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       Research suggests that Latino children are at an elevated risk for a 
variety of mental health problems (Flores, Fuentes-Affl ick, Barbot, et al., 
2002). Latinos are often vulnerable to the deleterious effects of poverty, 
institutional racism, community violence and other types of psychoso-
cial stressors, which have been linked to negative mental health outcomes 
(Flisher, Kramer, Grosser, et al., 1997; Saunders, Resnick, Hoberman, et al., 
1994). Furthermore, Latino children are likely to face signifi cant barriers to 
accessing mental healthcare services, such as limited availability of Span-
ish-speaking providers, diffi culty obtaining and navigating health insurance, 
and cultural obstacles, such as the belief that mental illness is a spiritual 
or religious matter. The current paper will: (1) explore specifi c risk factors 
for mental health disorders among Latino children; (2) examine barriers to 
appropriate mental health treatment among Latino children; (3) provide an 
overview of the types of intervention strategies currently used to address men-
tal health problems among Latino children; and (4) offer recommendations for 
the development of additional and/or improved methods for the prevention and 
treatment of mental health disorders among Latino children.

 here are more than 11.6 million Latino children living in the U.S., 
compromising the largest minority group of children in this country (Flores, 
et al., 2002). Despite the growing number of Latino children, there is a dearth 
of empirical research on specifi c mental health problems experienced by this 
burgeoning population. Lack of education regarding childhood mental illness 
and limited access to services are suspected to contribute to underreporting 
and, in turn, lack of treatment among Latino children. For example, studies 
have demonstrated that White children are more than twice as likely to receive 
diagnosis and treatment of Attention Defi cit Hyperactivity Disorder (ADHD) 
than African American and Latino children (Olfson, Gameroff, Marcus, et al., 
2003; Eiraldi, Mazzuca, Clarke, et al., 2006). In addition, despite problems 
with surveillance of Latino childhood mental health problems, a study by 
Canino, Could, Prupis, and Shaffer (1986) indicated that Latino children are at 
greater risk for depression, anxiety, school refusal, and diffi cult interpersonal 
relationships with other children than their Black or White counterparts.

Ian Holloway

T

LATINO CHILDREN’S MENTAL HEALTH: AN ANALYSIS OF RISK 
FACTORS, HEALTHCARE ACCESS, AND INTERVENTION STRATEGIES

LATINO CHILDREN’S 
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    The disproportionate mental health disease burden among Latino 
children is especially troubling given the negative health outcomes that result 
from childhood mental health disorders (Flores, et al., 2002). Childhood is a 
crucial period in the lifecycle, marked by rapid changes in cognitive and 
emotional development; mental health disorders can cause academic and 
social impairment, which have serious ramifi cations on the developmental 
trajectories of children later in life. For example, research has demonstrated that 
early-onset emotional and behavioral problems in children are related to 
negative consequences in adolescence, such as educational diffi culties 
(Tuakli-Williams & Carillo, 1995), substance use (Sterling, Kohn, Lu, & 
Weisner, 2004), juvenile delinquency and school dropout (Loeber, 1991; Ramey, 
& Ramey, 1998), and attempted suicide (CDC, 1999).

Risk Factors for Latino Children’s Mental Health Problems

       While it is clear that additional research must be conducted in order to 
determine base rates of mental illness among Latino children, a signifi -
cant body of literature exists documenting risk factors that may lead to or 
exacerbate mental health disorders among Latino youth. Twenty-eight of 
Latino families reside in poor families (NCCP, 2005), and Latino children are 
more likely to live in resource poor, urban neighborhoods than their White 
counterparts (Kasarda, 1993; Fass & Cauthen, 2006). These children are often 
exposed to negative environmental stressors, such as overcrowding, neighbor-
hood disorder, community violence, and trauma exposure, factors which have 
been linked to childhood psychopathology (Wandersman & Nation, 1998; 
Vostanis, Tschler, Cumella, et al., 2001; McKay, Lynn, & Bannon, 2005). A study 
by Xue, Leventhal, Brooks-Gunn, et al.(2005) demonstrated that children in 
neighborhoods of low socioeconomic status have the highest levels of mental 
health problems when compared to children in medium and high socio-
economic status neighborhoods. Low social control, lack of community cohesion,
and compromised social capital networks have all been linked to negative 
mental health outcomes in children (O’Brien, O’Campo, & Muntaner, 2003; 
Xue, et al., 2005).
     Two other crucial factors that may contribute to the development of 
childhood mental health disorders among Latinos are acculturation and 
adjustment stress. Recent data from the Mexican American Prevalence and 
Services Survey indicated a positive association between acculturation and 
risk for lifetime prevalence of diagnosable mental disorders, such as affective, 

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anxiety, and substance use disorders (Organista, Manoleas, & Herrera, 2001). 
Latinos who emigrate to the U.S. often experience diffi culties maintaining 
their traditional cultural norms while attempting to integrate North American 
cultural practices and beliefs (Sue & Sue, 2003). While some Latino 
children are able to navigate the acculturation process smoothly and establish a 
bicultural identity, which has been shown to be the most benefi cial resolu-
tion to acculturation confl icts for the individual (Miranda & Umhoefer, 1998), 
other Latino children often fi nd themselves caught between expectations of their 
family and their school or peer groups (Flores-Gonzalez, 2002). These types of 
acculturation confl icts can cause signifi cant psychosocial adjustment stress, 
which may lead to the development of mental health problems.

Latino Children’s Access to Mental Health Care

    Despite the greater need for mental health services among Latino 
populations, there is evidence that the majority of these children are not 
receiving necessary care. Recent studies by Kataoka, Zhang, and Wells (2002) 
and Zimmerman (2005) revealed that Latino children have especially high 
rates of unmet need in terms of mental health service delivery relative to other 
children. This diffi culty accessing mental health services can be attributed to 
three primary factors: (1) insuffi cient services, (2) health insurance barriers, and 
(3) cultural barriers.

Insuffi cient Services
   The U.S. currently faces a dramatic shortage of mental health 
providers who are specifi cally trained in the provision of mental health services 
to children and adolescents (Kim, 2003). A recent study by Thomas and Holzer 
(2006) indicated that youth living in poverty were least likely to have access 
to specialty child psychiatry services. These fi ndings are especially salient for 
Latino families, 28% of which are living below the federal poverty line (NCCP, 
2005). A study conducted by Lopez (2002) cited availability of services as one 
of the many barriers to accessing mental health care among Latino families. 
In addition, many Latino families lack information regarding mental health 
services and recognition of child mental health problems (Teagle, 2002). Thus, 
Latino parents may not have the knowledge necessary to obtain appropriate 
mental health services for their children even when such services do exist.
   Furthermore, some Latino families may have diffi culty seeking 
mental health treatment due to immigration status. A study by Granados and 

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colleagues (2001) demonstrated that Latino children of immigrant parents 
were less likely to access routine healthcare than Latino children of U.S. born 
parents. While more research must be conducted to determine specifi c reasons 
why children of immigrant parents seem to have more diffi culty accessing 
healthcare services, one possible explanation is that these parents may fear that 
they will be questioned about their immigration status when seeking care for 
their children. Research conducted by Canlas (1999), which examined mistrust 
of the health care system among Latinos in East Harlem, New York, found that 
fear of deportation was a major reason given for underutilization of medical 
services by Latino participants. As such, undocumented Latino parents may be 
afraid to inquire about mental health services for their children, for fear they 
may be questioned about their immigration status, harassed or deported.

Health Insurance Barriers
        Other factors impacting Latino children’s ability to access mental health 
services revolve around health insurance. Approximately 26% of Latino 
children are uninsured, compared with 10% of White children and 14% of 
African American children (Flores & Vega, 1998). While signifi cant improve-
ments have been made in health insurance for minority children over the past 30 
years, such as the expansion of Medicaid eligibility and the introduction of the 
State Children’s Health Insurance Program (SCHIP), insurance status continues 
to present a signifi cant barrier to Latino families’ ability to access mental health 
services (Alegría, Canino, Ríos, et al., 2002; Busch & McCue Horwitz, 2004). 
Medicaid and private insurance benefi ts are often administered through managed 
care organizations.While this arrangement has conserved a considerable amount 
of government money, signifi cant questions arise regarding pre-certifi cation for 
mental health services, disenrollment, and quality of care provided to minority 
children with mental illness.
         In addition to ineffective diagnostic and referral systems, managed care’s 
confusing guidelines also complicate coordination efforts between mental health 
providers, families, and schools. Children with mental health problems are 
often treated by many different systems and agencies, including schools, so-
cial services, and the juvenile justice system. Lack of coordination and failed 
communication (many times resulting from language barriers) among 
teachers, social workers, and the courts often lead to inconsistent care for 
Latino children. In some cases there may be an overlap in services, where 
children and families receive confusing messages from multiple sources. 
However, more commonly, due to large caseloads and reduced funding, children 

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fall between the cracks as the various agencies try to pass off costs to other 
sectors. This is evidenced by the fact that 92% of children with serious 
emotional disturbances receive mental health services from two or more  
systems, and 19% from four or more (Glied & Cuellar, 2003).

Cultural Barriers
    Latino communities face signifi cant cultural obstacles to obtaining 
mental health care. Research suggests that Latino families often do not 
view mental illness as a medical problem; instead some Latino families 
conceptualize mental illness as a spiritual or religious issue (Maduro, 1983; Sue 
& Sue, 2003). As a result, Latinos tend to underutilize mental health services 
while relying heavily on religious services for the resolution of emotional and 
interpersonal disturbances (Organista, Manoleas, & Herrera, 2001). While 
churches and other religious organizations may be a useful source of psychosocial 
support for Latino families, staff is seldom trained in the recognition of mental 
health disorders, which may lead to underreporting of mental health disorders 
and in many cases insuffi cient treatment of Latino children with mental health 
disorders.
      Insuffi cient research has been conducted on the impact of culture and 
language on the etiology of mental health disorders and the underutilization 
of mental health services among Latino children (Flores, et al., 2002). For 
example, few studies have examined the ways in which cultural constructs 
specifi c to Latino populations may impact the way in which mental health 
is viewed and treated in Latino communities. A shortage of bilingual and 
bicultural mental health providers further impedes access to effective mental 
health services for Latino children (Vega & Lopez, 2001). As a result, if Latino 
children are receiving mental health services, these services may be culturally 
irrelevant and ineffective, leading to premature discontinuation of treatment. 
Some critics of the U.S. mental health system assert that the dearth of bicultural 
mental health professionals is representative of a form of aversive institutional 
racism that may make it diffi cult for Latino families to participate in treatment 
altogether (Whaley, 1998).

Latino Children’s Mental Health Service Delivery

Micro-level Interventions: Individual & Family 
     The majority of intervention programs that address Latino children’s 
mental health on the micro level have been carried out within family systems. 

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Children’s ability to access health care services almost always relies on their 
parents’ willingness to seek out and/or accept these services (Newacheck, 
Hughes, Hung, et al., 2000). Unfortunately, Latino parents may not realize 
that their children may be experiencing a serious mental health problem. For 
example, a recent study that sought to measure parental problem recognition 
and its impact on child mental health service use, determined that parental 
perceptions of their children’s mental illness played a key role in 
determining whether or not their children were able to receive services 
(Teagle, 2002). Education at the parental level is crucial to the identifi cation of 
serious mental health problems.
    A handful of empirically tested intervention programs specifi cally 
tailored for Latino populations have helped to educate Latino parents on 
normal childhood development and train parents to identify abnormal child 
behavior. For example, culturally adapted parent management training was de-
signed by the Oregon Social Learning Center to educate parents on mental illness 
and help parents acquire general parenting skills in order to decrease external-
izing behaviors in their adolescent children (Martinez & Eddy, 2005).This inter-
vention proved successful in reducing a range of adolescent problem behaviors, 
including aggression and drug use. The strength of this program was its specifi c-
ity; all parent-adolescent dyads studied were Spanish-speaking and parents were 
encouraged to express their own views of normal vs. abnormal child behavior 
based on previous experiences.

Mezzo-level Interventions: School & Community
       School-based interventions are perhaps the most widespread programs 
to address mental health problems among Latino children. Schools are a 
logical place for the identifi cation of child mental health problems because 
the vast majority of children attend school and can be closely monitored by 
teachers and ancillary mental health staff (Hoagwood, Burns, Kiser, et al., 
2001). One of the primary strengths of school-based programs is their ability to 
provide consistent support to children struggling with mental health problems. 
In 1999, Ambruster and Lichtman conducted a study to evaluate the effectiveness 
of 36 school-based mental health services in inner city New Haven, Connecticut. 
This study demonstrated that children enrolled in school-based mental health 
services showed comparable improvement in functioning on the Children’s 
Global Assessment Scale and the Global Assessment of Functioning Scale to 
children enrolled in clinic-based mental health care. This study also 
highlighted the crucial role that schools can play in mental health problem 

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identifi cation and treatment because they are able to reach disadvantaged 
children who otherwise would not have access to mental health services. School-
based mental health services can be highly affective at improving academic 
achievement in high-poverty urban areas (Atkins, Frazier, Birman, et al., 2006) 
and are able to coordinate treatment planning with teachers and administrators, 
which allows for the development of educational plans that are informed by 
mental health treatment and vice-versa.
        Community-based interventions that address mental health treatment are 
also widespread (Hoagwood, et al., 2001). These interventions most often take 
place in community outpatient mental health centers or through integrated 
treatment coordinated through case management services at community-based 
organizations.While these settings are particularly effective in addressing 
mental health problems among children due to the presence of more skilled 
providers and psychiatrists who are able to prescribe medication, the 
weaknesses of community-based interventions lies in their inability to reach 
many Latino children. As previously mentioned, structural barriers, such  as 
availability of services and insurance restrictions inhibit Latino children’s 
access to mental health services (Flores, et al., 2002). Furthermore, cultural
barriers to treatment, such as lack of Spanish-speaking and/or bicultural 
providers, even in  communities where the majority of children come from 
Latino backgrounds, often prevent Latino families from utilizing community 
outpatient services (Vega & Lopez, 2001).

Macro-Level Interventions: Structural Transformation and Policy 
Development
      Policies to improve insurance coverage for low-income children, such 
as Medicaid expansion and the formulation of SCHIP, are examples of 
structural level interventions that have helped to alleviate the mental health 
disease burden in Latino children (Shone, Dick, Crach, et al., 2003). Another 
example of structural level change resulting in improved access to mental health 
services for Latino children is the Mental Health Parity Act, which took effect in 
1996. This act, which was an important step in acknowledging the importance of 
mental  health and placing it on an equal plane with physical health, ensured that 
mental health care benefi t limits were comparable to all other benefi ts (Sturm 
& McCulloch, 1998). This change was accompanied by the development of 
many new pharmaceuticals to treat mental health problems, and increased 
prescription benefi ts. As a result, insurance companies now cover mood 
stabilizers and psychotropic medications in the same way other medications 

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are covered, which has further equalized the mental and physical health sectors 
while reducing costs to patients.  
    Two other examples of macro-level interventions that have helped 
improve mental health among Latino children are Head Start and Early Head 
Start, two Federal programs within the Administration on Children, Youth and 
Families in the Department of Health and Human Services.These programs offer 
comprehensive services aimed at improving the physical and emotional 
well-being of pre-school children in low-income families (ACYF, 2007). 
Head Start programs have been effective in promoting mental health among 
participants by working closely with parents to identify mental health 
problems in the family system and work with children and parents to address 
these concerns (Mann, 1997). While Head Start and the other structural level 
interventions mentioned above were not specifi cally aimed at improving the 
mental health of Latino children, such far-reaching policy implementation has 
been crucial to the improvement of Latino children’s mental health due to its 
ability to affect systemic change.

Recommendations

Micro-level Interventions: Individual & Family 
        Mental health disorder identifi cation in children can be most effective if 
it occurs early (DHHS, 2000). Future intervention programs aimed at Latino 
families must target parents of younger children in order to help them recognize 
abnormal behaviors and seek appropriate care. In addition, all individual and 
family level interventions targeting Latinos must be culturally tailored to the 
specifi c Latino subgroup being targeted. There is a tendency in social work and 
public health research to group all Latino populations under the umbrella terms 
“Latino” or “Hispanic,” without paying attention to specifi c differences between 
subgroups based on country of origin (Flores, et al., 2002). This is problematic 
in that it fails to recognize the unique social and historical differences between 
Latino subgroups, including acculturation and other factors which may speak 
directly to child development and mental illness. While emerging research in the 
fi eld of mental health has begun to examine Latino subgroup differences, this is 
another area for the improvement of intervention strategies on the individual 
level. Mental health problem intervention programs must be tested with specifi c 
Latino subgroup populations in order to determine effi cacy and inform further 
specifi city.

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     Clinicians who work with Latino youth must also make themselves 
aware of the unique social and cultural issues affecting this population and the 
ways in which these factors may impact clinical work on the individual level. 
As previously mentioned, Latino youth are disproportionately affected by a 
number of psychosocial stressors, including the deleterious effects of poverty, 
institutional racism, and community violence. In preparing to work with 
Latino children, social workers must make a thorough assessment of the 
context in which the client lives, as well as individual functioning. Parental 
involvement is crucial to any intervention aimed at children (McKay, 
Pennington, Lynne, et al., 2001). Recent research has demonstrated that 
family support and family cultural confl ict were strongly associated with self-
rated mental health among Latinos (Mulvaney-Day, Alegria, & Sribney, 
2007). Therefore, it is essential that social workers treating Latino children 
engage parents and other family members in their efforts to help the child 
achieve greater psychosocial functioning.

Mezzo-level Interventions: School & Community
          In order to improve school and community-based services, a number of 
steps could be taken. First, schools and community-based clinics could begin 
funding and implementing social marketing campaigns to educate children, 
parents, and community members about mental health problems. Social 
marketing campaigns can have small-to-moderate effects on health 
knowledge, beliefs, attitudes, and behaviors, which can be translated into 
signifi cant, positive public health outcomes (Noar, 2006). Community 
mental health intervention programs with a strong social marketing 
component have been used in Australia with favorable results (Wright, 
McGorry, Harris, et al., 2006); similar programs that specifi cally target 
Latino children’s mental health in the U.S. may also be effective. Through 
culturally tailored materials and targeted outreach efforts in English and Spanish, 
schools and community-based clinics may educate Latino families on the early 
detection of childhood mental health problems, inform parents of where to 
take their children for mental health screenings, and help to reduce the often 
confl icting information regarding etiology and treatment of mental illness in 
Latino communities. 
       Service providers, especially teachers and pediatricians that work with 
Latino families, may also be targeted on a community level. These professionals 
are often encumbered by limitations in implementing preventative services. 
For example, teachers are often assigned large class sizes and primary care 

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physicians are required to see more patients in less time. As a result, these 
professionals have less time to develop strong, ongoing relationships with 
families and are less likely to identify mental health problems (AAP, 2000). 
While the American Academy of Pediatrics recommended increased funding 
for specialized training programs and job incentives for qualifi ed child mental 
health clinicians in 2000, the U.S. continues to lack suffi cient numbers of trained 
mental health workers to handle the specifi c mental health care needs of 
Latino children. In order to address this problem, school- and community-based 
interventions may offer teachers and pediatricians extensive training on the 
recognition of mental health problems in children. By educating these providers 
about the importance of mental health screening, school- and community-based 
programs can expand the network of competent providers evaluating Latino 
children for mental health problems.

Macro-Level Interventions: Structural Transformation and Policy Development
      Despite the success of existing policy-level interventions, much more 
can be done to improve Latino children’s mental health on a structural level. 
For example, one of the key problems with mental health service delivery to 
Latino children is the severe shortage in culturally competent, bilingual service 
providers. Without Spanish-speaking mental health professionals who are able to 
understand and address the unique cultural considerations surrounding mental 
illness in Latino communities in clients’ preferred language, Latino children will 
continue to be underserved by the mental healthcare system. Local, state, and 
federal governments must be involved in efforts to expand minority provider 
networks. This may be done through the implementation of scholarship programs 
for Latinos interested in mental healthcare and/or tuition payback programs for 
providers who learn Spanish, participate in cultural competency trainings and 
work in minority neighborhoods after graduation. These types of programs 
currently exist but they are often fi nanced by private foundations. City, state, 
and federal policymakers may expand such programs by drafting legislation that 
institutionalizes and funds tuition payback programs in order to improve Latino 
children’s mental health in a more widespread manner.
    Policymakers can also improve mental health services for Latino 
children by implementing monitoring systems for mental health service 
provision and economic penalization for substandard service. “Families need 
mechanisms to communicate their comments and experiences [regarding 
mental health services] to those who purchase health care plans” (AAP, 2000, p. 
862). In turn, healthcare purchasers must be responsible for providing adequate 

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LATINO CHILDREN’S 
MENTAL HEALTH

information to clients about the quality and availability of culturally relevant 
mental health services. Many Latino children receive mental health services 
through federal programs, such as Medicaid and SCHIP. By setting up feedback 
systems that allow parents to express dissatisfaction with the quality of care their 
children are receiving, policymakers will help clients have a voice in the type of 
care they are offered. Opening channels for criticism, and backing up criticism 
with economic ramifi cations, will encourage mental health care providers to 
increase levels of service to meet clients’ needs.
       State and federal level policies can also help improve the detection and 
prevention of mental health problems among Latino children by implementing 
mandatory mental health screening programs in public schools. One of the main 
reasons for disparity in the need for mental health services and service provision 
is missed opportunities for early intervention. While time, energy, and fi nancial 
resources have been devoted to programs promoting children’s physical health, 
little emphasis has been placed on mental health among children. U.S. children 
are required to have physical examinations in order to attend public school; 
however, psychological evaluations are usually reserved until social, 
behavioral, or cognitive problems are far advanced. Government policies to 
implement mandatory screening for mental health problems in public 
schools will ensure the early detection of Latino children’s mental health 
problems. However, in order for screening programs to be effective, they must be 
reinforced by comprehensive services to treat Latino children’s mental health 
problems. 

Conclusion

   Latino children are at heightened risk for developing mental 
health problems due to a range of psychosocial factors, including poverty, 
community violence, acculturation, and adjustment stress (Wandersman & 
Nation, 1998; Vostanis, Tschler, Cumella, et al., 2001; McKay, Lynn, & 
Bannon, 2006).  At the same time, these children often face signifi cant barriers to 
receiving mental health services resulting from limited education regarding 
mental illness, scarcity of bilingual and bicultural service providers, and 
aversion to the mental health system due to cultural, spiritual, and religious 
factors. While some intervention programs have been implemented at the 
individual, community, and structural levels to address Latino children’s mental 
health, much remains to be done in order to address this signifi cant public health 
concern.  

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      Improvement of education campaigns targeted at parents and primary 
healthcare providers, expansion of community-based programs to address the 
limited knowledge surrounding mental illness and the scarcity of appropriate 
service providers, and implementation of policies for early screening, detection, 
and treatment are just a few of the strategies that may be employed to reduce the 
negative outcomes resulting from mental health problems in Latino children.  
In order for these changes to take place, mental health practitioners must view 
Latino children’s mental health as a priority and engage in advocacy efforts at all 
levels of social work and public health practice.

References

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A.N. (2002). Inequalities in use of specialty mental health services among 
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American Academy of Pediatrics [AAP]. (2000). Insurance coverage of mental 
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Armbruster, P., & Lichtman, J. (1999). Are school based mental health 
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IAN HOLLOWAY is a second year student in the dual-degree master’s 
program with the Mailman School of Public Health, within the Reproduc-
tive, Adolescent and Child Health track in the Heilbrunn Department of 
Population and Family Health and CUSSW, within the Advanced Clinical 
Practice method, in the Health, Mental Health and Disabilities fi eld of practice.  
He is a graduate of the University of California, San Diego with a bachelor’s 
degree in Literatures of the World and a minor in Law and Society.  Ian is 
currently placed at the Payne Whitney Clinic of New York Presbyterian 
Hospital.  His e-mail address is iwh2101@columbia.edu.

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