University of Southern California Dissertations and Theses

Brazos Abiertos: addressing mental health stigma among the Latino Catholic community

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Brazos Abiertos: addressing mental health stigma among the Latino Catholic community

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Content Running head: BRAZOS ABIERTOS
Brazos Abiertos: Addressing Mental Health Stigma among the Latino Catholic
Community
Jessica Guerrero
Capstone Project Presented in Partial Fulfillment for the Degree
Doctor of Social Work
University of Southern California
Suzanne Dworak-Peck School of Social Work
August 2020
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Table of Content

Executive Summary …………………………………………………………………. 3
Conceptual Framework………………………………………………………………. 6
Problems of Practice and Innovation Solution ……………………………………… 16
Logic Model …………………………………………………………………………. 25
Project, Methodology and Action (Brazos Abiertos) ………………………………... 26
Conclusion …………………………………………………………………………… 38
References ……………………………………………………………………………. 42
Appendix A – Logic Model ………………………………………………………….. 54
Appendix B – ISMI-9 ………………………………………………………………… 55
Appendix C – Prototype ……………………………………………………………… 56
Appendix D – Website ……………………………………………………………….. 61
Appendix E – Sample Handout ……………………………………………………… 62
Appendix F – Budget (Pilot) ………………………………………………………… 63
Appendix G – Budget (Full Operation) ……………………………………………… 64
Appendix H – EPIS timeline ………………………………………………………… 65

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Executive Summary
The Public Policy Institute of California (California's Future Population, 2016) had
predicted that Latinos would have surpassed the White population in 2020. It also reflects that
the Latino youth make up 52 percent of the youth population within California. With population
growth, individuals' needs increase in multiple areas, and the need to receive support is stressed
as resources may be spread thin. The youth living in the identified demographic area of South-
Central Los Angeles are exposed to multiple layers of challenges, including marginalization.
Marginalized youth can face many challenges throughout their development and cultural
adaptation; such struggles include identifying where they belong within their family system and
their social network as acculturation and enculturation (Alamilla, Kim, & Lam 2010).
Many youths can benefit from mental health services to support their development and
overall functioning; however, these services are usually not sought out or unfamiliar to them due
to generations of beliefs and practices. The stigma associated with mental health can be caused
by various things which include, language, fear of judgment, cultural misunderstandings, and
their immigration status as being deported to their home country can have subsequent
consequences and possible difficulties in re-adapting (Schuster & Majidi, 2015). Due to the
stigma experiences, Latinos will seek support and guidance from a priest who may not have the
appropriate tools to support mental health issues.
Peterson (2011) discusses the collaboration and the need to have positive outcomes when
integrating a religious aspect of the targeted population's culture and incorporating it with mental
health, which Brazos Abiertos will be able to address. As Brownson et al. (2018) discuss, the
process includes assessing the readiness of the program, conducting a local needs assessment,
gathering tools for quality monitoring, conducting ongoing dynamic training, and providing
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support to the participants of the program to be interactive participants and lastly to prepare to
scale the program up in efforts to reach a large number of individuals.
Payan et al., 2019 discuss the benefits of having the religious leaders engage the
congregation in external topics from religion, such as discussing Mental Health with Brazos
Abiertos. The engagement of the church, funding, personnel, and the collaboration with an
already existing program such as with the youth group within the church will help facilitate
engaging the Latino Catholic community during the implementation of the workshops and
having a positive outcome with de-stigmatizing mental health and support any future expansion
of the program within the church and other community parishes. Brazos Abiertos is not limited
to the Catholic community; it can be adapted to any additional religious practice within the
Latino community.
Brazos Abiertos will provide psychoeducational workshops for the youth in the current
youth group. The workshops will provide ten topics that address mental health in multiple areas
and possible causes of mental health issues, such as family violence, generational trauma, and
community violence. The purpose of Brazos Abiertos is to de-stigmatize mental health among
the Latino Catholic community in efforts to increase dialogue on the topic, increase utilization of
mental health services in addition to decrease any behavioral health issues that may arise with
untreated trauma, depression, and anxiety.
The overall effects of having a preventative and informative program such as Brazos
Abiertos can support using resources available to help their mental health and reduce the risk
factors with behavioral health (Cervantes, Goldbach, & Santos 2011). Programs that may be
involved and be perceived as threatening and invasive include the Department of Child and
Family Services, law enforcement. For youths, possible involvement with the Department of
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Juvenile Justice Law Enforcement, which can result in these entities, confirms the fears of these
entities (Burns et al., 2004; Malett, Stoddard Dare & Seck, 2009). Additionally, not having
support with mental health for developing youth can affect overall academic achievement
(Bruffaerts et al., 2018).
Many programs exist currently that address mental health, de-stigmatizing mental health, and
those that use the spoken language and culture as a tool to reach the Latino community; however,
these programs are currently geographically unavailable to the current targeted population due to
distance in addition to the current global pandemic of COVID-19.
Brazos Abiertos is being piloted at St. Patrick's church youth group, conducted virtually.
The pilot will follow by engaging the parents of the participating youth and expand to be
included as part of the process of religious education at the forenamed church. Brazos Abiertos is
also engaging church leaders to ensure that the program's message is engaging the leaders. In
contrast, they support the congregation and the participants of the specific church groups. Due to
multiple groups within the church, the expansion of Brazos Abiertos can be anticipated.
Brazos Abiertos, on a larger scale, can be implemented in neighboring cities across Los Angeles
County. Future steps moving forward will also include reaching out to the Archdiocese of Los
Angeles to continue growth and implementation.
Lastly, the outcomes of improving the youth and family's perception of mental health and
possible changes that will occur within the community can be perceived as a successful
implementation of the program. Additionally, having collaborations emerge with community
mental health agencies in seeing the need for culturally relevant providers can support continued
fruitful outcomes (Caballero et al., 2017).

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Conceptual Framework
Problem
The Latino community has currently surpassed 60 million individuals in the United States
as of 2019 (Noe-Bustamante, Lopez, & Krogstad, 2020). The term Latino, in this document, is
used to refer to individuals that are Mexican, Mexican American, Central American and, those
with Central American descent. According to the Los Angeles County Statistics, the population
in Los Angeles County consists of a total of 10,441,080 individuals, 44.6 percent identified
as Latino compared to 31.1 percent, who identified as White. Public Policy Institute of
California (2016) reflects that the Latino youth under the age of 18 are 52 percent of the youth’s
population within the state of California.
With the Latino population increasing, so do the community needs and the lack of
available resources, which also contributes to an increase in the requirements of this growing
population. Isasi, Rastogi, and Molina (2016) discuss how the lack of resources in a high Latino
populated area can inadvertently cause greater health problems, including mental health. The
third reason out of the top five barriers for access to mental healthcare is mental health education
and awareness. As the resources within a community become scarce, meeting the needs of youth
and their family is quickly felt, especially when the development of the youth is impacted.
Latino families, especially those that have recently immigrated, may struggle with acculturation,
fear, and not knowing the language, which can become a massive barrier to receiving the
appropriate supports or resources (Ramos-Sanchez & Atkinson, 2009).
Latino parents, like most parents, have the hope and desire to have healthy and
prosperous children. In exploring healthy development, one must take a multilevel approach and
analyze what the youth may have been exposed to and, more specifically, looking into the
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Adverse Childhood Experiences. Caballero et al. (2017) assert that native Latino youth
compared to immigrant Latino youth have a higher ACEs score. However, the study also
acknowledged that the data might be inaccurate because the questionnaires do not ask
appropriate questions that reflect the experiences of immigrant youth, which may inevitably
contribute to the fundamental lack of proper services for these youth and families.
Masterpasqua (2009) explains how an experience of individuals can be passed down to
multiple generations from their ancestor’s experiences, as seen with wars, famine, slavery,
racism, extreme poverty, and illnesses. These experiences that families have had due to
generational trauma; it can place these individuals with a predisposition for continued
marginalization due to the lack of resources within their community. Research has identified
that past experiences can affect a person’s mental health. Masterpasqua (2009) indicates,
“Linkages between epigenetics and psychopathology are emerging that point to new possibilities
for conceptualizing, preventing, and treating disorders” (p. 194). Maintaining this information at
the forefront, the youth of current and future generations may have experiences that affect their
ability to get through adversity and making stressful situations more complicated.
Historically, Latinos will maintain individual and family struggles within the family as
they are usually close, protective, and communalistic and would not expose any family trauma
and challenges. However, Bermudez et al., (2010) declared that many Latinos, who are facing
life struggles, would seek out support from individuals that would provide a safe and non-
judgmental response. Campesion and Schceartz (2006) asserted that Latinos usually seek help
from family and friends and may also seek support and guidance from faith-based leaders.
Latinos of the Catholic faith have sought out their local priest when facing difficulties in their
lives (Oxhandler, Narendorf, and Moffatt, 2018).
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The priest in the Latino community represents not only a person that can provide
additional guidance but also a person that can represent trust and support with the blessing of
God. Some of the needs that are presented to a priest may require assistance from a mental
health professional as seen with those that have experienced trauma, community violence,
substance use, depression, anxiety and in extreme cases severe mental health conditions with
suicidal ideations (Lerman, et al., 2018; Office of the Surgeon General, 2001; Wong, & Miles,
2014). In the Latino culture, this topic of seeking help outside of their circle of family and
friends remains to be difficult (Cuadro, 2018). Religion and its practices are part of a Latino’s
life and overall culture; it also serves as a tool when working on coping through struggles or
significant life events, which is necessary to take into consideration when services are provided
to this group of individuals (Campesino & Schwartz, 2006). Many Latino Catholics will seek
out religion as a solution and will evoke their faith in times of need to fulfill any hope and
comfort as they go through life struggles (Pietkiewicz & Bachryj, 2016).
Bermudez et al. (2010) explored the gap that is found between the services that are being
provided and the individuals that are being served as seen with poorly developed programs that
meet the needs of families of color. When a program or service does not meet the requirements
or understands the consumer, it is challenging to have buy-in and investment in the services.
Lopez, Barrio, Kopelowicz and Vega (2012) discuss the importance of having the services in the
language of the individual seeking services in addition to being culturally adapted.
Currently, the fear of deportation may significantly influence decisions made regarding
mental health or seeking out support from a professional due to the fear of having their families
torn apart, and this fear can be present for both documented and undocumented Latinos (Arbona
et al., 2010). The fear of being deported and having to return to a home country that they no
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longer are familiar with or one that they escaped from due to the significant corruption,
terrorism, and danger of being killed continues to be very present (Richards, 2018).
Additionally, the fear of DCFS (Department of Children and Family Services) becoming
involved and the fear of having their children removed as a result of a possible mental health
need is a misconception; however, for Latino families, this fear may feel very real (Richards,
2018). Latino immigrants may at times experience irrational thoughts which increase feelings of
stigma, ideas of “what will people think?”, “I must be weak because I can’t just get over it!” and
“I will be treated differently” in addition to other negatively annotated comments (Bulanda,
Bruhn, Byro-Johnson, & Zentmyer (2014); Caplan (2019); Stanley, Hom & Joiner, 2018).
In the Latino Catholic community, many people refuse to seek professional help because
of the fear that finding a professional may equate to not having enough faith, not praying hard
enough, or not praying long enough (Kovess-Masfety et al., 2017; Rosario & Rosa, 2014), which
further exacerbates the stigma associated with receiving mental health services. Latinos most
commonly will seek trusted individuals such as a neighbor, family member, or the local place of
worship to assist them with their current struggles. Many will ask a Priest for support with all of
their needs regardless of the intensity or topic (Kovess-Masfety et al., 2017). However, most
religious leaders, such as Priests, do not have the training to assist their community with mental
health services, and just the same, mental health professionals may also be ill-equipped to
address any religious or cultural issues (Weaver, 1998).
Assessment of Current Support
Latinos, although one of the largest groups within Los Angeles County, continue to be
underrepresented within services provided by the Department of Mental Health and other
private- sector agencies. According to the Mental Health Service Act Annual Update for 2019-
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2020, 38% of the population within South Los Angeles (Service Area 6) is Latino (or as
identified on the report as Hispanic). This same report fails to recognize the percentage of
individuals that are monolingual Spanish; however, in their community planning process-
meeting notes, it is indicated that there is a lack of representation from monolingual Spanish
speaking individuals in the meeting.
Underrepresentation and lack of outreach to the Latino population will continue to create
an isolated world for Latinos that suffer from mental illness, especially the youth. Parents do not
have the tools or language to have their children receive the needed help unless it is through a
primary physician (Campbell, 2017). Throughout generations, in the Latino community, many
stressors can be identified but are not often addressed, such as financial, employment status,
family engagement, and health concerns (Turner, 2016). Some of those stressors include
experiencing a language barrier, lack of cultural understanding, in addition to the different family
dynamics within each family and their sub-groups. A service provider needs to take into
consideration the fundamental cultural aspects (Furman et al., 2009) and the various experiences
that these individuals may carry as a result of multi-generational trauma. Many mental health
stressors have been known to increase consequently due to acculturation, financial instability,
and lack of communication due to a language barrier (Bakhshaie et al., 2018).
Latinos are under-represented and don’t have their voice heard among those that provide
mental health services or those that create the service and their funding, which prevents
appropriate services to be offered to this population effectively (Lopez et al., 2012). Villatoro,
Morales and Mays (2014) present the struggles that Latino’s experience by their under-
representation as this affects their help-seeking behaviors. According to Kovess-Masfety et al.
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(2017), many Latinos will seek support from a religious leader, a priest, or someone within the
church that may offer guidance when experiencing unfamiliar life stressors.
Latinos find comfort and feel inclined to seek support from someone that they trust, and
that is accepting and understanding of their culture-having someone that shares the same beliefs
and speaks the same language can make a difference in how support and guidance are perceived.
Historically, religious individuals will seek out a priest or clergy when facing difficulties in their
lives, including their attempts to meet their mental health needs (Kezdy, Martos, Boland &
Horvath-Szabo, 2011; Wang, Berglund, & Kessler, 2003). Many Latinos that seek help may not
get appropriate direction or support due to the lack of education that Priests and religious lay
leaders may have regarding mental health. Without the necessary training, the advice given may
be counterproductive in a long-term view; however, at the moment, that individual may find
comfort and support (Rezac, 2016). An individual whether it be the priest or a lay church group
leader can become overwhelmed from the circumstances that may have brought the person to
seek support when not having the appropriate training or knowledge of how to handle or address
various topics such as marital discord, substance use, child abuse, anxiety, depression, and
possible gender identity issues. Additionally, it has been stated that on many levels a Catholic
priest may experience stigma and suffer in silence when it relates to mental health due to fearing
that they may present as weaker than the congregation when they experience their mental health
issues (Pietkiewicz & Bachryj, 2016; Wang, Berglund, & Kessler, 2003).
In the Latino community, families may have experienced various symptoms that lead to
such feelings of fear and isolation, subsequently may suffer an unintended consequence that may
have been related to engaging in relationships, actions, and interactions that were
counterproductive to not only their mental health but also physical health (Sowers, 2009). Many
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mental health issues have manifested in physical ailments among the Latino community. Valdes
Velasco et al. (2016) explored the increase in pain intensity as it is related to anxiety intensity
and depressive symptoms. The most common illnesses that may affect the Latino community
may surface from a lack of mental health treatment (High Focus Centers, 2018; Patel et al.,
2016).
The Office of Minority Health (2019) reports that Mexican Americans have a higher
probability of suffering from health conditions. Also, the Office of Minority Health (2019) finds
that there is an overall result of Latinos that suffer from heart disease, stroke, diabetes, obesity,
liver disease, and it also includes suicide. In stepping back and analyzing these illnesses, many
can be prevented with regulation and the ability to discuss emotional struggles. Emotional
distress can trigger physical symptoms and can place an individual in a vulnerable physical state
(High Focus Centers, 2018; Priest & Woods, 2015; Sowers, 2009). These individuals that have
physical complaints and are fortunate to have a primary care provider would need to have their
doctor discern whether physical ailments among Latinos are genuinely medical conditions or
somatic symptoms of mental health issues to ultimately determine the appropriate course of
treatment (Patel et al., 2016).
Social Significance
Brazos Abiertos will address a significant barrier that is preventing the Latino community
from seeking out a professional for mental health services. Having a program that will assist the
Latino community in understanding mental health, how mental health plays a role in their lives,
and how religion can work hand in hand with a therapist is a step forward for progress within this
community. Brazos Abiertos will provide an opportunity for participants to have clarity in what
they may have experienced or are experiencing at the time of participation. Many youths in low-
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income communities face various barriers and lack of resources, which causes an increase in
negative experiences due to the scarcity of programs available to them. Having a supportive
program and one that incorporates culture and information of ways to increase their overall
mental health can provide an outlet, an opportunity to openly discuss their experiences, and gain
knowledge on mental health and how to maintain good mental hygiene. Research had shown that
mental illness in adults could have been addressed when the individual was an adolescent and
could have received appropriate treatment, which in turn would have allowed for less severe
diagnosis as an adult (Jamieson & Romer, 2005).
Jamison and Romer (2005) discuss how mental illness and substance use can have a high
probability of co-occurring in adulthood, primarily when these adults were not provided with the
appropriate tools on how to address strong emotions as a youth. When youth reach an age of
adulthood, and they have not had the proper tools or support them with their mental health, it can
present a higher probability of a significant mental health issue and at risk for major depression
without the safety net of treatment in place (Thielking, 2020). Youth that has suffered a mental
health issue in silence for many years can develop maladaptive behaviors that can stay with
them.
Brazos Abiertos will provide youth the opportunity to engage in a supportive
environment and learn about mental health and how they can practice mental hygiene to
reinforce coping skills and being able to have a connection that can be revisited as needed once
they become adults-having a program that provides mental health psychoeducation and support
can establish a good foundation for future situations that would otherwise place the youth or
young adult in an awkward position. Youth within the Latino Catholic community and those
living in a low socio-economic community are usually ill-equipped to take on hurdles that life
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would though at them when experiencing any depression or anxiety as they enter adulthood. As
a society, it is not always thought out how resource placement can impact a community and how
the lack of resources can affect a person’s development from youth to adulthood.
Youth from Latino cultures may find it difficult to seek support outside of their
community and family due to beliefs, comments, ideas, or feelings towards what mental health is
and what it represents as expressed by their parents or elders in the family. Latinos have rich
cultures and may be influenced by past practices, which present as a barrier for reaching out to
external supports. Allen, Davey & Davey (2010) discuss that minorities may eventually receive
services; however, they may receive them when it is too late. Early intervention or support with
mental health education for youth that come from immigrant families can assist in better
development and role identification among Latino youth as there is a high prevalence of mental
health needs with immigrant youth or those that have immigrant parents (Hatzenbuehler et al.,
2016). The earlier the service is sought out, the higher probability in a positive outcome would
be found. Although Latino individuals have high levels of mental health distress, they continue
to be the cultural group with the least utilization of services, entering into services at a later time
than those of other groups in addition to not engaging in as many sessions to support their mental
health (Hough et al., 2002; Pineros-Leano, Liechty, and Piedra 2016).
Brazos Abiertos will have an impact on the education of mental health on an otherwise
marginalized group of individuals that are not informed of the services that are available to them.
Having resources that would provide support for the developing youth will assist not only the
youth, family, and immediate community, but can have an impact in other areas as well.
Additional results in society will be seen in the local schools, community, and long-term
implications in society as a whole. Youth that participate in Brazos Abiertos will have tools that
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will support them in receiving information and engaging in a conversation on mental health
issues and causes, which will allow for a better critical thing when experiencing negative
feelings or negative situations at home or in the community. This opportunity will provide
alternative reactions and responses to conditions that otherwise would cause a behavioral
response, which could impact their academic success, including the ability to learn.
Youth that are struggling with their home life due to poverty, domestic violence, even
child abuse can fight in managing their feelings and experiences. Many of these youth go out
into the community to engage in behaviors that are not the safest nor legal (Garcia & Lindgren.
2009). Historically, youth may participate in high-risk behaviors such as unsafe sexual activity,
substance use, gang involvement, and criminal activity (Cervantes, Goldbach & Santos, 2011;
Van Dommelen-Gonzalez, Deardorff, Herd, & Minnis, 2015). These youth will have multiple
encounters with law enforcement and may even be a part of the juvenile justice system.
Lastly, as these youth grow and are not provided with the resources and support services
that can assist them when in need can cause their development to be hindered and consequently
have an impact on their adulthood. As adults, these youth will not have learned appropriate
coping skills, and relationships may suffer. Cycles of their youth will continue, such as with
domestic violence, substance use as a coping mechanism, and possible criminal activity. Brazos
Abiertos, a psychoeducational workshop will be used as a preventative and early intervention
approach to ensure that youth are provided with needed information and experience a positive
interaction with a mental health professional. Allowing youth to have positive interactions in a
safe and non-threatening environment can assist in building positive experiences and ultimately
help with the development in a healthy manner.

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Problems of Practice and Innovative Solutions
Solution
The innovative solution to the current norm of having individuals seek support from a
priest is having a program that is collaborative between the catholic church and a mental health
professional. Brazos Abiertos was developed to provide psychoeducation on the topic of mental
health and how it can present itself in the youth and families within the Catholic church
community. A modular approach used to create a psychoeducational curriculum for Familia
Adelante in combination to the teaching process of a medical program designed by Kate Lorig;
Chronic Disease Self-Management was used to develop the structural process for the workshops
for Brazos Abiertos (Cervantes, Goldbach, & Santos 2011; Lorig et al. 2001).
Brazos Abiertos is a psychoeducational workshop that will provide youth, parents, and
the Catholic church leaders information on topics that can impact a youth’s mental health.
Brazos Abiertos will be able to bridge the cultural and religious aspects of a Latino youth’s life
to support the de-stigmatization of mental health. The workshops will provide a safe and
culturally relevant space to gain insight into efforts to destigmatize mental health. The
workshops, due to the recent global health crisis with COVID-19, will be conducted via a virtual
platform to accommodate current state requirements but also can to be implemented in a face to
face meeting.
The goal of Brazos Abiertos is to provide the psychoeducation that will support the de-
stigmatization and allow for open discussions between parents and their children, neighbors,
grandparents, and other adults to ensure that the youth receive the needed support and guidance
in seeking help. Additionally, Brazos Abiertos is intended to create an ongoing relationship with
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the Catholic church to support the congregation with mental health related issues and support the
use of external community-based agencies for ongoing direct care.
Contributions for Improvement
In efforts to support the grand challenge of Ensuring healthy development among all
youth, Brazos Abiertos has been developed. These workshops allow for engagement in a group
setting with other youth from their youth group family, with familiar faces in a place that they
have chosen to be in to receive support when things may seem difficult at home, school or in the
community. The director of the youth group and Confirmation classes, when approached about
Brazos Abiertos, it was shared how the youth come to get away from their home life and spend a
good couple of hours away from the struggles that they may be facing. These workshops, aside
from providing psychoeducation on mental health, will also give a name to what they may have
been experiencing and allow for the opportunity of healing without the fear of judgment.
Although the workshops are not therapeutically based or a source of services, they will provide
support and an opportunity for open discussion without having to go through the process of an
assessment or having to go to a clinic or building that may be visibly intimidating.
The youth group is a voluntary program, and thus the youth’s participation may not be
consistent. Brazos Abiertos will have an opportunity to engage and present during a regular
meeting and have volunteers participate in the 10-week workshop and commit to receiving this
information every week. The development of youth can be complicated, and when things are
forced to comply with academics, rules or structure, youth tend to fight back, Brazos Abiertos
will allow for a safe space for them to learn about topics that can help them develop tools to
assist them throughout their continued development no matter what stage they might be in
themselves.
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Mental health education may be provided in schools or community mental health
agencies; however, the settings may not be conducive to allowing youth to take an active
participatory role due to having feelings of being forced or having to attend therapy without
really understanding why or how it would benefit them. Although Providing youth with the
information of what mental health can look like within themselves or with their family, it can
open up multiple opportunities for understanding. Youth can understand and make better
choices when provided with the appropriate information. The development of youth is
dependent on various collaborations and forces within their lives, such as family, community,
education, and faith.
Having support in each of these areas can ensure that the youth can develop healthy and
thrive; however, for the Latino youth, these areas may be non-existent, which causes a strain in
their emotional well-being. Thus, having Brazos Abiertos available to this group of youth can
support their resiliency and ensure that they have a healthy development. Most importantly,
when youth have the support and tools as they develop into adults, we can foresee a bright
future. If youth are not provided with the tools to develop in a healthy manner mentally and
emotionally, we have youth that may engage in behaviors that are less likely to have a positive
outcome and may impact adulthood.
Stakeholders
In analyzing the problem by the multiple stakeholders, identifying who those
stakeholders are is necessary. For Brazos Abiertos, the stakeholders include the church,
community-based mental health agencies, law enforcement, academic settings, the department of
children and family services (DCFS), and potentially policymakers in addition to the youth and
family. Although some of these stakeholders may not have a financial investment or gain in the
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project, it is necessary to identify how they will be directly or indirectly affected and therefore
need to be included.
In analyzing how the church views the problem that Brazos Abiertos is addressing, it
provides some justification for the reason why this program is necessary to support the Latino
community. The church has seen the need and, in the multiple interviews conducted,
emphasized the great need for the program to help support areas in which the Priest is unable to
address, such as the needs with mental illness.
Community mental health agencies can experience the need to having the community,
especially those that have a solid religious practice, have some knowledge of what mental health
is, and what services can be provided. Individuals interviewed, that had attempted to receive
services, expressed feelings of disconnect and difficulty having a therapist offer the needed
support when they felt intimidated and lost in the system. Additionally, Latino families that have
been referred to services may not follow through with services, or the youth will not want to
engage in services due to the misconception of what mental health is and how it works.
Consequently, behaviors and untreated mental health can overflow into the community situation
in which new entities will become involved and be impacted, such as with behavioral issues in
the school or behavioral misconduct in the community.
Law enforcement and academic settings may express the need to have mental health in
the community to address mental illness and more so severe mental health illness. These entities
have been identified as stakeholders due to their involvement with the community and the
interactions that are encountered with the identified population; not all those encounters are
positive, which can exacerbate mental health issues. Unfortunately, the relationship that most
law enforcement officials and academic settings have with Latino youth that struggle with
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mental health and lack of treatment can cause long-lasting effects and impact the development of
healthy youth. By identifying the needs, services can be implemented and a lower risk of having
negative encounters with law enforcement. Similar experience with academic leads as they have
experienced students and parents as they may present with symptoms of mental health needs;
however, not having treatment available or not having an understanding can hinder the ability of
these individuals to progress not only academically, but also in the community.
Youth and family are impacted by the lack of knowledge of mental health and how it can
present itself in children, youth, and the overall family. As a parent, not knowing the language
and not being able to support their child when having struggles beyond what is known can be
very difficult and can impact family dynamics. Parents and youth that are not familiar with
mental health can have very negative experiences among themselves, and it will overflow in the
community. Once family difficulties have worsened, new systems come into play, such as
DCFS. Many individuals that have been interviewed have also encountered DCFS due to the
lack of following through on resources provided for mental health as the youth’s emotional needs
may be identified as attention-seeking, laziness, or plain defiance. Once DCFS is involved,
many of the services available for mental health are forced and unfortunately, become a negative
encounter for the youth and family alike.
Lastly, policymakers can also be identified as possible stakeholders with Brazos
Abiertos. Policymakers are essential within this program as they can assist with changing or
initiating policy in providing immigrant individuals to receive health care coverage that also
covers mental health services. Rubio-Hernandez and Ayon (2016) review the emotional
stressors that children encounter when Latino youth struggle with any immigration limitations
and the trauma they face due to deportation and other immigration related policies. Currently,
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there are limited programs that allow undocumented immigrants to receive health care coverage
that would cover behavior/mental health (Ramos-Duffer, 2018). According to the Center for
Health (2019), there were 64% of undocumented immigrants in 2006, which indicates that they
would not receive regular health care and much less mental health care. Policymakers must
acknowledge the need for support with mental health funding for programs and the possible
expansion of federal funds to have a program that is free to those families that are unable to
afford services.
Current Practice
Working in low socio-economic areas and with minorities is not a new practice; however,
having the ability to connect to the Latino community requires specific steps to being successful.
Some of the programs that have been identified that reach out to the Latino community include
Latinx Therapy, La CLAve, Roots of South LA, and NAMI (Lopez et al., 2009; NAMI; Roots of
South LA). These programs are all found in Los Angeles County, and both Latinx Therapy and
NAMI have crossed across the country. These programs are currently attempting the process of
de-stigmatizing mental health among the Latino immigrant community.
Latinx Therapy is a podcast that was started and has evolved into a resource that has a
directory of private practice therapist that is located in the San Fernando Valley, CA. Latinx
Therapy has a resource-filled website that includes therapists that have a private practice, and the
site provides information on their location. Although these resources would benefit the
population that Brazos Abiertos is targeting, a significant barrier that is identified within this
program is the lack of funding for these individuals. The available therapists are in private
practice and require formal health insurance or to be able to pay out-of-pocket. The therapists
that they identify within their program are Latinos, Spanish speaking, and have had experience in
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working with the Latino population. They provide resources that can serve the large community
of Latinos within the state and throughout the country; however, the target population for Brazos
Abiertos may not be able to seek support from this group of mental health professionals due to
financial limitations that the target population may face.
La CLAve is a program that not only provides psychoeducation but also provides support
groups for participants in the San Fernando Valley, CA. La CLAve targets the Latino population
that is experiencing severe mental illness such as psychotic symptoms, schizophrenia, those with
bipolar disorder, and possibly those experiencing borderline personality disorder. Lopez et al.
(2009) discuss the opportunity to use materials such as movie clips and the Spanish language to
educate and increase knowledge to the Latino population on what severe mental health
symptoms may look like and how to identify them possibly. These services can reach the Latino
population in a way that addresses the stigma that Latinos face with mental health; however, this
program is intimidating for those that are not familiar with symptoms of psychosis or those that
have never had any experience with mental illness overall.
Currently, NAMI has a program that provides services to the Latino community in their
language and in a way that it is understood and culturally relevant De Persona a Persona de
NAMI and De Familia A Familia De NAMI. De Persona, a Persona, is a recovery model
program that provides ten classes that are conducted in Spanish and assist individuals that are
currently suffering from mental health illness with recovery. De Familia A Familia is a support
group that provides a place where family members that are struggling with mental health can
attend and receive support and guidance as they engage in discussion on ways to help their
family member. Although the Latino culture is represented, many of these programs and
resources are not openly available to individuals that may not know how to obtain the services or
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resources. NAMI currently offers these groups in the South-Central Area; however, it is only
offered in English and requires registration and a follow-up call from the President of this
location. There are additional locations in the County of Los Angeles, such as Torrance, CA,
Lakewood, CA, and Los Angeles; however, these locations were unable to be verified due to
numbers being incorrect on their website. These services would be ideal; however, many of the
individuals that are being targeted by Brazos Abiertos might not have use of a vehicle or any
other form of transportation, which would present as a barrier from attending an offered group by
NAMI. NAMI has been serving families for over four decades and has helped many families.
Still, there is a continued need to reach families that are Spanish speaking in the lower socio-
economic areas.
Most recently, Roots of South LA has begun to make a name for themselves as they have
been identified as a non-profit organization in October of 2018. Roots of South LA was created
to assist with providing awareness on rights, services, and healing to the Latino community in
the South Los Angeles area in a modern, inclusive, and integrated manner. Roots of South LA
provides healing circles which they advertise on their Instagram page in addition to having
readily available resources, and they post events that provide support to the Latino community.
They are highly involved with community advocacy and providing enrichment to the community
of black and brown individuals. Even though this program serves the Latino community in south
Los Angeles, the page and resources that are provided are directed for a more general audience
welcoming anyone willing to engage. This program is not directed to a specific group, nor is it
strictly in English as they host bilingual events as well.
These programs are great resources that provide an excellent opportunity for
collaboration. They provide support and education on mental illness to those individuals that
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reach out and can contact them. NAMI has been around for a multitude of years, and it
continues to provide support and has built a name due to historical advocacy and support. La
CLAve and Roots of South LA are innovative ideas that can reach many individuals need
psychoeducation to assist them in understanding mental illness. Despite of their inherent
limitations, collaboration with these programs may come once individuals have experienced
Brazos Abiertos and know what they may need or benefit from the most.
Additionally, there is no current research that indicates the effectiveness of collaboration
between a mental health agency and a church. In 2013, the Department of Mental Health and the
Los Angeles Archdiocese had a collaboration conference, which allowed for discussion on how
faith-based leaders and the department of mental health would work well together in meeting the
needs of the individuals of color. No research was conducted to reflect outcomes; however, as of
this point in time, there are no programs that are located at a Catholic church.
Research has been done on the effectiveness of the Promotoras (Waitzkin et al., 2011).
Currently, the Promotoras of mental health from the Los Angeles Department of Mental health
has had two full workshops at a church in which they provide education on mental health topics.
The promotoras are trained in topics of mental health and have their lived experiences; however,
they are unable to provide a fluid conversation with those in the workshops due to their scope of
practice. The promotoras provide general information regarding resources and support as they
are unable to suggest direct services nor agencies. Although this program was presented in the
church, there is no documentation on the effectiveness or the decrease in stigma from the
participants.

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Logic Model
The logic model (see Appendix A) was used as information was processed to develop the
proposed program. The proposed innovative program will have concrete inputs with a supportive
mental health professional as lead presenter, substance use counselor, and the church personnel
(Priest and lay church group leader/ youth group director). Activities for the proposed
innovation have been discussed, as psychoeducation will be provided initially to the Priest and
lay church group leaders on the “red flags” of mental health and assist in identifying a situation
in need of religious-based support or mental health support. The output will be tracked with the
number of participants in each workshop, the number of returned participants in the workshops
conducted in addition to the pre and post questionnaires for levels of stigma (see Appendix B)
that will be done at the first and last workshop.
Lastly, the outcomes that are being anticipated include the decrease in stigma around
mental health, an increase in open discussion, and having participants’ openness to mental health
services as needed. The additional indirect outcome is for the Catholic church priest and the
youth group leader to have the tools to support individuals and direct them to appropriate
resources when discussing possible mental health issues, lastly, for participants to seeking out
services or support from professionals, decreasing the use of family, friends and church leaders
as therapist and counselors. Most importantly, increasing the open conversation of mental health
services within the Latino community to ensure that they receive the appropriate care and
support as they decrease the rejection of those that may encounter a mental health illness.

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Project Structure, Methodology, and Action

Purpose of Program
Brazos Abiertos will provide psychoeducation to the target population, Catholic Latinos,
to assist with de-stigmatizing mental health and assist with increasing open discussion.
Historically, Catholic Latinos do not usually seek out professional help when experiencing
difficulties in life, and they find themselves seeking support from a priest; however, the priest
does not have the education or training for specific needs of their congregation (Bermudez et al.,
2010; Interian et al., 2010; Weaver, 1998). The process of implementation in the prototype will
address the lack of education on mental health issues and the need to have a professional
collaboration with the church leader (Appendix C). This process would allow for Catholic
Latinos to receive information in a familiar environment to allow judgment-free engagement and
support through the education process. Due to current global pandemic with COVID-19, the
psychoeducational workshops will be conducted virtually via zoom and have a website with
supporting documents and resources (Appendix D).
Description of Program methodology
In exploring the process for the development of the program, the logic model was used to
identify each phase of the process by using the modular approach used with Familia Adelante
and the structure of workshops used with the Chronic Disease Self-Management model
(Cervantes et al., 2011; Lorig et al., 2001). Throughout the process of the logic model, various
phases were identified to address the current need within the Catholic Latino community. The
method of determining the need included interviews with community members and gathering
disparities in addressing mental health stigma in the Catholic Latino community. Throughout
this process, it appeared to have great importance to include the religious aspect of the culture to
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engage the individuals that would be participating within the workshops. Additionally, the
incorporation of religious and spiritual beliefs was examined to see how it would support the
implementation of the program. It is mentioned that collaboration with religious practices and
religious leaders can assist with having positive outcomes as it addresses a personal and cultural
aspect of the population (Peterson, 2011).
Following the structure of the Chronic Disease Self-Management Program (Lorig et al.,
2001), Brazos Abiertos is a ten-week psychoeducational workshop that will present ten main
topics. The workshops will be done predominately in Spanish (English as needed) and have the
culturally appropriate material. The program will run for ten weeks, with a different topic being
presented and have an opportunity for review in efforts to ensure retention of the discussed topic
and to have a step forward in destigmatizing the discussion of mental health. Maintaining the
modular approach (Cervantes et al., 2011), the material and information will be culturally
appropriate to address the topics presented in the workshops.
The topics that will be addressed include an introduction to mental health, the various
struggles with depression, anxiety, Family/relationship violence, substance abuse, and suicide
education and prevention. The topics address multiple areas that can assist in supporting
healthier development and the future for the youth. According to Ramos-Sanchez & Atkinson
(2009), Latino families experience many obstacles to receiving the support needed to be able to
overcome the many difficulties that they may have experienced and have affected them and their
children. The workshops will be led by a Therapist (Associate Social Worker-ASW/ Licensed
Clinical Social Worker-LCSW) that has provided the priest and lay church group leaders with
information on the workshops to support the promotion and the investment of individuals
participation. The goal of these workshops is to provide psychoeducation and assist in de-
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stigmatizing mental health among the Latino community, especially the youth, while continuing
to maintain the cultural and religious aspect very present.
The psychoeducational workshops will provide the priest and the congregation with an
opportunity to be exposed to mental health topics, methods of treatment, and an opportunity to
engage in discussion regarding the participants’ experiences between workshop sessions through
completing take-home assignments. In efforts to ensure that the youth are receiving age-
appropriate information, and because of the specific needs of the Latino youth compared to other
ethnic groups, the workshops will have material gathered from multiple sources to ensure that it
is understandable and relatable. The materials used will include information from the evidenced-
based practice of the Youth Mental Health First Aid curriculum; modified videos form an
organization that is based in Maryland; Anxiety and Depression Association of America
(ADAA), material from NAMI and a combination of resources created specifically for the
curriculum for Brazos Abiertos. The use of multiple sources for the workshops will allow for a
fluid process and ensure that it is adjusted and adapted as needed to assist with meeting the needs
of the youth. The workshop will provide the opportunity to have a fluid conversation during the
topics discussed and allow for a review on a previously discussed topic to ensure that the
participant can receive needed or wanted information. The workshops will provide a short
questionnaire to identify the participant’s current stigma during the beginning of the workshops
(pre-test) and will complete a second questionnaire to determine the effectiveness of the
workshop (post-test).
Unlike Familia Adelante, in which youth and parents had parallel experiences with the
workshops (Cervantes et al., 2011), Brazos Abiertos will be provided to the youth initially. As
Brazos Abiertos expands, it will continue with the adults, parents, and grandparents in the
BRAZOS ABIERTOS 29
community and offer the opportunity to learn about mental health in an environment that they are
familiar with and with the presence of the priest to assist with facilitating the workshop as
needed. Brazos Abiertos will provide a safe environment to discuss topics openly and have
questions answered by a therapist conducting the workshops. Having a therapist guide the
workshops fills a gap that other educational programs may have, especially any program that
might be presented within the church. Previously, the host church has had the Promotoras de
Salud present on mental health; however, due to their limited education and training, they were
limited to only providing general information and general resources without being able to
provide individual support or answer the specific question as a therapist would.
Implications of Program
The implication for implementation of the program includes possibly overwhelming the
target population, which can deter the participants from not returning to the follow-up
workshops. Additional concerns may consist of having an influx of participants after a possible
snowball effect once the workshops get started. The program also may not have enough
information/material to allow for the workshop to replicate among future possible scheduled for
a different church. Lastly, materials used or identified in the prototype may be outdated, and
participants may be discouraged by irrelevant information during the implementation of the
program. The program can be adjusted and adapted to the needs of the community as necessary.
Program Implementation
The location of implementation is identified, Saint Patrick’s Church at 1046 E 34th St,
Los Angeles, CA 9001; however, due to the current global pandemic of COVID-19, the program
is being piloted via virtual meetings. The lead priest and collaborator in the process of Brazos
Abiertos is Fr. Tim Dyer. Fr. Tim has been the priest at this parish for the past nine years and
BRAZOS ABIERTOS 30
has engaged the families within the community and, more so the youth. Fr. Tim has shared his
passion for helping the youth have healthy lives and is open to having Brazos Abiertos as a part
of the parish. Fr. Tim has seen and experienced the current lack of education and supports that
some families experience and shared the benefit of receiving educational information regarding
mental health. The program is being piloted with the current youth group, and it is reaching 15
youth between the ages of 16-21.
Brazos Abiertos was introduced to the priest and subsequently to the youth group leader,
who is also the leader for religious, educational classes for Confirmation one of the seven
sacraments. The program was discussed throughout a dialog with the priest on the current needs
of the congregation and what he has seen with the individuals coming to him for help. The
discussion was fluid on the experience of the priest with families that have had their youth
experience depression, suicidal ideation, gender identity issues, and severe anxiety. The priest
shared feelings of impotence in not knowing where to send the families for appropriate help or
how to help them in an area that research has identified already as priests being ill-equipped for
these situations. The director for Confirmation classes shared the same difficulty with her
experience with families and was able to also touch on the struggles that the priest may
experience as he is saturated with individuals seeking help outside of confession or any religious
discussion.
The beginning phase of Brazos Abiertos has been completed as the priest and lay church
leader agreed to implementing the pilot. The first part of the implementation includes the
education and guidance of the Catholic priest and the lay church youth group leader to have a
better understanding of mental health and how the youth might be experiencing symptoms as a
Catholic youth. The education and the information provided included common signs of mental
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health issues that affect the Latino community. Additionally, information was provided on the
multiple ways people may express their need for additional help, such as by showing physical
symptoms such as chronic pain. Priest and lay church youth group leader has been provided
with support and an opportunity to ask questions to clarify information, also, to follow up and
provide them with a Mental Health 101 crash course such as seen with Mental Health First Aid.
Once provided with the essential information regarding mental health, there will be an
advertisement for two weeks prior, during the church youth group activities, to invite the youth
to the workshop to support overall health with Brazos Abiertos. In efforts to engage as many
youth in the Latino community as possible, it is essential to continue having in the forefront the
current stance that many Latinos have regarding mental health and what it represents for their
families, as individuals and their community. Additionally, the workshop will be offered to youth
that are part of South-Central LAMP as an additional resource for the youth that are not directly
connected with the youth group from St. Patrick’s Church.
During these workshops, Latino youth will be welcomed in a virtual meeting room. To
ensure that the culture is represented, it is essential to have familiar things within the workshop,
such as the language and having the Priest or a lay church youth group leader, someone of
familiarity present as this may provide a sense of comfort. Additionally, having material that
will be readily available to give a quick reference handout will be provided (Appendix E).
In having the desired language needed to communicate with the Latino community, a
service provider can assist with building trust, as there is a sense of understanding.
Collaborating with community-based agencies with bilingual staff and individuals that are
informed on cultural needs can be an asset for providing continuing support to those individuals
that require extended care. These individuals would be identified with the screening tools during
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the workshops in addition to having individuals request continued support, support beyond what
Brazos Abiertos can provide during the initial implementation phase.
Latino youth experience multiple difficult situations due to their parent’s immigration
status or their own. At times these struggles can inhibit their ability to develop in a healthy way,
which can trigger many maladaptive behaviors as they grow into adulthood and have their own
families. Many of these youth carry the family culture and traditions very close, which includes
religious practices. As a youth in the catholic church, many may struggle with the fine line of
being able to overcome barriers in their lives and others not knowing how to proceed with the
struggles that life might throw at them.
Financial Plan Summary

Brazos Abiertos will be developed and implemented in multiple phases, and in efforts to
assist in the start-up, the cost for many items have been gathered. These items will reflect the
various needed material to ensure that the program is successful in the start-up and as the
program expands. The initial start-up amount required will be $79,000. This cost will include
initial expenses that will not be repeated in the full year of operation; however, as the expansion
occurs, some costs will double to ensure that the budget covers the structure and the personnel.
Although the Start-up financial need is a large amount, the amount will be used to support
the program to expand and ensure implementation to its fullest. The start-up budget will include
the cost of In-Kind donations that will be significant during the start-up. The in-kind donation
will be renewed every year and would support the program during the first full year of operation,
in addition to the In-Kind contributions that will be directly through personnel. During the initial
implementation through the pilot, location will not be needed as it will be conducted virtually.
Funds will be obtained from Catholic Charities ($5,000) to assist with the start-up of a website
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and the Zoom account that will support the workshop. Additional funding will be sought out
through CalMHSA (California Mental Health Services Authority) and grants available through
Project AWARE (Advancing Wellness and Resiliency in Education) State Education Agency
Grants (AWARE-SEA). Lastly, funds will be allocated through private donors that will provide
a commitment of two years at a time to ensure the continuity of the programs for those two
years, which will allow for the projection of impact for an additional two years when outcomes
are presented.
The full Start-up financial needs include the First Year of Operation, including the pilot.
The Start-up, although reflecting a significant amount, will consist of the In-Kind contributions,
which will have a high probability of continuing through the year of operation and the expansion
within the following year. The first full year of operation will include having a CEO in place to
manage the program and assist with the expansion of the program. The CEO will be responsible
for ensuring that the program maintains its purpose and implementation with needed adjustments
and adaptions to continue with providing education to de-stigmatize mental health within the
Latino Catholic community. The CEO will give a total of an average of five to eight hours of
services towards the need of the program which includes the workshops, preparation of materials
and presentation review in addition to an hour/hour and a half of meeting with the priest and the
youth group leader to address any barriers or suggestions. The priest and the youth group leader
will provide a total of three to 5 hours of their week to support Brazos Abiertos as they will
alternate workshops and will be present for weekly meetings to discuss any additional
suggestions or issues with the implementation, specific resources needed or a need with a
particular youth, or family.
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Technical support will be provided by IT, which will provide the setup of the website and
be available for any technical difficulties during the workshops once they are conducted in
person. IT will complete the needed development of the website that will hold the program and
allow for providing resources at the touch of a button. IT will also provide feedback on any
additional needed material to ensure that the workshops, both virtual and in-person, is proficient
and impactful.
The first year of operation will have the initial start-up for virtual workshops and the cost
of the development of the website that will hold the material used for workshops in addition to
the resources that can be provided to the community without necessarily being a part of the
workshops themselves. Detailed expenses are included and can be reviewed in for the Start-up
and pilot budget and for the first full year of operations and expansion as it reflects an itemized
budget (Appendix F & Appendix G).
Multiple sources will provide current revenue projections for start-up (83,000). As
mentioned, there are in-kind donations, Catholic Charities, private donors, monetary gifts in
addition to available grants. Additionally, the first full year of operating will have a revenue of
$193,000 that will be a combination amount provided by in-kind donations, Catholic Charities,
and grants from CalMHSA and AWARE-SEA. Detailed lined items reflect the amounts that will
be received from each entity.
Efforts to ensure that the program is being monitored for consistency and the outcomes
are evaluated for the effectiveness of the program, the managers, CEO will ensure to measure the
outcomes to support any need for adjusting and adapting change. Due to the risk that may arise
with financial budget flaws or changes, risks with low community involvement or having
implementation delays are some risks that have been considered. In addition to establishing
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secure connections with the host Church, these risks can be highlighted early on in the pilot to
allow an immediate response and assist with correction.
Project Impact
The impact of the program will be monitored using the scale created by Hammer and
Toland (2017), Internalized Stigma of Mental Illness Inventory (ISMI-9). The stigma scale will
be applied as a pre and posttest to identify the stigma present with each individual. The pre-test
results will serve as a guide to address any specific thoughts that may prevent youth and their
families from getting the support they need or may benefit from. The scale will catalyze the
discussion of mental health and what it means. The post-test will allow for comparing the results
and identify any improvements made throughout the program.
In having a visual of the process of implementation and the impact of the program, using
the EPIS framework, the implementation timeline is documented and depicts the process and
overlaps. The exploration phase, preparation phase, implementation phase and sustainment
phase have some areas of overlap as these phases are consistently moving, adjusting and
adapting to the needs of the Latino Catholic community. The EPIS model allows for a clear
understanding of where each implementation phase is and how long will it remain during the
timeline provided (Appendix H). In monitoring the process of implementation and gathering the
outcomes, data will be collected from the pre-test and data gathered from the posttest to gather
any progress with workshop and within those after that. Although not a focus of the workshop,
also to assist with the process of de-stigmatizing mental health, there will be an opportunity to
engage in screenings to determine if there is a need for more support than that of just the
workshop. Success will be noted with the number of individuals in attendance during the
workshops and the stigma reduction based on the questionnaire results.
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The dissemination of the findings will be compiled in a report that would be used to
present to stakeholders, possible future funders, and to be used to support additional networking
opportunities and scale-up. Being able to provide written documentation on the success of being
able to help the progress in de-stigmatizing mental health by increasing the awareness and
possible use of services will support not only the community but also any external agency and
the overall well-being of individuals.
In considering culture, Brazos Abiertos is designed to help the Latino Catholic
community. With that, there are many considerations to take, which not only include language
but also possible sensitivity to the topic as some line items to be discussed during the workshops
may be a trigger-maintaining the cultural consideration and to support responsiveness from
individuals participating in the program. Additionally, having youth engage in the workshop
initially it will also be important to ensure that during follow up workshops to be presented to the
parents as well as a parallel process in efforts to support the change in thinking about mental
health to go beyond the youth.
Lastly, Brazos Abiertos is an innovative program that will provide support and education
to those most vulnerable individuals within the community. Providing supportive services in a
timely manner, as seen with the process of identifying the EPIS process, the timeline, and having
the logic model reflect the multiple layers that make up Brazos Abiertos can support a growing
population. Brazos Abiertos is culturally aware and will provide support in a sensitive and
beneficial way to ensure the healthy development of youth.
Program Considerations
Brazos Abiertos is a program that provides psychoeducational workshops in the Latino
Catholic community. By offering services such as the workshop, some concerns that arise with
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the implementation and expansion. Unlike an agency that has settled in a community of Latinos,
Brazos Abiertos is new and foreign to many of the individuals that are the identified targeted
population. Programs in the past have targeted the African American church community as well
as in a Catholic Latino congregation. These programs have had their separate approach in the
type of service or program introduced; however, both showed significant improvement in their
targeted project. In the African American church, there was a successful partnership in
supporting the leaders of the congregation to provide mental health support by guiding followers
to appropriate mental health resources (Allen, Davey & Davey, 2009). The Catholic church had
an experience in which a group provided an intervention to assist in decreasing the stigma that
testing for HIV can have. At the end of their project, they found that stigma was reduced, and
individuals were more open to engaging in testing to maintain health (Deros et al., 2016; Payan
et al., 2019). These programs have shown some progress in providing educational support to
ensure that the congregation has a healthy mind, body, and soul.
Concerns with Brazos Abiertos includes having the congregation express continued
stigma and speak ill about a program that is present to help. Unfortunately, many individuals are
not open to the thought of spirituality and mental health working together. A recent study
completed by Oxhandler, Narendorf, & Moffatt (2018) explains the continued complexity of this
topic and how further research is needed to ensure youth are provided with both successful and
meaningful mental health services. Having individuals continue to struggle with the idea of
mental health and religious practices working together can cause disruption and therefore create
change, which can be an internal conflict for not necessarily the youth that will participate but
their parents or elders. The program can be interpreted as unfavorable due to the topic of mental
health, and it continues to be seen as something that may need more prayer, more faith and
BRAZOS ABIERTOS 38
engaging in services can be seen as giving up on God and his ability to save the struggling
individual.
Conclusions, Actions & Implications

Brazos Abiertos is a project that will provide psychoeducational workshops to Latino
youth in the Catholic community. Addressing mental health among the Latino community is a
high need yet the topic of mental health has and continues to be stigmatized among many
individuals. Bulanda, et al. (2014) discussed how stigma can prevent help seeking behaviors
which can affect youth. Waitzkin et al. (2011), review the various reasons why individuals may
not seek out services to assist with mental health illness which include language and not having
financial coverage to cover their mental health or physical/medical needs.
Caballero et al. (2017), examined how Latino youth are exposed to a significant number
of situations that cause trauma such as family conflict due to acculturation, community violence
and racism/discrimination which can trigger symptoms such as anxiety, depression and may
suffer from low self-esteem. With the various situations that may trigger an individual’s decline
in mental health, members of the Latino community may not seek out support in a conventional
way which may result in their needs not being met which can cause mental health needs to
remain or increase. Due to the Latino culture and the significant roles that individuals have with
in the family and community, many Latino’s seek support from those that are within a leadership
and guidance role such as that seen with a religious leader.
Summermatter and Kaya (2017) review the various influences that culture and tradition
have on an individual and their ability to seek out support. Latino’s hold religion with high
regard and seeking support from a religious leader in time of struggle is frequently done.
Kovess-Masfety et al. (2017) and Rosario & Rosa (2014), analyze how many Latinos will seek
BRAZOS ABIERTOS 39
guidance through prayer or other culturally relevant rituals to assist when experiencing difficult
situations. Due to Latinos having specific help seeking behaviors, this project will incorporate
what religion or religious faith represents with in the culture and mental health as a combination
to support individuals. Mental health stigma will be targeted to assist in increasing help seeking
behaviors with the help of religious leaders in the process.
Brazos Abiertos will provide a 10-week psychoeducational workshop that will target the
youth in the community. These workshops will be conducted virtually by a therapist
accompanied by the church priest or youth group leader to facilitate discussion. Brazos Abiertos
is not a treatment program; however, it can facilitate the linkage for services if needed, but it is
not the main focus. With having co-facilitators, the hope is to allow for the youth to feel
comfortable and engage in a fluid discussion on the topics presented and seek out support when
needed. Due to the program being piloted during a global pandemic, Brazos Abiertos has the
opportunity to reach many more youth through a short period of time with the availability of
technology. Brazos Abiertos will have a website available to allow for navigation through the
topics, material and also resources.
Brazos Abiertos is designed to be replicated among additional parishes to support the
youth in the Catholic Church community and beyond Catholicism as the discussions are not
merely focused on the religious piece, but more so the spiritual. The program can continue
adjusting to community needs and have an opportunity to expand beyond the psycho educational
workshops to youth, but also as part of an ongoing program for various church groups including
being incorporated into the religious education programs as supplemental community service
hours. This would not only service a purpose of benefit to the individual and church but also to
the development of the children within each family that participates.
BRAZOS ABIERTOS 40
Brazos Abiertos will provide a supportive approach to individuals that otherwise may not
reach out for services or may not be aware of the resources available to them. This provides
Social Work implications as to how Latino youth and overall Latino families would benefit from
mental health services. It raises the awareness of the need to have social workers take into
consideration the multilayered experience that once person from a Latino community can come
with. A study conducted by Kanel (2002), provided information on the current needs of Latinos
in California as it relates to mental health which included language barrier, the lack of therapist
that understand the culture and the need for someone to know the balance between professional
and non-formal provider. Studies have shown that Latinos lack the understanding of how mental
health services support an individual in multiple levels and thus not receiving the needed
services. In the Social Work Field, an increase in culturally competent and informed trainings
need to be in place in addition to programs reaching out and engaging in the work to de-
stigmatize mental health is critical. Lastly the need to have a working relationship with
culturally, spiritually and influential individuals within the community would assist in moving
forward in supporting the Latino community progress.
Having Brazos Abiertos engage the priest and the youth group leader of St. Patrick’s has
provided that first step in completing the introduction of the workshops and facilitates working
on initiating the pilot program prior to the end of the Summer 2020. The opportunity to engage
other group leaders within the church has also ensued as the leaders of the Eucharist Family
group has also expressed interest in having the program presented during their group meetings.
With the two groups identified, Brazos Abiertos will be impacting the youth group and families
within the Church. Brazos Abiertos is hitting the ground running and it is providing the initial
steps to support a community that otherwise would continue to struggle in silence and
BRAZOS ABIERTOS 41
overwhelm the current support system in place with the priest in the church. Brazos Abiertos is a
step forward to support the development of all youth within the Latino Catholic community.
Plan for advancement of the workshops include having informative meetings with other
priest from local parishes to support the extended community. Funding is available through
Catholic Charities as it would support for each additional parish as it participates in receiving the
psychoeducational workshops. Brazos Abiertos can also be adapted to other religions as the
program is not strictly focused on the Catholic religion, but more so on the spiritual practices and
the stigma that is present as individuals experience mental health issues.

BRAZOS ABIERTOS 42
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Appendix A Logic Model
Project: To provide psychoeducational workshops to support Latino Youth Mental health
Goals: To decrease mental health Stigma among the Latino Catholic Community and foster
open dialogue about mental health
Inputs: • Collaboration with the Catholic church
• Engage Priest and lay church group leaders: Youth Group
• Supportive staff open and willing to support Catholic Latinos
• Secure location for workshops
• Identify funding sources
• Collaborate with the promotoras
• Adjust to current global pandemic
Activities: • Engage Priest and Youth group leader in discussion on general topics
of mental health to support advertisement of psychoeducational
workshops
• Initiate workshops
• Complete Mental Health Stigma Questionnaire
• Develop quick resources for the Priest to support and encourage
individuals to reach out to a professional
• Weekly psychoeducational workshops serving a group of 15 youth
• Used Social Media for Advertisement of workshops
Outcomes: • Increase awareness of mental health
• Improve positive attitudes towards mental health services
• Motivation to have seek out professional support for their mental
health
• Increase in awareness of generational trauma and how ACE’s
• Increase the utilization of mental health services within their
community
Impact Long
term
• Decrease the disparities between mental health services and the
Latinos Catholic Community
• Increase in positive family and community relationships (i.e.
decrease with CPS calls, DV incidents and community violence
• *Increase in attendance at school/work
• *Decrease in medical diagnosis (i.e. diabetes, high cholesterol, high
blood pressure, etc.)
• Increase in knowledge of MH by priest and church group leaders
Assumptions:
• Congregation will be open and willing
to participate.
• Youth will be open and willing to
engage throughout the workshops and
they will
• Implementation of the workshop will
be linear (10 consecutive weeks)
External Factors:
• Stigma continues strong, prevents
active participation
• Scheduling of the workshop is
interrupted by community or church
activities.
• Technology not working during live
workshops
• Current global pandemic

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Appendix B Internalized Stigma of Mental Illness Inventory – 9-item Version (ISMI-9) *

We are going to use the term “mental illness” in the rest of this questionnaire, but please think of it as
whatever you feel is the best term for it.

For each question, please mark whether you strongly disagree (1), disagree (2), agree (3), or strongly
agree (4).

Strongly
disagree Disagree Agree
Strongly
agree
1. Stereotypes about the mentally ill apply to me. 1 2 3 4
2. In general, I am able to live life the way I want to. 1 2 3 4
3. Negative stereotypes about mental illness keep me
isolated from the ‘normal’ world.
1 2 3 4
4. I feel out of place in the world because I have a mental
illness.
1 2 3 4
5. Being around people who don’t have a mental illness
makes me feel out of place or inadequate.
1 2 3 4
6. People without illness could not possible understand
me.
1 2 3 4
7. Nobody would be interested in getting close to me
because I have a mental illness.
1 2 3 4
8. I can’t contribute anything to society because I have a
mental illness.
1 2 3 4
9. I can have a good, fulfilling life, despite my mental
illness.
1 2 3 4

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Appendix C Curriculum Prototype – Brazos Abiertos

Brazos Abiertos is a Psychoeducational Workshop that provides support in a culturally
appropriate way to Latino Catholic youth 16-21 years old.

Workshops are 1.5 to 2 hours long and will be conducted throughout a 10-week period. The
workshops will host 15 to 20 individuals at a time. Workshop will be conducted by a therapist
and a co-facilitator (priest or youth group leader).

Due to current COVID-19 and safety orders, workshops will be conducted via virtually.

*The workshops will be conducted in the main hall of the church. There should beverages
(coffee, tea, hot chocolate and water in addition to light snacks (pastries/pan dulce). The setting
should include chairs for the 1
st
session with 2
nd
and subsequent sessions to have tables and
chairs.

Materials
• Handouts**
• Worksheets for activities and notes **
• Computer
• Projector ***
• Pens***

Workshops will be conducted in the Spanish/English Language (taking inventory on the comfort
level of language spoken by participants).

Workshop #1 – Mental health Overview
Objective:
• To have an understanding on the definition of mental health.
• To gain knowledge of the percent of individuals suffering with mental health issues
and those that may suffer in silence.
• To gain an understanding that therapy, prayer and their own faith can work together
• To have an understanding that seeking help is not indicative of betrayal to their faith in
God
• To allow a safe environment to conduct a reciprocal conversation/discussion on thoughts
and experienced with mental health or treatment
Welcome and introduction:
Therapist and co-presenter (Priest/therapist/Case Manager)
• Provide questionnaire on Mental Health Stigma
• Introduction of Mental Health (Developmental Disabilities Vs. Behavioral Health) and
How Stigma prevents treatment

Workshop #2 – Depression
Objective:
BRAZOS ABIERTOS 57
• To have an understanding of the difference between being sad and being depressed
• To gain an understanding that therapy, prayer and their own faith can work together
• To have an understanding that seeking help is not indicative of betrayal to their faith
in God
• To allow a safe environment to conduct a reciprocal conversation/discussion on
thoughts or questions regarding depression
Welcome
Check-in/review from last workshop, Q&A
• Introduction to topic – Depression vs. feeling down or sad (provide handouts with quick
reference information)
o What is depression
o Risk factors for depression
o How does Depression look in young children, elementary aged children,
teenagers, young adults, adults and older adults
o Open discussion
Homework
Have you ever felt any of these symptoms or have you observed these symptoms in
someone else? What stood out for me and how can I support my own mental health?

Workshop #3 – Anxiety
Objective:
• To have an understanding of how anxiety may look within the Latino culture.
• To learn relaxation techniques that can support reduction in feelings of anxiety
• To gain an understanding that therapy, prayer and their own faith can work together
• To have an understanding that seeking help is not indicative of betrayal to their faith in
God
• To allow a safe environment to conduct a reciprocal conversation/discussion on
thoughts or questions regarding anxiety
Welcome
Check-in/review from last workshop, Q&A
• Introduction to topic – General worries vs. Anxiety (provide handouts with quick
reference information)
o What is anxiety (signs and symptoms)
o Risk Factors of Anxiety
o How does anxiety can look like in Latino children, adolescents and adults
o How anxiety may feel and what are panic attacks
o Open discussion
• Activity – Breathing techniques and grounding
Homework
Have you ever felt any of these symptoms or have you observed these symptoms in.
someone else? What stood out for me and how can I support my own mental health?

Workshop #4 – Generational Trauma-how does it affect teens
Objective:
• To gain an understanding on the generational trauma and how it may be affecting
individuals now
BRAZOS ABIERTOS 58
• To how generational trauma can affect discussion making
• To gain an understanding that therapy, prayer and their own faith can work together
• To have an understanding that seeking help is not indicative of betrayal to their faith in
God
• To allow a safe environment to conduct a reciprocal conversation/discussion on
thoughts or questions regarding generational trauma
Welcome
Check-in/review from last workshop, Q&A
• Introduction to topic – Trauma, what it is, how it looks like
o Physical responses to trauma
o Psychological responses to trauma
o Generational trauma, what is it and how can we stop it
o Open discussion
Homework
Have you ever felt any of these symptoms or have you observed these symptoms in
someone else? What stood out for me and how can I support my own mental health?

Workshop #5 – Suicide (Signs and prevention) and self-harm
Objective:
• To gain knowledge of the difference between suicide and self-harm, the signs and.
prevention
• To gain understanding of suicide: not an act of selfishness or a way to punish others
• To gain knowledge of steps to take to support someone that is experiencing suicidal
thoughts and how to seek help
• To gain an understanding that therapy, prayer and their own faith can work together
• To have an understanding that seeking help is not indicative of betrayal to their faith in
God
Welcome
Check-In/review from last workshop, Q&A
• Introduction to topic – Is self-harm indicative of suicide (provide short video clip) or does
it present on its own or both
o statistics on prevalence of suicidal ideation by age
o possible causes for self-harm – what to look out for
o provide background on how suicidal ideations can be present
o how to support someone with suicidal thoughts
o suicide is not …a selfish act, a call for attention
o Open discussion
Homework
Have you ever felt any of these symptoms or have you observed these symptoms in
someone else? Have you experienced anyone close to you with these behaviors that have
acted on their emotional state? What stood out for me and how can I support my own
mental health?

Workshop #6 – Family Violence (Domestic Violence), Violence in teen relationships
Objective:
• To gain knowledge of what is family violence including violence in teen and young
BRAZOS ABIERTOS 59
adult relationships
• To gain an understanding that therapy, prayer and their own faith can work together
• To have an understanding that seeking help is not indicative of betrayal to their faith
in God
Welcome
Check-in/review from last workshop, Q&A
• Introduction to topic – Family violence and relationship
o What it looks like, how it can affect the individual, the couple and the family
o How does it look in teen and young adult relationships
Homework
Has this been present in my family, have I seen it with others? What stood out for me and
how can I support my own mental health?

Workshop #7 –Child Abuse, how can I stop the cycle
Objective:
• To gain knowledge of what is child abuse
• To have an understanding of ways to prevent child abuse
• To understand the differences in discipline and abuse
• To gain an understanding that therapy, prayer and their own faith can work together
• To have an understanding that seeking help is not indicative of betrayal to their faith in
God
Welcome
Check-in/review from last workshop, Q&A
• Introduction to topic –Child Abuse
o What is discipline and what is abuse?
o Why should I change by behavior? (the differences from what may have been
common in their native country to what is against the law in the United States)
o Brief intro to positive parenting and ways of more effective discipline
Homework
Practice one technique learned. Did it help, how was the experience of using a different
technique. Was the result what was expected? What stood out for me and how can I
support my own mental health?

Workshop #8 – Grief and Loss, transition from teen to young adult to adult
(college/university life away from home)
Objective:
• To gain knowledge of the difference between suicide and self-harm, the signs and.
prevention
• To gain understanding of suicide: not an act of selfishness or a way to punish others
• To gain knowledge of steps to take to support someone that is experiencing suicidal
thoughts and how to seek help
• To gain an understanding that therapy, prayer and their own faith can work together
• To have an understanding that seeking help is not indicative of betrayal to their faith in
God
Welcome
Review from last workshop, Q&A
BRAZOS ABIERTOS 60
• Introduction to topic – Grief and Loss
o Stages of grief (understanding it isn’t always linear)
o How does grief look like in children and adolescents
o What can trigger the feelings of grief and loss
o Risks factors for unresolved grief
Homework
Have you ever felt any of these symptoms or have you observed these symptoms in
someone else? What stood out for me and how can I support my own mental health?

Workshop #9 – Substance Use and Abuse
Objective:
• To gain knowledge of how substances can affect mental health
• To gain understanding how seeking help can minimize the effects of substance use
• To gain an understanding that therapy, prayer and their own faith can work together
• To have an understanding that seeking help is not indicative of betrayal to their faith in
God
Welcome
Review from last workshop, Q&A : present guest speaker (expert in the field of substance
use)
• Introduction to topic – substance use
o What is substance use and abuse
o Risk factors of substance use and abuse
o How to identify when an individual is struggling with substance use
o How to identify when someone is intoxicated
o How to address and support someone’s substance use
Homework
Review handout with information – Identify important takeaways

Workshop #10 – How to help when a crisis arises, do I know how to identify if I am in a
crisis
Objective:
• To gain knowledge on the multiple crisis that can arise as it relates to mental health
• To gain understanding of ways to support someone in crisis
• To gain an understanding that therapy, prayer and their own faith can work together
• To have an understanding that seeking help is not indicative of betrayal to their faith in
God
Welcome
Check-in/review from last workshop, Q&A
• Introduction to topic – What is the crisis
o What can you do to help keep someone safe
o When a loved one have crisis due to mental health, what is helpful
o Q & A
Review
Provide questionnaire ISIM-9
*Implemented once it is safe to engage face to face, **Materials will be emailed to participants throughout the 10-week
workshop, ***Materials needed once face to face workshops conclude
BRAZOS ABIERTOS 61
Appendix D Website

BRAZOS ABIERTOS 62
Appendix E

BRAZOS ABIERTOS 63
Appendix F
Budget (Pilot: Virtual Start-Up)

Revenue

Contributions $78K Catholic Charities ($5K)
Private Donors & Gifts
($10K)
In-Kind ($63)
Foundation
Grants
$5k CalMHSA($5)
Total Revenue $83K

Expenses

Personnel Exp

Management $63K CEO Part-time
($53K):in-kind,
Priest ($5k): in-kind
Youth group Director
Part-time ($5k): in kind
IT support $12K Computer Tech ($12K)
Total Personnel $75K
Operating Exp
Rent $0
Technology $4K 1 computer ($300)
software included
($500): in-kind,
Portable Internet ($50),
Website design
($3K);Zoom account
($180)
Supplies $0
Total Operating $4K
Total Expenses $79K
Surplus/Deficit +$4K Contingency/Reserve

BRAZOS ABIERTOS 64

Appendix G
Budget (1
st
& 2
nd
Year of Operations) – Two Locations

Revenue

Contributions $164K Catholic Charities ($5K),
Private Donors & Gifts
($10K)
Fundraisers ($10K) In-
Kind($139K)
Foundation
Grants
$25K CalMHSA($5K) AWARE-
SEA grant ($20K)
Reserve from
Start up
$4K
Total Revenue $193K
Expenses

Personnel Exp

Management $138K LCSW Part-time
Supervisor ($65K): in-kind,
CEO ($53K in-kind), Priest
(x2) ($10k): in-Kind
Youth group Director
Part-time (x2)($10k)) in
kind
IT support $12K Computer Tech ($12K)
Total Personnel $150K
Operating Exp
Rent $12K $1K/mo (in-Kind)
Technology $3K 2 computers ($2K)
(software included; in-
kind $500), portable
Internet ($300), Portable
projector ($100), Printer
($159)
Supplies $2K Supplies (i.e. Pens,
notepads, paper, staplers,
highlighters, clipboards,
etc.), refreshments
Total Operating $17K
Total Expenses $167K
Surplus/Deficit +$39K Contingency/Reserve

BRAZOS ABIERTOS 65
Appendix H Timeline

Stage
Task

Target
(Measure to
indicate task
is
completed)
Activity by Quarters from the start of the project (Please note that the Exploration
phase has been in place since Summer of 2018)

Spring 2019 Summer 2019
Fall/Winter
2019
Spring 2020
Summer
2020
Fall/Winter
2020
E
Identify the need
for the
community,
location,
participants,
supporting staff
Secure the
multipurpose
hall

E
Meet and
discuss
program,
progress and
implementation
with priest
Meet with
priest

P
Funding,
network with
community
agencies,
identify staff
roles
Have Money
from Catholic
Charities

I
Set
implementation
goals, ensure
process and
materials are
culturally
appropriate,
engage as many
individuals as
possible
throughout the
workshops
During youth
group
announcements

provides to the
local community
centers (i.e.
SouthCentral
LAMP, APCH,
etc)

I
Monitoring of
the success of
the program
Use
questionnaires
ISIM-9

S
Ensure
continued
funding,
preserve Pries
and youth group
leader

S
Maintain roles
and continue
with exploring
community need

S
Explore need in
other parishes
Priest facilitate
meetings with
other parishes

Abstract (if available)

Abstract The Latino population in the United States continues to rise. A large number of Latinos living in Los Angeles are self-identified as Catholic. With a rich culture and a strong spiritual belief, Latinos may struggle with seeking Mental Health Services. The Latino Catholic Community struggles when Mental Health needs arise, and stigma rains true with so many. Brazos Abiertos is developed to provide a collaborative approach to support the Latino Catholic Community's spiritual beliefs in addition to meeting the Mental Health needs. Brazos Abiertos will provide psychoeducational workshops for the youth in the current youth group. The workshops will provide ten topics that address mental health in multiple areas and possible causes of mental health issues, such as family violence, generational trauma, and community violence. The overall effects of having a preventative and informative program such as Brazos Abiertos can support using resources available to help their mental health and reduce the risk factors with behavioral health (i.e., Department of Child and Family Services, juvenile justice system and decline in academic achievement). Brazos Abiertos, the pilot program, will engage the youth from St. Patrick’s Church located in South-Central Los Angeles. The program has the capacity to scale up to additional groups within the church and support the community as collaboration and resources are incorporated to support the development and overall mental health of the youth and families within the community.

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Asset Metadata

Creator Guerrero, Jessica (author)

Core Title Brazos Abiertos: addressing mental health stigma among the Latino Catholic community

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Publication Date 11/22/2020

Defense Date 07/31/2020

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

Tag Catholic,Latino,Mental Health,OAI-PMH Harvest,stigma

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Lewis, Jennifer (committee chair)

Creator Email brazosabiertos20@gmail.com,doctoraguerrero2020@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-398856

Unique identifier UC11668083

Identifier etd-GuerreroJe-9145.pdf (filename),usctheses-c89-398856 (legacy record id)

Legacy Identifier etd-GuerreroJe-9145-0.pdf

Dmrecord 398856

Document Type Capstone project

Rights Guerrero, Jessica

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