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Caring for Young Adult Latinos with Anxiety Disorders

Dr. Cristiane Duarte is Clinical Site Director of the Washington Heights clinic. Dr. M. Carolina Zerrate, a psychiatrist, is Medical Director of the Washington Heights clinic.

Can you talk about the goals of YAC’s Washington Heights programs?

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Cristiane Duarte (CD): 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.

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M. Carolina Zerrate (CZ): 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.

Would you expand on that?

CD: Well, first, we’re full to capacity! This alone illustrates the need.

CZ: We actually have a waiting list. There really isn’t a clinic in the 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 this population.

CD: Our entire Washington Heights staff is both bi-cultural and bi-lingual.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 well-being for a successful transition to college. We’re very proud of it—and of our patients!

The Washington Heights patient population is predominantly Latino, correct?

CZ: Yes. We see a mix of immigrant youth and young people who were born here. Some of our patients are dealing with issues of acculturation, while others have lived in the city since birth. Each population has its own challenges.

CD: It’s a population in which, for many, there is a stigma surrounding mental illness. We often need to educate patients and families about anxiety and related disorders before we can even begin treatment.

What are some of the challenges your patients face?

CD: There are a great many stressors our patients are dealing with that can both trigger and exacerbate anxiety. For patients with a Latino cultural background—as Carolina just noted—there are the 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.

CZ: The patients we see also have high rates of trauma history, which Caring for Young Adult Latinos with Anxiety Disorders Dr. Cristiane Duarte is Clinical Site Director of the Washington Heights clinic. Dr. M. Carolina Zerrate, a psychiatrist, is Medical Director of the Washington Heights clinic. 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.

CD: Youth who have more recently migrated may face language barriers and may be worried about relatives left behind—and about their own or their parents’ immigration status. Kids 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.

You take a holistic approach to your patients that goes beyond psychiatric services.

CD: We do. There’s a need in this population for services for young adults 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.

CZ: We’re also diligent about follow-up, whether psychiatric, psychopharmacological, or medical—we don’t want anyone falling through the cracks. But due to the nature of our population, keeping patients engaged in care can be very challenging. Compliance is a big issue for us.

CD: In addition, we do outreach to doctors and nurse practitioners on NewYork-Presbyterian’s outpatient services—pediatric and adult—so we can better integrate and infuse our work with theirs.

Is there a story you can tell about a patient that will bring your work to life for our readers?

CZ: We follow the YAC 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. Indeed, he mirrored many in our patient population—family and religion are core values of most Latino families.

This individual had a great deal of social anxiety and remained virtually housebound. However, we got 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.

Bluntly: what do you need?

CD: A blunt answer: we need to expand! We need to hire more clinicians—psychiatrists, psychologists, social workers, a care manager—to be able to handle a burgeoning patient population. 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!


In November, Drs. Duarte and Zerrate, along with Drs. Anne Marie Albano, Rebecca Erban, Jasmin Reyes- Portillo, and Chiaying Wei, presented a YAC-focused symposium at the 51st annual convention of the Association for Behavioral and Cognitive Therapies entitled “Improving treatment for underserved racial/ ethnic minority young adults with anxiety disorders,” showcasing their program’s work with Latino youth.