Providing Culturally Responsive and Empowering Services for Latino Families with Developmental Disabilities Celia Jaes Falicov, Ph.D . University of California, San Diego cfalicov@ucsd.edu No conflict of Interest UCSF Developmental Disabilities Conference, March 2016 What we know about Latinos and DD ADHD, Autism, Deafness, Intellectual Disabilities a. Diagnosed at ½ the rate of African American and White Children b. Diagnosed later (average 2.5 years) c. Receive medication and educational interventions at a lower rate Latinos and DD • Less likely to get services and to seek psychological or neuropsychological testing • 80% of physicians screened for autism but only 29% offered Spanish language screening for children and families • Early intervention, home services and sign language occur much later than critical age or not at all for the hard of hearing
Understanding Challenges and Strengths of Immigrants Barriers to Detection and Seeking Services: 1.Transportation, child care, limited time, lack of insurance and money to seek services, immigration status. 2. Low parent education: unfamiliarity with health care system, fear of stigma and discrimination 3. Lack of language and culturally related assessment and treatment The Practice Encounter is not Culturally Neutral CLIENT CULTURE Practitioner Culture Theory/ Training Personal MULTICULTURALISM Encompasses two different but related aspects CULTURAL DIVERSITY Values, beliefs and meaning differences (ethnicity, religion, nationality) RESPONSIVENESS SOCIAL JUSTICE Contextual Stressors tied to power differences (race, class, immigrant) EMPOWERMENT
Culture-Specific Competence with Latinos Equated with ethnic values such as: • Familismo (family-centered lives) • Machismo (men’s predominance) • Personalismo (social manners) • Respect for parents and elders • Religiosity The Problem with Ethnic Values only • They may perpetuate stereotypes because values: • Are not static, they evolve • Are Contextual (class, education, nationality, urban-rural) • Latinos come from many different cultures & generations • They may have bicultural or multicultural identities M MULTIDIMENSIONAL E ECOLOGICAL C COMPARATIVE Same 4 domains A APPROACH
ECOLOGICAL FAMILY CONTEXT LIFE CYCLE MIGRATION/ FAMILY ACCULTURATION ORGANIZATION FAMILY Cultural Maps Practitioner Cultural Maps Theory/ Personal Training Cultural Competence or “Cultural Humility”? Practitioner’s self- reflection about her or his own personal and professional culture (race, class, beliefs and values) Clients as Experts on their culture and context Practitioners become aware of power dynamics and give more voice to clients (Tervalon and Murray-Garcia, 1998) ECOLOGICAL FAMILY CONTEXT LIFE CYCLE • Community • Ideals • Work (discrimination, racism) POWER DIFFERENCES • Meanings CULTURAL VALUE DIFFERENCES • School • Timings • Religion • Transitions MIGRATION/ FAMILY ACCULTURATION ORGANIZATION -Separations & FAMILY -Nuclear/ Reunifications Extended MAPS Family -Trauma/ Undocumented -Connectedness Practitioner -Losses and -Hierarchies Maps Gains Personal -Communication Theory -Cultural Styles Training Identities Falicov, 1995 4
Cultural Diversity Meaning and Belief Clinical Approaches differences tied to • Curiosity & Respect • Ethnicity • Culture-Attuned • Religion Therapies (traditional • Nationality healing) • Profession • Transformations of Theory (attachment, individuation) Social Justice Contextual Stressors Clinical Approaches tied to • Empowerment • Gender • Social Action • Race • Legitimize Local • Social Class Knowledge • Minority Status Migration (Impact on Families)
MIGRATION STRESSORS • LANGUAGE BARRIERS • UNDOCUMENTED OR TEMPORARY VISA STATUS • LACK OF KNOWLEDGE OF INSTITUTIONS AND SERVICES Deafness example: Trilingual challenge • Decisions about what type of communication (sign language, English, Spanish • Sign language is based on English • Very difficult for parents who do not speak English, most opt for what they are advised to do about English and ASL but hope for a trilingual future for their child New forms of SEPARATIONS and REUNIFICATIONS • Grandparents and Extended Family • Father • Father and Mother • Mother ( Feminization of Migration ) Ratio of Latina women to men has increased considerably
A confusing picture The interaction between migration family stress, trauma and ADHD Diagnosis of Attention Deficit and Hyperactivity Oscar (10) was diagnosed by the school counselor and the teacher as having ADHD and referred for medication, without consideration of the child as new immigrant, the tensions of family separation and reunification and cultural attitudes towards medication. Attitudes towards medication • Belief in risk of addiction • Related to drug use in the neighborhood • Preference for natural and home remedies---fear toxic and addictive effects of medication A candid parent said: “It could be the beginning of a life in the streets”
Trauma Pre-migration trauma may be involved as precipitating events for migration Post-migration trauma, at reunification there may be increased risk of child maltreatment Symptoms of trauma can look like ADHD Recommendation • Explore migration stresses, separations, trauma • Avoid suggesting medication initially or explore parents’ attitude towards it • Use translators and cultural consultants when needed, use “promotoras” with information about Family Resource Centers in Spanish Ecological Context (Isolation, low interaction with Institutions-schools, medical system)
Re-Building Community Increases social capital: • protects against depression in women, • alcohol abuse in men • gang involvement in youth (Vega et al, 1991; Vigil, 2002, Smorowski et al, 2009) Doubly Challenged: Many Latinos with DD • Poverty • Unsafe neighborhood • Lack of Transportation • Lack of Child Care • Overwork Lack of entitlement to question types of services, timing of appointments, or voicing their opinions unless encouraged towards shared decision making Community Empowerment Group: UCSD Medical Student-Run Free Clinic • Weekly Participants: underserved, uninsured, isolated patients and medical students, physicians, psychologists, social workers • Facilitator or “promotora”: experienced community member/ STRENGTH BASED • Discussion of current issues in ALL of our lives and communities. • Patients are the experts. Topics for discussion: forgiveness, gratitude, self-care …
CULTURAL BELIEFS ABOUT HEALTH & CURE Complementary Conventional Traditional Latino Healing Traditional Medical Religious Witchcraft Illnesses ▪ Mal de Ojo (evil ▪ Life Bewitchment eye) Problems ▪ Universal tragedies ▪ Jealousy/ illnesses ▪ Illnesses ▪ Susto (fright) envy ▪ Sin & Guilt ▪ White & ▪ Priests ▪ Curanderos ▪ Physicians Black witches Helpers ▪ Pastors ▪ Yerberos ▪ Psycho- ▪ Espiritistas therapists ▪ Sobadores ▪ Santeros SPIRITUAL BELIEFS ABOUT CHILD WITH DD • A gift or a blessing from God to be accepted with dignity and devotion. Parents report an increase in faith after diagnosis • A smaller number believe disability may be a punishment from God. • Mothers viewed child as bringing positive transformations in their lives. (Skinner, Bailey, Correa and Rodriguez, 1999) Ask families about beliefs • 1. What thoughts do you have about may have caused the condition? • 2. Who else have you consulted with? (relatives, priests)? What do they advise you to do? • 3. What do you think will happen over time?
MEDICAL/ PSYCHOLOGICAL EDUCATIONAL PATIENT/FAMILY & CULTURE CENTERED TRADITIONAL RELIGION HEALING COMMUNITY HEALTH CARE COLLABORATIONS For Immigrants Recommendation: the power of networks • Explore ecological context (social network, work, schools, church, traditional healing) • Explore neighborhood health and education services Recommendation: the power of the local • Provide services in the school (Latino parents expect intervention and support from school) • Primary health care clinic in the community is the second preferred place • Provide parent support groups in Spanish * in the clinic, the church or the school) • Be open minded about local healing Lynch and Stein (1987)
Family Organization (models of nuclear and extended family life) The Family as the Unit of Treatment Who is Family? Grandparents, siblings,uncles, aunts, nephews, cousins, godfathers and godmothers ( padrinos, madrinas ---they have considerable authority and responsibility towards the child) compadres, comadres (close friends of father and mother—their help and opinion matters) Highly interconnected network—functions long distance via Skype, WhatsApp, phone and text Family Size & Practitioner’s Ideals SMALL FAMILIES (LARGE FAMILIES) PARENTHOOD Intensive Extensive INDIVIDUAL High Limited ATTENTION CONTROL Democratic Authoritarian KIN NETWORK Exclusion Inclusion Small Large SIBLINGS Independent Involved PROBLEMS Magnified Minimized
Recommend
More recommend
