An innovative partnership in North Carolina is pairing counseling graduate students from the University of North Carolina at Charlotte with clients of a free medical clinic nearby. Many of these clients are recent immigrants.
According to those involved with the effort, the partnership provides the student interns with a chance to hone their counseling skills while also offering them a firsthand lesson in advocacy and social justice issues.
The Bethesda Health Center (BHC) provides free primary care, diabetes and hypertension management, and health education for low-income and uninsured residents of Charlotte and the surrounding county. The UNC Charlotte counseling interns offer mental health care alongside these physical health services.
The partnership provides much-needed care to minority populations who are, statistically, the least likely to seek or access mental health services, says Daniel Gutierrez, an assistant professor of counseling at UNC Charlotte, as well as a licensed professional counselor, licensed mental health counselor and member of the American Counseling Association.
It has also provided counseling students with some valuable learning that transcends the typical textbook lessons, says Katherine Wilkin, an ACA member and clinical mental health counseling student at UNC Charlotte. Wilkin, who was born in Venezuela, is able to offer counseling to BHC clients in Spanish and English.
The experience has opened Wilkin’s eyes to the cultural factors that often increase risks for mental health struggles, including the stress of navigating a language barrier and acculturation to a new location.
“My experience at Bethesda Health Clinic has enriched my training and has strengthened my passion for providing mental health services to the Hispanic population in their native language of Spanish,” Wilkin says. “… This program exposes counselors and students to a diverse population with unique issues. The [U.S.’s] growing Hispanic population calls for mental health professionals to be sensitive and aware of the cultural considerations when working with this population.”
UNC Charlotte’s work at BHC was highlighted recently by National Public Radio (NPR). CT Online reached out to Gutierrez for a Q+A to find out more.
CT: In your own words, how does this program meet a need?
DG: Latinos are the fastest-growing and largest minority in the U.S., and they experience mental health disorders at the same rate — some argue at higher rates — as the majority culture. Yet, when compared to the majority culture, they are the least likely to access mental health treatment. They, on average, receive a lower quality of care and end up presenting with more severe symptoms.
There is no doubt that there is a great need for effective and accessible mental health care for this population. However, there are numerous barriers that keep Latinos from accessing mental health treatment, such as language difficulties, a lack of appropriately trained mental health workers, stigma and an overall difficulty trusting providers.
On the other hand, counselor educators everywhere preach the importance of teaching our students to work with underserved and vulnerable populations, but we don’t always have the opportunity to give our students quality learning experiences doing this work. This program meets two needs: a) it creates access to appropriate mental health services for an underserved population; and b) it creates a diverse and dynamic learning experience for our students.
What have you learned from this program?
I don’t think you have enough room [in this article] to describe what I’ve learned. I learned how complicated it is to set up a program like this. I learned the importance of doing work with the community and not just in the community. This program has also reaffirmed my belief that understanding people is more important than understanding illness.
Talk about the logistics of how this program came together. What did it take to get started?
First off, the real credit goes to people like Wendy Mateo, the executive director of the Bethesda Health Center. Before all the publicity from NPR, and with limited resources and under some very challenging circumstances, Wendy was wholeheartedly serving the Latino community by providing medical care and chronic health management to the low-income and uninsured immigrant families in Charlotte. She does an amazing job and is an inspiration to helpers everywhere.
When we met with Wendy, she expressed that although they were making considerable strides in improving the physical health of Latinos in Charlotte, there was a great need for mental health services for their patients. We quickly realized that serving at a clinic that helps the underserved in Charlotte would be an amazing opportunity for our counseling students, and that our counseling students could provide the services that Bethesda truly needed. So, we brought together a team of faculty from different departments and began conversations about building counseling capacity at this free clinic.
We began by first evaluating the mental health needs for the current patients. We conducted chart reviews, spoke with staff at Bethesda and began to develop an understanding of what kind of mental health needs they were facing. We then had a series of meetings evaluating space needs; developing the right type of forms; discussing issues related to supervision, ethics, confidentiality, HIPPA compliance, how to manage interpreters; and examining the whole process for providing services.
I think we were all very aware that starting this program had many moving parts and that it wasn’t going to be as easy as just putting two chairs in a corner and assigning clients to students. It was a long and complex process, if we were going to do this right. These clients are already underserved by the community and are statistically more likely to receive substandard quality of care. It was important that we gave them the best care we could and that our students were going to have a positive experience.
After establishing a format and structure for the services, we recruited two doctoral-level counseling students who were licensed professional counselors to begin seeing clients. We called this our pilot study. We evaluated the progress of these initial students and used this data to inform the placement of master’s students. That following semester, we began placing master’s counseling students in their internships and practicums at the site. Thus far, the clients and the students both consider this program a great success.
Based on your experience, what advice would you give to counselors who might want to get involved in something similar in their local area?
One of the key members of our team, Mark DeHaven, is known for saying, “Collaboration is good, but partnership is better.” Too often we try to collaborate with community sites because they are great places to get data or place students, and that has merit. However, when you partner with a community agency, you begin to share responsibility and work together toward common goals, and that’s a whole other wonderfully beautiful thing.
I invite those who want to start these kinds of programs to begin by building strong community partnerships. It is complicated and sometimes cumbersome to partner with community agencies, but it has to be less about you and your agenda, and more about the needs of the people you are serving.
It’s also important that you develop a strong team of like-minded people [who are] willing to not just talk the talk but also walk the walk. I am lucky to work along some great and passionate people from different departments. Our team consists of Edward Wierzalis, a fellow Department of Counseling faculty member and the UNCC counseling program clinical coordinator; Mark DeHaven, a distinguished professor in public health science; Roger Suclupe, a lecturer from social work; Amy Peterman, an associate professor and director of clinical training in the Health Psychology Department; and a counseling Ph.D. student, Carolina Benitez.
This team made this project come together. So, my second piece of advice for future counselors is to build a good team.
The NPR piece says this came about because you were “looking to get more involved in the community.” Can you elaborate? Why is that important to you?
Well, I think this is probably a pretty personal question. I think everyone on our team serves in the community for different reasons. For me, I am driven by the spiritual ideas of welcoming the stranger, reaching out to those deemed the least and doing justice. I was also mentored by people who continually stated that in a world with so many health disparities, economic disparities and so much need, counselor educators should strive to go beyond mere talk and do impactful work.
After the NPR story went national, the first words from my mentor’s mouth were, “Some people got help — and that is the important thing.” I hang that email by my desk at work because it keeps me focused. Those of us with counseling training are equipped to do good in this world. Doing nothing seems like a mistake to me.
What type of nontextbook lessons have you seen your students learning?
Probably what I’ve enjoyed the most about this process is the surprising reactions I’ve seen from students. Our program has an emphasis on multiculturalism and diversity, so the students are well-versed in textbook knowledge. However, the internship experience [at BHC] offered them a real quality experience working with a population that was culturally different from their own.
I have had students come to me during their experience and sit in my office with tears in their eyes, and say things like “I just didn’t know” and “I love working with these people.” I think it raised student awareness to some of the struggles Latino immigrants face, such as having to cope with the traumas they experienced before entering the U.S., the stress and anxiety of leaving loved ones behind, and trying to care for family with limited resources. They also expressed new levels of multicultural awareness and realized that there was much they had taken for granted, such as the ability to speak the same language as their clients.
At the end of the most recent semester, we had students describe their experiences, and most stated that what [they had] learned most form the program was “working with people who are culturally different from you,” “understanding that most Latinos are very different and come from different countries, even though they are all labeled as Latino” and “learning the challenges of working with translators and the importance of tuning into body language.” Students also stated that this site [BHC] provided them with experiences that many of the other sites could not.
What do you want counselors to know about this program and your experience with it?
I would want my colleagues across the country to know one thing: This is worth doing. Latinos and other racial ethnic minorities are not receiving services at the same rates as the majority population. There is a need for helping professionals willing to reach out to our communities.
This kind of work might be complicated to set up and require more energy than you want to expend, but it’s good work and it is worth doing. It’s a great experience for the students and the community. It’s not simple work; you will most likely make a lot of mistakes getting this kind of a program off the ground – I know we did – but it is so much better to dance and miss a few steps than to never dance at all.
Find out more about the Bethesda Health Center at caminocommunitycenter.org
Contact Daniel Gutierrez at DGutierrez@uncc.edu
Bethany Bray is a staff writer for Counseling Today. Contact her at firstname.lastname@example.org
Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.