Analysis of Network Characteristics to Assess Community Capacity of Latino-Serving Organizations in Philadelphia.

Latino immigrants are disproportionately impacted by substance use, HIV/AIDS, domestic violence, and mental health (SAVAME). The burden of these syndemic conditions is influenced by limited access to health and social services to prevent and treat these conditions. The syndemic nature of these factors necessitates an integrated, coordinated approach to address them simultaneously. We analyzed characteristics of Latino-serving organizations in Philadelphia, PA, that provide SAVAME-related health and/or social services, and their interorganizational collaborations to meet the needs of Philadelphia's Latino communities. We surveyed Latino-serving organizations (N=43) identified through existing resource directories and key informants. Network analyses identified patterns and density of collaborative ties (i.e., referrals, administrative, or planning/advocacy) across organizations and characterized these ties by type of service. Density (expressed as percent of all possible ties) revealed a higher referral rate (40%) than administrative (29%) or planning (26%) coordination. Network sociograms display clusters of providers by geography. Examination of bonding (within-group) ties revealed comparable perceptions of high value among both South/Center Philadelphia (57%) and in North Philadelphia providers (56%), but bridging (between-group) ties suggest lower levels of high-value perceptions (24%). No evident clustering by type of service based on syndemic factor was observed. Density of bridging across types of providers was highest for referrals (38%) followed by planning (23%) and administrative coordination (20%). Interventions to promote collaboration between providers should focus on facilitating administrative and planning collaborations that leverage existing capacity of the network. Given the syndemic nature of these conditions, greater collaboration between providers of complementing SAVAME services is imperative.

Provider Perspectives on Latino Immigrants' Access to Resources for Syndemic Health Issues.

INTRODUCTION: Latino immigrants to the United States experience disproportionate impacts from the syndemic formed by substance abuse, violence victimization, HIV/AIDS, and mental health (SAVAME). This study characterizes resource access for Latino immigrants living in Philadelphia, as perceived by staff at Latino-serving organizations. METHODS: An online cross-sectional survey of staff at key Latino-serving Philadelphia organizations assessed access to their organization and citywide access to each type of service (substance use, HIV/AIDS, domestic violence [DV], and mental health) for Latino immigrants. Descriptive statistics for organizational access indicators and citywide access scores across four syndemic domains (availability, accessibility, adequacy, and quality) and by syndemic condition were computed. RESULTS: Organizational access and citywide access across HIV/AIDS (mean = 1.94, SD = 0.83), mental health (mean = 1.37, SD = 0.95), substance use (mean = 1.11, SD = 0.74), and DV (mean = 1.49, SD = 0.97) services were perceived as far from optimal. Domain scores were highest for accessibility (mean = 1.66, SD = 1.03), followed by quality (mean = 1.44, SD = 0.79), availability (mean = 1.41, SD = .81), and adequacy (mean = 1.24, SD = .75). CONCLUSION: Based on findings from a survey of staff working at Latino-serving organizations, this study highlights the lack of support and resources for Latino immigrants, in particular those related to mental health and substance use. Programs and interventions are needed to improve service delivery in Latino immigrant communities.

"We All Have Strengths": A Retrospective Qualitative Evaluation of a Resilience Training for Latino Immigrants in Philadelphia, PA.

Background: Limited research has explored sources of resilience for Latino immigrants or the potential of resilience-based interventions to promote Latino immigrant health and well-being. Purpose: To evaluate Latino immigrants' experiences with a resilience training and application of the training to participants' personal lives and their communities among Latino immigrants. Methods: We conducted a retrospective, qualitative study in Philadelphia, PA from 2017 to 2018. We completed semi-structured, key informant interviews with nine participants who had taken the resilience training, and one facilitator (N=10). Transcripts were analyzed via interpretive content analysis. Results: The training resonated deeply with participants because of their personal traumas and immigration-related adversity. Participants were primed by past experiences of violence, as well as by daily struggles they encounter as Latino immigrants in the United States amid worsening anti-immigrant rhetoric and policy. The training was found to be transformative by allowing participants to discover and tap into their own inherent resilience. Participants utilized the knowledge and skills acquired from the training to better manage daily situations, as well as worked to strengthen others within their networks. Conclusions: Resilience-based interventions can help to strengthen communities against adversity. Cultivating resilience in Latino immigrants can have positive effects on psychosocial health. Resilience-building approaches could be implemented as stand-alone or enhancing components of more complex health promotion interventions. More research is needed on resilience, as well as its utility in community-based interventions to promote the health and well-being of Latino immigrants.

CARES: A Community-wide Collaboration Identifies Super-utilizers and Reduces Their 9-1-1 Call, Emergency Department, and Hospital Visit Rates.

BACKGROUND: A subset of individuals who inefficiently and frequently use emergency department (ED) services are called "super-utilizers." Our healthcare system is fragmented and complex, making it difficult for providers to identify super-utilizers and address their wide range of health issues. OBJECTIVE: The objective of our study was to evaluate a novel community-wide collaboration program called CARES (Community Assistance Referral and Education Services) designed to identify super-utilizers through local partnering organizations. CARES assists patients in developing their personal health and wellness goals, and navigates them away from 9-1-1 calls, emergency room visits, and hospital admissions, and toward more appropriate resources over 90 days. METHODS: This was a retrospective observational analysis of the CARES program. Data were collected from March 2013 to December 2015. The study population included: enrolled adults with non-compliance of medication or treatment; behavioral health problems; multiple 9-1-1 responses in a short period of time; three or more ED visits within six months; patients with multiple hospital admissions. Adults who were outside of the study period or had missing outcome information were excluded. The primary outcomes of this study were the median rate of 9-1-1 calls/month/person, ED and hospital visits/month/person. Wilcoxon rank-sum tests were used to compare changes between pre- vs. post-enrollment for each subject. RESULTS: A total of 441 subjects were included in this study. The majority of patients (64%) were female, 64% were white, and the median (IQR) age was 48 (35-62) years old. A total of 51% were on Medicaid and 69% identified behavioral health issues as their barriers to optimal health care. Between pre- and post-enrollment periods, the median (IQR) monthly rate of 9-1-1 calls, ED visits, and hospital admissions significantly decreased by 0.26 (-0.06, 0.90), 0.25 (-0.08, 0.71), and 0.18 (0.04, 0.53) (p < 0.001 for all). CONCLUSIONS: When health systems in a geographic area share data, they are better able to recognize patterns of overuse, and address them properly. This study demonstrated that a collaborative 90-day intervention identifying super-utilizers reduced the monthly rate of 9-1-1 calls, ED visits, and hospital admissions.