Spanish Spoken Here: CASA CHESS offers anytime, anywhere bilingual support

A Spanish version of A-CHESS (Addiction Comprehensive Health Enhancement Support System), the smartphone application developed to provide support to people with substance use disorders, is now being tested in Boston. Called CASA CHESS, the application offers all of the A-CHESS features in Spanish, along with an additional tool to monitor medication adherence.

Dr. Jordana Muroff, Assistant Professor at the Boston University School of Social Work, is collaborating with Boston’s Casa Esperanza on the three-year project funded by SAMHSA.  Casa Esperanza opened in 1987 as Massachusetts’s first bilingual/bicultural residential treatment program.

As the U.S. population becomes more diverse, behavioral healthcare organizations face the challenge of providing culturally and linguistically relevant care. It’s a pressing need for the growing Hispanic and Latino population, which today represents 16.7 percent of the U.S. population and is estimated to grow to 30% by 2050. (National Hispanic and Latino ATTC Network, “Meet your new clients: Hispanics and Latinos”)

“In Boston, Latinos have the highest rate of substance abuse treatment admissions compared to other racial/ethnic groups, along with the highest mortality rates due to heroin and opioid use,” says Dr. Muroff. “We frequently see substance abuse and co-occurring mental health disorders in this population, associated with a higher likelihood of homelessness and more frequent relapse. Additionally, Latinos have lower rates of health insurance contributing to poor management of health overall,” she adds. Compounding the problem is the limited availability of linguistically and culturally competent services for Latinos.

But mobile apps can help bridge this gap. “Mobile applications present an ideal tool for delivering support and information to populations that may not otherwise have access to the Internet,” says Dr. Muroff.  “And there is high usage of mobile technology in the Hispanic and Latino population, perhaps because this group is less likely to have home computers with Internet access.”

Hispanics and Latinos are also very open to using a mobile health intervention. “This may be again due to the lack of access to culturally and linguistically appropriate care and because of the privacy it affords,” notes Dr. Muroff.    

While Spanish-language mobile applications are widely available, Dr. Muroff was unable to find one that delivered support and information for people with substance abuse and mental health issues.  And A-CHESS offers the suite of tools she was looking for, but not in Spanish.

“The solution was to translate A-CHESS into Spanish and make some culturally relevant adaptations,” explains Dr. Muroff.  “It allows us to create a tool that is not only bilingual, but one we can also fine-tune in terms of language.” Dr. Muroff notes that a Spanish-language application needs to consider the many varieties of Spanish: Hispanics and Latinos in the U.S. represent more than 20 countries, each with unique vocabulary and idioms.

 “CASA-CHESS was developed to reflect the Spanish-speaking population in the Boston area, which is predominantly Puerto Rican and the Dominican.”  A consumer advisory board and clients using CASA CHESS have been providing feedback on language issues as CASA CHESS was developed and is being tested.

A small group of patients who recently completed residential treatment at Casa Esperanza began to test CASA CHESS in January.  Study participants will have access to smart phones loaded with CASA CHESS for a year.  The research team will follow up with patients at 6 and 12 months to measure relapse, mental health symptoms, issues related to medication adherence, client engagement in social activities, and social connectedness overall.     

The medication adherence survey is a new tool developed for CASA CHESS. “This tool includes personalized reminders to take medications and notifies the case manager whether the clients took their medications and specific barriers that may need to be addressed (e.g., the client ran out of a medication),” says Dr. Muroff.

“At the end of the study period, we will evaluate the overall effectiveness of CASA CHESS.  Our goal is also to develop a sustainability plan for using technology to support Latinos recovery and prevent relapse,” says Dr. Muroff  “This is a new and exciting service delivery method that is being offered to a group of clients. If successful, we will be looking at ways to make CASA CHESS a service that would be available to all Casa Esperanza clients and beyond.”