Building A Pipline for Bilingual Behavioral Health

The Denver Foundation

When Yajaira Johnson-Esparza was searching for an internship on her path to becoming a licensed clinical psychologist, she was searching for an organization that shared her mission: to work with Spanish-speaking immigrants in the U.S.

She found Salud Family Health Centers. Founded in 1970 in Fort Lupton, Salud now has 13 clinics throughout Colorado and a mobile unit that brings health care directly to all who need it, especially people with low incomes and migrant and seasonal farmworkers.

Johnson-Esparza completed her internship at Salud and was hired in 2015 as part of a three-year project funded by a Colorado Health Access Fund grant to offer integrated behavioral and physical health care. Now she practices mainly at Salud’s Commerce City clinic, where she also supervises students on the path toward becoming licensed psychologists.

The Colorado Health Access Fund grant allowed Salud to hire Johnson-Esparza and two other behavioral health providers. Salud is now able to cover their salaries without the grant’s support.  Salud also streamlined its referral process for behavioral health services and offers psychological testing and evaluations to help improve its overall care.

Jonathan Muther, vice president of medical services at Salud, said the Colorado Health Access Fund has allowed clinics to help patients get behavioral health care more quickly and consistently. Having psychologists in the same clinic as primary care providers lets people access care without having to search for a provider, deal with the complexities of insurers, or face the stigma that can come with seeking help in specialized settings.

Providers hired through the grant have reached more than 1,500 people: 801 in Brighton, 258 in Commerce City, and 595 in Frederick. The grant also allowed Salud to build a stronger pipeline of Spanish-speaking bilingual providers, he said, including by forging relationships with universities in Puerto Rico and Chile. 

According to the U.S. Census, there are just 5,000 Hispanic psychologists in the U.S. — just 5 percent of all psychologists — while people of Hispanic origin make up nearly 18 percent of the U.S. population. In Colorado, Hispanics make up about 21 percent of the total population.

“For a long time, I was the only Spanish-speaking student in my program. It was hard to find supervision,” Johnson-Esparza said. Working at Salud has been a different experience. “I’m a little spoiled – it seems like the norm.”

Johnson-Esparza said a psychologist who speaks the same language as patients and understands their cultural backgrounds makes a difference.

She recalled a patient who had migrated from Central America. She was struggling to manage her diabetes, and at the same time was referred to Johnson-Esparza to help work through conflict with her daughter.

 “Sometimes people are not adhering to their treatment not because they don’t want to, but because they have a lot they’re trying to deal with, including cultural issues and issues related to families,” she said. After six sessions of therapy, the woman began managing her diabetes more consistently.

Johnson-Esparza said patients regularly tell her they appreciate speaking with someone who “gets” them and their problems.

“It’s important for patients to feel they have a shared experience,” she said