Culturally Responsive ADHD Care With El Futuro's Dr. Luke Smith

Dr. Luke Smith walks us through how El Futuro, a nonprofit addressing Latino mental health care in North Carolina, advances culturally responsive ADHD support. He shares what culturally responsive care looks like, from philosophy to practice. Listeners gain insights into effective, culturally-attuned approaches for ADHD within a community-centered focus.

Highlights

• How being understood culturally helps clients heal and thrive.

• Examples of holistic and lifestyle-based ADHD treatment.

• Examples of common hurdles and real-world nuances in navigating treatment options.

Mentions

• El Futuro - https://elfuturo-nc.org

• ADHD Online Assessment: adhdonline.com/adultingwithadhd (use promo code ADULTINGADHD40 for $40 off)

Summary

In this episode, we sit down with Dr. Luke Smith, the founder of El Futuro, a nonprofit organization dedicated to transforming mental healthcare for the Latino community. Dr. Smith shares his philosophy that "culture cures," explaining how community connection and a sense of belonging are vital components of healing that go beyond standard Western medicine. He introduces the concept of incorporating more than just medication and therapy into treatment, highlighting the importance of "parties, play, and pushups"—using social gatherings, physical activity, and community events to reduce isolation and stress for families navigating mental health challenges.

The conversation dives deep into how this culturally responsive model specifically applies to ADHD. Dr. Smith discusses the challenges of stigma and the wariness many families feel toward medication, emphasizing the need for education in a family's native language. He highlights "El Faro" (The Lighthouse), an online, Spanish-language parenting program developed in collaboration with Duke University. This course empowers parents with behavioral training and psychoeducation, helping them advocate for their children in schools and realizing they are not alone in their struggles.

Finally, Dr. Smith addresses the systemic barriers in healthcare, noting that insurance often covers medication but fails to reimburse for essential holistic support like coaching and parenting classes. He advocates for a "lifestyle medicine" approach that treats the whole person, focusing on nutrition, sleep, nature, and limiting screen time to naturally boost dopamine. The episode wraps up with resources for listeners to connect with El Futuro’s work and a reminder of the importance of finding a supportive community on your ADHD journey.

Transcript

This is the adulting with A DHD podcast. Self-empowerment for people with A DHD. Today I am excited to have with me Dr. Luke Smith, founder of El Futuro. It's a community based nonprofit organization that seeks to transform Latino serving mental healthcare in North Carolina and beyond. Welcome to the show, doctor.

Thank you very much. It's great to be with you. To start, tell us a little bit about yourself and how you came to specialize in culturally responsive care for Latinos. Well, I am. Working in a Latino serving organization and I'm not Latino. Mm-hmm. I'm from Arkansas. Mm-hmm. Um, sometimes my joke is that I moved to the north when I moved to North Carolina, so I migrated, which is silly and funny, but it was a little bit of a change for me.

I went to North Carolina to do my training in psychiatry residency, and then a fellowship and child and adolescent psychiatry. And during that time. I was around the Latino culture. Mm-hmm. And fell in love with culture and just the differences that culture makes on treating people with mental illness.

And I found that to be as fascinating as the work that I was doing learning about psychiatry. Right. Yeah. So why is this model of care so important? It seems like the emphasis here is culturally responsive care. Can you talk a little about that? Yes, I can. The phrase that we've used sometimes is culture cures and that we understand as, um, sociologists and social workers and psychiatrists or mental health professionals have traditionally seen that people who feel in community, who feel understood by people around them, their culture, that if it's a positive culture, that it can be healing and therapeutic.

For the Latino community where I work at Futuro and the work that we've been doing over 20 years, we've valued that and really enhanced that as part of our actual practice. How do we bring people together around culture, deepen their roots and connections in that way, and that's what's we've found is protective and helpful for them in their healing or just in their wellbeing.

Mm-hmm. Can you give us some examples of what that looks like? Just a week ago during Hispanic Heritage Month, we had a huge cultural community fiesta called a es, which is mm-hmm. In Latin America, very traditional, and it brings people out to make food and share their crafts and play games and raise money for, um, an event of some sort.

That would be one example. Mm-hmm. For us, what we see is that when people participate in that. It reduces their feelings of stress, uh, reduces depression and anxiety, increases togetherness and reduces loneliness. It makes people feel proud. And right now, especially in a time where immigrant communities are feeling under attack and threat and feel, uh, they're not being accepted or welcomed, that makes them feel a sense of belonging.

And that's really important. So that's a way that we can. I have a hope someday. I haven't done this. I've done a draft of it, of a t-shirt that says Prozac. It's all P words. Prozac and psychotherapy, and parties and play. And this would be a pachanga or a big party of some sort or pushups, like physical exercise.

There's a lot of P words, it turns out. Yeah. Painting. Planting, there's, there's a lot of wonderful p wordss that you can put in there and kind of say, you know, it's not all about a medication or a psychotherapy necessarily, but it's a lot of other things like that party. I love that. Yeah. What are some of the challenges you've encountered with your A DHD patients specifically, and, and where does culture fit into that?

Well, the culture that we are in, very much segments and silos, people. In Western medicine, the medicine that I learned around A DHD in particular was first of all to label it as a disorder. And I think a lot of people are relabeling it as, actually this is not bad. There's some really great parts about being attentive to everything all at once, but sometimes you need to focus and you needed to actually lock in.

But the way that we have traditionally done that is to do a quick rating scale and give 'em medicine and. I found that a lot of families were coming to me and they were already wary of medicine and they were first leading with, is there anything but medicine that we can do? And I didn't find myself real prepared to address that question.

Um, and so as we thought about that, we actually brought the families in and we said, all right, let us hear what you're thinking. First of all, how do you understand what is a DHD in your own language? Not in our DSM four language. And then what are the things that have helped you so far? And that was very eye-opening for somebody who had trained as long as I'd trained, thought I was all that, all of a sudden I was listening and, and really learning a lot from these parents.

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Yeah, there's a lot of examples that I could give around that. Yep. Please do. I think maybe I'll start with just principles of how we're understanding what is the best kind of treatment and we, um, first of all, wanna make sure that if it is a DHD, it really is a DHD in a culture or in a language. Change that.

There are some other things that can be very distracting and disruptive for kids and families. There's a lot of stigma and a lot of biases in there. And so the first is just understanding it and describing it and using language that people can understand. Mm-hmm. Um, and that sometimes happens in individual communication with a provider like me, or it happens.

Maybe with a cultural ally, somebody who looks like that person and can talk with them after an appointment, or we've of videos where we do conversations to normalize it. And so we have a, a parent who is from country that maybe this other parent is from, and we have a short little eight minute conversation and just talk about what does it mean to be impulsive?

And all of a sudden they go, oh, I'm not the only one with a kid like this, and this really is legitimate. This is something, it's not just. What my mother-in-law has told me, which is like, I'm a bad parent. And so it really starts with that first initial, what is it? What's, what's going on with my kid? And then how do we socialize that and communicate it in a way that the parent doesn't feel further put upon or stressed because they've done a bad job.

So that's the principle and that's an example. The other principles that we use besides psychoeducation or just education and acculturation of what this is mm-hmm. Is. Actual the treatment or the, the support that we provide. And so we see coaching is essential for the parent. Oftentimes the parent also has a DH, ADHD, or one of the parents does.

So we need to actually help that parent out with their own distress and, and help them, but also how they can behaviorally shape what they're doing at home to better support their child if the child is bold enough that that child can also do their own coaching. And I say that because we've really found that it's a, it's a, the smaller children have a little bit more difficult time engaging in formal coaching.

Mm-hmm. It's more gonna be what the parents do to shape them on a daily basis. School supports is another really big thing that we invest in. How can we get environments better for these children? And, you know, a lot of those environments don't understand just as much as a family member doesn't understand and actually criticizes the mom.

Same thing happens at school. The teachers and staff look at that mom and say, it's just 'cause you didn't speak English at home, or because you're not reading to them enough, or because you're not disciplined enough. They're, they're not acknowledging, Hey, this is a kid with a different learning style. And it's not a, a kid who is less capable but actually just needs to be helped differently.

Um, and then the other thing that we do is we do, let's go out and let's go on a hike. We take our kids and our families, and, and we did, we've done this primarily with the, the kids and the fathers who don't oftentimes come to the appointments. Mm-hmm. And so we go on hikes, we go camping, we do things that are very physical and in those we have opportunities to do more education and more socialization with other families so that, that, that dad perhaps looks at another dad and goes, oh, your kid's got that too?

I thought it was just my kid being misbehaved. And then they start to have conversation. I'll give another example of something that we've done. So parent behavior, or I'm sorry, behavior Parent training is a gold standard American Academy of Pediatrics. This is the way we help parents know how to help their children, and we looked at that and we solved that.

Well, that's been around for 20 years and is well studied and well validated that when. Done in another language. It's kind of like a Google Translate moment. Mm-hmm. But it's not really adapting it in a way that makes a lot of sense for those parents. So, pulled it apart and put it back together. Did did it in a research collaboration with Duke University's A DHD program.

And then we validated it on the backside to, to say, Hey, does this work? And we, we saw parents really engaged. We did things like realizing, and this was all online. It's an online class because we can reach more people. Yes. Free. Mm-hmm. Um, parents from all over came into these classes and we would send them a workbook.

'cause we realized that a lot of 'em were watching on the little screen on their telephone. And that was not big enough to see a PowerPoint. And so we would send them a workbook. They would go through, do homework exercises. We taught the things that I've mentioned, which are around psychoeducation education, about what it is, empowerment for school, other enrichment resources.

They can do their own emotional regulation, as we know with A DHD. That's, that is true for children and adults who have a DHD. That emotional regulation is challenging and it's especially challenging when you're dealing with that kid who just sets you off. Um, and then we did A, B, C. Eds behaviors, consequences, training, which is a, you know, very tried and true parenting methodology.

We taught these parents how to do that. We do role plays. It's beautiful. It's like eight sessions. We facilitate this. We do this on an ongoing rolling basis, and we have people now because it's online from other states, other countries who join in, it's all in Spanish, that that was really. Helpful in a lot of ways.

'cause as we evaluated it, we saw people feel better about their parenting skills and know how to handle their kids feel more empowered to go into the schools. One of the big things that I always watch that is just amazing and consistently happens is the parents do this moment where they step back and they see all these other parents in the class and they say, oh my goodness, I'm not the only one with a kid like this.

Not my fault. And. Listen to other ideas, and all of a sudden they get more confidence. And that right there I think is so important in everybody's journey along this road of their own struggles with their own A DHD or with their child child's. A DHD is just being connected. I, I love your podcast because that's what you're doing.

You're connecting people with other people, and I think that that's an essential component that. I don't need to go to medical school and psychiatry program and prescribe a, a medication or something to get that kind of outcome. That outcome is golden and I'm so glad to see people rushing into that space to do that kind of link and connecting.

Mm-hmm. Thank you for saying that. Where are you guys still giving that class? Is it an an ongoing thing? Where can people learn more about that? It is. It's all in Spanish. Mm-hmm. We have hopes to make it into English at some point. It's called El Farro, which is Lighthouse in Spanish. That's how that's said.

And it's kinda a lighthouse class for these parents. And so it's online. It's on our website at El Fuo. We hope to do it in English at some point. We also are in a season right now where we're serving and we're listening to adolescents and their parents because that class was really developed for pre-adolescent children

Parents? Mm-hmm. It's just for the parents. It's not for the children, it's for the parents. But we'd like to do something for adolescents 'cause we haven't got that class for adolescents. We may do individual work with adolescents, but we really need to do a better job for the adolescents. And then after that, we're gonna squarely look at adults.

Even though we do that kind of work, we just wanna keep building out our toolkit to help more and more people. I love it. And again, where can listeners keep up with you and your work? What else do you guys have Resource wise? Yeah. Well, we have social media that I'm not always the most, I'm over 50 now, and so I'm not always the best on that, but we have Facebook and Instagram and we have our website.

We have a whole webpage dedicated to our program where all of our videos are on their registration for those classes, other resources. And we're very open for collaboration. We're finding that. One of the bigger structural issues right now is that the healthcare agencies, Medicaid or CMS people in those positions have not valued yet either the impact of A DHD of people's lives and valued it as a diagnosis that actually needs to get help and support, or have actually acknowledged that there's a treatment outside of a medication to get reimbursement for coaching.

For running one of those classes for supporting the school intervention, that's not reimbursed. That's not something that healthcare payers are yet willing to acknowledge is needed, even though it's a best practice and it is exactly what the evidence is saying we need to do and has been saying for a long time.

It's not, it's not valued, and so we need to push forward, keep doing those practices that are, like you said, whole person care. Then we need to really advocate for those bigger healthcare entities to actually put their money where their mouth is and say, this is what we need to do to help these kids, these adolescents, these adults, to flourish and have success.

Because short of that, just paying for a medication is not gonna do it. We all know that. And it can be very helpful. Definitely. And it can also be harmful and it can also not be exactly what the person needs. We have to consider each person individually. Um, if you can even access it. If you can even access it.

I just, this morning was texting back and forth with a mom who I had prescribed medicine for last week and trying to explain what is good RX, because she doesn't have insurance and she needs to find it. And then I need to be a sensitive practitioner to make sure that I prescribe one that is. Supported by GoodRx and a pharmacy that will acknowledge that as well.

So it's a lot of little nuances in there, and it's not as black and white or as simple as put 'em on a long acting stimulant that's too expensive that that insurance won't pay for and that is gonna cause a host of side effects potentially that you overdosed and didn't give it appropriate level.

There's a lot of nuance that needs to be thought about. Absolutely. I can attest to that firsthand. It's very tricky, tricky constellation of stuff. Yeah, for sure. Yeah, and and I think one other thing is that we really think I am, am a big fan and our team is a big fan of lifestyle medicine, what's been called lifestyle medicine now, and all of those pillars.

Every family I meet with, I go through a little quiz and talk about how. How do we increase the dopamine in our brain? What are the things that we do that we do a quiz and I have the kids and the families respond on what is it like to eat protein-based nutrition and plant-based nutrition and physical activity and being in nature and how that boosts your attentional abilities and getting good sleep and staying off the technology, right?

There's, these are just foundational. Elements that every practitioner now needs to really be on top of and say, I know this stuff. I believe it and I'm gonna preach it out because this, and, and then do it in a motivational interviewing kind of way where we are not preaching it out. That was the real word, but really.

Yeah. Empowering out. Yeah. It was an appointment recently and the doctor pulled out an image and was this is your brain on a screen after two hours? So effective. I, I love that kind of stuff. Oh man. I want that image. Yeah, that sounds really powerful. Yeah. Well, Dr. Smith, thank you for being on the show.

Yeah, thank you. Been a pleasure.