Objectives Define cultural competence Explore biases and personal beliefs and their implications on service delivery Describe the Latino/Hispanic population Identify common diagnoses among Latinos Discuss barriers to services
Objectiveso Examine indicators for acculturationo Explore cultural characteristics of Latino interpersonal relationshipso Identify best practices for community agencies/schools
Cultural Competence “Cultural competence is a set of attitudes, skills, behaviors, and policies that enable organizations and staff to work effectively in cross-cultural situations.” (Cross et al.,1989)
Evaluating Oneself Anhonest desire not to allow biases to keep us from treating individuals with respect Anhonest assessment of positive and negative assumptions about others Recognizing and admitting if we harbor negative stereotypes and prejudices
Avoiding Stereotypes Challenging when describing an entire group Diversity exists in every group People change through acculturation and assimilation Avoid jumping to conclusions
Points to Consider Develop partnership with the client (trust). Maintain cultural humility.
Points to Consider Mexicans Peruvians, ETIC Salvadorans Approach Colombians , Puerto Ricans, Cubans, etc. Mexico individual Chile individual EMIC Peru individual Approach Cuba individual
Latino Population in the USUnited States Estimate PercentTotal Population 308,745,538 100Latinos/Hispanics 50,477,594 16.3 of total population in USMexican 31,798,258 63.0 of total Hispanics in USPuerto Rican 4,623,716 9.2 of total Hispanics in USCuban 1,785,547 3.5 of total Hispanics in USOther 12,270,073 24.3 of totalHispanic/Latino Hispanics in USSource: census.gov
Demographics in SCSouth Carolina Estimate PercentTotal Population . 4,625,364 (2010) 100Hispanic or Latino 235,682 (2010) 5.09% of total(of any race) population in SCMexican 104,700 (2009) 2.4% of population in SCPuerto Rican 18,176 (2009) 0.4% of population in SCCuban 3,550 (2009) 0.1% of population in SCOther 42,813 (2009) 1.0% of populationLatino/Hispanic in SCSource: census.gov
Demographics in North CarolinaNorth Carolina Population PercentTotal Population 9,535,483 100.0• Latino/Hispanic 800,120 8.39 of total population in NC• Mexican 486,960 5.10 of total population in NC• Puerto Rican 71,800 0.75 of total population in NC• Salvadorians 37,778 0.39 of total population in NC• Cuban 18,079 0.18 of total population in NC• Other Hispanic or 185,503 1.94 of total Latino population in NCSource: Census.govYear 2010 11
Where do Hispanics comefrom? Mexico Central America: Guatemala, Honduras, El Salvador, Nicaragua, etc. South America: Peru, Venezuela, Colombia, etc. Caribbean: Cuba, Puerto Rico, Dominican Republic.
Why do Hispanics/Latinoscome to the US? Economic reasons Political reasons Natural Disasters Medical Treatment College/University
CULTURE SHOCK Many Latinos experience it when they arrive here. Thisis translated into a state of anxiety. Anxiety is precipitated by the loss of familiar signs and symbols.
Common Issues AmongLatinos Immigration status (Fear of deportation) Current economic crisis Domestic violence Legal assistance Food stamps
Common Issues Access to healthcare Transportation School Drop-outs More educated Latinos may not be able to work in their professions (Doctors, Lawyers, Engineers, etc.) and may then seek MH services.
Possible indicators forlevel of acculturation: The number of years in the US Language Use of service network Community involvement
Examples of non-acculturation: No banking DMV violations No use of preventive health care No PTA involvement No access to credit
Acculturation Clashes Childrenacculturate faster (Responsibilities on children – “Cultural Broker”). Elderly acculturate more slowly. Technologystops many Latinos from accessing certain services.
Common Diagnoses Depression (Latinos tend to experience depression in the form of somatic symptoms [e.g., stomachaches, backaches, or headaches] that persist despite medical treatment).
Common Diagnoses Post-traumatic Stress Disorder- PTSD: (Wars, natural disasters, domestic violence, etc.) Generalized Anxiety Disorder-GAD: (Unfamiliar signs, language, etc. can exacerbate this condition) AlcoholismSource: Surgeon General David Satcher, 2001
Common Diagnoses Adjustment Disorder (identifiable stressors that result in the development of emotional or behavioral symptoms).
Service Providers Makehome visits at times that are convenient for families. Usea more directive approach in counseling if appropriate. Introduce family members to other service providers when making referrals. Receivegifts or food graciously when offered.
Services Providers Use self-disclosure (if comfortable). Attend social gatherings when possible (baptism, graduation, etc.). Explain confidentiality (many Latinos may be unfamiliar with this). Should avoid perceiving clients’ lack of disclosure as “therapeutic resistance.”
Services Providers Should be aware that research shows 50% quit counseling after the first session. Understand that the first place many Latinos look for help is family, then church, then YOU!
Interpersonal Relationshipsin Many Latino Cultures Otherfamily members may want to be present when meeting with counselor or other professionals. Disclosureof personal problems can be threatening for many Latinos. Interruptionsin the dialogue mean that Latinos are involved in the conversation.
Relationship Roles…Females Thefemale tends to be the caregiver for the family. More Latinas are entering the labor force and are experiencing greater chances for economic opportunity.
Personal Space andGestures Closeness is comfortable: Latinos tend to stand close during gatherings, conversations and in lines. Physical contact is common: (Kissing when greeting, touching when talking).
More Tips! Donot raise your voice. Speak slowly. Do not speak with abbreviations. Latinosmay not be familiar with the system. Do not overwhelm them with too much information.
Barriers to Mental Health Services Less than one in 11 contacts a mental health specialist. Among Latino immigrants with mental disorders, fewer than one in 20 uses services from an MH specialist. Less than one in 10 uses services from a general healthcare provider.(Report of the Surgeon General, 2001).
Barriers to Mental HealthServices Thereare 20 Latino mental health professionals for every 100,000 Latinos in the US. Latinos’ reluctanceto utilize mental health services: “No se lava la ropa en casa ajena” (One must not wash one’s dirty clothes in someone else’s home).
Best Practices for Non-EnglishSpeaking ConsumersBest Practices… NOT Recommended Bilingual/Bicultural Use of interpreters, professionals except when qualified Frontline bilingual bilingual support staff professionals are not available Double sided bilingual forms Use of family (Releases, members /children to consumer’s interpret rights, confidentiality, Only English consent for services) language forms prepared for consumer’s signature
Best Practices for Non-EnglishSpeaking Consumers Best Practices… Practices NOT Recommended Bilingual materials in lobby Voice mail with Building signage only English options Special aid to Unresolved illiterate clients prejudice Negotiate Inaccurate alternative cultural diagnoses and treatments treatment due to lack of cultural knowledge
Solutions? Immigration Reform? Recruit bilingual professionals from other states. Distribute educational material. Outreach programs. Evaluate outreach campaign. Information about Title VI.
WebsitesPew Hispanic Centerhttp://pewhispanic.orgHispanic Scholarship Fundhttp://www.hsf.netHispanic College Fundhttp://www.hispanicfund.orgNational Council of La Razahttp://www.nclr.org
References Cross,T.L., Bazron, B.J., Dennis, K.W., & Isaacs, M.R. (1989). Services to minority populations: What does it mean to be a culturally competent professional? Focal Point. Portland, OR: Research and Training Center, Portland State University Center for Mental Health Services (CMHS, 1999)
References U.S.Bureau of the census (2010). U.S. interim projections by age, race, and Hispanic origin. Retrieved January 11. 2010 <http://www.census.gov U.S.Department of Health and Human Services. Office of the Surgeon General (2001). Mental Health Care for Hispanic Americans. In Mental Health: culture, race, and ethnicity. A supplement to mental health: A report of the Surgeon General. SAMHSA