Rooted In Community: Puentes

Since Ricardo shared with us last year in our CCC TurningPoints series that receiving treatment services from Central City Concern’s (CCC) Puentes program in his native Spanish language “was like music,” we’ve heard from many others who shared the same sentiment. Roberto, who also went through our culturally specific behavioral health program for Spanish speakers, says that his time receiving Puentes services helped him “feel like I belonged to a group of people that want to help the Latino community.”

But offering services in Spanish is only part of Puentes’ story. Over the years, thousands of clients have heard the music of treatment because Puentes worked hard to invite Portland’s Spanish-speaking community into a place they could trust. Puentes was never intended to simply drop into the Latinx community from above; Puentes staff members are the Latinx community, responding to the needs of their own. Puentes has worked hard to demonstrate that their services respect and respond to who the community is. They understand the Hispanic culture — in all its beauty, as well as its barriers — and the community has responded in kind.

“Most Puentes staff are active community members inside and outside of Central City Concern,” shares Daniel Garcia, CCC’s director of Latinx services. “At Puentes, our clients finally feel at home, not only because we speak their language, we also understand their culture and their unique stories and histories.”

Historically in Multnomah County, the Latinx community has been disproportionately affected by poverty and by a lack of access to preventive services, including the knowledge of where to seek help, location of treatment facilities and childcare. Lack of insurance coverage has also been a significant barrier; even after Medicaid expansion in Oregon, documentation status still kept many from applying. The lack of Spanish-speaking providers who are trained to understand and meet the needs of Latinx individuals and families had also been a barrier to receiving care.

To start bridging the gap in treatment access, CCC received a federal grant in 2004 to serve Latinx families at risk of homelessness due to substance use disorders. Originally called Family Latino Outreach and Addictions Treatment (FLOAT), the program approached potential clients with care and humility, leaning on a partnership with Catholic Charities’ El Programa Hispano to establish trust with the Latinx community.

Simply interpreting Western-style behavioral health treatment into Spanish would be setting up the program and its clients to experience many of the same cultural barriers to care and underwhelming results. Rather, from the start, Puentes integrated a deep and firsthand understanding of Latinx cultural values into how they approach and provide treatment, including:

• Personalismo: upending the mainstream approach of providing care that is detached, overtly clinical and relatively impersonal, Puentes staff are intentional
  about being warm, willing to make a personal connection and self-revealing.
• Respeto: Puentes staff understand that clients may avoid expressing doubt, disagreement or confusion in conversations with them, as Latinx culture
  lends significant importance and influence to authority figures like parents, elders and health care providers. In response, staff are trained
  to ask smart questions, listen to individual’s stories and validate their experiences.
• Familismo and colectivismo: Puentes often embraces the potential that the family unit holds in the therapeutic process and its role in helping clients
  remain in treatment. The extended family serves as a support system for all members and puts the collective needs of the family above those of
  the individual.
• Spirituality: The Latino culture tends to view health from a holistic position, implying a continuum of body, mind and spirit. Many cultural values
  and attitudes are heavily influenced by their spiritual beliefs that, in some cases, may become a barrier to care. On the other hand, la espiritualidad
  can provide a positive foundation for well-being and recovery.
• Gender roles: The concepts of machismo and marianismo that reinforce gender roles can often be barriers for clients to talk about their addiction,
  mental health and traumas. Puentes staff provide treatment with an understanding of how these values affect how forthcoming and willing clients
  are about their addiction or mental health.

Some research suggests that Latinx clients, especially newcomers and Spanish-speaking clients who see Latinx therapists (who are both bilingual and bicultural), are more likely to remain in care and to have better outcomes. For people like Roberto, working with staff members who not only understood the values he was raised in but also created a treatment environment that acknowledged and worked within them “helped me have a special connection with the staff and even other clients of Puentes. I trust Puentes.”

Puentes has done well to earn that trust from its community of clients. People receiving care from the program have seen the program grow thoughtfully to continually respond to their needs: in addition to substance use disorder and mental health treatment, Puentes offers treatment for co-occurring disorders, early and specific interventions for Latinx youth who are using substances and are gang-affected, family support and connections to CCC’s primary care services. The program has even moved locations several times to relocate closer to the centers of Portland’s Latinx community, increasing accessibility.

For individuals and families, many of whom left behind extended families and friends to move to Oregon, Puentes has become a place where familiarity can promote healing, where shared values lead to communal victories.

“Geographically, we are so far removed from our home Latin American countries, and yet there is a place named Puentes, where Spanish-speaking people can come and receive treatment,” says Daniel. “We treat each person with the utmost friendliness, dignity, kindness and respect, leaving our clients without fears of being discriminated against, misinformed or misdiagnosed.”

The special connection that Puentes creates has also led to the development of a community within a community. Many people who complete treatment stay close to Puentes through El Senado, an advisory committee of former clients who find ways to give back and provide peer support and encouragement to newer clients. Empowering a community to recognize the collective strength of its experiences and to play an active role in its own healing is perhaps one of the truest hallmarks of how deep Puentes’ roots in the Latinx community have grown to reach.

“I am so proud that we can all — clients, former clients and staff —be leaders in and for our own community,” Daniel says.