“La Frontera”- DDRAC 8/4/09

1. “La Frontera”- DDRAC8/4/09 Susan M. Gallego, LCSW DSHS MH/SA – Program Implementation Border Programs Coordinator

3. Texas Border: Colonia

4. Texas Border Health

5. Borderlands – “La Frontera” • 32 Texas Border counties in 4 MH/SA regions with approx. 4.1 million people. • 68% of legal truck crossings between US and Mexico come through Texas (Laredo). • 48% of legal crossings of people between the US and Mexico come through Texas. • El Paso/Ciudad Juarez is the largest TX border community, and the busiest crossing. Population increased by 38% from 1990-2000. • McAllen/Reynosa is the 4th fastest growing metro area in US. Population increased by 38% from 1990 -2000.

6. “If the Texas Border counties made up a “51st” state, it would rank last in per capita personal income and first in poverty and unemployment.” Texas Borderlands: Frontier to the Future, February 2007, State of Texas, Eliot Shapleigh

7. Texas Border Health: DSHS Office of Border Health Binational “Sister-Cities” Health Councils held a Strategic Planning Meeting, 6/08, sponsored by USMBHA and TX OBH, and identified the top five border-wide healthpriorities: • Diabetes/obesity/nutrition • Tuberculosis • Dengue fever • EDIDS/EPI • Mental Health/Substance Abuse/Domestic Violence

8. Substance Abuse Prevention - Six Effective CSAP Strategies • Prevention Education/Skills Training • Alternative Activities • Problem Identification & Referral • Information Dissemination • Community-Based Process • Environmental/Social Policy

9. Youth SA Prevention Programs Border Region 8 (Eagle Pass, Uvalde) Community/School SA Prev. =19 Border Region 9 (Pecos,Terrell Co.) Community/School SA Prev. =6 Border Region 10 (El Paso) Community/School SA Prev. =11 Border Region 11 (Brownsville, Laredo) Community/School SA Prev. =31

10. Purpose & Goals of the Texas Rural Border Intervention (RBI) Projects PURPOSE: To develop and implement a comprehensive behavioral health model that promotes and embraces culturally competent prevention, intervention, and treatment for youth and adults in rural border areas (including Colonias) of the State. GOALS: • Increase access to health and social services • Increase substance abuse awareness and prevention • Decrease risk factors and strengthening protective factors. • Promote recovery and improve quality of life for community members • Increase the number of people receiving services • Enhance motivation for change related to substance use/abuse.

11. Hudspeth Culberson Jeff Davis Brewster Presidio Maverick Val Verde Edwards Kinney Real Uvalde Dimmit Zavala Frio La Salle Zapata Starr Duval Jim Hogg Brooks The 5 RBIs currently serve the following 20 counties along the Texas – Mexico border (Regions 8, 10, 11):

12. Counties Targeted by RBI Land Area 42,220 mi2 Estimated Population 303,648

13. Texas Border Health: Substance Abuse Clinics

14. Recent Anecdotal Findings 2/09 – 5/09 • Increases in: • Fear, trauma, stress for border residents • demand for SA treatment services • Heroine use (adults) • Heroine, speed and cocaine use (youth) Increasing fear and mental health issues. • Truancy • Youth involved in drug trafficking • Referrals from JPs in rural border counties for youth at risk • Fear and barriers to asking for SA/MH services for immigrants • Decreases in: • Ability to collaborate and coordinate across borders. • Families and support systems are more broken. • Community level responses seem weaker. • Homeless shelters and domestic violence shelter in the border areas are full (fuller) more often. • Growing concerns about providing group SA prevention services in communities experiencing increase in violence and crimes related to drugs. • Fear that “addictive tendencies” may develop into “addiction” to violence. • Increased poverty due to global economics. • Exodus of upper and upper middle class Mexicans to Texas (San Antonio).

15. Recommendations for our work on “La Frontera” • Adopt a Borderlands (an “across”) mindset for joint strategies and programs. • Build on the willingness of the border population to get involved with programs that relate to the well-being of children • Support and grow current binational initiatives. • Increase youth community counseling, MH and SA treatment programming and facilitate access. • Increase focus on community based outreach models and services provided by Community Health Workers or Promotoras(es) and other para-professionals. • Develop and support new evidence-based interventions that are culture-informed • Evaluate community-developed, grass roots interventions to determine efficacy and possibility of replication

16. Recommendationscont’d Fund and support new services/programs targeting out-of-school youth and violence prevention. Create bilingual multi media campaigns, social marketing. Develop creative and responsible strategies to increase bilingual and bicultural work force Make an effort to integrate trauma knowledge into service delivery systems Support and fund mechanisms that increase the number of bilingual mental health and substance abuse counselors. Increase support for integrated behavioral health services within medical clinics. Utilize creative approaches to target resources to the 32 Border counties, such as directing a % of seized money towards SA/MH prevention, intervention and treatment programs.