El Futuro, which has offices in Siler City and Durham, is a nonprofit outpatient clinic that provides comprehensive mental health services for Latino families in a bilingual environment of healing and hope.
This week, we speak with Executive Director Dr. Luke Smith about El Futuro’s programs and how its delivery methods are changing during the COVID-19 crisis. Dr. Smith was raised in Arkansas and moved to North Carolina for training in child and adult psychiatry. After volunteering in the community and perceiving a need for Spanish language services, he helped mobilize the community to create El Futuro, begun as a volunteer effort in 2001 and as a nonprofit in 2004.
Dr. Smith is El Futuro’s executive director and medical director, and provides psychiatric care to both children and adults. Each year, he and his staff provide services to more than 1,500 children and families who come for help. He is double board certified in both adult psychiatry and in child and adolescent psychiatry. In addition to being active with direct services and shaping policy at the local and state level, Dr. Smith leads the organization in research efforts through projects funded by the NIMH and PCORI with a focus on creating evidence based practices that are especially targeted to help the North Carolina Latino Community.
Thinking back to your own upbringing…what impact did it have on your desire to do the kind of work you’re doing and the kind of people you serve?
I grew up in the South where race separated us visibly and invisibly in so many ways. My parents encouraged us to practice the golden rule and constantly emphasized acts of service as a love language — one we needed to learn, but not the only language. They also enrolled us in Spanish classes.
Ironically where I grew up in Arkansas, nobody actually spoke Spanish! It wasn’t until I went off to college that I met people who spoke Spanish and later I came to North Carolina for training in Psychiatry and put my Spanish to use. I discovered that many people who spoke Spanish didn’t have access to mental health services in their primary language or what I would call their heart language. I’m still working on my Spanish, which often has an Arkansan accent, but my patients are forgiving and even encouraging to me as they help me when I get stuck. I guess you could say that both languages my parents helped me learn are ones that I now use every day and I’m building my fluency which is a lifelong endeavor.
Can you talk about El Futuro’s mission and goals, specifically how those relate to Chatham County?
Our mission is “to nurture stronger familias to live out their dreams.” Latino families come to our community with dreams of a better life — to find work, provide for families, get education, and have things better. Often those dreams are sidelined by incredible adversity and hardship. When mental illness strikes, it’s often the last straw and devastating.
Our goal is to nurture and rehabilitate those who are suffering and help them get back on the path they set out on. More and more this involves helping them not only with the depression, anxiety, post-traumatic stress, insomnia or ADHD, but also thinking about what in their environment is negatively impacting them or giving them stress. We work to connect people with resources because it’s often not what you know but who you know. When you’re in a new place and don’t have social networks you are at a real disadvantage and so we try to help people get connected. Many times that involves helping someone with a translation or being aware of an opportunity.
What all falls within the scope of “culturally-responsive mental health services”?
We constantly scan what we’re doing to see how we can be more welcoming. Often times it is the little things that make a difference — how to make eye contact, a short word or phrase in Spanish to be polite, asking about the country of origin, or talking about food!
People who are fluent in Spanish can actually be culturally off-putting with certain mannerisms and attitudes if they’re not careful. Ironically, others who can barely say a word in Spanish are can nonverbally show warmth and welcome. We used to use the phrase “cultural competence” but don’t prefer it any longer because the idea of competence communicates having figured it all out. In reality, nobody completely understands the many nuances of culture — so instead of being competent and completely understanding, we instead always need to be listening and learning.
We prefer the term “cultural humility” instead because we should be flexible in our understandings and always open to listen and learn. It’s important to realize that everyone is unique. When we think in rigid stereotypes it puts up barriers to understanding and gets in the way of offering helpful, effective mental health services. When we take the time to listen and learn about each person in a culturally humble manner, then it might take more time but the mental health treatment provided is more impactful.
El Futuro’s clinics are in Durham and Siler City. Why those communities, and why are the needs so great in Chatham?
We began our work in Siler City in 2006 because of the explosive growth of the Latino community who came in the 90s and early 2000s. There were no mental health services for the community, however. Our little clinic on South Chatham Avenue in Siler City received so many referrals and we opened up school-based services at Chatham Middle School.
After the chicken factories in Siler City closed down we thought maybe the Latino families would leave but they had put down roots and liked living in Siler City. They looked to us for support and help and we were glad to be there. There are some big challenges for those families even still. Transportation and relatively low wages make it hard for many to get their footing so they are often living at or below the poverty level with anxiety about how they will pay the rent or provide food for their family. Many youth feel pressure to work to support their family.
Can you walk us through the process through which clients/patients are referred to El Futuro, how treatment plans work, and what happens after treatment is completed?
People are referred to El Futuro by school teachers, primary care providers, immigration attorneys, soccer coaches, and many others. Our main source of referrals though are from friends or family members who have received services at El Futuro and now recommend it to others. For us that is a marker of success because winning and keeping the trust of the community is of paramount importance.
When someone comes we meet with them in their heart language...for many that is Spanish but for an increasing number, especially the youth, it is English. Or sometimes a mixture of the two which we refer to as Spanglish! After the assessment session we decide whether or not receiving services at El Futuro is the best option or maybe refer the person somewhere else if it isn’t a mental health or substance use issue.
A treatment plan is formed which includes meetings with a therapist and/or a psychiatrist. We might also include some sessions with a case manager who gets to know the person and finds out more about needs that could include connecting the person to job training, education, or childcare support. We clarify goals that the person and their family want to accomplish with treatment. This could be sleeping through the night, feeling less depressed, stopping alcohol use, or something else. We provide treatment as long as the person needs it and then are available for booster sessions or maintenance in the future.
There aren’t as many people coming with schizophrenia or bipolar disorder because we don’t see those more severe mental illnesses as frequently in new immigrant communities. Often people with those disorders aren’t healthy enough or mentally able to make such a long journey here.
So how have things changed at El Futuro with the spread of the coronavirus?
In March we decided to close our clinic because of the coronavirus. We provide services that mostly can be offered via video and the state and federal government authorized relaxed encryption standards and offered competitive reimbursements.
Within a week of our transition we were offering almost 100 percent video services. For four weeks now we have been at or above capacity with regards to our productivity expectations, essentially not seeing any drop off in our services. Many of our patients have difficulty with transportation, childcare or other issues that make it hard to physically come to the clinic so this new video approach has been helpful. Unfortunately, the extra stress of the virus, job insecurity, and alarming news stories have really distressed the Latino community so I’m glad El Futuro is here to help.
In addition to mental health and substance use treatment services, we are also partnering with other nonprofits to raise awareness of and support for many families who are financially struggling right now. We are doing this through the Solidarity Fund which is collecting donations to redistribute to some of the most vulnerable in our community.
We are also working with the Health Department, Piedmont Health Services, Chatham Hospital, El Vinculo Hispano and others to help communicate important messages about the coronavirus to the Latino community so that they will know how to protect themselves and their families and not spread the virus.
We’ve seen reports from law enforcement agencies, including Chatham County’s Sheriff’s Office, that domestic violence cases are on the ride during this stay-at-home order. What are you seeing?
El Futuro isn’t a crisis or DV organization. Of course, Intimate Partner Violence (IPV) is something we see in our work, either directly as something that is happening or something that happened in the past that caused a person to feel a certain way and so now we’re helping them to cope and overcome. But, when situations arise, people generally are alerting law enforcement and are getting directed to domestic violence organizations who specialize in crisis and stabilization. We then later get referrals for mental health and substance use disorder assessments and treatment.
Over the last month, we have been at the table with those who provide services and they described a eerie quiet during the first of April, like the quiet before the storm. And during the last two weeks of April the reports and referrals started coming in. So, that confirms what the Sheriff’s Office was reporting to you. We are further downstream so haven’t seen those come to us yet but I know we will.
And what about incidents of depression and anxiety?
With regards to depression and anxiety, we’re seeing a number of responses. Some are feeling better. School children don’t feel the stress of school, the drama of peers, and the intensity of life like they knew it before. And for some this is a welcome relief at a time of year when we often see so many referrals of children who are feeling overwhelmed. They have turned to crafts, being outside in nature, and have been with family more.
There are others who are having a worsening of symptoms as they are more isolated and in environments that aren’t very healthy. They also worry about the stability of their family. Not many children are worried about the virus itself because they don’t feel like it really is a physical threat to them.
Some worry about grandparents. With the adults it’s a different situation. Many of the adults we treat haven’t taken off from work because they continue to work factory jobs, construction, housekeeping, and other jobs that haven’t been offered reprieve. When factories have shut down, it has been very very stressful for the workers because they are pushed to the breaking point as economic resources dry up.
For those who don’t have citizen benefits and no stimulus benefit is coming to them, it’s quite concerning. That stress in the family affects the adults and the children alike. I think some of us got a taste of that when our toilet paper rolls ran low and we worried about getting the next roll. For many of the families we help, the scarcity is not just with toilet paper but with food, medicine, rent payments and light bills. This has been a really hard time for the Latino community and so depression and anxiety has increased. We’re seeing an increase in the demand for our services.
For more information, go to https://elfuturo-nc.org