Using Cuento to Support the Behavioral Health Needs of Hispanic/Latinos


According to the 2020 National Survey on Drug Use and Health (NSDUH), nearly eight million (18.4 percent) Hispanic/Latino adults reported experiencing a mental illness. Among those with a mental illness, 1.9 million (24.4 percent) had a serious mental illness or a mental illness that affected their ability to function.

Although the prevalence of major depressive episode (MDE) was lower in Hispanic/Hispanic adolescents, a greater proportion of those with MDE compared to non-Hispanic White adolescents reported suicidal thoughts. In 2020, 18.7 percent of non-Hispanic White and 15.7 percent of Hispanic/Latino adolescents reported MDE. Among non-Hispanic white youth with MDE, the proportion with suicidal thoughts fell from 71.6 percent in 2019 to 69.4 percent in 2020. In contrast, the proportion among Hispanic/Latino youth increased — from 67.1 percent in the year 2019 to 72.1 percent in 2020.

The data show that efforts to eliminate health behavior disparities need to continue. This blog will highlight additional data, present culturally appropriate approaches, and provide a framework for doing so.


treatment gaps

In addition to differences in prevalence, it is important to consider differences in treatment. For MDE, non-Hispanic White adolescents received treatment at rates 12-13 percentage points higher than Hispanic/Latino adolescents. In the 2019 NSDUH, nearly half of non-Hispanic white youth with MDE did not receive any treatment, compared to 63.2 percent of Hispanic/Latino youth. This remained relatively unchanged in 2020, with 49.1 percent non-Hispanic White youth and 37.0 percent Hispanic/Latino youth. Additionally, 18 percent of Hispanic/Latino women ages 12 to 17 with MDE had a major impairment in 2019 (PDF | 4.2 MB), a sharp increase from 11.5 percent in 2016.

Treatment gaps for Hispanic/Latino adolescents with MDE worsened for those with suicidal ideation. Serious treatment gaps exist for Hispanic/Latino adolescents with MDE. In 2020, 57.3 percent of non-Hispanic white youth with MDE and suicidal thoughts received treatment. However, only 39.6 percent of Hispanic/Latino youth received treatment, a gap of nearly 18 percentage points.


Suicidal behavior in youth

A closer look at suicidal behavior reveals a worrying trend among Hispanic/Latino female youth. Between 1991 and 2015, Latinas outperformed other adolescent girls in attempting suicide. In 2019, 18.8 percent of teens reported suicidal thoughts, compared to 17.2 percent of Hispanic/Latino teens. However, 22.7 percent of Hispanic/Latino female adolescents reported suicidal thoughts, almost four percentage points higher than the overall sample. Similarly, 2.5 percent of youth reported attempted suicide that resulted in injury, compared to 3 percent of Hispanic/Latino youth and specifically 3.6 percent of Hispanic/Latino female youth.

Understanding suicidal behaviors in Hispanic/Latino youth requires a cultural lens. It is important to consider the cultural traits, beliefs, and values ​​that may be risk or protective factors for suicidal behavior. Cultural factors (PDF | 1.3 MB) such as greater acculturation, greater exposure to mainstream United States culture, and racial/ethnic discrimination have been associated with an increased risk of suicide.

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Gaps in evidence-based practices and treatments

Evidence-based practices and treatments (EBPs and EBTs) are considered the gold standard of behavioral healthcare. EBPs/EBTs have undergone rigorous evaluation and clinical studies and are replicable. The use of EBPs/EBTs assists countless people in accessing life-saving behavioral health services. However, gaps in just service to diverse and hard-to-reach communities remain.

Many EBPs/EBTs rely on a Western medical model that may not reflect perceptions of health in different cultures. Culturally appropriate EBPs/EBTs for Hispanic/Latino populations tend to add cultural elements such as personalismo and familismo to existing mainstream treatment modalities. In contrast, culturally defined interventions are designed and implemented with culture integrated in specific and intentional ways. Culturally defined treatment approaches utilize the therapeutic value inherent in Hispanic/Latino cultural practices.


Latinos often rely on cultural context to understand and address their health needs. This may involve assessing progress in psychotherapy in terms of relationship improvement rather than internal or individual growth. Understanding relational or collectivist needs within Latino culture is important for effective and equitable behavioral health care.

Understand and encourage storytelling

Many Latinos use cuento, or storytelling, to answer questions in narrative form. Storytelling preserves a collective memory and shares historical knowledge. Through cuento, Latinos can find healing through the intersections of their culture and personal stories. Storytelling allows people to learn about, share and better understand each other’s culture. When used properly, storytelling is beneficial to behavioral health wellbeing, treatment, and recovery. Digital storytelling, or the use of images to describe experiences, has been effective for several different communities, including their peers in recovery, Indigenous youth, and members of the immigrant/refugee community. In Latinas, photonovelas, or images of soap opera narratives, have proven to be an effective health education tool to reduce stigma associated with access to treatment. For more culturally appropriate strategies, providers should consider incorporating storytelling into all aspects of Latino care.


Use of the culture formulation interview

A clinical tool for promoting storytelling is the Cultural Formulation Interview (CFI). The CFI grew out of years of research focused on culture and its relationship to behavioral health. The tool aims to gather nuanced information based on a person’s experiences and understanding of their culture. Clinicians can also use the informant CFI (I-CFI) to gain cultural insights from those close to the patient. There are additional CFIs for even more unique experiences based on subcultures such as older or younger patients. Most health assessments ask general, closed-ended questions. In contrast, the CFI mixes general and probing questions that allow the provider and patient to explore deeper issues.

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implementation support

It is important to understand the positive impact of culturally appealing tools like CFI on achieving behavioral health for Latinos. However, this understanding is only the first step. Behavioral health professionals serving Latinos must take meaningful, actionable steps to provide culturally and linguistically tailored care. Beyond a one-time assessment, the use of tools such as CFI should be required for all patients throughout the care continuum of service delivery. Ensuring that these culturally driven changes are sustainable requires a sense of urgency and broad support from behavioral health leaders and policymakers.

Organizational leaders and decision makers are encouraged to adopt the National Standards for Culturally and Linguistic Appropriate Services (CLAS) in Healthcare and Public Health. Integrating tools like the CFI into behavioral health practice achieves CLAS Standard #4: “Educate and train governance, leadership, and employees in culturally and linguistically appropriate policies and practices on an ongoing basis.” To ensure sustainability, must Behavioral health leaders advocate for increased accountability, ongoing training and incentives for providers to use culturally and linguistically pleasing care.

challenge for change

EBPs/EBTs are not one size fits all. Equitable, patient-centered care requires behavioral health professionals to consider community-defined evidence (CDE). CDE is an evidence base that uses cultural and/or community indices to define successful practices. Using the CFI and other culturally appropriate assessment tools can help providers determine what will best meet the unique needs of an individual, their family, and their community. The use of such culture-centric strategies allows for a better understanding of the experiences and origins of suffering. They also allow the individual to draw strength from culturally protective elements.

The challenge for providers is an ongoing commitment to learning how an individual’s cultural experiences shape their behavioral health. However, real change takes place at the system level. Behavioral health leaders can replace antiquated, discriminatory corporate values ​​and policies with ones that reflect and celebrate diversity, equity, inclusion and accessibility.

If everyone accepts these challenges, we will eliminate health behavioral disparities as they affect young Latinas. We will create a behavioral health system that takes a genuine interest in the Latino experience and achieves the long-lasting positive outcomes they chose.


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