El Futuro works closely to maintain a responsive reputation in the community.  Clinics are located in Latino “barrios” (neighborhoods) and on bus routes.  In Carrboro, we are co-located with the county’s Latino Center.  Evening appointments are available on Monday, Wednesday and Thursday so that vulnerable wage-earners don’t miss work.

As veterans of the pre-reform public mental health system, our staff were all too familiar with traditional barriers to access to services.  As a result, we have invested in simple best practice measures that open our doors to all clients:

• All staff, including volunteers, trainees and administrators, are bilingual and working toward fluency if not already fluent in Spanish and English.
• The answering machine messages are in Spanish.
• All signs and patient education materials are in Spanish or bilingual.
• Those who seek help are consulted as to the appropriateness of calling them back on the phone numbers they give, to take into account vulnerable job situations or possible domestic conflict or extended family residences impeding privacy.
• In consultation with staff and volunteers who are native Latin Americans, we have decorated and equipped our offices to make them comfortable and homelike for our clients.
• Client rights and responsibilities are explained verbally as well as provided in writing, to take into account the varying availability of education in our clients’ regions of origin.
• It is made clear to clients that immigration and insurance status do not affect provision of care at El Futuro.
• We include culturally specific questions on our checklist, including the use of community or folk resources in past help-seeking, whether clients have experienced hunger in their lives, spiritual practices that may guide their recovery, and what the clients’ immigration experiences were like. 
• All staff are trained and supervised in issues such as using warmth and humor to develop trust with clients and work through the anxiety about authority that can impede Latino client-therapist relationships.
• Therapists openly broach possible areas of cultural difference, for example “Maybe it’s hard for you to deal with your children acting out in public, because it seems to really embarrass a lot of Latino parents,” or “I wonder if where you grew up a lot of people say they hear voices of people who’ve died, or is that unusual.”
• Psychiatrists tailor initial doses of medicine, taking into account whether the client is “naive” to psycho-pharmaceutical agents.  Some clients seem to be “exquisitely sensitive” to SSRIs, and benefit from smaller initial doses than those commonly prescribed in traditional psychiatric settings.
• Staff are trained in helping clients feel comfortable saying what they want even though smooth social interactions traditionally lead some Latinos to say “yes” to things they really don’t want to do.
• We work with clients to understand what gender roles they feel are appropriate to their family, and whether there is consensus among all family members about this issue or it is a source of conflict.

As a result of our care, even clients who did not return say they felt good about El Futuro and experienced clinical improvement from their (brief) treatment.  We feel these are positive indicators of client perceptions of El Futuro, and possible guideposts for new approaches to therapy.