Puerto Rico Prevention Organizations Partner with PS@EDC to Address Health Disparities

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Throughout the summer, Prevention Solutions@EDC provided customized support and consultation to prevention coalitions across Puerto Rico, ensuring that they had the knowledge and skills needed to understand and reduce health disparities in their communities.

Behavioral health disparities affect the health of diverse communities across the U.S., including racial and ethnic groups; lesbian, gay, bisexual, transgender, and questioning (LGBTQ) populations; people with disabilities; transition-age youth; and young adults.1,2 One of the main causes of these disparities is lack of access to culturally and linguistically appropriate services.3

"If we want to have equitable health for all people, and prevent substance misuse among different types of people and groups in different areas, we need to make sure that we see and address the disparities that are occurring, and that the prevention workforce is prepared to develop and deliver the quality of services necessary," says Prevention Solutions@EDC Training and Technical Assistance (T/TA) Provider Lourdes Vazquez.

In Puerto Rico, the island’s team of federally funded prevention organizations were committed to doing just that. They were energized and informed, having participated in multiple trainings on health disparities. But they needed support taking what they knew and putting it into action.

To provide this support, Vazquez provided 31 hours of intensive TA to approximately 20 prevention practitioners working at six of the island’s prevention coalitions. The TA was designed to deepen the organization’s understanding of health disparities, overall, and its impact on substance use and prevention; to increase the cultural and linguistic competency of its coalition’s members and advisory teams; and ultimately, to promote health equity in their communities.

Sessions were customized to meet each organization’s unique needs. Some highlighted the connections between behavioral health disparities and cultural competency. Other explored topics such as how to collect data on “hidden” populations, diversify coalition membership, and engage leadership. Practitioners discussed strategies for ensuring the adoption and consistent use of culturally competent prevention approaches, and explored questions of inclusion, seeking to expand their notion of what it means to be inclusive. For example, does it just mean including youth in your coalition, or youth who both are and are not enrolled in school? Some groups developed training modules and marketing tools they could use to educate their local advisory committees and coalitions; others developed plans engaging populations experiencing disparities, including LGBTQ youth and new immigrants from the Caribbean.

Vazquez also worked with the organizations to develop tools they could use to assess the readiness of their coalitions and advisory teams to engage in this work. “It’s important to know what members and other key stakeholders understand and think about health disparities,” says Vazquez. “Their support is critical if we want to make a difference.”

As part of the TA, Vazquez reviewed the organizations’ existing policies and procedures, including recruitment and orientation manuals, to determine the extent to which they reflected the Enhanced National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care—the blueprint for implementing culturally and linguistically appropriate services.

“I challenged them to think more broadly about what it meant to be “linguistically appropriate,” she said. “It’s about more than just translation—since all the materials were already in Spanish—and to think in terms of literacy, and how different levels of literacy might produce disparities.”

In August, PS@EDC convened a 2-hour virtual community of practice, where TA recipients had an opportunity to reflect on their experiences and mentor one another. Participants described concrete steps they’d begun taking to create more inclusive and equitable communities. They shared and invited feedback on new organizational policies and procedures they’d developed, and newly minted readiness tools.

The discussion also reflected the participants’ growing awareness of the relationship of health disparities and substance misuse. For example, one participant expressed concerns that growing number of bars and restaurants in their largely rural area would lead to an increase in underage drinking. Were their youth more at risk, she wondered, because the region lacked the resources needed to enforce existing laws restricting youth access? Did this problem reflect health disparities?

Over the next three months Vazquez will continue to work with the organizations as they begin conducting their readiness assessments, incorporating the CLAS standards into their organizational policies, and educating their coalitions and advisory teams.

“It’s exciting to see their efforts take off,” says Vazquez. “They’re thinking about new ways to reduce disparities, and new partners who can help them do so. They’re learning from one another, sharing resources and lessons learned. Many of these organizations have been engaged in this work for some time. They’re now applying the TA they received to be more deliberate, strategic, and purposeful in their efforts.”


1. Healthy People 2020 defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”

See U.S. Office of Disease Prevention and Health Promotion. HealthyPeople.gov. Disparities.

2. Substance Abuse and Mental Health Services Administration (SAMHSA). Overview of Health Disparities.

3. The National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care state, "Though health inequities are directly related to the existence of historical and current discrimination and social injustice, one of the most modifiable factors is the lack of culturally and linguistically appropriate services, broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of all individuals." See U.S. Department of Health and Human Services, Office of Minority Health, Enhanced National CLAS Standards.