Addressing Emotional Wellness During the COVID-19 Pandemic

The Role of Promotores in Delivering Integrated Mental Health Care and Social Services

Kyle J. Moon; Gloria Itzel Montiel, PhD; Patricia J. Cantero, PhD; Saira Nawaz, PhD, MPH


Prev Chronic Dis. 2021;18(5):e53 

In This Article

Abstract and Introduction


Introduction: The disproportionate impact of the COVID-19 pandemic on Latino communities has resulted in greater reports of depression, anxiety, and stress. We present a community-led intervention in Latino communities that integrated social services in mental health service delivery for an equity-based response.

Methods: We used tracking sheets to identify 1,436 unique participants (aged 5–86) enrolled in Latino Health Access's Emotional Wellness program, of whom 346 enrolled in the pre–COVID-19 period (March 2019–February 2020) and 1,090 in the COVID-19 period (March–June 2020). Demographic characteristics and types of services were aggregated to assess monthly trends using Pearson χ2 tests. Regression models were developed to compare factors associated with referrals in the pre–COVID-19 and COVID-19 periods.

Results: During the pandemic, service volume (P < .001) and participant volume (P < .001) increased significantly compared with the prepandemic period. Participant characteristics were similar during both periods, the only differences being age distribution, expanded geographic range, and increased male participation during the pandemic. Nonreferred services, such as peer support, increased during the pandemic period. Type of referrals significantly changed from primarily mental health services and disease management in the prepandemic period to affordable housing support, food assistance, and supplemental income.

Conclusion: An effective mental health program in response to the pandemic must incorporate direct mental health services and address social needs that exacerbate mental health risk for Latino communities. This study presents a model of how to integrate both factors by leveraging promotor-led programs.


Mental health needs of working-class Black and Latino communities have long been insufficiently met in the United States.[1] The COVID-19 pandemic has exacerbated mental health needs through unpredictability and uncertainty, physical distancing, social isolation, loss of employment and income, mortality, and social suffering.[2] Among US adults surveyed in June 2020, 52.1% of Hispanic adults reported at least 1 adverse mental or behavioral health condition, compared with 37.8% of non-Hispanic White adults. Hispanic adults reported higher prevalence of anxiety or depressive disorder, trauma-related and stressor-related disorder, substance use to cope with stress, and suicidal ideation.[3] These disparities in mental health effects reflect the grief, bereavement, and stress related to financial insecurity resulting from the pandemic in Latino communities,[4] which along with other racial and ethnic minority communities, have been disproportionately affected by COVID-19 as a result of structural racism.[5]

Experts have called for local implementation[6] of community-level mental health interventions and prevention efforts that integrate financial relief and social services, promote social cohesion, and provide culturally and linguistically tailored education on COVID-19 and mental health.[2,3] The American Psychological Association has also called for a "reimagining" of the behavioral health system as one that reaches people where they are, recognizes wisdom in each community to solve its own problems, and looks to innovative roles for new mental health practitioners who are firmly rooted in their communities.[6,7] Responding to these calls to action, this study investigated the role of promotores de salud (community health workers) in providing community-led and integrated mental health care and social services in response to the COVID-19 pandemic in Latino communities of Orange County, California. Our findings may provide a model for integrating equity in mental health interventions during and after the pandemic.