Oregon University September 2008 Relational Intercultural With Latino Families

785 views
697 views

Published on

Published in: Education, Technology
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
785
On SlideShare
0
From Embeds
0
Number of Embeds
19
Actions
Shares
0
Downloads
0
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
  • Oregon University September 2008 Relational Intercultural With Latino Families

    1. 1. Relational-Intercultural Therapy & Consultation with [email_address] Families Gonzalo Bacigalupe, EdD, MPH Associate Professor & Department Chair Counseling Psychology Department University of Massachusetts Boston [email_address]
    2. 2. Our Location (s) <ul><li>Who? </li></ul><ul><ul><li>Self </li></ul></ul><ul><ul><li>Other </li></ul></ul><ul><li>Why? </li></ul><ul><ul><li>Self </li></ul></ul><ul><ul><li>Institution </li></ul></ul><ul><li>What… </li></ul><ul><ul><li>do I know? </li></ul></ul><ul><ul><li>should/want to know? </li></ul></ul>Do dragons exist only in picture books ? Reproduced with permission by Mona Caron
    3. 3. Latin@ Demographics
    4. 4. Disparities Context <ul><li>Majority and minority populations persistent gap: </li></ul><ul><li>research evidence is overwhelming but policy is often not informed by powerful research… </li></ul><ul><li>Health insurance is a family issue </li></ul><ul><li>among families with children, Latino families are most likely to have at least one uninsured member (41%), followed by non-Hispanic African-American families (23%), and non-Hispanic white families (13%) (IOM, 2002) </li></ul><ul><li>Socioeconomic conditions play an important role but even not socio-economically disadvantaged people of color have different health care experiences (with similar medical conditions and health coverage). </li></ul>
    5. 5. Problematic research trends <ul><li>Clinical evidence research (EBT) may be studying minority clinical populations but not as collaborating partners fostering resentment and suspicion rather than partnerships </li></ul><ul><li>One bullet approaches miss opportunities for culturally competent interventions </li></ul><ul><li>Few research leaders resemble the population studied </li></ul><ul><li>With researchers “added on” as the “population studied is diversified” </li></ul><ul><li>Prevalence of large and costly studies with tremendous overheads and little impact on communities. Studies with high level of community involvement are rarely funded adequately </li></ul><ul><li>Continuous attention to disintegrated approaches to research that mirror and reinforces non-holistic health interventions as well as in child protective services, education, housing, and working conditions </li></ul>
    6. 6. A Brief Exercise on Cultural Humility <ul><li>Create a story … (in no more than 5-8 minutes) </li></ul><ul><ul><li>Who is the driver? If he were part of your clinical portfolio, how would you characterize him? </li></ul></ul><ul><ul><li>What is the most likely scenario (past-future)? </li></ul></ul><ul><ul><li>What assumptions inform your perspective? (If you have time…) </li></ul></ul>
    7. 7. BICAP Ten Cultural Competence Commitments <ul><li>the client is the expert on his or her own experience, culture, traditions, values, and belief systems </li></ul><ul><li>and is the expert of which of these traditions, values and behaviors are adaptive, maladaptive, effective or ineffective </li></ul>Boston Institute for Culturally Accountable Practices (BICAP) (Bacigalupe, Kamya, King, Kliman, Llerena-Quinn, & Trimble, 2007)
    8. 8. BICAP Cultural Competences <ul><li>3. one of the clinician’s challenges is to facilitate the deconstruction and/or analysis of 1 and 2 </li></ul><ul><li>4. all clinicians are potentially ethnocentric in the way they think, feel, and intervene with clients. Clinicians who aspire to be culturally competent accept as one of their responsibilities, a relentless search for ethnocentric blind spots, privilege and bias in their interactions with clients and especially clients who have experiences that are foreign to or unfamiliar to the clinician </li></ul>
    9. 9. BICAP Cultural Competences <ul><li>5. there should be frequent and periodic multicultural team analysis of 4 </li></ul><ul><li>6. cultural competency is a continuous process that can be enhanced but not completed </li></ul>
    10. 10. BICAP Cultural Competences <ul><li>7. the clinician “innocent by way of good intentions” is contrary to the mission of cultural competence. The goal is to accept that we will injure and to constantly dicover how our ethnocentrism, privilege and blind spots can undermine our respect for difference and our mission to become culturally competent </li></ul>
    11. 11. BICAP Cultural Competences <ul><li>8. Cultural competence requires an obsessive deconstruction and reconstruction of the power dynamics in cross-cultural, cross-gender, cross-ability, cross-class, cross-racial, etc. in relationships </li></ul>
    12. 12. BICAP Cultural Competences <ul><li>9. The development of CC is virtually impossible to do with without significant discomfort. The clinician agrees to persist and endure in the face of discoveries about him/her that may be egodystonic and discomforting but the clinician does so with the belief that ther will be growth educing experiences and will ultimately improve his or her capacity to become aculturally competent clinician </li></ul>
    13. 13. BICAP Cultural Competences <ul><li>10. A commitment to receptive learning from and exposure to people who are from different cultures with full regard for the very significant risk about how this learning and exposure incrases the risk of steoreotyping and developing atrbutions that invite the dismissal of the individual differences that exist in every culture. </li></ul>
    14. 14. <ul><li>Powerful contexts define the lives of Latin@s but researchers insist on construing Latin@s only within a cultural and ethnic framework </li></ul><ul><li>Individualistic ethnic psychology define Latin@s’ identities enclosed within an amorphous cultural landscape </li></ul>Research Premises 1
    15. 15. Research Premises 2 <ul><li>Research continue to construe Latin@s, almost exclusively, in terms of how they have been victimized, robbing Latin@s of their agency and capacity to reorganize their familial, social, and political contexts </li></ul><ul><li>Psychotherapy continues to treat “the culturally different” rather than support alternative epistemologies </li></ul>
    16. 16. Psychology & Health Research View of (…) <ul><li>Deficient </li></ul><ul><li>In need </li></ul><ul><li>Passive (or too impulsive) </li></ul><ul><li>Without agency </li></ul><ul><li>Backward </li></ul><ul><li>Needing to acculturate without ambivalence </li></ul><ul><li>or, informed by misplaced intentions </li></ul>Photo by Bacigalupe (2004)
    17. 17. Constructing an Identity Part 1 Family History and Clinical Practice <ul><li>Aspects of clients’ immigration history and stories parallel clinicians’ own immigration histories and stories </li></ul><ul><ul><li>Acculturation processes </li></ul></ul><ul><ul><li>Economics </li></ul></ul><ul><ul><li>Family as an identity focus </li></ul></ul><ul><li>It is more than just being an immigrant. We all have suffered some for of racism or oppression. </li></ul><ul><li>Being on the other side, my experiences, makes me more sensitive. I always ask, “Am I really listening to this person? Is my own racism coming in? “ I’m also asking them to educate me. </li></ul>
    18. 18. Constructing an Identity Part 2 Family History & Clinical Practice <ul><li>Family experiences provide a fundamental framework for professional learning and choice of professional focus </li></ul><ul><ul><li>I have immigrated twice, from a rural area to the city and then the USA. The first thing that guided me to this career choice was my own personal struggle. </li></ul></ul><ul><ul><li>When I came, I didn’t have the language, so I was searching for a Spanish-speaking therapist. I can use my experience as a child who was maltreated in her family </li></ul></ul>
    19. 19. Constructing an Identity Part 3 What is Family ? <ul><li>Being in the “hyphen” </li></ul><ul><li>Extended family’s involvement </li></ul><ul><ul><li>Families afar are close (alla/aca) </li></ul></ul><ul><ul><li>Transnational families </li></ul></ul><ul><ul><li>Plastic configuration of nuclear family </li></ul></ul><ul><ul><li>You’re always with somebody, you’re never alone, the more they acculturate, though, the more they are willing to help or connect with others, they see less people, they worry about having more… </li></ul></ul>
    20. 20. Immigration assumptions <ul><li>The and “ the” immigrant experience </li></ul><ul><li>A process rather than an event </li></ul><ul><li>Separation / reunification are core </li></ul><ul><li>Relational may not = family work </li></ul>
    21. 21. Immigration assumptions <ul><li>Bicultural triangulation (be careful) </li></ul><ul><li>Needs delivery rather than bicultural expertise availability </li></ul><ul><li>Mutual-fluid learning experience </li></ul>
    22. 22. What interventions / research? <ul><li>Dally Sanchez spent her adolescence getting &quot;treatment&quot; - and the memories still sting: As a traumatized incest survivor, she recalls dealing with a social worker who couldn't talk to her Spanish-speaking mother, being restrained by staff at a youth psychiatric facility and a threadbare education in special-education classes that offered no hope of going to college. &quot;The reality is that in the mental health system, once you fall in there, you're not a person anymore,&quot; said Sanchez, now 27. </li></ul><ul><li>&quot;Somehow, having a label or having some sort of emotional problem or trauma removes your civil and human rights.” </li></ul><ul><li>Beyond enhancing services, some advocates look toward systemic reforms that can tackle the social factors driving psychological issues. In Sanchez's view, promoting mental health is not about clinics or hotlines, but more fundamentally, improving lives and communities.&quot;We need to build communities and communities' ability to take care of themselves,&quot; she said, by strengthening schools, social-service groups, and other community institutions. </li></ul><ul><li>(Michele Chen, Gotham Gazette, 2008) </li></ul>
    23. 23. Why don’t they come? <ul><li>Structural barriers </li></ul><ul><li>Institutionalized racism </li></ul><ul><li>Acculturation and bicultural processes </li></ul><ul><li>Fear & distrust </li></ul><ul><li>Mental health seeking behavior </li></ul><ul><li>Microaggressive interactions </li></ul><ul><li>Services don’t fit </li></ul>
    24. 24. Structural/Institutional Barriers <ul><li>Insurance </li></ul><ul><li>Transportation </li></ul><ul><li>Child care </li></ul><ul><li>Managed care rules </li></ul><ul><li>Lack of flexibility in scheduling </li></ul><ul><li>Lack of understanding of therapeutic Institutions </li></ul><ul><li>Family literacy vs. agency’s expectation </li></ul>
    25. 25. Overcoming Access Disparities <ul><ul><ul><li>Bacigalupe, G., Upshur, C., Cortes, D., Torres, A., Chernoff, M. & Gorlier, JC. (2004, January). MAS SALUD: Assuring quality health care for Hispanic MassHealth Consumers. Final Report. DHHS, CMMS. Grant # 25-P-9093911-01/02. </li></ul></ul></ul><ul><ul><ul><li>Bacigalupe, G., & Upshur, C. (2002). How do insured Latinos overcome barriers to health care access and quality? Developing a model based on qualitative findings. American Public Health Association 111 th Annual Meeting, Philadelphia. </li></ul></ul></ul>
    26. 26. Institutional Competency <ul><li>Increase availability and access </li></ul><ul><ul><li>Available </li></ul></ul><ul><ul><li>Access </li></ul></ul><ul><ul><li>Acceptability </li></ul></ul><ul><ul><li>Accountable </li></ul></ul><ul><ul><li>The challenge of outreach </li></ul></ul>Organista, K. C. (2007). Solving Latino psychosocial and health problems: theory, practice, and populations . Hoboken, N.J.: Wiley
    27. 27. Institutional Competency <ul><li>Assessment and Intervention </li></ul><ul><ul><li>Social justice </li></ul></ul><ul><ul><li>Acculturation/adjustment </li></ul></ul><ul><ul><li>Stratification </li></ul></ul><ul><ul><li>Ethnic identity </li></ul></ul><ul><ul><li>Diversity </li></ul></ul><ul><li>The challenge of empowerment </li></ul>
    28. 28. Institutional Competency <ul><li>Select culturally and socially acceptable interventions </li></ul><ul><ul><li>Latin@ client expectations and needs </li></ul></ul><ul><ul><li>Family-centered services </li></ul></ul><ul><ul><li>Community-based services </li></ul></ul><ul><ul><li>Attend to different groups </li></ul></ul><ul><ul><li>Work outside the culture in non-oppressive ways </li></ul></ul><ul><li>Increase service accountability </li></ul><ul><ul><li>Evaluate </li></ul></ul>
    29. 29. Acculturation & Psychological Distress Model <ul><li>Lineal negative relation: low acculturated immigrant experiences the strains of persistent isolation, unfamiliar and unpredictable environment, and low self-esteem </li></ul><ul><li>Lineal positive relation: higher acculturated immigrant becomes isolated from traditional support group and internalize stereotypes and prejudicial attitudes toward Latin@s </li></ul><ul><li>Curvilinear relationship: good mental health is the result of an optimal combination of cultures (bicultural identity) </li></ul>Rogler, L. H., Cortes, D. E., & Malgady, R. G. (1991). Acculturation and mental health status among Hispanics: Convergence and new directions for research. American Psychologist, 46 (6), 585-597.
    30. 30. CBPR Partnership: Trust <ul><li>First Level of Trust (initial partnership) </li></ul><ul><ul><li>Acknowledge personal & institutional histories </li></ul></ul><ul><ul><li>Understand historical context of the research </li></ul></ul><ul><ul><li>Be present in the community and listen to community members </li></ul></ul><ul><ul><li>Acknowledge expertise of all partners </li></ul></ul><ul><ul><li>Be upfront about expectations and intentions </li></ul></ul>Christopher, S., Watts, V., McCormick, A. K., & Young, S. (2008). Building and maintaining trust in a community-based participatory research partnership. American Journal of Public Health, 98 (8), 1398-1406. Wallerstein, N. B., & Duran, B. (2006). Using community-based participatory research to address health disparities. Health Promotion Practice, 7 (3), 312-323.
    31. 31. CBPR Partnership: Trust <ul><li>Second level (expanding partnership) </li></ul><ul><ul><li>Create ongoing awareness of project history </li></ul></ul><ul><ul><li>Revisit first-level recommendations </li></ul></ul><ul><ul><li>Match words with actions </li></ul></ul><ul><ul><ul><li>Recognition of community </li></ul></ul></ul><ul><ul><ul><li>Benefits community </li></ul></ul></ul><ul><ul><ul><li>Collaborative work </li></ul></ul></ul><ul><ul><ul><li>Community informed </li></ul></ul></ul><ul><ul><ul><li>Sustainability efforts </li></ul></ul></ul>Christopher, S., Watts, V., McCormick, A. K., & Young, S. (2008). Building and maintaining trust in a community-based participatory research partnership. American Journal of Public Health, 98 (8), 1398-1406. Wallerstein, N. B., & Duran, B. (2006). Using community-based participatory research to address health disparities. Health Promotion Practice, 7 (3), 312-323.
    32. 32. Research / Clinical Findings: Health seeking behaviors <ul><li>Trust ( confianza ) </li></ul><ul><li>Trust in the person rather than the institution ( personalismo ) </li></ul><ul><li>Respect of elders ( respeto ) </li></ul><ul><li>Sense of shame ( verguenza, privacidad ) </li></ul><ul><li>Pride ( orgullo ) </li></ul><ul><li>Familism </li></ul><ul><li>Fatalism </li></ul><ul><li>Present orientation </li></ul>Rogler, L. H., Malgady, R. G., & Rodriguez, O. (1989). Hispanics and mental health: A framework for research. Malabar, FL: Robert E. Krieger.
    33. 33. Racial microaggressions <ul><li>Brief , commonplace daily verbal, behavioral, or environmental indignities, intentional or unintentional, that communicate hostile, derogatory,or negative racial slights and insults toward people of color. </li></ul><ul><li>Perpetrators of microaggressions are often unaware that they engage in such communications when they interact with racial/ethnic minorities. </li></ul>Sue, D. W. (2004). Whiteness and ethnocentric monoculturalism: making the &quot;invisible&quot; visible. American Psychologist, 59 (8), 761-769. Sue, D. W., Bucceri, J., Lin, A. I., Nadal, K. L., & Torino, G. C. (2007). Racial microaggressions and the Asian American experience. Cultural Diversity Ethnic Minority Psychology, 13 (1), 72-81.
    34. 34. Categories and Relationships among racial microaggressions Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M., Nadal, K. L., et al. (2007). Racial microaggressions in everyday life: implications for clinical practice. American Psychologist, 62 (4), 271-286.
    35. 35. Examples of racial microaggressions your examples? Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M., Nadal, K. L., et al. (2007). Racial microaggressions in everyday life: implications for clinical practice. American Psychologist, 62 (4), 271-286.
    36. 36. Making research matter <ul><li>Focus on values </li></ul><ul><ul><li>Where are we going? Is it desirable? What should be done? </li></ul></ul><ul><li>Place power at the core of the analysis </li></ul><ul><ul><li>Who gains and who loses? What possibilities of changing existing relationships? </li></ul></ul><ul><li>Anchor research problem in context (external validity) </li></ul><ul><li>Emphasize little things (thick description) </li></ul><ul><li>Look at practice before discourse </li></ul><ul><li>Study cases and contexts </li></ul><ul><li>Ask how (in addition to why) </li></ul><ul><li>Focus on the actor and the structure (both/and) </li></ul><ul><li>Dialogical: an ongoing social dialogue (not the truth) </li></ul>Flyvbjerg, B. (2001). Making social science matter : why social inquiry fails and how it can succeed again . New York: Cambridge University Press.
    37. 37. Research Collaboration <ul><li>Community participates in data analysis & interpretation </li></ul><ul><ul><li>Advisory board </li></ul></ul><ul><ul><ul><li>Focus group coding, modeling, interpretation </li></ul></ul></ul><ul><ul><li>Community media </li></ul></ul><ul><ul><ul><li>Murals </li></ul></ul></ul><ul><ul><ul><li>Webpage </li></ul></ul></ul><ul><ul><ul><li>Wiki </li></ul></ul></ul><ul><ul><li>Embed research into community intervention </li></ul></ul><ul><ul><ul><li>Photo-voice </li></ul></ul></ul><ul><ul><ul><li>Family literacy groups </li></ul></ul></ul><ul><ul><ul><li>Map Mashups </li></ul></ul></ul>For example: Cashman, S. B., Adeky, S., Allen, A. J., 3rd, Corburn, J., Israel, B. A., Montano, J., et al. (2008). The power and the promise: working with communities to analyze data, interpret findings, and get to outcomes. American Journal of Public Health, 98 (8), 1407-1417. Wandersman, A. (2003). Community science: bridging the gap between science and practice with community-centered models. Am J Community Psychol, 31 (3-4), 227-242.
    38. 38. Example: immigration raids <ul><li>Immigration policy matters </li></ul><ul><li>Strength-Based approach </li></ul><ul><ul><li>Ecosystemic and Family life cycle </li></ul></ul><ul><ul><li>Cultural negotiation </li></ul></ul><ul><ul><li>Health promotion interventions </li></ul></ul><ul><li>Cultural and community resources </li></ul><ul><li>Multi-method data collection </li></ul><ul><ul><li>Collaborative </li></ul></ul><ul><ul><li>Accountable </li></ul></ul><ul><ul><li>Supports advocacy </li></ul></ul>Adapted from Shapiro, Atallah-Gutierrez, Corona-Ordonez, Lykes (2008). Latino immigrants’ psychological and sociopolitical responses to immigration raids: Personal and community resources promoting resilience, resistance, and familia. APA Annual Convention, Boston MA.
    39. 39. What interventions / research? <ul><li>Dally Sanchez spent her adolescence getting &quot;treatment&quot; - and the memories still sting: As a traumatized incest survivor, she recalls dealing with a social worker who couldn't talk to her Spanish-speaking mother, being restrained by staff at a youth psychiatric facility and a threadbare education in special-education classes that offered no hope of going to college. &quot;The reality is that in the mental health system, once you fall in there, you're not a person anymore,&quot; said Sanchez, now 27. </li></ul><ul><li>&quot;Somehow, having a label or having some sort of emotional problem or trauma removes your civil and human rights.” </li></ul><ul><li>Beyond enhancing services, some advocates look toward systemic reforms that can tackle the social factors driving psychological issues. In Sanchez's view, promoting mental health is not about clinics or hotlines, but more fundamentally, improving lives and communities.&quot;We need to build communities and communities' ability to take care of themselves,&quot; she said, by strengthening schools, social-service groups, and other community institutions. </li></ul><ul><li>(Michele Chen, Gotham Gazette, 2008) </li></ul>
    40. 40. MECA <ul><li>Multidimensional </li></ul><ul><ul><li>Cultural borderlands (no cultural purity) </li></ul></ul><ul><li>Ecosystemic </li></ul><ul><ul><li>Interaction with larger systems </li></ul></ul><ul><li>Comparative </li></ul><ul><ul><li>Difference that makes a difference </li></ul></ul><ul><ul><ul><li>Migration </li></ul></ul></ul><ul><ul><ul><li>Ecological context </li></ul></ul></ul><ul><ul><ul><li>Family organization </li></ul></ul></ul><ul><ul><ul><li>Family life cycle </li></ul></ul></ul>Falicov, C. J. (1998). Latino families in therapy: A guide for multicultural practice . New York, Guilford Press.
    41. 41. What is therapy about? Reactions towards helpers <ul><li>Latin@s may construe non-medical personnel as dangerous </li></ul><ul><li>Family members may disguise the truth to protect family’s sense of identity ( i.e., not to condone child abuse) </li></ul><ul><li>Developing trust is sometimes a complex task (not a taken for granted reality) </li></ul><ul><li>You build trust and this is like dancing. If you tell someone, then everybody knows, their definition of confidentiality is not the one we learn in school or conferences.. . </li></ul>
    42. 42. What is Therapy About? The Therapist <ul><li>Cultural broker (i.e. spiritual worlds & medical/science ideas) </li></ul><ul><li>We pray together and help them relax with hypnosis </li></ul><ul><li>Bridge between institutions </li></ul><ul><li>Collaborator that keeps hope alive </li></ul><ul><li>Learner of a story and stories </li></ul><ul><li>Advocate and educator </li></ul><ul><li>Witness </li></ul><ul><li>You listen to so many horrible stories, you have to be very strong to listen them, and feel what they feel in order to know… </li></ul>
    43. 43. What is therapy about? The therapist <ul><li>Accepts clients’ fear of institutions as part of reality rather than as resistance to obtain services </li></ul><ul><li>Keeps larger system view </li></ul><ul><li>Maintains a dual vision (continuity and change) like immigrant families do </li></ul><ul><li>Involves and accepts extended family’s participation (as defined by the person who seeks help) </li></ul><ul><li>Envisions clients as future members of their agency or institution </li></ul>
    44. 44. Contemporary Culturally Accountable Family Therapy Practices <ul><li>Cultural and Spiritual Genograms </li></ul><ul><li>Reflecting Teams & Reflexive Conversations </li></ul><ul><li>Just Therapy </li></ul>
    45. 45. Family Community Engagement <ul><ul><ul><li>Outreach Family Therapy </li></ul></ul></ul><ul><ul><ul><li>Wraparound Services </li></ul></ul></ul><ul><ul><ul><li>Cultural Context Model </li></ul></ul></ul><ul><ul><ul><li>Family Group Conferencing </li></ul></ul></ul>
    46. 46. Appreciative Inquiry VIEJITA by Ana von Reuber (Authorized Reproduction) www.anavonrebeur.com.ar
    47. 47. Positive Deviance http://www. donquichotte .at/dq/images/stories/today/yeniler-3/luiseduardo.jpg Ana von Reuber (Authorized Reproduction) www.anavonrebeur.com.ar

    ×