based approach to addressing mental health
and acculturative stress that offers person centered care to Latino youth and their families
impacted by stigma, cultural barriers, and misunderstanding of mental health. We provide a
two-person team (a licensed clinician and master level case manager) to each family
providing culturally sensitive therapeutic interventions, psycho- education, information about
community resources, and how best to adapt to their community.  

Date of Referral:    Name of Referring Worker:        
 
Agency:           Phone:     Fax:

Last Name:                                               First Name:                                                  Date of Birth:        

Home Address:

City:                                                                                            Zip Code:  
Telephone number(s) include emergency numbers:
Cell:                                                 Home:                                                 Work:                                     Other:
Preferred Number: Cell   Home Work Other
Identified Child/Children Date of Birth School Male, Female, Other
   
   
   
   
     
Others in the Home Date of Birth/Age Male, Female, Other Relationship
   
   
   
   

Nationality of Family (i.e. El Salvador, Guatemala):  

Preferred Language of Family:

1. Reason for Referral:  




2. Relevant Family History/Problems:

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3. What services do the family currently receive (i.e. CPS, Court, Food Assistance):  




4. Additional Pertinent Information:





**Please make sure family has signed the attached consent form.  


     
 
     
 
     
 
     
 
     
 
     
 
     
 
     
 
     
 
     
 
 
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    SPANISH

 

El Programa Clínico de Aculturación es un enfoque de equipo para abordar la salud mental y el estrés
aculturativo que ofrece atención centrada a los jóvenes latinos y sus familias afectados por el estigma, las
barreras culturales y la incomprensión de la salud mental. Un equipo de dos personas (un clínico con
licencia y un administrador de casos de nivel maestro) a cada familia que brinda intervenciones clinicas
que son culturalmente sensibles, psicoeducación, información sobre los recursos de la comunidad y la
mejor forma de adaptarse a su comunidad.

Fecha de Remision:    Nombre del trabajador remitente:        
 
Agencia:           Telefono:     Fax:


Apellido:                                                                           Primer nombre:                                          Fecha de
nacimiento:  

Dirección de domicilio:

Ciudad:                                                                                      
Código postal: Número(s) de teléfono incluya
números de emergencia:
Celular:                                                Casa:                                               Trabajo:                                     Otro:
Numero Preferido: Celular    Casa  Trabajo  Otro  
Nino/Ninos
Identificados
Fecha de Nacimiento Escuela Hombre, Mujer, Otro
   
   
   
   

Otros in Casa Fecha de
Nacimiento/Edad
Hombre, Mujer, Otro Relacion
   
   
   
   

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Nacionalida de Familia (i.e. El Salvador, Guatemala):  

Idioma preferido de la familia:

1. Motivo por remision:  



2. Historial familiar/Problemas relevantes:



3. Qué servicios recibe actualmente la familia (i.e. CPS, Corte, Assistencia con Comida):




4. Informacion adicional:  
 
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Appendix D Interviews with Community Members and Potential Stakeholders
Name Title/Organization Response to ATBCP






Diana
Ayala


Middle School Teacher
Prince William County School

Currently working with target
population in a public school setting
and frustrated with lack of MH
options for her students


Overall Diana felt that a program like my capstone
would “positively impact” the Latino community. In
particular, she shared how such programs would really
be a voice for Latino youth and their families as well as
“challenge labels” which society and anti-latino
groups/people use. Most importantly, she mentioned
how challenging stigma and providing parents with
tools to use so they won’t feel singled out or alone is
another important component that needs to be
emphasized in this program. She shared her student’s
experience and praised this innovator’s idea noting that
it would really make a difference in the world of these
youths’.  








Karina
Bustillo


Non-Profit Manager
AIAA

Experienced MH issues as a youth
but did not receive treatment until
she was an adult.  

Per Karina, this capstone would “make a great impact
on Latino families” because of cultural barriers and
stigma attached to mental health within the Latino
community. She explained how she herself had to come
to terms with her own mental illness and how she
wished she would’ve dealt with her own MH sooner.
She also believes a program like this would normalize
MH in the Latino community and hopefully make it
easier for Latinos to seek treatment. She was impressed
with the program wanting to provide community
connectedness as per her experience, Latinos face
hardships and most times don’t know where to go or
where to turn.  







Ana
Romero


High School Counselor
Montgomery County Public Schools

Works in a predominantly Latino
high school and has shared her
student’s ongoing difficulty with
acculturation, mental health, and
drug use.

Per Ana, a program like this would be “hugely
beneficial” especially because she works in a majority
Latino community. She shared the difficulty she has
seen with the families she works with noting that
adapting to and understanding American culture can be
extremely overwhelming. She has seen how cultural
norms in Latino culture versus American culture in
factors like education, religion, and overall beliefs
collide and as a result, students and parents become
depressed and angry when trying to assimilate. She also
states that programs like these are needed as a way of
providing an “outlet” for youth and families to feel safe,
discuss their fears, and provide hope. Ms. Romero also
mentioned how there are no culturally sensitive
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programs or programs similar to this one in the area she
serves and that it is greatly needed.  








Jessica
Reyes






Educational Specialist
HeadStart Fairfax County

Works closely with target population
in a prevention and community
resource role

Jessica believes a program like this would have a
“powerful impact” on Latino youth and their family as it
would provide “a space’ for dialogue and support on
issues that are stigmatized and not easily recognized. It
would provide parents the necessary tools they need to
exercise their rights while supporting their youth. This is
important as she shared the majority of her clients do
not ask for help out of fear or the unknown and
involvement with systems is mostly due to lack of
education or “not knowing any better”. The program
could potentially provide a way for the Latino youth and
their families to prosper and increase their education as
well as opportunities. Jessica shared stories of the
families she has worked with and their hardships noting
that very few, if any programs, practice culturally
sensitive ways and a program like this is desperately
needed. She then asked if she could be hired if this
program ever takes off and is very interested in helping
the program become a reality as the need is so great!  










Stephanie
Lizama






Student
Virginia Commonwealth University

Bachelor level social work student;
interned in predominantly Latino
community

Stephanie stated that a program like this would be
“essential for Latino youth”. She shared stories from
Latino youth clients she has worked with who have
expressed their challenges as a Latino adolescent and
how their family depend on them so much because they
either speak English and parents don’t or youth
understands American culture better and parent is too
afraid to face something alone. She also believes that
program such as these can help with the oppression that
Latino youth and their families face and shared how she
wished growing up, she could’ve taken part in a
program such as this. In all, a program like this would
not only alleviate stress but contribute to learning and
growing for both the parent and youth. In addition,
having a community connectedness component like
what is proposed (a family support worker) would help
Latino youth and their families potentially feel safer and
connected to their community and believes it would
actually increase a youth and family’s ability to
effectively deal with racism and anti-immigrant
groups/people.







Per Karen, “this is an amazing endeavor that is in dire
need across the nation!”. She shared her personal
experience growing up with her brother who struggled
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Karen
Coca
Paralegal
AARP

Has brother who dealt with mental
health since adolescence and is
currently incarcerated for drug
related charges. She is also an anti-
human trafficking advocate.

with addiction and mental health and how systems
seemed oppressive and punitive versus helpful. A
program like this she states would provide desperately
needed resources and support systems for youth and
their families. In particular she mentioned the
importance of programs not only catering to the specific
needs of families but also helping them understand their
rights and systems as trying to blindly navigate a foreign
system is challenging, stressful, and ineffective
especially if the culture is completely new and different.  









Carolina
Diaz




Social Services Specialist
Fairfax County DFS – Reston

Has extensive work history with
target population including gang
involved youth, immigrant families,
and trafficked victims. Carolina is
also a proud immigrant from El
Salvador.  

Carolina believes that a program like this would be
“very beneficial to helping the families I serve as it
would address many barriers\risk factors faced by
immigrant families”. She further states how current
services fall short of addressing the same barriers I
mentioned and the reason why I have proposed such a
program. Moreover, programs are not really promoting
what she referred to as cultural awareness especially in
very needy communities. She shared stories of past
clients including clients who had been murdered or are
currently incarcerated which she believes occurred
because programs like the one I am proposing don’t
exist and existing programs fail her clients time after
time. At the end of the interview she shared her interest
in contributing to such a program and working to
promote the importance of such projects in the
community.  







Caroline
Guevara


Associate Producer
Cartoon Network

Advocate for Latino youth, designed
a social awareness game on
immigration, and struggled with
acculturation as a youth  

Per Caroline, a program like this would have a huge
positive impact because she has seen how too many
times “Latino youth struggle to find their identity when
they’re stuck between following American cultural
norms, their cultural norms of their heritage, and finding
their own mesh of the two”. She shared her own
experience with acculturation, both victories and
hardships and how important it is to recognize that this
is an impactful issue. She shared her difficulty with her
parents and their faith and shared how she has observed
how “Latino parents often rely on faith and family
advice only when they are faced with uncertainties and
tribulations”. This leaves a huge concern because mental
health is then not spoken about, mocked and further
stigmatized within the community. She shared how not
only is this detrimental to those who are actively
suffering from mental health, it perpetuates a vicious
cycle where mental health isn’t taken seriously and
brushed off. Caroline believes that a program like this
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and others developing similar programs, can really help
Latino youth and their parents learn the importance of
self care, mental well being and breaking the stigma of
mental health.







Chela
Clark


Clinical Supervisor
Fairfax County CSB – Adult

Has extensive work history in the
mental health field, in particular,
minority adults with substance use
issues  

Chela believes a program like this is needed and notes
that “it would provide a supportive community and an
accessible resource for Latino youth and their families”.
She shared her experiences within her community
regarding personal and professional first hand
experience of witnessing acculturative stress. She notes
how the majority of programs do not address this nor
support the family through the complexity of
acculturation which then becomes a huge barrier for the
client. Given the parameters of the program, she
believes it could really help in decreasing or even
eliminating negative impacts from the mentioned
stressors and really build a stronger Latino community.  











Adrian
Desmond







Correctional Officer
North Carolina

Experience with both professional
and personal experiences of mental
health

Per Adrian, “I think a program like this would entice
extreme mental growth and tolerance while increasing
the ability of first line of defense in preventing
acculturative stress within the household”.  He shared
his experiences as a correctional officer and also shared
stories of inmates he learned a lot from as well as what
they had to deal with acculturation wise and mental
health wise as youth that led them to be offending adults
in the prison system. As Adrian stated, so many of the
inmates he has supervised where once kids who either
fell through the cracks or had parents that couldn’t help
(either because they didn’t want to or didn’t know how
to).  He believes a program like this would help teach
parents how to cope with what is affecting their kids and
contribute to preventing youth from lashing out in the
community. Furthermore, a program like this would
create a sort of “safe zone” for the youth, encourage
addressing what is happening at home or with their
mental health and have a better understanding of what
they are facing and ways to effectively manage the
stressors.  














School Social Worker
Per Elizabeth a program like this, “would be a positive
effect on the families morale; a place to belong that
understands where they come from and what they value
and what their struggles may be”. She shared stories of
the immigrant students and families she’s worked with
in both New Mexico and Virginia, relayed their
struggles and discussed seeing specific barriers that
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Elizabeth
Maynor
Fairfax County Public Schools

Currently working with target
population and has over 10 years of
social work experience

Latino families face which impedes their success.
Moreover, she shares how a lot of programs in the area
do not address the specific dynamics of Latino culture
which makes it even harder to really engage families in
interventions. She spoke of the importance of programs
like these making it possible for Latinos to “have a seat
at the table” when it comes to changing policy and
inclusion. She also emphasized the importance of
programs including a way for clients to know their
human rights and to work closely with community
leaders.  






Laurie
Laso


School Social Worker
Fairfax County Public Schools

Currently working with target
population and has over 30 years of
social work experience

Laurie believes that a program like this would be
“particularly helpful and a great resource for families
experiencing reunification and single parent families”.
She gave examples of families she has worked with and
shared struggles they have dealt with both on a personal
and societal level. She mentioned making sure the
professionals within the program meet with clients in
the community or their home to better engage them.
Laurie enjoyed learning of this program and stated she
would help with referrals and spreading the word in the
community if it gets off the ground.  








Jenny
Betancur



Program Manager
Latin American Youth Center

Works with Latino young adults
transitioning from high school to
work or college

Per Jenny, a program like this would “definitely
encourage youth and families to seek mental health
services. She shared how one of the biggest challenges
she’s seen with the population she works with is often
family inclusion and awareness of mental health is
lacking and in some cases, youth might seek support
services secretly as to not alert their family because of
stigma. She believes that this detrimentally inhibits the
youth from fully engaging in therapy, making positive
changes or taking necessary life decisions. She believes
that programs fail to really sustain relationships with
families and that they don’t find ways to engage the
families cultural beliefs when addressing mental health.
Something that I had not thought of but Jenny pointed
out was how programs like these would help families
understand family roles and youth roles/responsibilities.
She shared how she has seen too often her clients
assume “mature responsibilities at a young age and are
met with a responsibility/stress they are unable to
process”. She shares how it is not out of malice but
more so out of need to survive and parents not really
understanding the developmental capacities of their
youth. As a result, a lot of youth become limited by their
dependability on their family as providers. She gave
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examples of some of the parents she works with not
understanding why a youth has to spend X-number of
hours outside of home at the library, why a youth should
partake in student leadership, why a youth should
volunteer or intern, why students are unable to pick up
siblings or elder relatives due to academic
commitments, etc. She stated, “Too often our youth
carry a burden for changing traditions, expectations and
wider perspectives”.  





Estela
Ramirez


Paralegal
Corporate and Business Law Firm

Parent of a Latina teen who was
diagnosed with depression  

Estela believes a program like this would “really help
teens deal with their mental health and learn to navigate
their environment”. She shared her experience of when
her daughter was diagnosed as well as the experience of
her daughter’s friends. She worries about the mental
health stigma not only in the Latino culture but also how
it impacts people’s abilities to ask for or seek help. She
stressed the importance of the program and
professionals using “non-judgmental ways” of working
with the family and implementing interventions.  









Angelica
Ninet





Retired/Mother of former Latina
youth with mental health issues

Parent similar to potential clientele
my program is aimed to work with

Per Angelica, “I wish a program like this existed when
we were looking for help for my daughter”. She shared
her experience in attempting to understand her
daughter’s mental health, trying to convince her
husband that there was something more than her
daughter just “being lazy”, and understanding what
could help her daughter. She also shared how she never
really was able to find an appropriate fit (as in a
therapist) for her daughter and that her daughter was not
able to successfully deal with her mental health until she
entered college. She really stressed the importance of
supporting the parent, walking the parent through
mental health, the intervention, and really building
support for the parents especially if they are single
parents or parents who fully belief the stigma of mental
health. She shared how hard it was on her daughter for
her father to not understand what she (the daughter) was
struggling with. She believes a program like this
could’ve saved her family so much grief and that her
daughter probably could’ve addressed her mental health
a lot sooner. Although her daughter is doing better and
her husband somewhat understands more about mental
health, some struggles arise every now and again. She
encouraged me to pursue this program and spoke of how
she really hopes it happens as to help families in
situations like she experienced.  

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Appendix E 2019 – 2020 Acculturation Team-based Clinical Program – Pilot Timeline

January to March • Choose Board of Directors (BOD)
• Begin office search
March  
March
• Verify Name of Organization
• File non-stock articles with VA State Corporation
Commission
• Obtain EIN number


April to May
• First BOD meeting
• Develop mission and vision statements
• Create/Establish bylaws
• Implement/create filing system (non-profit records kit)
• Apply for 501I(3)
• Estimated to take between 30 days to 8 months*
June to July • Research current market
• Find office space
August • Office space (if still haven’t located)
• Staff descriptions and orientation manual

September to November
• Fundraising/stakeholders planning
• Marketing campaign  
• Outreach to foundations
• Outreach to local partners/agencies

December
• Recruit staff
• Establish payroll/funding
• Receive authorization for non-profit establishment

January to February
2020
• Apply for state tax exemption
• Register for charitable solicitation
• Obtain licenses and liability insurance
March  March • Open for business

   *timeline to be adjusted as needed pending amount of time taken for 501(c)(3) establishment
 
ACCULTURATION CLINICAL PROGRAM                                                                             74
Appendix F  Center for Empowerment and Change Line Item Budget – 1
st
year

Center for Empowerment and Change Line Item Budget System
     
First Year Operation
     
     
Revenues
     
1. Insurance/Medicaid
   
65000
2. Private Pay
     
2a. Comprehensive Mental Health Assessments @525
   
10500
2b. Counseling Services @190 per session
   
38000
2c. Correspondence/Letters/Phone Calls @80 per request
   
1600
3. CSA
     
3a. Counseling Services @190 per 50 minute session  
   
38000
3b. Case Management Services @350 per month  
   
42000
3c. Comprehensive mental health assessments @525
   
10500
3d. Comprehensive substance use assessments @525
   
10500
3e. Court testimony @ 400
   
2000
4. Clinical Supervision @ 110
   
1100
5. Government grants/contracts/donations
   
165000
6. Subleasing @40 per hour
   
4000
7. Travel for assessments outside of Center @100 per case
   
2000
8. Workshops/Trainings
     
8a. Training/Workshops for groups/agencies @1500
   
7500
8b. Follow up calls/consultation @200 per month
   
1200
Total
   
398900
     
Expenses
     
1. Salaries and Wages
     
Founder @ 70,000
 
70,000
 
Licensed Clinician (2) @60,000
 
120,000
 
Master Level Case Manager/Family Support Worker (2) @55,000
 
110,000
 
Support Staff/Admin
 
40,000
 
2. Rent @ 1800 per month
 
21600
 
3. Utilities
 
1000
 
4. Health Insurance
 
20000
 
5. Liability Insurance  
 
500
 
6. Website Services  
 
400
 
7. Internet Services  
 
400
 
8. Telephone
 
300
 
9. Marketing
 
2000
 
ACCULTURATION CLINICAL PROGRAM                                                                             75
10. LLC Legal Paperwork
 
120
 
11. Business Cards
 
50
 
12. Cleaning Services
 
200
 
13. Maintenance Services
 
3000
 
14. Office Supplies
 
1000
 
15. Laptops and accessories
 
1000
 
16. Celebration Items
 
5000
 
Total
 
340,000 56570

396,570
     
Profit/Loss
   
(surplus) 2,330


Appendix G Three-year Revenue Projection for Center for Empowerment and Change

CFEAC 3-YEAR PROJECTION

     

% Increase Year 1 Year 2 Year 3
Beginning Balance

0 $16,600.00 $50,499.00

   
Revenues:

Services 5.0% $398,900.00 $418,845.00 $439,787.25
Other (Additional Pgms)
5.0% $0.00 $5,000.00 $5,250.00
Total Revenues

$398,900.00 $423,845.00 $445,037.25

Expenses:

Salary and Fringe
2.00% $340,000.00 $346,800.00 $353,736.00
Supplies 2.00% $9,100.00 $9,282.00 $9,467.64
Maintenance

$5,700.00 $5,814.00 $5,930.28
Equipment

$27,500.00 $28,050.00 $28,611.00
Total Expenses

$382,300.00 $389,946.00 $397,744.92

   
Ending Fund Balance

$16,600.00 $50,499.00 $97,791.33





ACCULTURATION CLINICAL PROGRAM                                                                             76
Appendix H  ATBCP Infographic – Referral Source Flyer


 
More Likely to be Diagnosed
Latino Youth Mental Health
In 2016, 72 percent of Latino youth were diagnosed
with Post Traumatic Stress Disorder compared to their
non-Latino peers. They are also more likely to suffer
from depression, anxiety, and substance use
disorders.
Latinos face decreased educational
opportunities, discrimination, high acculturation
stress, higher likelihood of poverty, language
barriers, and lack of access to resources such as
culturally adequate mental health services
Barriers to Getting Help
One study showed an 80% decrease in parent-
child conflict and mental health problems
among Latino families who received
acculturation stress interventions. Our Center's
Acculturation Team Based Clinical Program
(ATBCP) provides culturally appropriate mental
health treatment and case management
Acculturation Must be Addressed
By 2050, Latinos will make up approximately
1/3 of the United States population with Latino
youth being most of this growth, greatly
impacting the future of the United States work
force, education and health systems
Why We Should Care
Help is available and all it takes is a referral from you.
Visit our website at www.empowermentandchange.com
for tips on how to support Latino youth and families or
to make a referral. You can also contact us at
(571) 555-1234 for more information
What You Can Do
Brought to you by the
Center for Empowerment and Change
(571) 555-1234

Sources:
Jaggers, J., & MacNeil, G. (2015). Depression in hispanic adults who immigrated as youth: Results from the
national latino and asian american study. Best Practices in Mental Health, 11(2), 1.

Smokowski, P., & Bacallao, M. (2011). Becoming Bicultural: Risk, Resilience, and Latino Youth (1). New York:
NYU Press
ACCULTURATION CLINICAL PROGRAM                                                                             77

Appendix I  Implementation of Acculturation Team-based Clinical Program



Barriers Facilitators













Implementation
Outer
• Economic factors
• Poverty
• Lack of health
insurance
• Cost of services
• Social Factors
• Stigma
• Misdiagnosed mental
illness
• Misunderstanding of
mental diagnosis
• Medicaid availability
• Availability of grants
• local, state, federal
• length of grants
• Strict anti-immigration policies
• Anti-immigrant groups
• Lack of community
collaboration
• Lack of system of care
approach in mental health
fields

Inner
• Difficulty finding
bicultural/bilingual staff
• Investment from staff to follow
model with fidelity
• Low enrollment of clients
• Developing organization’s
policies
• Team-based model fit in the
community and organization

Outer
• Stakeholder inclusion in meetings
and development
• Identified leadership to oversee
implementation and fidelity
• Training of staff and stakeholders
on the program
• Networking/promoting to
colleagues and community
• Pro-immigrant groups pushing the
use of bicultural interventions
• Increase in system of care
approach by various groups and
providers
• Increasing Latino population
warranting different approaches to
mental health treatment

Inner  
• Specific organization mission and
goals for the program
• Job descriptions, roles, and
responsibilities of program staff
• Organization’s policies and referral
process identified
• Data collection and leadership
oversight of model


 
ACCULTURATION CLINICAL PROGRAM                                                                             78
Appendix J  Barriers and Strategies for ATBCP Implementation

Implementation Barriers Implementation Strategies

Anti-immigrant political
climate

Mistrust/Stigma related to
mental health services

Misunderstanding of mental
health and related diagnosis

Unaware of Mental Health
Resources

Lack of culturally relevant
theories/frameworks
Planning
• Develop rapport with referral sources/stakeholders
who can promote program and confidentiality to
consumers
• Use innovator’s current reputation and networks to
promote program to consumers
• Create CBT/Acculturation curriculum
Educating
• Provide consumers with “Know Your Rights”
psycho-education material to contest fear of
government involvement/immigration status
• Facilitate informational sessions and how to
encourage participation in program  
• Provide psycho education on mental health to
consumers and stakeholders  


Future of Medicaid
Cost of services
Lack of health insurance
Restructuring
• Providing private practice services to consumers not
in need of program
• Alter program as needed to meet needs of community
Financing
• Fundraising with local Latino based organizations and
other community members/organizations
• Apply for local, state, and federal grants
• Provide stipend for those who have completed
program and refer others

Finding bicultural and
bilingual staff
Financing
• Provide incentives for staff to encourage accepting
position with program
Planning
• Build rapport with staff to further develop
relationship and staff recommendations

Reactive Interventions versus
Prevention/Early Intervention
Quality Management
• Track data in data system and provide findings to
stakeholders and consumers
• Continuously evaluate program and work of staff to
ensure fidelity; adjust intervention as needed

Applying Powell et al.’s (2012) Compilation of Strategies for Implementing Clinical Innovations
in Health and Mental Health to the Implementation of proposed Acculturation Team-based
Clinical Program 
Abstract (if available)
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Asset Metadata
Creator Guevara, Jacqueline (author) 
Core Title Acculturation team-based clinical program: pilot program to address acculturative stress and mental health in the Latino community 
School Suzanne Dworak-Peck School of Social Work 
Degree Doctor of Social Work 
Degree Program Social Work 
Publication Date 02/25/2019 
Defense Date 11/27/2018 
Publisher University of Southern California (original), University of Southern California. Libraries (digital) 
Tag acculturation, acculturative stress,behavioral care,cultural barriers,cultural sensitivity,evidenced based practices,Latino,Latino beliefs,Latino culture,Latino families,Latino youth,Mental Health,mental health stigma,OAI-PMH Harvest,trauma 
Format application/pdf (imt) 
Language English
Contributor Electronically uploaded by the author (provenance) 
Advisor Benedict Nelson, Andrew (committee member), Navarro, Ernelyn (committee member), Singh, Melissa (committee member) 
Creator Email jguevaralcsw@gmail.com 
Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-127231
Unique identifier UC11676799 
Identifier etd-GuevaraJac-7113.pdf (filename),usctheses-c89-127231 (legacy record id) 
Legacy Identifier etd-GuevaraJac-7113.pdf 
Dmrecord 127231 
Document Type Capstone project 
Format application/pdf (imt) 
Rights Guevara, Jacqueline 
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
Tags
acculturation, acculturative stress
behavioral care
cultural barriers
cultural sensitivity
evidenced based practices
Latino
Latino beliefs
Latino culture
Latino families
Latino youth
mental health stigma
trauma