Working Effectively with Hispanic Families. What every healthcare provider should know.

1. Carlos F. Martinez, MHA, M.Ed.

2. 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

3. Objectives
o Examine indicators for
acculturation
o Explore cultural characteristics of
Latino interpersonal relationships
o Identify best practices for
community agencies/schools

4. 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)

5. 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

6. Avoiding Stereotypes
 Challenging when describing an
entire group
 Diversity exists in every group
 People change through
acculturation and assimilation
 Avoid jumping to conclusions

7. Points to Consider
 Develop partnership with the
client (trust).
 Maintain cultural humility.

8. Points to Consider
Mexicans
Peruvians,
ETIC Salvadorans
Approach Colombians ,
Puerto Ricans,
Cubans, etc.
Mexico individual
Chile individual
EMIC
Peru individual
Approach
Cuba individual

9. Latino Population in the US
United States Estimate Percent
Total Population 308,745,538 100
Latinos/Hispanics 50,477,594 16.3 of total
population in US
Mexican 31,798,258 63.0 of total
Hispanics in US
Puerto Rican 4,623,716 9.2 of total
Hispanics in US
Cuban 1,785,547 3.5 of total
Hispanics in US
Other 12,270,073 24.3 of total
Hispanic/Latino Hispanics in US
Source: census.gov

10. Demographics in SC
South Carolina Estimate Percent
Total Population
. 4,625,364 (2010) 100
Hispanic or Latino 235,682 (2010) 5.09% of total
(of any race) population in SC
Mexican 104,700 (2009) 2.4% of population
in SC
Puerto Rican 18,176 (2009) 0.4% of population
in SC
Cuban 3,550 (2009) 0.1% of population
in SC
Other 42,813 (2009) 1.0% of population
Latino/Hispanic in SC
Source: census.gov

11. Demographics in North
Carolina
North Carolina Population Percent
Total 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 NC
Source: Census.gov
Year 2010
11

12. Where do Hispanics come
from?
 Mexico
 Central America: Guatemala,
Honduras, El Salvador, Nicaragua,
etc.
 South America: Peru, Venezuela,
Colombia, etc.
 Caribbean: Cuba, Puerto Rico,
Dominican Republic.

13. Why do Hispanics/Latinos
come to the US?
Economic reasons
Political reasons
Natural Disasters
Medical Treatment
College/University

14. 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.

15. Common Issues Among
Latinos
 Immigration status (Fear of
deportation)
 Current economic crisis
 Domestic violence
 Legal assistance
 Food stamps

16. 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.

17. Possible indicators for
level of acculturation:
 The number of years in the
US
 Language
 Use of service network
 Community involvement

18. Examples of non-acculturation:
 No banking
 DMV violations
 No use of preventive health care
 No PTA involvement
 No access to credit

19. Acculturation Clashes
 Childrenacculturate faster
(Responsibilities on children –
“Cultural Broker”).
 Elderly acculturate more slowly.
 Technologystops many Latinos
from accessing certain services.

20. 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).

21. 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)
 Alcoholism
Source: Surgeon General David Satcher, 2001

22. Common Diagnoses
Adjustment Disorder
(identifiable stressors that
result in the development of
emotional or behavioral
symptoms).

23. 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.

24. 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.”

25. 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!

26. Interpersonal Relationships
in 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.

27. 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.

28. Personal Space and
Gestures
 Closeness is comfortable: Latinos
tend to stand close during
gatherings, conversations and in
lines.
 Physical contact is common:
(Kissing when greeting, touching
when talking).

29. 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.

30. 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).

31. Barriers to Mental Health
Services
 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).

32. Best Practices for Non-English
Speaking Consumers
Best 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

33. Best Practices for Non-English
Speaking 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

34. Solutions?
 Immigration Reform?
 Recruit bilingual professionals from
other states.
 Distribute educational material.
 Outreach programs.
 Evaluate outreach campaign.
 Information about Title VI.

35. Websites
Pew Hispanic Center
http://pewhispanic.org
Hispanic Scholarship Fund
http://www.hsf.net
Hispanic College Fund
http://www.hispanicfund.org
National Council of La Raza
http://www.nclr.org

36. 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)

37. 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