The RAICES/Promotoras Project: Culturally Competent Research
on Children's Mental Health with Latino Communities

NCDDR Webcast #6
January 10, 2007, 2:00-3:39 PM CST

Presenters: Mario Hernandez, Linda Callejas, and Maggie Sanchez

Edited Transcript

>> JOANN: Good afternoon, everyone. And thank you for joining the webcast on the RAICES/Promotoras Project: Culturally Competent Research on Children's Mental Health with Latino Communities. My name is Joann Starks, and I'm with the National Center for the Dissemination of Disability Research or NCDDR, based at the Southwest Educational Development Laboratory in Austin, Texas. 

I'll be moderating today's webcast and getting your questions to our presenters. Co-hosting today's webcast is Frank Martin, who is also with the NCDDR. Before we move on to the introduction of today's presenters, I want to be sure to thank our partners at ILRU in Houston for helping with the technical side of this webcast. 

There are some materials accompanying today's webcast that can be found on ILRU's Web site. This includes a PowerPoint file and several presenter handouts related to the RAICES/Promotoras project for your use. 

You can submit questions at any time during the webcast and the presenters will decide whether to answer them at the end where we have set aside a question and answer period, or during the webcast if clarification is needed. 

To ask a question, you can click the "Submit Question" button at the bottom of your RealOne or Windows Media Player screen or you can send an e-mail to webcast@ncddr.org.

If anyone has any technical difficulties during the webcast, please call ILRU at 713-520-0232 and dial 0 for the operator to ask for assistance. This number is both voice and TTY capable. 

I also wanted to mention that we would appreciate your feedback by filling out an evaluation form that can be found on ILRU's Web site. I will remind you about this at the end of today's webcast. 

Now I'd like to turn it over to Frank Martin who will introduce today's guest presenters. Frank... 

>> FRANK: Thank you, Joann. The NCDDR is pleased to bring you today's webcast on the topic of research outreach and diverse communities. Conducting outreach to diverse individuals with disabilities and their families can be a challenge for researchers and service providers. 

Many authors believe that researchers and service providers can improve the likelihood of success by actively involving diverse groups in the outreach process, by building trust, and by gaining knowledge of cultural groups, their histories, and their strategies for perceiving the world. 

We are privileged to have Mario Hernandez, Linda Callejas, and Maggie Sanchez as our presenters to discuss this topic today. 

Mario Hernandez, PhD, is a psychologist and professor in the Department of Child and Family Studies at the Louis de la Parte Florida Mental Health Institute at the University of South Florida, Tampa. He is also the principal investigator for the RAICES/Promotoras project sponsored by NIDRR. Dr. Hernandez is nationally recognized for his expertise in systems of care, cultural competence and disparities, measurement of outcomes, and theories of change. He recently edited a special issue of the American Journal of Community Psychology that focused on planning approach and he has edited a book entitled Promoting Cultural Competence in Children's Mental Health Services. 

Ms. Linda Callejas conducts research and evaluation activities on collaborative community development, educational programs, and mental health among racial and ethnic minority populations. Most recently, she developed a training curriculum for case management teams in the Hillsborough County Public Schools that integrates the promotoras model of outreach. Ms. Callejas serves on the Board of Directors for the Federation of Families for Children's Mental Health in Hillsborough County, and she is a doctoral candidate in applied anthropology. 

Ms. Maggie Sanchez has over 25 years of experience working in the health and human services field. She currently holds the position [with the Hispanic Services Council] as program supervisor for the bilingual Family and School Support Team, or FASST, with the RAICES/Promotoras project. Ms. Sanchez has a bachelor's degree in applied behavioral science and is involved in numerous community and church activities. 

Now I'd like to invite Dr. Hernandez to begin today's presentation. 

>> MARIO: Hi everyone. I want to start by thanking NCDDR for inviting us and allowing us to present our work here in this webinar. I want to start by just sort of framing why there are three of us on the webinar. 

(Slide 1) I was the principal investigator on the project and originally had the idea that we'll be talking about. Linda is the project director and was responsible for really pulling off this three-year project in all of its aspects. And then Maggie is the person who is responsible for actually running the RAICES program and providing the direct services and supervising the team. What we thought is that if we each came on this webinar that folks listening in would get three different perspectives from three different parts of the program and how it was developed over time. 

(Slide 2) As I said, it was a three-year project funded by NIDRR. One of the things that we are lucky to have here in Hillsborough County, Florida is something called the Hillsborough County Children's Board, which is a local taxing authority. It receives funding from property taxes, and they fund many services for children in Hillsborough County. 

One of them is the Family and School Support Team, which is a long-standing community service that is linked to elementary schools. Those teams are composed of family members and paraprofessionals who take referrals from the schools of kids that are having problems where the skill staff knows that the issues go beyond what the teachers or anybody at the school is able to do. Sometimes those problems involve the child's whole family or living situation, including things like losing their housing or not having transportation or somebody losing a job. The teams are to help those kids, including their entire family, in whatever way is needed in order to correct situations and also to get the family to be in a stable situation. 

The teams have functioned for many, many years; however, we're challenged in being able to serve Latino families and children. In fact, when we began this project now almost four years ago, it was clear to us that there were almost no Spanish monolingual families and children being served. When we started a needs assessment to try to understand why that was occurring and that was occurring among the partners. 

(Slide 3) So if you could go to the next slide, it describes the name of the project, and that's the RAICES/Promotoras project and if you go to the next slide it has the partners. 

(Slide 4) With a group of these partners we began to investigate why teachers and school personnel were not making referrals of these families and kids, especially in schools where the enrollment of Spanish speaking children and associated families was over 85 percent. And what we found was that because teachers and other school personnel knew that there were not services in Spanish and that the services that did exist -- because this started in a rural part of our county -- were so far away that families would not be able to get transportation to receive services, they didn't make the referrals. They knew the need was there, but they didn't make referrals. 

In essence, this population of kids and families really became invisible and because they weren't being served, then it looked like there wasn't a service need. So part of the initial efforts in our outreach, as Frank was describing, was to unearth and make public this issue and the serious need in the county. 

So from the beginning, the effort involved school people, professionals, and PTA folks. It involved community-based providers who we thought were -- as they learned with us how to create this effort -- they would then be the folks that would carry it out and implement it. We involved the Children's Board of Hillsborough County because they were the funder and the idea was to have the funder involved from the very beginning so that once we were done with funding from NIDRR, the program has a chance of becoming sustainable. 

One of the things that we heard in every school we went to and all the family members that we spoke to was "Please don't bring us another grant. It gets us excited. We get services, and then the grant is over and everything goes back the way that it was." And so we listened to that and we tried from the very beginning to turn this into a sustainable effort. And that's what it's become now. Maggie will talk about all the schools that it's in now and increases in funding that have occurred since the end of the funding cycle. 

One other benefit that occurred as a result of this project is that we knew that -- sort of our weakest partner, our weakest link -- was an organized group of families that could give voice and reach out to families in a more personal way. We thought that that would also create a potential pool of people who would then be interested in applying for promotora positions. 

So what we're very proud of is that we have the country's first and only Spanish-speaking chapter of the Federation of Families for Children's Mental Health. It's called Familias Latinas Dejando Huellas which means "Latino families leaving footsteps" for others to follow here in Hillsborough County, and that was founded by Luz Garay. We tried from the design of the research and the program building to involve the community in many different ways so that the program was sustainable and also relevant. 

Again, just to kind of back up in terms of the reason, the grant announcement that we applied for asked that we take a community practice, or a practice that had some evidence and modify it in such a way that it was more accessible to a group or population group that was not able to receive services. 

Within the FASST teams that already existed, there was always what was called a family advocate. The problem with the family advocate in the Latino populations that we were trying to reach is that in those Latino populations, the family members didn't necessarily identify themselves as a parent with a child with a serious emotional disorder or a child with a behavior disorder or my child has attention deficit disorder. They weren't even close to having that identity as a class of parents with a "type" of child. 

And so what we learned, about work that we had done in Texas with College Station, we learned about promotoras and that for Latino communities, it didn't necessarily have to be a parent of a child with these kinds of issues. A promotora could be anyone from the community that the community respected; that knew the community. It might be a grandparent; it could be a person who hasn't even had children yet. It could be someone who's had children and they've grown up and left. It's a person who is well-respected. 

So we had to modify the model of the FASST teams, to kind of replace the family advocate with a promotora so that it would be more culturally congruent with Latino communities and where those communities were developmentally in their thinking about these sorts of mental health issues. That was probably the largest modification. Then the curriculum that was developed and tested was a blend of the way the FASST teams functioned, with how a FASST team would function when it incorporates a promotora on to the team. 

The third modification -- adding the promotoras, basically the first; adjusting the team to work with the promotora. The next modification was to change some of the methods, some of the ways that the FASST teams worked so that they were culturally appropriate. Some of the materials that are used for either consent or for assessing families' needs, or reporting back to the schools, all those things had to be looked at and modified so that the families that were participating and were the service recipients were able to access and understand what was going on. 

I'll leave the next slides up to Linda Callejas. Thank you. 

 >> LINDA: (Slide 5) If we could go to the next slide. This is Linda Callajas. I'm going to talk a little bit about the promotora model and give a little bit more detail on the selection of the model for this project. 

As Mario mentioned, we found the model through work that we had done on another project with Texas A&M University, actually, and as an exemplary practice that was being used along the U.S.-Mexico border in the colonias of Texas and New Mexico. These colonias were overwhelmingly poor, isolated neighborhoods lacking basic infrastructure such as water and housing and those types of things. The residents tended to be Spanish-speaking, little to no English, worked in migrant or agricultural work or largely unemployed, or employed in informal sectors. 

The study found the promotoras were effective in connecting these particular communities to resources and services that were available to them, but that they were not able to access because of linguistic and other cultural barriers. We thought that the model could work. Initially when we started the project we focused it primarily in the south Hillsborough County area, which is traditionally a rural agricultural part of the county. And it had some parallels to the original communities that we studied in the other project. 

So we thought it would be a good fit and we knew that it had a high number of Spanish speaking families and migrant workers. Although the infrastructure is not as lacking as in the colonias, we have very limited public transportation, limited services. Most of the services are located in central Tampa and the community in south Hillsborough County, which is the Ruskin-Wimauma area, is about 30 minutes away driving on the highway. So for families that have to -- 

>> MARIO: On a good day. 

>> LINDA: When there is no traffic! So for families that need services, there is that travel time and for families that are also overwhelmingly poor, that may not have cars, the transportation becomes a major issue. 

Also we found when we did our assessment of the schools and needs in the area, a lot of the schools in the area were lacking in terms of -- in terms of the services that were available for children in special education. So a lot of times we found that children had to be bussed to other schools when the schools are supposed to provide those services. And, did you want to say something else? 

>> MARIO: Yeah, one of the things we found is that not only was this community isolated transportation-wise from where most of the services are offered, you might spend five hours if you tried to take a bus, maybe more, for a 15 minute appointment. But also the schools were isolated themselves within the community and when we reached out to the schools asking about their participation, they, as Linda said, they knew very little about some of the possibilities and some of the services. I think it was almost sort of -- not in a negative way -- but almost like a "fort mentality." That what went on in the school was their primary issue, and where they needed help was to have somebody to create a bridge between the school and the community, and the services for the community. 

>> LINDA: Mario mentioned the modifications that we made to the FASST teams. We also modified the promotora model from what we had seen in other areas because of the numbers of promotoras that we were going to start working with. The team initially had two promotoras, and usually promotoras are working together in a team and train together. We also trained and had them work closely within the entire team, which were the case manager and the supervisor. So we trained everybody together and we never really separated or isolated the promotoras in order to better incorporate them into the team and give them that team building from the beginning, which we had learned from the literature was also very important.

Promotora essentially is a Spanish term, as the slide shows, for community health worker and literally it can be translated into the word promoter; health promoter is one of the terms often used. We found that the literature identified over 70 different terms for describing community health workers, of which promotora is one. Primarily in the literature and in a lot of the programs, promotoras tend to be female. Although there are males - promotores --but in the study we did prior and currently, in fact, I believe they are all women. 

Next slide (Slide 6). Promotoras typically live in the communities that they serve. They have an intimate knowledge of the community's needs and particularly in the health and social issue area. They also tend to know -- these individuals are often -- the people that go into this line of work, or work as promotoras, often tend to be what is known as a natural helper. They are already individuals identified within their communities as people to go to for help or advice, or someone who can help them get to where they need to go in terms of services or anything else, practically. So they already have knowledge of the resources, the services, and the providers that are available to the community that residents might not know about on an individual level. 

That was another reason for us to select this model for the project. In other research that we've done, we've known that for Latinos, especially, when there is a mental health issue in particular, the first step is not to go out to formal, to seek formal help. Rather it tends to be an informal help-seeking; going to family, friends, and oftentimes these people that serve as natural helpers are key people within the community that they can often turn to. 

So when working with providers, promotoras used their knowledge to educate residents on health issues, on disease prevention, and healthy living. And, again, that was another modification in what we tended to see in the earlier study, the promotoras tended to work in the area of physical health. So this was another area where we did a slight modification in terms of focusing primarily on children's mental health. 

>> MARIO: When we were doing the work that Linda referred to and I referred to with Texas, we learned as we accompanied promotoras that even though they were focused on health, that the issues that they were dealing with really were -- a lot of them were social in nature and mental health in nature. It could be that the resident or the person they were talking to did not identify their issue as a mental health issue or as a social issue, but a lot of what they spoke to folks about in their homes or in the community we identified as being in kind of the social domain. 

>> LINDA: Right. Let's see, next slide (Slide 7). Just to close on the promotoras, in the literature they are often identified as boundary spanners because they straddle the world between the communities and the providers. They bridge that boundary. They serve as a bridge for the community as well as for providers, oftentimes teaching agency personnel and professionals better ways to connect with the community. 

We also found that -- this is one thing we found that over time in the study at Texas A&M -- the providers changed to become more responsive to the community's need and preferences because of the knowledge that the promotoras provided them. They also provide a number of services to their community including informal support, advocacy, and capacity building, to mobilize communities. Among a number of issues that we talked about before: housing, community development, setting up infrastructure, job training; a whole host of issues that may not be specifically tied to health, but to larger community well-being. And as I said, oftentimes, these individuals are doing this sort of thing in a natural capacity, on a volunteer basis. 

Next slide (Slide 8). This slide shows the cover of the RAICES/Promotoras Training Manual, which was the main product of the grant. The training is presented over eight sessions that last from four to six hours for the entire team, including the team supervisor. 

The training provides important concepts and skills that provide the foundation for the work of the bilingual FASST teams and incorporates the skills that are needed for promotoras in it. So they all get this skills training together. The slide shows you the URL for accessing our documents [http://raices.fmhi.usf.edu/]. You can go to the URL shown to get copies of the training manual and an orientation guide that we developed as part of the project to assist us with dissemination of the project. A community interested in implementing this project in their own community could learn how we did it and what are the things needed, the steps needed in order to do so.

Next slide (Slide 9). This next slide gives you the first four chapters of the training manual, what we call foundational knowledge or the important concepts that ground the work of the FASST team and the promotoras. We have systems of care and wraparound -- the concepts. 

>> MARIO: One of the areas that we work in quite a bit is systems of care and wraparound. System of care from our definition is a very collaborative family and child-centered approach to getting agencies to work around the needs and strengths of a family, rather than having the family work in trying to fit in to agency services and structures. So that's the idea of a system of care. 

Wraparound is at the practice level. There are policies, and agencies that form interagency agreements and collaborations at the systems level. Then at the practice level, the team actually then actualizes that collaboration and creates a wraparound plan. That wraparound means, that rather than giving kids more restrictive services, instead they are provided with services that help them to stay within their families and their communities and in their home school, in their neighborhood school. That's what the word wraparound means in systems of care. 

>> LINDA: We also focused a lot on cultural competence, which was chapter 2. Even though we knew that the teams -- we hired specifically bilingual individuals and individuals from the community we were serving -- we wanted to stress the fact that, simply because you're Latino doesn't mean you're going to automatically be culturally competent in serving Latino communities. We wanted to make sure that they got a good understanding and grounding in that. 

We also provided information in this area on the school system, the elementary schools in particular, the particular programs that the team would be involved with through the students, as well as an understanding of children's mental health and overall well-being and developmental well-being. 

The next slide, please (Slide 10). This slide shows the last four chapters and this part of the manual is what we call the core skills that help to implement the concepts that we presented earlier. They include how to do effective case management, connecting families to providers, and how to conduct effective home visits. 

The last chapter focuses on teaching the teams how to assess the level of implementation of the concepts and skills presented throughout. They are given training in how to evaluate themselves and what they are doing. 

Let's see, initially we conducted a training with the first team that we put together in September of 2004. We did, again, a training with a team consisting of most of those members, but we had some turnover and some change in the supervision of the supervisory agency, and we did a training again in December of 2005. So that allowed us to test the manual and the training. Each time that we did the training, we did a pre- and post-test and we evaluated the participants to determine changes in skill and knowledge level. 

The actual manual has changed; it was an iterative process essentially after we developed it. What we did was we looked at a number of different existing curricula for promotoras in particular that had been used throughout the country, as well as training manuals for case management, cultural competence, et cetera. Instead of reinventing the wheel, what we tried to do was incorporate what we found to be the best practices in these areas. So we put this together the first time; we tested, we did the training, and looked at our evaluation of the training, and changed the manual based on the responses that we got. And we also - our evaluator [Teresa Nesman] talked with the participants to see what they found to be most effective for them. 

The second training was also interesting and unique because we conducted it using two trainers who worked simultaneously, one speaking English and one speaking Spanish primarily. We found that this was really useful to a lot of the team because of the varying levels of English speaking ability and not only that, but there were certain concepts that are very difficult to translate from English to Spanish. In Spanish there aren't, for instance, words for wraparound or systems of care. The discussion of these topics was very important in both languages so that we were sure that the entire team really got them and that was one thing that we highly recommend and would like to see done again. 

>> MARIO: The team that was trained really highly rated that. A simple example was just the English speaking trainer saying something like "IEP," and then the team looking at the person not knowing what he said, and then the Spanish speaking trainer would then explain it. The benefit was they're going to hear IEP when they are in the school, so having the word or the phrase or the acronym said in English and then having it explained in Spanish helped them to be able to not only remember those terms, which they have to become familiar with to help these kids connect with the schools, but also then to have it explained in Spanish was useful. 

>> LINDA: Right. The other thing that the curriculum includes is ongoing training, coaching, and supervision. We knew that the first training course was just sort of the first step to get this project going. The team really -- we listened to what they said in terms of topics, additional topics they wanted covered, and held workshops with them. And then, continued with one of our trainers having coaching over time while they were working in the field and working with families, to reinforce fidelity to the practices that we presented. The coach also serves as a clinical supervisor. Maggie can talk more about that during her part of the presentation; I'm going to turn it over to her. 

>> MAGGIE: Okay, I'd like to bring your attention to Slide No. 11, please. And the topic is the community providers. The bullets that I put in the slide are some of the things that we have found that are going to be even more helpful as we continue to grow and expand in the south county area. Which is something that I think, that across the country the more qualified people we have to serve our communities, the better access they will have for services. 

So these are the areas that we found where we will continue to work diligently. The community providers must continue to increase their number of bilingual-bicultural staff. One of the reasons why RAICES/Promotoras program has been so instrumental in the south county area is because the promotoras do accompany the families if they are limited English speaking families or monolingual Spanish speaking families, they accompany them to appointments and will provide interpretation for the families. And so that's some of the beauty that the promotoras bring to the RAICES program. 

Increasing the services...We have our own office in the south county area that is going to have providers co-locate to our agency and make it even more accessible for some of our families to have access to an inclusion specialist from one of our United Cerebral Palsy programs that is now in south county. Those are the issues that we are working towards and trying to implement so that our families can continue to have access to services needed. 

Another area that I believe is so strongly in my heart is that communication amongst providers has to continue to be ongoing. I think that we have a social responsibility to our families as a community provider to ensure that our philosophies are unilateral, as far as the services provided to the community at large. 

In the areas of cultural competency, one of the deficiencies that we have found is the translation of forms. Many of our families continually sign forms that are not in their native language. They don't know why they are signing these forms; don't know the consequences of signing a form that is not in their language, and, therefore, don't understand the responsibilities that they are held to as far as their role as a parent for many of our children with special needs. 

And cultural competency -- what we're trying to do is help change that in our own community. We're trying to ask agencies to ensure that forms are being translated into Spanish and that the level of education is to be understood by all of our families, not at the level where we're translating verbatim vs. the content of the information. So that's an area where RAICES is really helping us open those doors as the promotoras work within the community. 

Again I think it's important to reiterate what Linda has mentioned, the hiring of the promotoras is not because of their Hispanic origin. One of the things that is very vital and important was that the cultural competency aspect of the curriculum was not only exposed to them, but also that we ensure that our promotoras are fluent, that they can understand both languages. That they can interpret for families and interpret the content of the information and explain [the process] to the families. When we look at some of the jargon that we speak, we can speak an entire sentence in abbreviations and understand each other in English, but it's not possible when we're trying to interpret for families in the Spanish language. 

These are the areas within the community providers that we are truly trying to make headway. I think it's important that this model is not only proving that it is working. It will continue to work as long as we have the agencies that have come on board with us to make some of the headway that we've already seen in the few months, and how we've implemented our team. I strongly believe that by accessing the services and using those people that we have, we'll continue to open doors and bridge the gaps that our families have unfortunately dealt with for such a long period of time. 

And when we're looking at community providers, on Slide No. 12, the school is also a community provider. For many years, we've had this myth or this mentality as Dr. Mario has already mentioned, that a lot of our schools have been working in isolation for so long, they've detached themselves from the community and the community has detached themselves from the school. 

What we'd like to do and what we have been trying to do is really build a collaboration within the school. That the school is part of the community, the community is involved with the school in whatever area or aspect we can, for the success of our kids. But, unfortunately, many times families have told us that they've had very sad experiences when they would go to the schools for assistance. [I am] proud to say that [our school district is] looking at training their personnel [regarding customer service]. 

Many of our families [have mentioned that they] would walk in through the door and if they did not speak the language, they sometimes were avoided until [a representative was found who] spoke their language. What we're asking for is to at least acknowledge the parent is standing there. Let them know that someone will be there in a few minutes to be able to help them or assist them in any way. 

Again, we are wanting more cultural competency personnel in the schools. It's not only okay to know the language, I think it's important that we know there are very important traditions that families hold, that families value, and that we should not ask them to give up [their traditions] just because they now live in the United States. It's important that we learn how to embrace [differences] so that families can be successful, no matter where they are, still holding on to their traditions and their values. And just encouraging them to continue to do so. 

We do have, as we have mentioned earlier, the Family and School Support Team, which is now the team that our promotoras work in. The Family and School Support Team is exactly what it stands for: the families working with the school system, with key personnel within the school system, whether it's a social worker, a guidance counselor, a school psychologist to look at the needs of a child. The children are being identified if they have any type of social, emotional, behavioral, academic, and/or mental health issues. 

What we have found, as Dr. Mario and Linda have already mentioned, is that many of the children we currently work with have other issues that could impede their success in school. For instance, a parent losing a job; not enough food in the home. We've walked into homes where children are sleeping on the floor because there are no beds. Well, if a child can't rest during the night, how is a child going to be successful and be able to focus the next day at school? If a child is hungry, how are they going to be able to focus in school? So the promotoras go into the home, as well as our family support coordinator. When they are doing home visits, these observations help us to try to meet the needs of the families. 

So when the family and school support team come together, not only are we discussing some of the needs of the family, but we are also exploring any type of informal supports that the family might have. Does the family have relatives nearby? Are they supportive to the family? All of this comes into what's called a family support plan and this is how we work with the families, helping them to meet practical goals, attainable goals for the families. And the families themselves discuss what goals they would like to reach, and we add any other goals the child may have, based on an IEP if the child has an IEP plan already made. 

When we train staff in school systems, it's important that they know that they are part of that success, that they are part of the planning, they are part of the process of keeping families on the case load so that we can help families. That families know that we're all in this together because what we want is for them to be successful. It takes a lot of education on our part to really engage the school system and the teachers because everybody is busy. But we do it by faculty presentations; we do it at principals' luncheons; we do it by being present at many events that the school system might have. Our presence shows we are there, we are caring; we're there to stay; we're there to help. We're not there to create more work for the teachers, but we're actually there to help the teachers with some of the students in their classroom settings. 

If I can also move your attention to slide No. 13, in the area of the promotoras, they've been through their training. They've been already spoken of as cultural spanners and it's important that promotoras, in itself -- and Linda has already mentioned this -- is the ongoing coaching and the training that is very important. 

Putting people that work in a community in a paraprofessional role brings responsibilities within that person's role so we try to work as closely as possible with our promotoras so that not only are they bridging the gaps, but they are not -- they are not used up. They don't get burned out, and to ensure that they can delineate their paraprofessional role versus their own cultural traditions versus personal relationships in the community and how do they balance that. I think it's important that we're very, very aware of those issues that can arise. 

So we've discussed the cultural competency. They work with all Latino/Hispanic families. Some of our promotoras are actually born here in the United States, so even though we are of Hispanic ethnic origin, we are raised the American way. Sometimes it just takes time for us to adjust; that we do need to make sure that we can work with all Hispanic families, and not particularly of our own ethnic background. 

We spoke about the fluency of the promotoras. I think it's important that they are fluent in both languages because we also have a responsibility to the providers, as well as we have a responsibility to the families, to know that we can do what we say that we can do. That we are equipped and that we can handle the interpretation for the families in a very responsible way. 

We do have ongoing coaching with one of our licensed mental health clinicians, Mr. John Mayo. He meets with us on a monthly basis and we talk about issues that arise, about family support plans, any barrier or challenge that we find with a child, how to handle a certain situation with the families. It's important that the promotoras feel a safe haven that they can discuss this with someone who is not going to look at us in a negative way, but also just to increase our own knowledge and skills. I think it's important that we have ongoing training and supervision so that we can continue to uphold the integrity of the program. 

The last slide I'd like for you all to look at is slide No. 14, and this pertains to the families, which is the reason we're here. We have a social responsibility, as I mentioned earlier, because families don't want grants to go away and then services go away. It's important that, like Dr. Mario said, we need to find programs that are sustainable. And so one of the things that we hear a lot from the families is that they really want a unified method of service delivery. We should all be working with our families, not in the same way, but projecting the same type of philosophy, and integrating services and letting the families drive the services versus the services driving the family's needs. 

Also it's understandable that families need time to build a relationship and trust. Families have many different experiences, some good, some not so good, with community providers. So it takes time for them to build up trust with us knowing that we are in a professional role and we are mandated reporters as well. But we're not there as a mandated reporter, we're there to work with the families holistically to try to bring services to the families, to help prevent other issues that might come up, but also to educate them on how things are appropriately done here in the United States. It's key that we educate our families. It's important that we don't let them do things that even though it was okay in their country, that they can do here and find themselves with responsibilities and consequences that they may not be able to handle. [Education is the key for us to continue to provide our families as well as the promotoras.] 

Again, the communication and collaboration amongst agencies is extremely vital in serving our families and I'd like to expand that just a little bit. We have families that have service providers already involved in their life, and it is a disservice to a family when there are two or three different community providers involved in their lives. Everybody telling them what to do, how to do it, when to do it and where to go to get it. 

I think it's important, and we ourselves -- we don't talk to each other about how to effectively make a service plan for a family so that a family is not set up to fail. We're still working with some agencies in our own county that based on their authority, sometimes it makes it very difficult for them to collaborate with other agencies. It's vital that we get to a point that families are not having such a run around with so many different providers wanting to help, that everybody has their own plan for this family and one family is trying to go ahead with every plan and every plan is different. 

The quote that I put down, "when families see consistent implementation of services that don't fade away because of lack of funds," I think that's when we will see our change, and the families will trust us. They will be able to advocate more freely, more openly about what's going on with their children and will actually partner more with community agencies, when they see the overall picture. I just want to thank you for this time. Do we have any questions? Linda is going to go back to a couple of more slides. 

>> LINDA: We have the next slide, No. 15, focuses on outcomes, "How well are we doing?" How well the project, what were the outcomes at the end of the project? The slides that follow just sort of provide detail on these four points. 

Based on the work of the bilingual FASST teams in south county and then in the west Tampa neighborhood, which is in a central Tampa area, the project eventually expanded to the west Tampa area and to an additional school in south county. So it was very successful and expanding, and the expansion showed that. 

Through their work in the schools, we found increased numbers of Spanish monolingual families were served through FASST. Increased number of referrals to the FASST teams from the community through the promotoras. Previously, FASST teams were primarily receiving referrals only from a teacher or from guidance counselors or school psychologists. With the addition of the promotoras, one of the ideas was to increase referrals from the community itself, so that promotoras could help parents and families learn about the program and let them contact the school to be referred. 

We also saw increased satisfaction with services from the schools and the families that have been served by FASST; and improved school progress of students that were being served. 

Next slide, slide 16, shows the detail of the increase in Latino families. The overall FASST saw an increase of 88 percent of Latino families served. And, the primary languages of the children are shown. We had Spanish, 43 percent, children that spoke English, children that were bilingual and children that spoke Portuguese. 

One of the things that was interesting when we first started the project was that, although FASST had documented the issue of not having Spanish monolingual children referred, they were showing pretty high levels of serving Latino families. We realized pretty quickly that they were not checking to see what the primary language was of families, and so that's how we found out that there was this discrepancy. In areas of the county where they had really high Latino families served, it was primarily Latino families that were English speaking and knew the system, and really didn't have a problem accessing the services. 

The next slide (Slide 17) shows the referrals from the community increasing; expansion to four schools and actually it's expanded to five schools. Just recently an additional school in south county was added, and the team has grown to reflect that change. 

The next slide (Slide 18) gives some of the information on school satisfaction. FASST has what it calls a FASST stakeholder satisfaction survey that it gives to the stakeholders periodically throughout the year. How many times a year does it do that, Maggie? 

>> MAGGIE: At least twice. 

>> LINDA: At least twice a year. So that includes school personnel, anyone else that sits on the family team, and parents. We found that there was increased effectiveness in the identification and service provision for families, that staff worked successfully with the students 100 percent in terms of what was reported, increased effectiveness in coordination of services, increased access to community services, and improved parent relationships between the schools and/or the service provider. These are all really good outcomes that FASST -- the overall FASST program is really happy with. 

The next slide (Slide 19) gives some detail in parent satisfaction. The FASST caregiver satisfaction survey is given to parents as well, and shows some of the areas that are measured with regard to parents evaluating the program. 

The "child improvement at handling daily life at home and school and in the community" was shown to increase to 100 percent, and this was reported at 100 percent for this team versus the overall FASST program, the other FASST program. Is that a cohort?

And then also parents reporting by and large that their children were better able to cope with problems when things go wrong, quality of family life improvement, and were able to get in touch with team members when they needed to. 

>> MARIO: One anecdotal quote from a family member that actually captured the theme of many families that were interviewed by our research team is -- two points, they were better able to advocate for themselves and their families and they knew how and they weren't scared any more. And they also were happy to learn new ways to manage their kids and that they actually could change some of their kids' behaviors with these new ideas that they were given. So that made us happy that all those statistics aside, that those two things were goals of ours that the families were able to advocate for themselves and were able to learn new methods to help kind of cope with their own children's' behaviors. 

>> LINDA: The next slide (slide 20) shows the detail on child outcome areas reported, with regard to school progress. School progress is measured through report cards for the children that are in the program, report cards are kept, test scores, looking at overall improvement in terms of the behavior. They do some assessments with regard to behavior and child functioning and family functioning. So in all of these areas there was improvement: family relationships, self-worth of the child, social and cultural adjustment, or improved academic performance and behaviors. 

>> MARIO: And all of these measures and indicators are -- they continue in the FASST team. The FASST team has an evaluation component and so we will always be able to monitor these and compare them to FASST teams overall, in general. So it's an ongoing part of the FASST program. 

>> LINDA: The next slide would be slide 21, and we could probably begin to wrap up so that we have time for questions and answers. These are just six components to consider for programs or agencies that are seeking to incorporate promotoras. It's important to do a thorough community assessment and follow these, and have all of these components. 

What we did was, we had a steering committee from the beginning that we created with the stakeholders for our project, and I can let Mario talk a little bit about that. 

>> MARIO: As I said when we started this webinar, we included all the key folks who were the players in terms of making this happen. We reached out to a larger group of people from the community; some were providers like Redlands Migrant Christian Association, Catholic Charities [Diocese of St. Petersburg]. There were a variety of other providers that had a variety of different services, some being seasonal, some being year-round. We also had as part of the team a Latina school psychologist who would go to the potential schools and talk with key people at the schools. It was really good because she was a school person; they could relate to her in the school. She could really find out whether the school was interested. That assessment of the school I would say was key, because the school then wanted to participate and also felt like it was being selected for a positive reason. If a school principal or staff or the key people, even if some teachers are interested in this, if the key leadership of the school does not want to do this or feels threatened by it, this cannot happen. So that was one of the things we did in assessing. Then again, looking at all -- there have been a lot of assessments that have been funded by the Children's Board of Hillsborough County about needs in this rural area of the county. So we were able to incorporate all of that. 

Of course when we moved to what Linda referred to as the west Tampa, which was West Tampa Elementary, that's in an urban area of Tampa, and so all the issues were all very different there. Transportation in Hillsborough County is a challenge, but it's not as bad when you're in the city where more bus routes are, and also other issues that had maybe more to do with safety. Also there was a different population of Latinos in the urban area than there in the rural areas. Part of that assessment, we also learned that there were many families who people identified as Latino or Hispanic, but spoke neither Spanish nor English. Many of those were people who were indigenous people from Mexico and other countries in Central America, and then as you saw, some who were Portuguese. 

So you find out all of those sorts of things, and while you're finding out, you're also getting input as you're talking to people about their feelings and their willingness to support and work collaboratively with a team like we've described. 

>> LINDA: You want to stop there and go with questions? 

>> MARIO: Frank, do you want us to stop at this point and start with the questions? 

>> JOANN: I think you could probably go ahead and wrap up with what you had and we do have a couple of questions that we could then ask you. 

>> MARIO: So what you'll see in the next few slides, we don't need to go into detail on them, I just want to emphasize the recruitment slide which -- 

>> LINDA: Is No. 24. 

>> MARIO: -- is No. 24. That is so important. You almost have to start that from the day you get this idea. You need to start scouting out who is going to do this, who you are going to get interested in participating on these teams, and then again, part of that recruitment is, who is the provider that's going to run this? As I said, we had the first; Hispanic Services Council is the first non-mainstream provider ever allowed to have a subcontract with the FASST teams. So that was a huge gain. We then knew the capacity of Hispanic Services Council... 

[>> OPERATOR: Someone has joined the conference.] 

>> MARIO: ...we knew what salaries the Hispanic Services Council could offer. One of the things we learned in recruiting FASST is that we were competing with the Hillsborough County school system and they have pretty good benefits. We've been growing at 5,000 new pupils a year so they're constantly trying to recruit people. So we had to at least have salary and benefits that competed with what people might get in the school system. 

The other recruitment issue, which was a little bit more difficult and again you have to think about it from day one, is to learn about who these potential gatekeepers are in a community. You have to start in a snowballing way, start to learn who those people are. If you start with the school, asking the school, "When you have meetings, who comes to the meeting? Who do you know in this community that's a leader?" It might be a political leader. It might be - there's any number of people that it could be. Somebody in a church; it could be a minister. It could be a priest. Whoever it is, and from there, that's when you start to find out about the community. 

So it's not just a recruitment where you put an ad in the newspaper. There is a lot of work. If you're really going to find the right person to serve as a promotora on these teams, you have to sort of, in some ways, really get to know the community, have them trust you, have them understand what this is. 

Then the benefit from it isn't that you just learn about somebody who might take the position, but all these people now know that this is coming to their community and you have a lot more support than you had when you started. 
People will give you a lot of ideas as you're asking them about what they think will work -- or not work -- in the community or how it could work best. So that recruitment is really key. 

I think the other thing I want to emphasize is the management and the maintenance. This isn't a one time training event; it's a continual process of coaching and mentoring people, and with renewals of the whole training. We're right now talking about setting up a second -- not a second, but another round of the entire training. Hispanic Services Council has formed an agreement with another agency where John Mayo, who has been one of the co-trainers of this, will continue the coaching. While people understand how to do a family plan that covers all life domains, when they actually sit down with a family and they actually talk with the schools and the agencies involved, that it's a very different experience. And to have a coach, somebody that can say, "Well, here is what you do with that information" or "Here is what you don't have yet," and then "Here is how you have to go back to the family and make sure it's okay with them." So that the practice is always driven by the values, which we really did not mention. 

But if you look at the information on the Web site, you will see the values that guide this. Some of those, just to quickly mention because I think it's a good place to end, is that things have to be strength-based; they have to be collaborative with the professionals, the providers, and the families. Including community leaders, not just family members as I said earlier, and that things have to be child and family-centered. In other words, the family is not okay with something and that's where you start and you need to figure out what it takes. 

The other thing is to think in terms of well-being and mental health, with not capital letters, and not seeing these kids as having a disability. I think focusing on all the needs -- sometimes as Maggie said, helping the family get bedding may be a key thing to both getting their support and also helping a kid's well-being in the school. So that's it. 

>> FRANK: Mario, this is Frank. We had a little bit of a technical problem, but I did hear you ask about the time. We are doing great on time. 

>> MARIO: Okay. 

>> FRANK: I wonder if you would like to cover the last few of your slides, particularly the one on evaluation. 

>> MARIO: Okay. I didn't emphasize that because I was worried about the time. Evaluation is key, and we have two levels to evaluation, one I've mentioned and that's some of the data that Linda presented, and that's the ongoing evaluation that is built into this project within the whole county. There is a team that goes through parent satisfaction, the providers, their satisfaction with the services of these teams, school achievement, and other sorts of domains that are assessed. 

Also we have something called a System of Care Practice Review. It's a case study methodology for going in and interviewing families and providers and seeing whether or not the services that have actually occurred with the family are consistent with the values and principles that we intend. That they are community-based, they are respectful and let the family drive what's going on, they are collaborative in nature; they are culturally competent, things like that. That tool allows us to give feedback in kind of a more formal quality of care way. And then of course, the evaluation that goes on when you have a supervisor and a kind of a coach. 

So really there are like three levels to this; one is the evaluation, at a programmatic level that includes satisfaction of not just the families but also of the providers. I mean, if teachers are not happy with this, you're messed up. The families could be thrilled, but if the teachers don't like it, you've got a problem. So everybody has to be happy. I always say that I have two daughters and I always want their teachers to be really happy being teachers and liking what they do. So we pay a lot of attention to school personnel satisfaction; then the evaluation more around quality of care, using the System of Care Practice Review, and then the evaluation that comes from a coach and a supervisor, looking at what these case plans look like. 

The idea is not to let the program kind of drift into whatever personalities happen to have the jobs at the time. That part of it is actually very challenging because it sort of goes against the way I think business is usually done in human services, where if you have a degree or you got trained once, that that's sort of it, and it's like you just train and then it somehow happens. Then maybe by the time two years pass or even a year, if there has been any job turn over, the training that occurs actually comes from word of mouth by whoever is still on the job. We are trying to avoid that so we don't get program drift and that we actually have a program that has fidelity to its intentions. 

Our plans are as the program grows, we have also applied for a NIDRR dissemination grant to continue to disseminate this. We're hoping to find partners out there who are willing to try this curriculum out, use it, and then to test this to see if we have enough families and enough children in the sample to be able to do other sorts of evaluations of the effectiveness of the model. 

>> LINDA: Right. 

>> JOANN: That sounds very interesting that you've got several streams of evaluation there to look at all aspects of the program. 

One question that I have--this is Joann by the way--is that now that your initial NIDRR funding is over, it sounds like you have a number of other partners already involved with the project. What else do you need in order for the program to be able to continue at this point or is that not really an issue, in terms of funding? 

>> MARIO: Yeah, it's not an issue in terms of funding because it's now part of the funding, like the ongoing funding for the county. So we're now in -- and actually, one thing that I did not mention is that of course everybody, the three of us are Latin, but the champion that we really got is not Latin at all. He's an Anglo but he saw that this was a need and he is the director of the FASST teams for the county. He is the one who was really embedded in all the politics and knew what was going on and how things were funded in the county. His name is Steve Martaus, and he was the champion that really made this a part of how things are funded in Hillsborough County. What we believe is that you never know what's going to happen in the future. There's tremendous anti-immigrant sentiment and we're trying to cope with that, and resentment of using property taxes for people that may not necessarily be citizens, or that whole negative thing going on now. 

One of the things that we continue to want to do is increase family involvement in these schools. West Tampa Elementary did not have a PTA and I believe there now is one forming, and Familias Latinas Dejando Huellas. So that there is an advocacy -- you always need -- if the families are happy and they are organized, and the schools are happy, then they create an advocacy that won't ever let this not get funded. In fact, as other schools find out about it, they want it. And that creates an advocacy. So we realize that it's all not just money, but there is a certain will that you have to create in the community and you might not need it, but it's really good that it's there. And so that's really more of our issue because the funding is there and we're growing. 

>> JOANN: That's great. It sounds like your success is what will keep things going. 

Another question I had is how many FASST teams are there in the county altogether? I wasn't sure if it was one team per school -- 

>> MARIO: No, no, that's the goal. The goal is to have one team per elementary school, but as I said -- 

>> LINDA: There's upwards of 60 to 70 schools in between there. 

>> MARIO: ...and one of the problems is that, it may have changed by the way, but we were growing at over 5,000 new pupils a year. They were opening as many as ten schools a year for like seven years. I mean, it's like beyond comprehension, and so that growth took everybody -- I mean, I thought the hurricanes were going to scare people away, but they didn't. 

So that became a challenge, and it's so big now that we're trying to think...and actually, some of what we're learning from this RAICES/Promotoras project, is that some of our families move between the schools that are near each other, because that's where their work is. We're able to cover maybe three schools with a team, but a team that might have a couple of extra members. And so we're trying -- the rest of the FASST teams are looking at how this is working because there is no way they're going to be able to reach their goal of having one of these per elementary school. But this year, by the way, for the whole state of Florida, as well as for the Hillsborough County schools, there was no growth. And that's the first time I believe in 15 years. We don't know if this is going to be a trend or if it's just a blip, we don't really know. But that's a big issue in terms of how you can match a team per school. 

>> JOANN: Frank, do you have any questions that you would like to bring up at this point? 

>> FRANK: Actually, I have a few comments. We'll see if any questions come in. First, I'd like to say I think this is really an impressive project and I encourage all of our webcast listeners and readers and viewers to go visit the ILRU Web site and download some of these materials and resources because it's really outstanding. 

Also what's really compelling to me with regard to disability and culture that is illustrated by this conversation, and perhaps Dr. Hernandez and Linda and Maggie, you can comment on this, is that disability is really not constructed the same way across cultures. This is a really important point to be aware of when we're talking, whether we're talking about doing research or conducting services. In the case of mental health often families and communities don't speak about it, and as you alluded to, it's often identified as some other issue. So I think that that's really an important point. 

And the other point that was made that I think is really critical for organizations and agencies that are interested in this, is the sustainability aspect. I think this is such a key that is reiterated in not only the scientific literature, but amongst people that we hear from on a day-to-day basis, that organizations come into communities and then leave. This is a serious problem in terms of building trust and sustaining future efforts. 

>> MARIO: And I have to say that we're just so fortunate to have Dr. Luanne Panacek as our director of the Hillsborough County Children's Board and her vision and her openness to this type of creative effort, but without that local taxing authority, that's a challenge. But, every community does have United Way, and there are a lot of local types of funding. 

We have tried to avoid at this point -- and it might change -- we've tried to avoid putting this in billing for like Medicaid case management. Because if there are issues that suddenly arise in terms of access, and also all these rules and things that come with it, that would then take it away and it wouldn't be this type of team anymore. So, having local funding is really, really important, but I think that most every community has some sorts of local funding, even school districts, if there is a way that this can be pulled together if you don't have something like the Hillsborough County Children's Board. 

>> FRANK: It looks like we do have a question in, and it pertains to recruitment. Regarding the pool of promotoras themselves, the general question is who are they? How are they recruited? Their ages, education level, has it been stable, et cetera? 

>> MAGGIE: Sure. Frank, this is Maggie and I'd like to go ahead and answer those questions. The pool of promotoras -- we currently have four with an open position for our fifth one, I'm very proud to say. 

All of our promotoras are actually females. It just so happens that's the way it is. I have three that are in their mid 20's, late 20's. I have one who is in her mid 40's and their educational level varies from high school diploma to college education. I actually have two of them who are completing their BA degree as we speak.  During weekends and personal time, they are going to school. 

As far as the program itself, we have had consistency with our staff. They all have just recently completed their first year anniversary with our agency, with Hispanic Services Council. We haven't had any problems with turnover, and the recruitment was basically going into the community during the time of research and also placing the ads in the paper for the recruitment process and the application process. 

>> LINDA: We talked to the schools; we talked to individuals in the schools. We tried to, as Mario mentioned, talk to parents through the advocacy group, Familias Latinas Dejando Huellas, as well as trying to connect with PTA's and those sorts of things. In the initial recruitment of the team way back when the project started, we had a team of recruitment and hiring. We had a team of interviewers, which was probably a little bit intimidating for the candidates, but there were about six of us around a table. We interviewed in English and in Spanish because it was something that the program people thought was very important -- to assess the bilingual capacity of people as well as to address the different questions that we had from different perspectives. So it was really like a team hiring. 

>> MARIO: We also did an evaluation of the recruitment experience and if you go to the Web site and you e-mail Linda, we can send people copies of that report of our experiences in trying to recruit people. 

>> LINDA: And our evaluator for the program, I didn't say this earlier, but Teresa Nesman did a great job of documenting the process that the steering committee took over time, as well as these key areas in terms of recruitment and hiring. And then, working with the teams and talking with the individuals to get a sense of their satisfaction and what they have learned and things that they've identified for further need in terms of training and that sort. 

>> MARIO: One of the things that we are hoping to create is that, I think when you have never done anything like this in a community...We have a lot of Latin people in the gulf coast here in Tampa, but it's not like Miami and I think that's a challenge. We don't have yet the providers to match the Spanish speaking population here, but we have a lot of Spanish speaking people. How do you create a pool, a snowball effect, so there are enough jobs and there's enough buzz around it, that you create kind of almost a pool of interested people? And I think starting from scratch that was one of our biggest challenges. 

>> MAGGIE: Frank, another area that I've noticed with recruitment, the school system is engaged with that. So, say, for instance, the new school that we have now expanded to, the position has been posted. We presented it yesterday at our first faculty presentation. I spoke about the position, and if we have interested applicants, then we have them go to the school and meet the principal. Then the principal and the key school personnel get to do a semi-interview with them as well, because they have to feel comfortable having that person working with their families and the children. So we have to engage the school personnel as well, in the interviewing process or the selection of an applicant. 

>> FRANK: Okay. 

>> JOANN: I have another question that came in here. 

>> MARIO: Can I ask a quick question? Once we answer that question, should we just quickly try to answer the questions that people sent ahead of time? 

>> JOANN: Well, we've taken a couple of those I think, but if there is anything specific you want to cover from there, please do feel free. And this actually does come from some of the questions we talked about earlier. 

Do you view the promotora model as being easily transferable to other communities or do you think it's especially suited to Latino communities? And how would you suggest people make modifications in that, if you think it is more tailored towards Latino communities at this point? 

>> MARIO: That's the one I wanted to answer. 

>> JOANN: Great. 

>> MARIO: I think it is. I don't think it's instantly transferable, but let me give you an example. If you look at the chapter in the curriculum that says, about the school district, for example, you'd have to modify that to match and know how the school district where you're implementing this works. 

So that's something that you have to look at. Some of it is stuff about IEP's in general, but you still have to modify it to your local policy in the school district. Some of the issues of cultural competence are really presented in a global way because cultural competence isn't just knowing about another population, but it's about knowing about your own culture and the dynamics that occur when you interact with a person different than you, including school personnel. 

So some of those are similar, but it would take a translation. You might not even use the term promotora. Let's say you do it in a Vietnamese community -- it may be a different name. Even in a project that we've heard about in Miami they call the person a madrina, like a godparent. There was a program that for a while was starting to get going in the county in an African American community, and they were calling people change-makers, for example. There was a lot more linkage to some of the churches and folks involved in the churches and in fact an effort to try to create interchurch agreements around serving people. I think some translation would be required, but the concepts that -- in other words, you already have the outline of areas that we've seen, that we think...Then, if you have folks who are familiar with the particular culture you're trying to reach, to help redo those sections for you.

>> LINDA: And I would add that in doing the literature review for this project that we did find examples in other communities, of the community health worker model, the general model has been applied in this country and in other countries; in Latin America, in Africa. As we said, there are over 70 different names for them. There are examples of community health workers working in Harlem, New York, with African American communities. So it can be -- obviously we called it promotoras. It's something that's been used and is recognized by community members when you say that. So that's one important thing, what you call it, and have it be something that is -- you work with the model so that you can make it more reflect the community's context, knowledge, and beliefs and all of that. 

>> MARIO: We will be posting a monograph that will be very helpful in that regard in terms of modifying this, and I'm blocking on the title.... 

>> LINDA: It's Examining the Research for Children's Cultural Competence. 

>> MARIO: We reviewed the literature for the last ten years for Latinos, African Americans, Asian Pacific Islanders and Native Americans, and we've come up with a conceptual model. It involves organizational components of a provider or a service system that are more on the policy management side, things that need to change to make the organization more culturally appropriate. And also direct service functions around access utilization and availability of services, and that monograph is completed. It's not downloaded to the site, but it will probably be on the site I would say within three weeks. If you go to the Research and Training Center for Children's Mental Health or you go to Florida Mental Health Institute, Department of Child and Family Studies, just Google that and look up the Research and Training Center -- which is also by the way funded by NIDRR -- and you'll find those monographs. You can even search for my name or Linda's name and you'll find those monographs. 

>> FRANK: This is Frank. We can place a URL link to those resources on the NCDDR Web site where we are currently describing this webcast. So that might help as well. 

>> MARIO: Yeah, that would be great. Because I think that will give people a lot of -- you don't have to then go to the literature for ten years. We tried to do that and so you could then look there and then branch out from the information we've provided. 

>> FRANK: Great idea. Okay, I have one question here, and this really pertains -- I have a lot of colleagues who are interested in issues pertaining to multicultural special education and this project seems to touch upon that. I'm wondering if the project addresses in any way the issues of inappropriate referral, and if so how might promotoras help in this process? 

>> MARIO: Actually that was -- when we were talking about assessing the schools and why they didn't make referrals or why they weren't identifying these kids, it wasn't like these kids were just invisible really, other things were happening to them and we have stories of kids being referred for being deaf that weren't deaf. We have -- all kinds of things were happening to these kids in the background.

I think what people were doing is they use special ed because the county school system has a bilingual assessment team and so they were trying -- you know, whatever resource they could get in Spanish they would use. One of the problems that I think underlies this issue that you brought up, which is a really good one, is that sometimes things happen to kids because people don't know what else to offer them. There isn't anything to offer them but X, Y, and Z, so they give them X, Y, and Z, when the child should have really had A, B, and C. But there was nothing in Spanish in A, B, and C. Or if it exists, it's so far away, the family is not going to get it. 

So I think that what this team does, I think that it helps to -- you know, using John Kennedy's speech where he talked about bending people's lives -- it bends that from happening. The original idea of these teams was to get kids at the child study team level before they necessitated special ed. But just as Maggie was saying, the families have to trust you that you're not going to go away and that you're serious and that you're going to stick with them. Even when their car breaks down, you might help them find somebody to fix it; that the school feels the same way. The more they can rely on this team and the team actually helping them, the more the teachers and the school folks begin to change their behaviors, some of which is not always apparent.

And I think that's an important element in this, but all of those issues exist here in our county. We have lots of examples, but I think having a team and then having the teachers and the school folks realize that it can make a difference, it can bend these lives, that I think that's where that change occurs. To deal with that directly gets everybody riled up and defensive, and then they don't want to work with you because they think you're going to either get them in trouble or you're going to be in a situation -- not an advocate, but a -- 

>> LINDA: An agitator. 

>> MARIO: An agitator...So I acknowledge what you're saying; we have lots of examples and I think that changes when the people that are making those decisions -- Sometimes it's not even apparent to the team, because they wouldn't know all the kids in the school, if there are 800 kids in the school. I think we see those changes begin to occur in the schools where people are willing to keep a kid, not get rid of them and realize the services can actually be offered in the school and the neighborhood. 

>> MAGGIE: I'd like to just expand, as Dr. Mario said, that advocacy can be done in a very positive manner where the school does not feel like you're going in there to fight. You're going there to advocate on behalf of the family so that families understand not only their role, but also their responsibilities. If we have that attitude [of fighting], then of course everyone is going to become very defensive. But when you take the approach of advocacy so that everyone understands their role and responsibility in the success of this child, then people's attitudes change. We take ownership for the success of this family. So if we can present it that way, that we're advocating and that the family -- actually when we go in with the promotoras, we're not speaking on behalf of the family. 

Sometimes just our presence, our silent presence helps promote, helps to empower the family who wants to share their frustrations, but doesn't want to go by themselves and meet with all these authoritative school personnel. And silence can never be misquoted. So even if they're there and we're silent, that's a way we advocate for the family. They are seeking outside services. They are seeking outside help because these are parents who want their children to be successful. 

We also hear -- well, why don't Latino families -- they don't care about their kids' education. Well, when we're present there with our families, that says that we do care. That says we do want - our families want their children to be just as successful as any other parent, even when they have special needs. Special needs are an opportunity for parents to explore the strengths that their children may have. It doesn't necessarily mean that they're not going to be successful. 

>> FRANK: Right; absolutely.

>> MARIO: The other side of that answer, Frank, and I know Maggie you'll add something to this, too, is that -- Beth Harry is a researcher in education and one of her case studies was a Puerto Rican family where the girl had a serious learning disability and could not read and she was 14 or 15 years old. When she was being interviewed for the research said, "Why won't you let your daughter go into these special classes?"..."I don't know why this school keeps trying to make my daughter have a problem. She's a wonderful girl. She helps me at home. She's great with her brothers and sisters. She's a wonderful, beautiful girl. Why they keep making her have a problem?"..."Well, because she can't read."..."Well, her father has never been able to read and look at what a good man he is, and nobody's made him have a problem." 

So the other side of this is that when a kid has a legitimate issue, that needs special education, how do you get the family to be okay with that and to understand what it is? I think that's the other side of this. Part of it is inappropriate placement, but when it is appropriate, then how do you get the family that might not understand it and might be actually freaked out, as any family would be? But if you don't speak the language, you have some fear, and you don't know what's going on, everything seems really formal during these school meetings -- it's very scary and you're more likely to reject it. So I think that other side is important, too, when it's appropriate to help a family be able to accept it and understand it. 

>> MAGGIE: And understand it....exactly. And why there is a process involved and what the process entails. When families learn that there is a process involved and what it entails and what their responsibility is, what's the role of every person there that's involved, then they're more apt to be willing to participate. Because as Dr. Mario said, many of our families don't participate because a lot of things are done in English. If they don't speak the language, they don't understand what's going on, if they don't have someone that's fluent that's able to interpret for them adequately and appropriately.

What I have found--and I have observed this with my own eyes--many times when there have been interpreters, the interpreters are speaking on behalf of the parents, they are answering for the parents. There is a dialogue going on and the parents are sitting there oblivious to what is being said. What is then told to the parent is, "Oh, don't worry; we know what we're doing. Don't worry, he's going to go here." 

And then the whole entire conversation has never been interpreted to the parent and they leave the same way they walked in the door -- not knowing what has happened -- and trust that what is being done for their child is in the best interest of their child. We have a responsibility to educate the families so they understand the process, feel comfortable with it, and are able to express their feelings towards whether or not this is something that they want for their child and/or the other issues that might come up. 

>> JOANN: Well, I want to thank you all very much. We have come to just over our time limit a little bit and so I want to thank Dr. Hernandez, Ms. Callejas, and Ms. Sanchez very much for your participation today, and thank you to everyone that came to the webcast this afternoon. 

>> MAGGIE: Thank you.

>> JOANN: I do want to encourage people who participated to fill out an evaluation form. This will be helpful to us at the NCDDR as well as to our presenters. You can find the evaluation form on the ILRU webcast page that you probably visited originally to look at the materials for today's webcast and to link to the webcast. 

I also want to thank the National Institute on Disability and Rehabilitation Research, NIDRR, that provided the funding for the webcast, and especially I want to thank the staff at ILRU because without their efforts the webcast could not have taken place. 

Thank you all very much. Frank, do you have anything else you want to add or does anyone else have any closing words? 

>> FRANK: No closing words here, just my appreciation for everyone participating today. 

>> LINDA: Thank you very much. 

>> MARIO: Thank you. Bye-bye, everyone. 

>> JOANN: Also, an audio file and a transcript of the webcast will be available on the ILRU Web site archive page in a couple of days, and you can find that as well at www.ilru.org. 

On behalf of my co-host Frank Martin and the rest of the NCDDR staff, thank you all very much again, and goodbye until our next webcast.