Youth Anxiety Center
Advancing the Understanding and Treatment of Anxiety in Teens and Young Adults
Drs. Duarte and Zerrate Talk About Caring for Young Adult Latinos with an Anxiety Disorder
Cristiane Duarte, PhD, MPH
Youth Anxiety Center Clinical Site Co-Director
Washington Heights Clinic
M. Carolina Zerrate, MD, MHS
Youth Anxiety Center Psychiatrist and Progam Medical Director
Youth Community Behavioral Health and the Washington Heights Clinic
Is the Washington Heights patient population predominantly Latino?
“Yes. We see a mix of immigrant youth and young people who were born here. Some of our latino patients with anxiety disorders are dealing with issues of acculturation, while others have lived in New York city since birth. Each population has its own challenges.” Dr. Zerrate
“In the Latino population, for many, there is a stigma surrounding mental illness. We often need to educate Latino patients and families about anxiety and related disorders before we can even begin treatment.” Dr. Duarte
What are some of the challenges your Latino patients face?
“There are a great many stressors our Latino patients are dealing with that can both trigger and exacerbate anxiety. For patients with a Latino cultural background, there are challenges of acculturation. New York can be a confusing and frightening city to someone not raised here or for those raised here who have to reconcile two different cultures. Youth who have more recently migrated may face language barriers, be worried about relatives left behind, and about their own or their parents’ immigration status. Children who come to the United States at older ages may arrive speaking some English, but with an accent, which can increase social anxiety. However, young people who were born here to immigrant parents may actually be more in conflict with their parents than recent immigrants — the old world way of doing things versus the new.” Dr. Duarte
“The patients we see also have high rates of trauma history, which Caring for Young Adult Latinos with Anxiety Disorders may be specific to the individual or something that has happened within the family. So we’re talking about addressing issues ranging from domestic violence or abuse, to learning and using interpersonal skills to manage complicated relationships and neighborhood violence.” Dr. Zerrate
Can you talk about the Youth Anxiety Center program goals at Washington Heights?
“We have a twin mission: patient care and research. Our aim is to bring the rigor of the scientific method to bear on improving treatment approaches for underserved teen and young adult Latinos suffering from anxiety disorders. We want to disseminate our treatment model and research findings to the broader clinical and research communities.” Dr. Duarte
“There’s a constant conversation going on among our clinicians and researchers spanning everything from implementation research and epidemiology, to program development and patient outcomes. There’s a tremendous need for culturally competent services in the community we serve.” Dr. Zerrate
Would you expand on that?
“First, we’re full to capacity. This alone illustrates the need. Our entire Washington Heights staff is both bicultural and bilingual. It also bears mentioning that this past summer we developed and completed a summer intensive college readiness group, which consisted of daily sessions for one week for young adults starting or returning to college in the fall. The curriculum focused on promotion of wellbeing for a successful transition to college. We’re very proud of it and of our patients.” Dr. Duarte
“We actually have a waiting list. There really isn’t a clinic in New York city where young adults can find the sort of care we’re offering. And there certainly isn’t one that concentrates, as we do, on the specific needs of the Latino population suffering from anxiety disorders.” Dr. Zerrate
You take a holistic approach to your patients that goes beyond psychiatric services.
“Yes we do. There’s a need for services in the young adult Latino population who are aging out of pediatric care but don’t have primary care physicians. As part of the coordination of care, we make the appropriate referrals and help our patients navigate the adult healthcare system. We also do outreach to doctors and nurse practitioners on NewYork-Presbyterian’s pediatric and adult outpatient services so we can better integrate and infuse our work with theirs.” Dr. Duarte
“We’re also diligent about follow-up, whether psychiatric, psychopharmacological, or medical because we don’t want any of our patients falling through the cracks. Due to the nature of our Latino population, keeping patients engaged in care can be very challenging. Compliance is a big issue for us.” Dr. Zerrate
Is there a patient story you can tell that will bring your work to life?
“We follow the Youth Anxiety Center Launching Emerging Adults Program (LEAP ) model and provide cognitive behavioral therapy and have made cultural adaptations to make it work for our patients. For example, we had a young man whose biggest motivation was to make his grandmother proud of him. She was very religious, attending church every day. He mirrored many in our Latino patient population as family and religion are core values of most Latino families. This individual had a great deal of social anxiety and remained virtually housebound. We were able to get him to start going to church with his grandmother. At first, he found sitting next to others overwhelming. However, being with his grandparent was deeply meaningful for him. It was a yearlong process, but at the end of it he was much improved and on a path to independence.” Dr. Zerrate
What do you need the most?
“Very bluntly, we need to expand. We need to hire more clinicians including psychiatrists, psychologists, social workers, and a care manager to be able to handle a burgeoning Latino patient population suffering from anxiety disorders. We need more funding for research. And we are almost entirely dependent — and grateful for — any and all philanthropic support. Our work wouldn’t be possible without it.” Dr. Duarte