On a cloudy fall morning in East Boston鈥檚 Maverick Square, two elderly women push their walkers with urgency to the door of a red brick neighborhood center.
鈥淲e鈥檒l want to get our seats first,鈥� one tells the other.
But the center鈥攔un by the East Boston Neighborhood Health Center (EBNHC)鈥攊s already bustling. Thirty-five older adults sit at long tables, concentrating on crosswords, flipping through ad circulars, sipping coffee, and chatting. A whiteboard on the wall runs down the day鈥檚 activities: newspapers, puzzles, knitting, art, exercise, an afternoon movie.
When Natalie Alas, MSW 鈥�16, enters the room, a man named Marcos*, in a Red Sox cap and camouflage shorts, greets her warmly in Spanish. He presents a gift wrapped in white plastic (a mango), then heads downstairs to the exercise bikes.
The members of this group, however, aren鈥檛 only here for socializing and recreation, explains Alas. Some will also meet with her for 15- to 60-minute counseling sessions, discussing feelings of depression, anxiety, and trauma that, she says, 鈥渢hey鈥檝e often never talked about before.鈥�
Natalie Alas, MSW 鈥�16, and Laura Zocchi, MSW 鈥�16
Alas is one of six recent alumni from the Boston College School of Social Work who work at the EBNHC, one of the largest community health centers in the country and a hub for a rapidly changing neighborhood. Scattered across its Maverick Square campus, the 51茶馆SSW social workers see patients of all ages, from newborns to 97-year-olds. Taken together, their work reflects the expansive mission of the EBNHC: to serve a largely Latinx, culturally rich, and hopeful community struggling with addiction, mental illness, complex medical needs, immigration status, housing instability, domestic violence, gangs, and poverty.
The concentration of alumni at the health center also signifies a growing commitment at the 51茶馆SSW: to prepare bilingual social workers with deep knowledge of the cultural beliefs and systemic factors that can prevent Latinx people from seeking mental health care. 鈥淭he question for us always,鈥� says Alas, 鈥渋s how can we work with our patients to decrease these barriers?鈥�
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The EBNHC, according to its website, was founded in 1970 to provide health care to a community cut off from the big teaching hospitals of downtown Boston by Boston Harbor. Once an enclave for Italian American families, the neighborhood of 40,000 has become home to many Latin Americans since the 1990s; current city data indicates it has the largest concentration of Central American, Mexican, and Colombian people living in Boston. Last year, 71 percent of the health center鈥檚 72,000 patients were 鈥淗ispanic/ Latino,鈥� as reported by the Health Resources and Services Administration.
Ximena Soto, MSW 鈥�98, assistant director of field education at the 51茶馆SSW, describes the health center as a model of behavioral health integration in primary care鈥攎aking it a dynamic practice site for 51茶馆SSW interns and graduates. In addition, she says, its sensitivity to adapting interventions to Latinx patients鈥� needs aligns strongly with the goals of the 51茶馆SSW鈥檚 Latinx Leadership Initiative (LLI), a program that prepares students to work effectively with Latinx communities through targeted courses (many taught in Spanish), research opportunities, and field placements. Four alumni at East Boston are graduates of the initiative, and currently, two LLI students are interns.
Yvonne Castaneda, MSW 鈥�18
This spring, Yvonne Castaneda, MSW 鈥�18, turned her internship into a full-time position as a behavioral health clinician in adult medicine at the health center鈥檚 Gove Street clinic. A graduate of the LLI program, Castaneda works on a multidisciplinary primary care team, providing interventions on the spot in clinic rooms in addition to outpatient counseling.
Her role is not long-term care, she explains: 鈥淚t鈥檚 figuring out how to move the needle a little so that patients can walk out the door and be okay.鈥�
The challenge, she adds, is that often patients have experienced more trauma鈥攆rom border crossings, violence, infidelity鈥攖han she can address in a primary care visit or 45-minute follow-up. 鈥淚f we open up all that upset,鈥� she says, 鈥渢here鈥檚 no guarantee they鈥檒l come back in two weeks.鈥�
Her strategy, then, is to remind patients of their resilience鈥攈ow they crossed the border without documentation, survived assault, and made their way to Boston without knowing English; how they got a job, then another, and raised a family. 鈥淚 tell them, 鈥楬elp me understand how you think you aren鈥檛 strong?鈥欌�� says Castaneda.
Upstairs in the pediatrics department, Jos茅 Rinc贸n Salazar, MSW 鈥�17, uses a similar integrated behavioral health model with children and adolescents with depression, anxiety, PTSD, and suicidal ideations. He, too, draws on personal histories and traditional values to decrease stigma and improve outcomes. Working closely with a physician鈥攐ften seen as 鈥渢he authority鈥� by Latinx families, he says鈥攈elps to educate parents that 鈥渕ental health care is health care.鈥�
Both Castaneda and Salazar make referrals beyond the clinic for patients who need long-term therapy or community resources. Patients age 55 and up with chronic conditions may go on to see Alas and Laura Zocchi, MSW 鈥�16. As part of the Neighborhood PACE Program, an all-inclusive care initiative coordinated by the EBNHC, Medicare, and MassHealth, Alas and Zocchi work with patients at two neighborhood centers with in-house primary care clinics. They provide case management and trauma-focused therapy as well as help oversee patients鈥� medical and social needs.
This summer, Alas observed that many of her patients felt hopeless and anxious over recent U.S. immigration policies, expressing fears about deportation, their families鈥� fates, and housing eviction. In response, the social work team identified 21 patients who might be interested and eligible for U.S. citizenship. They then managed the daunting application and exam process, collaborating with clinic doctors to write waivers for patients with dementia. To date, nine patients have received notices of naturalization, reports Alas.
鈥淭hey come to us with their letters for the citizenship ceremony in tears,鈥� she says, 鈥渏ust crying from happiness.鈥�
Thelma Terrero, 鈥�14, MSW 鈥�16, and Luzelly Frias, MSW 鈥�16
Thelma Terrero, 鈥�14, MSW 鈥�16, and Luzelly Frias, MSW 鈥�16, also provide ongoing support to patients鈥攊n their case, infants through adults up to age 65. Part of a new multidisciplinary 鈥淐omplex Care鈥� program launched in March, they work for three to four months with individuals whom the EBNHC or MassHealth recommends for intensive services. These are patients, says Terrero, with complicated medical and mental health needs, including substance abuse, 鈥渨ho miss medical appointments, end up in the emergency room, and are frequently hospitalized.鈥� Young patients, adds Frias, struggle with depression, autism, oppositional defiant disorder, and ADHD.
Based at the EBNHC鈥檚 main building at 20 Maverick Square, Terrero and Frias take on the barriers of stigma, time, poverty, and transportation instability by 鈥済oing wherever the patients need us,鈥� says Frias. They counsel patients at the clinic, but also in homes, at school, and over the phone.
Already, say Terrero and Frias, the approach is proving effective, even life-saving. Recently, they were able to help a young woman leave a domestic violence situation, talking with the patient by phone as she loaded her belongings into a cab. Once out of the relationship, they report, the patient quit smoking, stayed sober, and got a job. Another woman鈥攑regnant, undocumented, and facing eviction鈥攕ecured housing with the team鈥檚 support.
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Terrero describes the need for culturally sensitive social work at the EBNHC as 鈥渆ndless鈥濃�攁n observation echoed by her five 51茶馆SSW co-workers.
To help handle the demand, she, Zocchi, and Alas have enrolled in the Seminar in Field Instruction, an eight-session course offered by the 51茶馆SSW to train licensed social workers to become field supervisors for MSW interns. Their section is one of two that Soto is teaching in Spanish for clinicians working in Latinx communities. It covers the same topics as the sections in English, says Soto, but with a cultural lens to help first-time supervisors guide students toward more sensitive practice.
Understanding the 鈥渟ublayers鈥� of values, beliefs, and dialects that distinguish diverse Latinx populations is critical at the health center, explains Zocchi. It can be the difference, she notes, between recognizing that a patient鈥檚 trauma response is not a paranoid delusion but the expression of a traditional belief. Other effects of this approach are more subtle, she says, pointing to offerings such as 鈥渉eritage celebration days鈥� in the neighborhood center鈥檚 activities programming. 听
As another afternoon in her center winds down, Zocchi walks through the now empty activities room, bouquets of small handmade flags of patients鈥� home countries on its tables. 鈥淚n the middle of all this anxiety, all this instability,鈥� she says, 鈥渨e鈥檙e giving our patients a community where they feel welcomed and safe.鈥�
*Name changed to maintain patient confidentiality
Jos茅 Rinc贸n Salazar, MSW 鈥�17
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Photography by Tony Rinaldo and Caitlin Cunningham.