Demand for bilingual Spanish health care services is growing — can Utah keep up?

Nanci Rodriguez, left, receives care from ¡Vamos! Health medical assistant Ale Montilla at the West Valley clinic's grand opening on June 29, 2024. (Photo by Sydnee Chapman Gonzalez/Utah Investigative Journalism Project)

The following story was reported by The Utah Investigative Journalism Project in partnership with Utah News Dispatch.

When social worker Jules Martinez met one teen client, it seemed like the boy had given up: he’d dropped out of school, started selling drugs and stopped speaking with his mother. He’d been hospitalized multiple times for aggression and suicidal ideation and, as it later came out, was developing schizophrenia.

The teen and his mother, like a number of Hispanic Utahns, struggled to find health care that took into account their language, cultural background and experiences several years after immigrating to the United States.

It wasn’t until Martinez, who is bilingual and bicultural, was able to facilitate communication between mother and son and connect them with a Spanish-speaking therapist that things changed. Today, the teen is back in school, on good terms with his mom and involved in church.

“He actually feels good about himself and proud about himself for the first time in like five years,” said Martinez, clinical director for Latino Behavioral Health. Martinez said the obstacles that the two ran up against are typical for immigrants trying to access the U.S. health care system. “Having that person that understands culturally and linguistically just really was able to change things around for him.”

Multilingual therapist Martha Lilia Soto Ceballos said her clients have told her the wait to see a Spanish-speaking therapist usually takes months. She and her team do their best to refer the clients to a provider who can meet their linguistic or cultural needs but she said many times other providers are also full.

Martinez has seen similar trends.

“In some cases, there is nothing that I can offer folks,” Martinez said. “For psychiatry, I know a handful of folks. Whereas English speaking, there’s hundreds of psychiatrists in the valley. So it does exacerbate wait times quite a bit.”

It appears to be a far too common phenomenon for Spanish-speaking Utahns across different health care specialties.

“It’s pretty hard to get Spanish-speaking providers outside of primary care,” Redwood Medical Director Dr. José Rodríguez said. “Everybody sees patients … even those who are not on the Spanish team, because it’s just the demand is so great that it has to go to all of them.”

Understanding the need

Medical facilities are required by federal law to provide free interpreter services by qualified professionals, but most patients prefer having a Spanish-speaking provider who fully comprehends the nuances.

“It’s really helpful to have someone who maybe grew up the same way as you or had similar cultural experiences as you. It has helped me feel more seen. It helps me feel like I’m not just making things up and losing my mind,” Latino Behavioral Health Services Operations Director Amanda Martinez said. “That’s why culturally-responsive services are really important. It really helps the community feel heard and feel understood.”

Latino Behavioral Health Services, a nonprofit offering mental health services in Spanish and English, reported upwards of a 300% increase in demand since the pandemic. The nonprofit said the need has always been there but that the community is becoming more educated about how and when to seek help.

Rodríguez said demand can be hard to judge but that one way to measure it is wait times. Those have been up across all races, ethnicities and groups since the pandemic, he said.

“The shortages are everywhere, they’re worse in rural areas than they are in urban areas,” Rodríguez said. “And the rural areas are far more Latino than people realize because the industries that dominate the rural areas, mining and agriculture, are essentially mostly people who are migrants and so they’re coming in from other countries, mostly Latin America, to work.”

Alliance Community Services has been at the forefront of connecting the Hispanic community with health and social resources since its founding in 2002. The nonprofit has a number of partnerships across the state, such as the Ventanilla de Salud program with the Mexican Consulate, which offers free or low-cost health screenings, Medicaid enrollment help and other services in Spanish for anyone in the community who is uninsured or underinsured.

Lack of health insurance is one of the biggest issues. In fact, 22% of Hispanic Utahns are uninsured compared to only 6% of white Utahns , according to KFF, formerly the Kaiser Family Foundation.

An innovative subscription-based model from the recently launched Vamos! Health could help serve some of that uninsured population along the Wasatch Front. The clinic offers memberships from $60 a month for care from a team of bilingual and culturally fluent providers.

Maria Barnett , the clinic’s chief external affairs officer, said while the growth of Hispanic communities across the country has been undeniable for decades, the health care options available to those communities have lagged behind.

“There hasn’t been an increase in the types of services and the flexibility in the options for people to adapt to the sort of health care that the immigrant community and now really their American citizen children need to live healthy lives,” she said.

More than just hiring Spanish speakers

For many providers, fulfilling the Hispanic population’s health care needs goes far beyond simply hiring more Spanish-speaking staff.

“There are so many well-intended providers and agencies out there that feel or think that hiring someone to speak Spanish or translating a flier into Spanish is sufficient. It definitely helps,” Latino Behavioral Health Executive Director Javier Alegre said. “However, there’s nothing like walking into a space where everybody looks like you, speaks like you, has the same sense of humor as you, has similar relatable experiences in the past and even historical trauma.”

Alegre said while he’d give a lot of institutions an A for effort, he believes real change won’t happen until executive level teams are also diverse. Much of the success he’s seen from mainstream organizations, he added, stems from partnering with community-based organizations. But sometimes, he said, there’s some hesitation to do so.

“We need to lean into the concept of cultural humility: the fact that a large system needs to understand that they need to let go of some of their systemic requirements and need to let us or other minority agencies thrive outside of those elements,” Alegre said.

Soto founded Inclusive Minded Counseling & Consulting after working in previous roles where her employers were excited about serving the Hispanic community but weren’t necessarily prepared to do so. She often found herself translating intake documents on top of her normal workload or being shot down when she brought up suggestions to better serve her community

“Just because you’re hiring somebody doesn’t mean that will transform your agency all of a sudden to be bilingual,” Soto said. “Often more times than not, the agencies, these employers, were not ready. They were just assuming that because I spoke Spanish, I would make them ready, like magic.”

Soto has worked hard to take a different approach. Her team is entirely multicultural, and physical manifestations of those identities permeate the office space — such as palo santo used during therapy sessions, pan dulce to munch on in the waiting room or a Mexican-made mug in the hand of a therapist.

“It actually has had a great response from our community,” Soto said. “They love that they come in and everybody is Black, Indigenous or a person of color.”

Training the next generation

Soto, who is in the process of hiring another therapist, has tried recruiting from local schools but found the pipeline for bilingual, LGBTQ+ and BIPOC therapists to be lacking.

“It’s heartbreaking when I go present to a class … and maybe two individuals are BIPOC,” she said. “Well, no wonder when I try to hire, there’s like nobody. But then I talk to friends and colleagues that are in school and usually they drop out because it’s a system of oppression; it doesn’t work for us.”

A number of higher education institutions are trying to take steps to change that.

University of Utah public health professor Ivette López said recruiting Hispanic students for health and science programs often requires multiple interactions throughout a child’s education.

López also directs Utah Area Health Education Centers, the local arm of a national program developed by Congress to recruit future health professionals, especially from underrepresented populations.

The centers offer multiple programs and resources for students, including a six-week summer program for incoming college freshmen to get hands-on experience and college prep. The program is only a few years old, but initial data is showing about 50% of the participants are continuing on to health education programs, said the program’s director, Mindy Bateman .

“Our focus is on urban, underserved students … we’re hoping that really helps the pipeline down the road,” she said. “Our long-term goal is that then the health care population will match the Utah population, so we’ll have students in there that are serving people that look like and come from the communities that they serve.”

But training a new generation of health care providers is a yearslong endeavor. In the meantime, Utah has recognized community health workers can fill some of those gaps and create bridges between the health care system and the communities it has historically left behind.

The Utah Legislature passed a bill in 2021 creating a state certification process for community health workers, although many had been doing the work for years.

“It (using community health workers) ensures better service for the patient, yes, but also for the professional that’s trying to do their best and is wondering, ‘Why isn’t this working? Why am I not making progress with this patient?’” López said.

Utah State University professor Maria Jose Velasco Burgos runs the only community health worker certification program in the state that is taught in Spanish. The program recently graduated its first all-Spanish-speaking cohort and is graduating another 90 Spanish-speaking students in August. But Velasco said the demand for the program in Spanish is still high, with a waitlist of over 80 individuals and a WhatApp network of almost 240 members.

“Some people tell me 90 students is too much, but I believe that there is a place for everyone right now. I don’t think we’re saturated,” she said. “If we were saturating the market, we wouldn’t have the gaps that we have right now.”

Mainstream efforts and solutions

Rodríguez, who is also the University of Utah’s Associate Vice President for Health Sciences Workforce Services, said University Health’s efforts to address the need in the Hispanic community include opening up another Spanish clinic in Midvale and expanding to more Spanish-speaking areas like building a facility in West Valley City and taking over a practice in Rose Park. He said the university also has interpreters everywhere, including full-time, in-person interpreters at its Greenwood and Redwood clinics — which he expects to become more common.

“This is clearly an area of growth and an area of interest for University Health. … That need is not going away,” he said, pointing to a 2022 study that found it would take 92 years of sustained doubling of the number of Hispanic students to reach population parity nationwide.

Intermountain Health did not grant an interview for this story. Instead, it provided a statement highlighting some of its efforts to engage Latino communities: including employing over 2,400 caregivers who self-identified as fluent in Spanish, providing interpretation services, and offering patient education materials and classes in Spanish. In 2023, Intermountain Health recorded over 675,000 interpreting encounters for patients in 109 languages.

López stressed that there are a myriad of solutions to address health care needs in the Hispanic community.

“The thing is, there has to be a will. It can’t be like, ‘Oh, well,’ right? But if there’s a will, I’m sure they can find someone that can do this,” she said. “Now if we decide that we don’t care about people, that’s another story.”

Rodríguez offered up a few possible solutions, like more residency programs in Spanish-speaking areas and training-in-place models and incentives like loan repayment to increase the number of providers in rural areas. He also wants to see a benefit for Spanish-speaking providers like himself who often save their employers thousands of dollars in interpreter fees.

The Utah Division of Professional Licensing is working on another solution: removing barriers for internationally trained professionals to become licensed in the state. Its current priorities include pathways for clinical mental health counselors, dentists, nurses, physicians and surgeons.

Lauren Beheshti, a research and policy consultant with the division, said there’s been a lot of interest, much of it from Latinos. She is hopeful new pathways for most health care professions will be finalized in the next few years. While there are some existing pathways, education institutions with international accreditation are often in English-speaking countries.

“We’re hopeful that this can help solve labor shortages or at least work to mitigate them and mitigate their negative effects,” she said. “That it’ll get more hands on deck where they’re needed, and just close the language gap and just better serve an increasingly more diverse population.”

Utah Hispanic Dental Association co-founder Gracelyn Brito has been a driving force behind the push for a path for dentists. She moved to the states with her husband after graduating from dental school in Honduras in 2014. She quickly realized, however, that there were very few professional opportunities for her to practice or be involved in the industry.

“There is a myth that in Utah there are too many dentists,” she said. “But things are changing. … Right now there is a huge need and not just like dentists but culturally competent dentists — dentists that can really attend to the needs of the growing Hispanic population.”

She pointed to a non-native Spanish-speaking colleague who opened a dental practice in Utah recently.

“Just the fact that he had his Spanish-speaking people around his office … that could help them understand what they were talking about — treatment plans, money and all the things that are involved in dentistry — a lot of people start coming in,” she said. “There was this whole community of Hispanic people with dental insurance that were not using it because they didn’t find a doctor that spoke Spanish or where they felt comfortable going, where they were understood.”