“La Frontera”- DDRAC8/4/09

Susan M. Gallego, LCSWDSHS MH/SA – Program

ImplementationBorder Programs Coordinator

Texas Border: Colonia

Texas Border Health

Tamaulipas

California

Ojinaga20,371

Nogales156,854

Reynosa403,718

Tijuana1,148,681

Mexicali549,873

Matamoros376,279

Puerto Palomas5,210

CiudadAcuña

108,159

NuevoLaredo308,828

Ciudad Juarez1,187,275

Yuma77,515

Nogales20,878

Columbus1,765

Presidio4,167

Del Rio33,867

Laredo176,576

Calexico27,109

El Paso563,662

McAllen106,414

San Diego1,223,400

San LuisRio Colorado

126,645

Piedras Negras126,386

Eagle Pass22,413

Brownsville139,722

Sonora

Chihuahua

Coahuila

DurangoSinaloa

NuevoLeon

BajaCalifornia

Sur

BajaCalifornia

Norte

Texas

Arizona New Mexico

US-Mexico BorderSister Cities and Population

August 2003

Population Data Sources: US Census Bureau, 2000 Instituto Nacional de Estadística, Geografía, e Informática (INEGI), 2000

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.

“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

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 health priorities:

1. Diabetes/obesity/nutrition

2. Tuberculosis

3. Dengue fever

4. EDIDS/EPI

5. Mental Health/Substance Abuse/Domestic Violence

Substance Abuse Prevention - Six Effective CSAP Strategies

• Prevention Education/Skills Training• Alternative Activities• Problem Identification & Referral• Information Dissemination• Community-Based Process• Environmental/Social Policy

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

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.

The 5 RBIs currently serve the following 20 counties along the Texas – Mexico border (Regions 8, 10, 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

Counties Targeted by RBI

Land Area42,220 mi2

Estimated Population

303,648

Texas Border Health: Substance Abuse Clinics

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).

Recommendations for our work on “La Frontera”

1. Adopt a Borderlands (an “across”) mindset for joint strategies and programs.

2. Build on the willingness of the border population to get involved with programs that relate to the well-being of children

3. Support and grow current binational initiatives.4. Increase youth community counseling, MH and SA

treatment programming and facilitate access.5. Increase focus on community based outreach models

and services provided by Community Health Workers or Promotoras(es) and other para-professionals.

6. Develop and support new evidence-based interventions that are culture-informed

7. Evaluate community-developed, grass roots interventions to determine efficacy and possibility of replication

Recommendations cont’d

8. Fund and support new services/programs targeting out-of-school youth and violence prevention.

9. Create bilingual multi media campaigns, social marketing.

10. Develop creative and responsible strategies to increase bilingual and bicultural work force

11. Make an effort to integrate trauma knowledge into service delivery systems

12. Support and fund mechanisms that increase the number of bilingual mental health and substance abuse counselors.

13. Increase support for integrated behavioral health services within medical clinics.

14. 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.