LCFC COVID Report

FROM CHAOS TO REVELATIONS: Post-Covid Lessons In Addressing Service Disparities & Inequities For Latinos

STAFF JAMIE BAZELMAN Executive Assistant RACHEL GRIEGO Senior Vice President, Community Innovation & Strategic Partnerships CARLOS MARTINEZ President & CEO SETPHANIE MONGE Program Assistant PRISCILLA MONTOYA Vice President of Development & Communications KOURTNEY RIMBERT Director of Finance & Human Resources TASHINA SALAS Development & Communications Coordinator KAITLYN THROGMORTON Program Coordinator SONYA ULIBARRI Chief Impact Officer

BOARD ELSA HOLGUIN, Chair THOMAS BRYAN, Treasurer YESENIA SILVA-ESTRADA, Secretary MIDY APONTE JUDI DÍAZ BONACQUISTI, PhD ERIC ISHIWATA, PhD GUILLERMO LAMBARRI LISA LUCERO SUSANA SALAMUN ELAINE TORRES HOLLIE VELASQUEZ HORVATH

OUR GRATITUDE Thank you to the Rose Community Foundation for powering this report.

Inside the Report LETTER FROM CARLOS MARTINEZ, PRESIDENT AND CEO

4

DISPROPORTIONATE EFFECTS OF COVID ON LATINOS IN COLORADO

5

IMPACTS OF COVID ON LATINOS’ BEHAVIORAL AND MENTAL HEALTH

6

IMPACTS OF COVID ON LATINOS’ PHYSICAL HEALTH

8

ECONOMIC IMPACTS OF COVID ON LATINOS IN COLORADO

10 10

2023 AND BEYOND…

13 13

TAKING ACTION POST-COVID

14 14

15 POLICY RECOMMENDATIONS 15 CONCLUSION

20

LETTER FROM OUR PRESIDENT & CEO

Throughout my 35 years of being a leader in the nonprofit sector, my leadership has been challenged in navigating various large social crises – the HIV/AIDS epidemic, welfare reform, 9/11, the Great Recession and most recently, the COVID-19 Pandemic.

We also got to hear stories of courage where Latino “orgullo” (pride) kicked in and people supported each other no matter the risk. These heroic actions are assets in our communities, and we must honor them as contributions to our community leadership.

Each crisis brought its own set of challenges.

I’ve learned from each one, but none was as emotional, grueling, frightening and uncertain as COVID – perhaps because it was a global crisis for which the world was not prepared. In my role at the Latino Community Foundation of Colorado (LCFC), we witnessed the specific impact of COVID-19 on Latinos at the 5280-foot level.

Often, when a crisis impacts our community, we pivot to address the crisis, support our communities, and then move onward. Rarely do we take the time to document a “place in time,” especially for our Latino community. This report does just that. It chronicles the impact of the COVID-19 pandemic, puts a face to the pandemic with stories and quotes, shared lessons, and provides recommendations.

The effects that COVID-19 had on the Latino community did not end; we must still address many of its long-term impacts.

In Colorado, we experienced our share of challenges and also learned that Latinos were disproportionality challenged. Our community experienced high rates of deaths, infection and health complications, loss of jobs, lack of access to online learning for our children, food insecurity, rental evictions, difficulties with vaccination access, and misinformation about the pandemic. Furthermore, through our work at the LCFC in supporting the Latino and immigrant nonprofit sector, we witnessed the lack of capacities many of our organizations had to act as a remote provider of services and help our families maintain security, safety and access to basic needs.

4

The LCFC hopes that this report contributes to driving a new conversation and narrative around equity while deepening one’s understanding of inclusion. We don’t want our Latino story of the COVID pandemic to be erased, nor the stories of struggles and courage to be lost. Thank you.

Sincerely,

CARLOS MARTINEZ President & CEO

DISPROPORTIONATE EFFECTS OF COVID ON LATINOS IN COLORADO Disparities have always existed. COVID exacerbated those disparities and exposed the gaps in services, access and communication that Latinos and People of Color experience.

Two experts from the Colorado Health Foundation explain the significance of the situation in powerful words:

This moment in time was not just the story of a pandemic; it was the story of racial reckoning. This moment called necessary attention to the deeply entrenched racial inequities that have plagued communities of color since before the dawn of our nation. This moment called us to act.

Many of the challenges that Latinos face are compounded by legal status. Despite the regional demand for immigration pathways to the United States, the number of legal permanent residency permits given to citizens of the Northern Triangle remains relatively low4. Latinos without legal status will continue to face the compounded impacts of COVID in addition to existing inequities.

- ERIN BROWN, VP OF COMMUNITY INVESTMENT AND IMPACT, AND AMY LATHAM, CHIEF IMPACT OFFICER

Impact.

At one point in May of 2020, more than half of COVID-19 patients in Colorado were Latinos, according to data released by the state health department1.

Latinos comprise 22% of the Colorado population but represented 38% of COVID cases, according to the Colorado Department of Public Health and Environment (2023).

The Impact Was Greater on Those Undocumented

According to the Colorado Health Institute, COVID-19 worsened inequities amongst Latinos and Hispanics in Colorado. Data collected from their Colorado Health Access Survey highlighted that Hispanics/Latinos were more likely “to report job loss, reduced income and other financial hardships which deepened poverty”2.

“Undocumented and mixed-status (families), they’re dealing with something different than anyone else. They’re the most underserved of any population in the country”3. - Amanda Blaurock, Executive Director of The Village Exchange Center in Aurora

5

IMPACTS OF COVID ON LATINOS’

BEHAVIORAL & MENTAL HEALTH

The U.S. is facing a mental health crisis and Colorado is among the worst in the country. For Colorado’s Latinos, the crisis is complicated by language, cultural barriers, lack of services, accessibility, legal status and lack of insurance. Although there is a lack of data statewide, during the pandemic, organizations reported overwhelming increases in Colorado Latinos seeking mental health services which taxed the already overwhelmed system.

“The data suggest that our current mental health care system is not working for all Latinos,” says Alex Sánchez, President and CEO of Voces Unidas de las Montañas and Voces Unidas Action Fund.

“Simply funding the existing system without any systemic changes will not solve the problem of our mental health care system being ill-prepared to meet the needs of all Latinos, especially in rural areas where the system has created monopolies under a one-sizefits-all”.5

LACK OF CULTURAL COMPETENCY PRE-COVID More people of color are earning psychology degrees, a trend that is en­hancing the diversity of the psychology workforce. While overall most psychologists are still white (84%), racial and ethnic minorities represent 26% of psychologists under age 36, compared with 8% of those over age 50.6

6

“Latinos have faced challenges in obtaining culturally competent mental health care for years,” says Laura C. Morel, a journalist reporting on the COVID experiences of Latinos. “The need is only growing during the pandemic [... as] practitioners across the country receive more referrals from patients within the Latinx community [... and] Only 5.5% of psychologists can provide services in Spanish”.7

EXISTING CONDITIONS Poor Access to Mental Health Services in Colorado Over the past five years, Colorado has consistently ranked in the bottom half of states in terms of providing access to mental health care for its citizens.8

High Rates of Uninsured Amongst Latinos In Colorado in 2019, 15.6% of Hispanic residents were uninsured, compared with 6.8% of white Coloradans, as reported by John Daley on Colorado Public Radio.9 This makes accessing services more difficult and often impossible due to both lack of services and cost.

Nationally and in Colorado, the share of people without health insurance has long been significantly higher among Latinos than among non-Latino White, Black or Asian residents.

Immigrants lacking legal status and those who have legal residency but whose families have a mixture of immigration statuses make up a large portion of that group.10

REALITY:

STORIES FROM THE COMMUNITY Burdens Imposed on Essential Workers “The impact is always going to be greater and specifically to Behavioral Health, where Latinos were severely impacted by the virus.

Many individuals in the workforce are essential workers and did not have the opportunity to work from home or remotely, so this resulted in them having [faced] many barriers to overcome such as loss of housing, employment, increased psychological stress and anxiety, and not knowing where food could come from.”

- Ana Vizoso, LPC, LAC, Vice President of Health & Wellness, Servicios de La Raza

Increase in Mental Health Needs “Over the last 2 years, there has been an approximately 50% increase of Latino/x community members seeking behavioral health services.” – Ana Vizoso, LPC, LAC, Servicios de La Raza

Barriers to Care “Stress, depression, and anxiety increased.

[Latinos]learn to live with the conditions because they can’t afford the expensive healthcare without insurance or a discount. Many can’t access the available, affordable healthcare because it’s nearly impossible to schedule an appointment at the only Denver Health location in the neighborhood.” - Angela Tzul, Co-Chair, Conectoras de Montbello

COVID Compounded Existing Challenges “We have a participant, Señora Alvarado. The impact was losing her job, dedicating herself to caring for her grandson with ADHD, and not having an income to help with the household expenses or for her own personal expenses, and not having a place to go to ask for food. She has to use public transportation…It all contributes to the challenges. Levels of anxiety, depression, and frustration were elevated. I had to refer her to mental health services. Now she seems to be doing better and feeling better…This example helps us know that we are on the right path in the work we do, and that we need to continue to support them.” - Aurelio Avalos, Conectoras de Montbello

7

IMPACTS OF COVID ON LATINOS’

PHYSICAL HEALTH

COVID-19 brought forward the reality of current health conditions directly related to systemic racism for all people of color. Latino’s had higher rates of health concerns along with higher rates of being uninsured prior to the pandemic resulting in many more Latino’s dying from COVID-19.

EXISTING CONDITIONS Higher Rate of Health Concerns

“Throughout the pandemic, this [Latino] community has faced disproportionate health and economic impacts, including a higher risk of COVID-19 infection, hospitalization and death, than nonHispanic white Americans.”13 - Colorado Access

8

“Outside of COVID-19, other health concerns impact Latinos at a higher rate than other groups.

For example, Latinos are nearly 50 percent more likely to die from diabetes or liver disease than whites. Health factors like hypertension and obesity are also two factors that commonly plague Latinos. Heart disease and cancer are the leading cause of death among Latinos and represent 2 out of 5 deaths. That rate is nearly identical to studies of whites.”11 - Joseph Rios, community journalist for La Voz Colorado

Systemic Racism The National Academies of Sciences, Engineering, and Medicine note that there is little evidence to suggest that differences in COVID-19 related outcomes are a function of inherent susceptibility to the virus, but “rather reflect the impact of systemic racism leading to higher rates of comorbidities that increase the severity of COVID-19 infection and the socioeconomic factors that increase likelihood of acquiring the infection.”12

REALITY:

STORIES FROM THE COMMUNITY Lower Vaccination Rates Latinos in Colorado have the lowest vaccination rate of any race/ ethnicity at 39.35%. This is only slightly above half the vaccination rate of Colorado’s white/non-Hispanic population (76.90%).14 - Colorado Department of Public Health and Environment

Fear and Misinformation “Latinos experienced greater barriers and disparities and underserved communities. Lack of health care amongst Latinos, lack of information for Spanish speaking individuals. They were misinformed about COVID 19 and have a fear around this disease.”

Ana Vizoso, LPC, LAC, Vice President of Health & Wellness, Servicios de La Raza

Lack of Insurance Is Detrimental to Health “Latinos have consistently been overrepresented in the uninsured population… [As a result], Latinos are more likely to delay care, less likely to have a usual source of care, and more likely to be concerned about medical bills than their non-Latino counterparts.

The cost of services is also a significant barrier to care for many in the Latino community.”15 - Assistant Secretary of Planning and Evaluation, Office of Health Policy Former Denver Councilwoman-at-large Debbie Ortega says, “When you look at Denver numbers, at how drastic our Latino population has been impacted by COVID, it’s alarming.”

“COVID compounded the disadvantages for Latinos (fear of unemployment and eviction) and they had no safeguards and could not protect themselves. Many said they were reluctant to come to the hospital and were worried about bills and many feared being deported.”

- Lilia Cervantes, M.D., Associate Professor, University of Colorado Anschutz Medical Campus and Denver Health

9

ECONOMIC IMPACTS OF COVID ON LATINOS IN COLORADO Prior to COVID, the Latino community in Colorado faced a myriad of economic challenges that were not only exposed but exacerbated by the Pandemic. These challenges include lower household income, high childhood poverty rates, low rates of home ownership, higher rates of low wage essential jobs without paid leave, and higher unemployment rates. COVID made these challenges worse.

EXISTING CONDITIONS Economic Disparities • Despite the falling poverty rates, Latino and Black Coloradans were still about twice as likely to live in poverty as white Coloradans. Black and Latino children were about three times as likely to live in poverty as their white peers.16 • In Colorado, Latinos make $0.68 to every $1.00 earned by whites.17 • Latino families are 43 percent less likely to own a home than white families - 48.3% Latino families own homes compared to 70.0% of white families.18 • Sixty-three percent of Latino or Hispanic workers and 54% of Black workers earn low wages, compared to 37% of white workers and 40% of Asian American workers.19 • Latino Coloradans are disproportionately impacted by poverty, but even controlling for economic factors, people of color may be at greater risk for food insecurity.20

10

Barriers to Benefits • Essential workers have an uninsured rate of 13 percent, compared to 8 percent of nonessential workers.21 • The unemployment rate for Black workers was 5.7% and the one for Latino workers was 5.3% compared to 3.4% for Asian workers and 3.2% for white workers. Gaps in unemployment rates by race and ethnicity have persisted, even as the labor market went through a historical recovery from the pandemic induced recession.22 • Under the current state and federal systems, undocumented workers are not eligible for unemployment benefits. The general rule is that workers must have valid work authorization during the base period, at the time that they apply for benefits, and throughout the period during which they are receiving benefits.23

COVID INTENSIFIES ECONOMIC DISPARITIES

ACCORDING TO 2021 DATA FROM BSP RESEARCH, A RESPECTED POLLING FIRM WHOSE WORK FOCUSES ON CULTURAL COMPETENCE IN TODAY’S AMERICA:

“I had some thoughts about why this community was being disproportionately burdened.

They are often our essential workforce, they’re poor, they live in crowded housing conditions [which leads to greater spread of disease], and many of them don’t have the option not to work. They can’t work remotely, so they have to place themselves and their families at risk by taking public transportation, and sometimes having to work despite being ill.”

- Lilia Cervantes, M.D., Associate Professor, University of Colorado Anschutz Medical Campus and Denver Health

60% of Colorado Latinos reported they lost a job or work hours were reduced.

52% of Colorado Latinos did not have enough food to eat.

50% of Colorado Latinos had difficulty paying rent or mortgage and 56% had difficulty paying bills or utilities.

Furthermore, the Latino Policy Forum reports:

“Nearly one-quarter of Latinos report that their workload or hours increased without a raise or promotion [during the pandemic].

Finally, a statewide survey of Latinos in Colorado fielded in September 2022 found that half of Latinos in Colorado report that their economic situation has worsened in the past 12 months; this is a powerful statistic given how financially difficult 2021 was for the Latino community in the state.”

24

11

Major industries in the US rely on undocumented immigrant workers, including agriculture, construction and direct care for the elderly. These industries represented many of the essential workforce we relied on during the pandemic. For example, a 2021 article published by the Rice University Baker Institute for Public Policy contains important statistical data about America’s essential workforce and agriculture:

REALITY:

“An estimated 5.2 million undocumented immigrants [were] working in jobs designated as essential during the COVID-19 pandemic… nearly half of hired crop farmworkers are undocumented and are on the frontlines of the pandemic response to keep the nation’s food system and supplies moving.”26

STORIES FROM THE COMMUNITY

Granting legal status and/or work authorization could help America achieve a more stable and larger legal agricultural workforce.

Hard Choices

Housing Challenges

Veronica Crespin-Palmer is the co-founder and CEO of RISE Colorado, a community group based in Aurora that works with low-income families.

She describes the difficulties families face in this post-pandemic world:

Aurelio Avalos, a leader of Conectoras de Montbello, a community organization that helps community members access much needed services, explains how many Latinos in the area lost their housing during the pandemic:

“People are having to make really impossible choices, like, do I go back to work so I can keep a roof over my family’s head and put food on the table and leave my children alone because I can’t afford childcare?” (personal interview, 2023)

“Many clients lost their housing and were evicted because of COVID. They couldn’t pay rent. It was difficult for them to get assistance because of the language barrier. The system is very complicated…the clients don’t speak English or don’t have documentation. They couldn’t get help because they didn’t know how.” (personal interview, 2023)

Vulnerable Job Options “[Latinos are] still having to work two or three jobs [and] typically those are in the frontline, higher risk, type of jobs,” states Jim Garcia, CEO of Clinica Tepeyac, a community health center in Denver’s Globeville neighborhood.25

12

2023 AND BEYOND…

CHANGING REALITY

TAKING ACTION POST-COVID

As grocers have diminished and the need for food assistance has risen dramatically. Demand for public assistance programs such as SNAP has surged. And state legislators have been limited in their ability to provide recourse, as the recession forced some $3 billion in cuts.27

Government and service agencies can play a vital role in addressing these ongoing health and economic disparities. The proven strategies developed by local community agencies provide a roadmap on how to close these gaps. We need to expand these strategies to reach the entirety of Colorado’s Latino population.

Growing Demand for Essential Workers Researchers for the Baker Institute for Public Policy at Rice University, report that industry “relies on undocumented workers, who comprise 13% of its labor force. However, this is not enough to keep up: amid a shortage of building materials, the industry will nevertheless need another 430,000 construction workers to meet rising demand in 2021.”28

AS WE EMERGE FROM THE COVID CRISIS, COLORADO LATINOS FACE EXISTING CHALLENGES WITHIN A CHANGING LANDSCAPE. SERVICES AND POLICY DECISIONS NEED TO BE BASED ON CURRENT AND CHANGING REALITIES. 13

TAKING ACTION POST COVID

Culturally Responsive and Accessible Services According to Dr. Lilia Cervantes, Associate Professor at the University of Colorado Anschutz Medical Campus and Denver Health, having access to culturally responsive, equitable health care can reduce health disparities and improve patients’ trust in the health care system. Dr. Cervantes says that we make the Colorado health care system more culturally responsive and accessible by taking the following actions: • Increase the number of bilingual service providers and advocates to increase diversity in Colorado’s medical workforce.

• Implement curriculum and training specific to serving Latinos within Colorado’s higher education and medical institutions.

• Build on existing community-defined and strength-based clinics who use culturally appropriate practices/approaches. (personal interview, 2023).

CLOSING MEDICAL DISPARITIES: SOLUTIONS FROM THE COMMUNITY Servicios de La Raza, a provider contracted with Colorado Access, is one of the few organizations in Colorado to offer culturally responsive services to Spanish speakers in their native language (without the use of a translation service). Because of this, their organization received approximately 1,500 new inquiries from community members seeking care in the past year.29 We outline strategies for implementing culturally-responsive, affordable health care that come directly from community members serving on the frontline. In addition, we offer policy recommendations that can help to meet the high demand for services that local organizations, such as Servicios de La Razas, report.

14

According to Ana Vizoso, Vice President of Health and Wellness at Servicios de La Raza, improving access to technology will increase the resources and services available to Latino communities. She recommends that Colorado: • Increase satellite offices and mobile health clinics to reach rural communities.

• Utilize telehealth and other digital tools, such as Whatsapp (a messaging app), to improve patients’ access to accurate and timely information regarding their health.

• Maximize existing social media platforms such as FaceBook, Instagram and Tik Tok to announce resource availability, clinic hours, and food assistance.

• Host public health workshops via Zoom that teach participants how to access health information and how to recognize warning signs for mental health and get help.

• Expand statewide internet services to improve access to information and services for rural and low-income communities. (personal interview, 2023)

POLICY RECOMMENDATIONS

1. Maintaining Expansions to Medicaid During the pandemic, many expansions were made to increase Medicaid enrollment and prevent disruptions in coverage. These expansions made a big difference for America’s most vulnerable populations, yet many are set to expire. Extending Medicaid expansions would substantially increase Latino’s access to health care, as would expanding eligibility requirements to include undocumented individuals.

2. Continuous Enrollment During the pandemic, Health and Human Services provided continuous enrollment in Medicaid, ensuring protection from disruptions in coverage. This practice resulted in a 25% increase in Medicaid enrollment between 2020-2022, which provided initial and stable coverage for the highest risk populations in the country who are disproportionately people of color. As the health emergency ends, so will continuous enrollment for Medicaid.30

3. Continuous Coverage for Children A new report from CCF and UnidosUS shows that because Latino children are more likely to be covered by Medicaid and CHIP, adopting Medicaid/CHIP policies that remove barriers to

participation would narrow inequities in health coverage and access. The report highlights one proven strategy in particular – 12-month continuous coverage. Under 12-month continuous eligibility, a child is guaranteed a full year of coverage (even if income fluctuates) unless the child requests disenrollment, reaches adulthood, or moves out of state. This policy has proven effective in reducing the rate of churn – when beneficiaries lose coverage and re-enroll within a year.31

4. Eligibility Pregnant undocumented immigrants and their children will be eligible for Medicaid starting in 2025 under a bill signed by Gov. Jared Polis.

HB22-1289 is aiming to close gaps in healthcare access for immigrants. Under the law, pregnant undocumented people who would otherwise qualify for Medicaid and the Children’s Basic Health Plan, or CHIP, would be provided full health insurance coverage for up to a year following a child’s birth. Undocumented children will be eligible until they turn 18.32

15

POLICY RECOMMENDATIONS:

HOW TO BETTER SUPPORT MENTAL & BEHAVIORAL HEALTH FOR COLORADO

LATINOS

Now is the time to implement policies that better support the mental health needs of Colorado’s Latino communities. Colorado legislators are deciding how to spend the $450 million in federal COVID relief funds that have been allocated to improve behavioral health care. The need is real.

Mental Health America ranks Colorado the lowest overall for adult mental health.33 To address the shocking prevalence of mental illness and limited access to care that account for such a ranking, Colorado state legislators have established the new Behavioral Health Administration.34 Here are some of the plans that the new Behavioral Health Administration has developed thus far: Allocate $90 million in grants to fill service gaps across all regions with an emphasis on familybased services, substance use prevention, housing support, and recovery homes.

Create a new safety-net system of behavioral health organizations and providers offering emergency and crisis services, ongoing outpatient care, care coordination, etc.

Improve access to mental health care and addiction services within public schools Integrate behavioral health into pediatric and primary care clinics.

Expand educational outreach and access to digital resources.

16

Once put into action, these bold measures will help many Coloradans. But what can policymakers do to address the behavioral and mental health needs of Latino communities in particular? Especially when Latino communities have been systematically denied equal access to the care that such measures intend to provide?

Latinos represent nearly a quarter of Colorado’s state population. As the Substance Abuse and Mental Health Services Administration reports, “31.5% of Hispanic/Latinx adults with mental illness receive treatment each year compared to the U.S. average of 46.2%,”35 which is due to many unique barriers to care. The following policy recommendations can help close the gap in behavioral and mental health services for Colorado Latinos.

1. Insurance Legislation & Enforcement Federal law mandates that insurance plans cover mental health services, and health parity protections require that all plans offer mental health coverage on par with medical and surgical benefits. In practice, however, that has not happened: Insurance companies in Colorado pay mental health doctors 30% less than they pay other medical professionals, and consumers have to pay for out-of-network care seven times more often than they do for other medical care.36 Colorado’s Behavioral Health Care Coverage Modernization Act (HB 19-1269) addresses these issues by legislating better compliance with parity laws.

Colorado policymakers can build on this progress to better serve Latinos in several ways: Require insurance companies to provide choices of mental health care providers that offer bilingual and culturally competent services to the Latino community.

Reverse policies that limit health plan enrollment based on legal status.

Create a state-sponsored hotline accessible to Spanish speakers where callers can share their health insurance information, be matched with a list of mental health providers who are currently taking patients, and receive assistance making an appointment.

Provide insurance commissioners with the enforcement tools they need to get insurance companies to comply with parity laws, as Dr. Carl Clark, CEO of Mental Health Care Center of Denver recommends.37

2. Focus on Mental Health Providers The rates of reimbursement that mental health providers receive is so low that many choose to work in a private practice that takes payment directly from clients rather than accepting insurance. Paying out-of-pocket for mental health care is not a viable financial option for most individuals. The lower salaries offered in community-based behavioral health create workforce shortages that contribute to a lack of providers who are linguistically and culturally competent. Remember that only 7% of psychologists in the U.S. are Latino.38 We can create policies that attract mental health providers to work in the community-based health centers and schools that serve Colorado Latinos: Offer government-sponsored benefits to mental health providers who work in community-based health centers and public schools that provide culturallycompetent services, such as student loan debt forgiveness or tuition credits.

Offer service scholarships in addition to the salaries mental health providers are paid at

community-based health centers and public schools, especially those that offer bilingual and culturally-competent services to Latinos.

Partner with higher education institutions to create community-based residencies for newly credentialed mental health providers.

Streamline the licensure process for mental health providers who relocate to Colorado to work at community-based health centers and public schools.

Open local career pathways beginning in high school for Latino youth to receive recruitment and support to become mental health providers.

3. Public Health Awareness Campaigns The Colorado Health Institute cites mistrust, fear, and stigma as a primary factor preventing immigrants and people of color from accessing mental health care. For example, the Trump administration expanded a Medicaid rule in 2019 to say that use of such programs could be used as grounds for denying pathways to citizenship. The Biden administration repealed this rule in 2021.

Nevertheless, 1 in 6 adults in immigrant families reported avoiding such benefits for fear of being denied green cards.39 Stigma surrounding mental health is common amongst immigrant and refugee groups even though they face a higher risk of trauma before, during, and after migration, which is then compounded by experiences of racism.27 Public health awareness campaigns can help reduce these barriers to care for Latinos. Public health officials may consider taking the following steps: Give accurate information about enrollment policies for programs such as Medicaid to community centers so that they can distribute or share such information with the Latino populations they serve.

Build trust by addressing the barriers to care that impact Latinos and their families directly in awareness campaigns.

17

Increase opportunities for social connection and community building. For example, the Broomfield Department of Public Health the Environment runs a program called “Let’s Talk About It” that uses an app to feature the stories of Latino individuals experiencing mental health issues and then gives community members the chance to anonymously share their own experiences or ask questions.

Create a culturally competent mental health toolkit specific to serving Latino students and families to support mental health and wellness in public schools. Emphasis should be placed on best practices for early screening and prevention.

4. Community-Based Solutions Research shows that mental health interventions that prioritize community and familial support as protective factors contributing to resilience better serve Latino populations.40 Protective factors are positive aspects of a person’s life that help them cope with trauma, stress, or other difficulties.

Here are steps policymakers can take to facilitate community-based solutions for mental health care: Cultivate partnerships between providers at clinics/schools and the Latino communities they serve by requiring state-funded providers to develop community partnership plans.

Prioritize funding for new programs that integrate traditional, culturally specific models of healing into existing care.

Fund programs that use peer mentors or peer navigators to address mental health needs and integrate those programs into state-funded clinics and schools.

MORE RESEARCH IS NEEDED Policymakers should fund mental health research that is inclusive of Latinos and people of color to better determine their service needs.

Much of the mental health research focusing on Colorado does not provide demographic data specific to racial groups, despite the established fact that people of color face many unique barriers to accessing mental health care.

The Colorado Health Institute emphasizes that the lack of mental health research focused on nonwhite racial and ethnic groups contributes to a system that limits access to equitable care.41

An Example of Community-Based Solutions

Alma is a peer support program for pregnant and postpartum women experiencing depression created by Dr. Sona Dimidjian and the CREST Lab at CU Boulder. In partnership with Valley Settlement, it serves Spanish-speaking women in Colorado’s Roaring Fork Valley by partnering them with a “compañera,” another woman who has experienced depression and supports them through their mental health journey.

18

IMPROVING WORKING CONDITIONS: LATINOS WORKING, BUT NOT GETTING AHEAD

2. Housing Crisis & Food Insecurity Control rent and offer co-housing to help families build wealth.44 Build more affordable housing and create alternate housing, such as zoning neighborhoods for ADU’s (building multiple units on a single lot).

Expand food resources and lower food insecurity by ensuring neighborhoods with predominantly minority populations have access to supermarkets and fresh produce rather than fast-food restaurants.45

3. Legal Work Permits & Pathways to Citizenship Many of the challenges Latinos face are tied directly to the disproportionate numbers who work in low-wage jobs with little or no benefits.

By addressing these deficits in their employment situations, Colorado can directly impact other disparities, including those affecting behavioral, mental and physical health.

According to the bipartisan political organization FWD.us, “Undocumented immigrants are a vital part of America’s workforce, particularly as the U.S. continues to respond to and recover from the COVID-19 pandemic.”46 Providing pathways to citizenship will have sizable positive impacts on the US economy. For example:

We outline policy recommendations to address working conditions, the housing crisis, food insecurity, and pathways to citizenship. Such policies will help Latino families overcome economic disadvantages and build wealth for their families.

When previously undocumented immigrants become U.S. citizens, they are more likely to live two times or more above the poverty line and file taxes.

1. Working Conditions for Latinos & All Working-Class Coloradans Expanding workers’ rights regarding paid time off and access to health care benefits.

Increase access to unions and workercooperatives. Union workers are more likely to receive health care benefits and improve health and safety factors in the workplace.42 Raise the minimum wage.

Create generational wealth through small business development. Colorado has a higher percentage of Latino-owned small businesses than the national average. Support of small business development can serve as an economic accelerator for the Latino community.43

It is estimated that undocumented immigrants earning U.S. citizenship would annually contribute an additional $149 billion in taxes to the economy. This could result in a potential annual increase of $39 billion more in combined federal, state, and local taxes.47 More than 160,700 immigrants without documentation live in Colorado and collectively contribute to $156.5 million in state and local taxes and $272.8 million in federal taxes each year.48 Undocumented workers fill critical gaps in our labor force and make up 4% of Colorado’s workforce.49 Even when excluding the limited public services available to undocumented immigrants, their net annual impact on Colorado’s economy is more than $1 billion.50

19

HOW NONPROFITS AND FOUNDATIONS REPSONDED Foundations

Nonprofits/Service Agencies

Pivoted to refocus their funding priorities to address immediate needs of those served by their grantees such as food, shelter, transportation, etc.

Recognized a greater need to have a policy arm to represent their constituents more formally in legislative decisions.

Simplified both funding application processes and grant reporting requirements to reduce administrative burdens on grant recipients.

Experienced the value in sharing the stories of those they serve to educate both funders and policy makers. This raises the question of how nonprofit/service providers can be more effective in sharing stories that best illustrate the realities of those in need–beyond the basics of data.

Shifted their relationships with grantees taking the role of a partner/collaborator in addressing their communities most pressing needs.

Discovered that story sharing is invaluable where data does not exist, especially in terms of mental/ behavioral health needs and services.

Increased cross-foundation communication to ensure funding was being spread across regions. This communication led to a better distribution of funds to ensure more people were served by existing funding sources.

Conclusion.

20

Globally and locally, foundation and service agencies were quick to adjust and respond to meet the most immediate needs of their constituents and partners. Of the many lessons learned through this experience many can be used for lasting improvements in the way they do business and serve their constituents. Sometimes a crisis can bear gifts!

Recognized the value in utilizing coalitions to educate funders regarding state-wide issues affecting specific constituencies, such as immigrants.

Experienced the value in utilizing coalitions to support building capacity of all organizations serving Latinos/Immigrants through lessons learned (shared strategies).

Colorado Latinos faced many barriers to accessing behavioral and physical health care in tandem with economic challenges prior to COVID. For undocumented Latinos, the barriers and challenges were even greater. COVID exposed these barriers and challenges and compounded their impact on families.

Today, as we emerge from COVID we are facing new realities that will shape the solutions needed to address inequities in services and economic gaps. As government and service agencies in Colorado and across the country worked to respond during the pandemic health care crisis, many lessons were learned that we can build on to improve the lives of Colorado Latinos.

Glossary of Terms BIPOC: an acronym that stands for Black, Indigenous, and People of Color (pronounced “bye-pock”).

Legal status: refers to whether or not a person has government-issued documentation permitting them to live in the U.S.

Behavioral health: includes mental health and substance use disorders, life stressors and crises, and stress-related physical symptoms.

Mental health: a person’s condition with regard to their psychological and emotional well-being.

Cultural barriers: differences in language, values, or beliefs that prevent people raised in different cultures from understanding one another.

Cultural competence: the ability of an individual or organization to understand and respect the values, attitudes, beliefs, and practices of people from diverse cultures and interact with them effectively.

People of color: people who do not self-identify as exclusively white.

Predominantly minority population: a population in a city or state that is mostly (more than 50%) people of color.

Race: a socially defined population characterized by distinguishable physical characteristics, usually skin color.

Culturally responsive: understanding cultural differences, recognizing biases, and looking beyond differences to work productively with children, families, and communities whose cultures may differ from one's own.

Racism: the belief that some racial groups are inherently superior to others; discrimination, prejudice or a system of advantage and/or oppression based on race.

Disparities: a situation in which two or more things are not equal or similar.

Socioeconomic status: a person’s or group’s economic status (e.g. poor, working-class, middleclass, wealthy) or position in society based on their financial situation.

Ethnic: describes a group of people that share a common and distinctive culture, language, ancestry, etc.

Hispanic: a person with ancestry from a country whose primary language is Spanish.

Implicit bias: a negative attitude, belief, or behavior that a person has about others but that they do not consciously think about or recognize.

Inequities: differences in well-being that unjustly disadvantage one group in favor of another group.

Latino: a person of Latin-American origin living in the U.S.

Systemic or structural racism: policies and practices that exist throughout a whole society or institution, resulting in unfair advantages to some people and/ or harmful treatment of others based on race.

Undocumented: a person or persons residing in the U.S. without legal documentation, including people who entered the country without inspection or permission from the government as well as those who entered with a legal visa that is no longer valid.

Wealth gap: the difference in earnings and assets between groups, reflecting resource and opportunity disparities.

21

11 Rios, J. (2022, Sept. 14). Latino health in recent years. La Voz Colorado. lavozcolorado.com/2022/09/14/latino-health-inrecent-years/

Endnotes

12 University of Illinois Chicago (2021, Feb. 02) publichealth.uic.edu/news-stories/black-hispanic-americansare-overrepresented-in-essential-jobs/ 13 Colorado Access. (2023). Colorado’s Hispanic and Latino communities faced unique health challenges throughout pandemic, which Colorado Access is working to highlight and address. coaccess.com

1 Daley, J. (2020, Sept. 10). The coronavirus exposed Colorado’s racial inequities in health care: community health centers are trying to help. Colorado Public Radio News. cpr.org/2020/09/10/communities-of-color-hit-hard-bycoronavirus-step-in-to-fill-the-gaps-in-the-governmentsresponse/ 2 Colorado Health Institute. (2021, Oct.). Colorado health access survey: navigating unchartered waters. coloradohealthinstitute.org/sites/default/files/file_ attachments/2021%20Colorado%20Health%20Access%20 Survey%20Storybook.pdf 3 Hindi, S. (2020, Dec. 10). Immigrant families received some pandemic aid, but Colorado advocates say need is much larger. The Denver Post. denverpost.com/ 4 Bernal, R. (2021, April 7). Five reasons why US faces chronic crisis at border. The Hill. thehill.com/latino/547044-fivereasons-why-us-faces-chronic-crisis-at-border/ 5 Longwell, A. (2022, Sept. 19). Statewide report shows Latino policy priorities dominated by economics. Post Independent. postindependent.com/news/statewide-report-shows-latinopolicy-priorities-dominated-by-economics/ 6 American Psychological Association. (2019). Data tool: demographics of the U.S. psychology workforce. apa.org/ workforce/data-tools/demographics 7 Morel, L. C. (2020, Oct. 22). Mental health services for Latinos are in low supply, higher demand due to COVID-19. Poynter Institute. poynter.org/reporting-editing/2020/mental-healthservices-for-latinos-are-in-low-supply-higher-demand-dueto-covid-19/ 8 Monaghan, S. (2021, Aug.). Colorado isn’t prepared to deal with the mental health fallout from COVID-19. 5280 Magazine.

5280.com/colorado-isnt-prepared-to-deal-with-the-mentalhealth-fallout-from-covid-19/

14 Colorado Department of Public Health and Environment.

(2022, Mar. 8). Vaccine data dashboard. covid19.colorado.gov/ vaccine-data-dashboard Colorado Health Institute 15 U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (2021, Oct. 8). aspe.hhs.gov/sites/default/files/documents /68c78e2fb15209dd191cf9b0b1380fb8/ASPE_Latino_Health_ Coverage_IB.pdf 16 Hindi, Saja (2023, Feb. 16) denverpost.com/2023/02/16/ chasing-progress-colorado-child-poverty-rates/ 17 U.S. DEPARTMENT OF LABOR dol.gov/agencies/ofccp/ about/data/earnings/race-and-ethnicity 18 Sanchez-Moyano, PhD, Rocio (2022, Mar. 15) frbsf.org/ourdistrict/about/sf-fed-blog/neighborhood-differences-betweenhispanic-and-white-homebuyers/ 19 Metropolitan Policy Program at Brookings (2019, Nov. 7) brookings.edu/wp-content/uploads/2019/11/201911_ brookings-metro_pressrelease_lowwageworkforce.pdf 20 Colorado Health Institute (2020, June 16). coloradohealthinstitute.org/research/uneven-burden-foodinsecurity-colorado 21 Cision PR Newswire (2020, Aug. 12) prnewswire.com/newsreleases/essential-workers-have-a-13-uninsured-rate-makingsome-states-more-at-risk-for-essential-workers-301110597.html 22 Weller, Christian (2023, Mar. 11). People Of Color See Higher And Rising Unemployment In Possible Signs Of Softening Economy. Forbes. forbes.com/sites/christianweller/2023/03/11/ people-of-color-see-higher-and-rising-unemployment-inpossible-signs-of-softening-economy/?sh=6a275e3b41cb 23 Smith, Rebecca (2020, Mar. 31) NELP nelp.org/publication/ immigrant-workers-eligibility-unemployment-insurance/

9 Daley, J. (2021, June 25). Life expectancy fell sharply in Colorado during the pandemic, especially for people of color.

Colorado Public Radio News. cpr.org/2021/06/25/pandemiclife-expectancy-fell-health-care-inequality/

24 Latino Policy Forum. (2022). Long-term socio-economic consequences of COVID in the Latino community: creating a path forward. latinopolicyforum.org/publications/briefs/ document/Long-Term-Socioeconomic-Consequences-ofCOVID-in-the-Latino-Community-1.pdf

10 Bichel R. E. & Hawryluk M. (2022, June 26). Chasing progress: Colorado aims to close Hispanic insurance gap.

Colorado Politics. coloradopolitics.com/health-care/chasingprogress-colorado-aims-to-close-hispanic-insurance-gap/ article_65e6a41b-6fe4-5043-aa4b-60dc48d77a6e.html

25 Daley, J. (2021, June 25). Life expectancy fell sharply in Colorado during the pandemic, especially for people of color.

Colorado Public Radio News. cpr.org/2021/06/25/pandemiclife-expectancy-fell-health-care-inequality/ 26 Payan, T. and Cruz, P. L. (2021, Aug. 30). Pathways to immigration: prioritizing the undocumented population residing in the United States. Rice University’s Baker Institute for Public Policy. bakerinstitute.org/research/pathways-immigrationprioritizing-undocumented-population-residing-united-states

22

27 Char Gilbert, Julia. (2020, June 16) Colorado Health Institute. coloradohealthinstitute.org/research/uneven-burden-foodinsecurity-colorado 28 Payan, T. and Cruz, P. L. (2021, Aug. 30). Pathways to immigration: prioritizing the undocumented population residing in the United States. Rice University’s Baker Institute for Public Policy. bakerinstitute.org/research/pathways-immigrationprioritizing-undocumented-population-residing-united-states 29 Colorado Access. (2023). Colorado’s Hispanic and Latino communities faced unique health challenges throughout pandemic, which Colorado Access is working to highlight and address. coaccess.com 30 Rosenbaum, S., Murphy, C., and Morris, R. (2022, July 7).

When Medicaid’s COVID-19 pandemic continuous enrollment guarantee unwinds, safety-net providers will play a critical role.

The Commonwealth Fund. commonwealthfund.org/blog/2022/ when-medicaid-pandemic-continuous-enrollment-guaranteeunwinds 31 Whitener, K. (2021, Oct. 20). COVID-19 exposed many inequities for Latino families, adopting continuous eligibility would repair cracks and protect more Latino kids from losing Medicaid/CHIP. Georgetown University Health Policy Institute: Center for Children and Families. ccf.georgetown. edu/2021/10/20/adopting-continuous-eligibility-would-repaircracks-and-protect-more-latino-kids-from-losing-medicaidchip/ 32 HB22-1289: health benefits for Colorado children and pregnant persons. (2022). Colorado General Assembly. leg.colorado.gov/bills/hb22-1289 33 Mental Health America. (2022). The state of mental health in America report. mhanational.org/sites/default/files/2022%20 State%20of%20Mental%20Health%20in%20America.pdf 34 Miller, F. (2022, Apr. 8). Lawmakers want to transform Colorado’s behavioral healthcare system. Colorado Newsline. coloradonewsline.com/2022/04/08/lawmakers-transformcolorado-behavioral-health-care-system/ 35 Substance Abuse and Mental Health Services Administration.

(2022). National survey on drug use and health. samhsa.gov/ data/report/2020-nsduh-detailed-tables 36 Brown, J. (2019, Mar. 27). By law, mental health benefits are supposed to be as good as medical coverage. In practice, that’s not happening. The Colorado Sun. coloradosun. com/2019/03/27/colorado-mental-health-parity/ 37 Brown, J. (2019, Mar. 27). By law, mental health benefits are supposed to be as good as medical coverage. In practice, that’s not happening. The Colorado Sun. coloradosun. com/2019/03/27/colorado-mental-health-parity/ 38 Colorado Health Institute. (2021, Oct.). Colorado health access survey: navigating unchartered waters. coloradohealthinstitute. org/sites/default/files/file_attachments/2021%20Colorado%20 Health%20Access%20Survey%20Storybook.pdf 39 Colorado Health Institute. (2021, Aug.). Stigma and systemic barriers: why mental health care is not the same for everyone. coloradohealthinstitute.org/sites/default/files/file_attachments/ CHI_Stigma%20and%20Systemic%20Barriers_Online_Final_1. pdf

40 Gopalkrishnan, N. (2018, June 19). Cultural diversity and mental health: considerations for policy and practice.

Frontiers in Public Health. frontiersin.org/articles/10.3389/ fpubh.2018.00179/full 41 Colorado Health Institute. (2021, Aug.). Resilience and protective factors: avenues to improving mental health and reducing health disparities. coloradohealthinstitute.org/sites/ default/files/file_attachments/CHI_Resilience%20and%20 Protective%20Factors%20Online_Final_0.pdf 42 Hindi, S. and Griego, T. (2023, Feb. 1). Colorado Latino and Black poverty rates near historic lows, but economic stability remains elusive. KUNC NPR for Northern Colorado. kunc.org/ news/2023-02-21/colorado-latino-and-black-poverty-ratesnear-historic-lows-but-economic-stability-remains-elusive 43 de Leon, L. (2022, Aug. 2). “Business accelerator” takes Colorado’s Latino, BIPOC entrepreneurs to the next level. 9News.

9news.com/article/money/business/small-business/businessaccelerator-colorados-latino-bipoc-entrepreneurs/73-444ce042378c-48ca-b18a-9c716065ebb9 44 LiveWork Denver. (2023). liveworkdenver.com 45 Colorado Health Institute. (2020, June 16). An uneven burden: food insecurity in Colorado. coloradohealthinstitute. org/research/uneven-burden-food-insecurity-colorado 46 FWD.us. (2021). Pathways to citizenship for undocumented immigrants. fwd.us/wp-content/uploads/2021/06/ PathwaysToCitizenship.pdf 47 The Bell Policy Center. (2021, Feb. 19). Tax contributions of undocumented immigrants. bellpolicy.org/2021/02/19/ undocumented-immigrants-tax-contributions/ 48 American Immigration Council. (2022). New Americans in Colorado. map.americanimmigrationcouncil.org/locations/ colorado/# 49 Svajlenka, N. P. (2020, Dec. 2). Protecting undocumented workers on the pandemic’s front lines. Center for American Progress. americanprogress.org/article/protectingundocumented-workers-pandemics-front-lines-2/ 50 McCormick-Cavanagh, C. (2019, June 29). Study shows immigrants contribute billions to Colorado, national economy.

Westword. westword.com/news/immigrants-contributebillions-to-colorado-national-economy-11395653

REPORT AUTHORS AND CONTRIBUTORS Carlos Martinez, LCFC TaShina Salas. LCFC Cate Croft, Kin Collective Johanna Leyba, LeybaGurule Consulting Gayle Warner, LeybaGurule Consulting Sarah Olivier, LeybaGurule Consulting Andrea Giron Mathern, PhD Kimberly Sanchez

23

2250 S. ONEIDA STREET, SUITE 102 DENVER, COLORADO 80224 720.923.7614 INFO@LATINOCFC.ORG

@LATINOCFC

LATINOCFC.ORG