code of ethics · 5/27/2016 · common misconceptions communication in provider/client settings is...

Home Bound: Strategies for Success 6/15/2016

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Understanding the Needs of Hispanic/Latino

Families in Nevada:

Culturally Competent Practice for Helping

Professions

Presenter:

Dr. Lillian Wichinsky, LMSW, Associate Professor of Social Work

University of Arkansas at Little Rock

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Code of EthicsThe NASW Code of Ethics refers to cultural competence in section 1.05 and

reads as follows:

1.05 Cultural Competence and Social Diversity

(a) Social workers should understand culture and its function in human

behavior and society, recognizing the strengths that exist in all cultures.

(b) Social workers should have a knowledge base of their clients’ cultures

and be able to demonstrate competence in the provision of services

that are sensitive to clients’ cultures and to differences among people

and cultural groups.

(c) Social workers should obtain education about and seek to understand

the nature of social diversity and oppression with respect to race,

ethnicity, national origin, color, sex, sexual orientation, gender identity

or expression, age, marital status, political belief, religion, immigration

status, and mental or physical disability.

http://nasw.org

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Standards to Guide Social Work

Practice• Ethics and Values

• Self-Awareness

• Cross-Cultural Knowledge

• Cross-Cultural Skills

• Service-Delivery

• Empowerment and Advocacy

• Diverse Workforce

• Professional Education and Language Diversity

• Language Diversity

• Cross-Cultural Leadership

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Snapshot of the United States

• There are approximately 38.3 million foreign born people in

the US or 13% of the total population. (~30% are

undocumented or unauthorized) (U.S. Census)

• Most unauthorized immigrants are from Mexico and other

Latin American Countries

• 10 countries contribute half of all immigrants to the US

• Between 2000-2007 the greatest percentage increase in

foreign-born residents was found in South Carolina,

Arkansas, Nevada, Tennessee and Alabama.

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Myth or Reality?

• Most undocumented workers do not cross legally into

the US?

• Immigrant laborers displace US workers from jobs?

• Immigrant labor drains the US economy?

• Immigrants use up American tax dollars through the use

of social programs?

• Immigrant workers from Mexico do not contribute to

their own economy or families?

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Common Myths Dispelled

• More immigrants derive their undocumented status from

overstaying legal entry permits

• Unskilled immigrant labor rarely displaces native workers

• Immigrant labor contributes to overall economic growth

• Immigrants as a group pay more taxes in the US than they receive

in public benefits over their lifetimes

• Remittances from migrant workers in the US are a major source of

income for Mexico and Central America.

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US Population by Race and Ethnicity:

What does it mean for you as a Social Worker,

Nurse, Public Health Worker, Therapist?

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Hispanic and Latino

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Demographics for Nevada

529,164 foreign born in Nevada or 19% of the total population

(U.S Census Bureau, 2013)

• 47% or 250,949 were naturalized U.S. citizens (eligible to

vote)

• 7.6% (210,000) were unauthorized

• 20.8% (244,551) of all registered voters in Nevada are “New

Americans” or the US born children of immigrants

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Ethnicity

• Growth of the Latino population from 10.4% in 1990 to

27.5% in 2013

• Asian population grew from 2.9% in 1990 to 7.7% in

2013

• In Nevada 86% of children with immigrant parents were

U.S. citizens

• 90.6% of children in Asian and Latino families were

U.S. citizens

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Hispanic Population by County

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Characteristics of Immigrants

• Lack of health insurance

• High rates of marriage, lower rates of divorce

• High rates of poverty

• Lower levels of educational attainment

• High rates of home ownership

• Two parent families

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Poverty Rates

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Immigration: Impact and

Implications

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Why do people emigrate?

•Economics

•War

•Political and Religious Freedom

•Reunite with Family

•Persecution

•Education

•Environmental

•Jobs

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The Route to the U.S.

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Common Problems Associated with

Immigration•Health

•Mental Health

•Family Dynamics

•Language, Education and Economics

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Health & Mental Health

•What’s at stake?

•Medical “knowledge” and research as

ideologically and culturally constructed

•Folk illnesses and remedies

–Empacho, mal de ojo, mollera caída, susto

–Healers: curanderos, parteras, comadres,

hueseros, sobadoras, santeros

–

–

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Health & Mental Health, Cont.

•Familismo y fatalismo

•Respeto/simpatía/personalismo

•Food and exercise

•Women’s health and relationship violence

•Mental health, disabilities & elder care

•Language issues


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Culturally Competent Practice: Key

Concepts•Self-Awareness

•Awareness of:

–clients religious and/or spiritual beliefs about

health and mental health,

–indigenous helping practices of the client’s

culture and

–ethnic helping networks with the clients

community

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Common Contrasts Between Helping

Professionals and Refugee or Immigrant Clients

U.S Helping Professionals

•Secure societal status

•Autonomy and

independence

•Relativity in values;

situational ethics

•People versus nature; the

need to master or control

nature

Refugee or Immigrant

Clients

•Insecurities in language,

vocation, societal position

•Interdependence and

traditional family values

•Correct social relationships

rejection of authority

•Holistic cultures; people

living in harmony with

nature

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Common Contrasts Between Helping

Professionals and Refugee or Immigrant Clients

•Relatively comfortable attitude

•View mental illness as a result of

psychological and biological

factors

•Belief that psychotherapy is

valuable and promotes growth

•Awareness that cure will be

extended and time consuming

with the therapist often passive

•Fear of mental illness, handling

mental illness and symptoms

•View of mental illness as caused

by imbalance of cosmic forces or

supernatural events, by an agent

such as a ghost, or by a strong

emotional experience

•No cultural analogy of extended

psychological therapy

•Belief that cure should be rapid

with the healer active

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Remember

•The DSM was developed in a specific

historical, cultural and sociopolitical context.

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Mental Health Concerns

•Most commonly observed

problems among

immigrants, and particularly

refugees:

–Grief

–Alienation and

loneliness

–Decreased self-esteem

–Depression

–Somatization

–Paranoia

–Guilt

–Post-traumatic stress

disorder

–Substance abuse

–Anxiety

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General Clinical Considerations

•Traditional Healers

•Cultural differences

•Role Preparation

•Language problems and the use of interpreters

•Use of psychotropic medications

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Break Time

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Family Dynamics

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Values and Impact on Assistance

•Collectivism and communal orientation

•Family relationships and connectedness

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Role of Children

•Traditional roles

•Symbols of the future

•Discipline

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Family Dynamics

•Issues faced by immigrant and refugee

families:

–Marital conflict

–Intimate partner violence

–Intergenerational conflict including child abuse

and elder abuse (work, chores, dating,

discriminating rules)

–Life cycle issues (identity formation)

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Best Practices with Families

•Marital Therapy: General principles for assessment including

assessment of language ability (Behavioral marital therapy,

cognitive therapy and structural-strategic marital therapy)

• Intergenerational conflict: genograms, eco-maps

–Acknowledge family hierarchy

–Family Therapy

–Psychoeducational approaches

–Interventions for identity conflict

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Social Work Practice with Latinos

Key Issues for Social Workers

•Risk Factors

–poverty, low educational attainment, mental health

concerns, various psychosocial maladies, ill health,

substance abuse, exposure to violence, racism and

systemic barriers for people of color

•Key Variable: Acculturation

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Workplace and Job Satisfaction

•Largest percentage of working poor in the

United States

•Strong work ethic, two-parent household

•Lower levels of job satisfaction

Think about the impact on your clients!

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Health Disparities

•Severe symptoms

•Miscommunication

•Mistrust of the health care system

•Lack of bilingual social workers and mental

health care providers

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Key concepts

• Personalismo and family ties

• Acculturation

• Interdependence and compadrazgo

• Machismo and marianismo

• Intergenerational conflicts

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Skills needed for culturally competent social

work practice

1. Importance of hope

2. Helper attractiveness (warmth, genuineness,

and compassion)

3. Techniques designed to empower clients

4. Rites of initiation, (defined as rituals designed

to cope with life-stage transitions

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Skills

• Professional use of self

• Building a working alliance.

• Respect for clients worldview

• Cleansing experiences (rituals designed to

eliminate unwanted emotions

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WomenCulturally Bound Syndromes for

• Ataque de nervios (nerve attacks)

• Susto (fright)

Treatment Modality

–Mutual support group

–Psychoeducational group approach is superior to individual therapy

Group work: Best practices

»Migratory experiences

»Development of positive and supportive peer relationships

»Development of new coping skills

»Discussion of child-rearing practices

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Working with Hispanic Women

•Familiarity with client’s cultural values and points of reference

•Awareness and sensitivity towards the role of the Hispanic woman

and how migration has altered that role

•Areas of struggle and conflict related to the migratory experience

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Working with Women

•Familiarity with how Hispanic women express

feelings of grief, stress, unhappiness

•Use of family-based assessment to help determine

support systems

•Ability to become part of the group (mutual

reciprocity)

Key Component: Integration of the client’s cultural

context and self-awareness

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Language

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Language: Working with Translators

and Interpreters

To effectively, efficiently, completely,

and accurately transmit the message

from the source language to the target

language

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Common Misconceptions

● Communication in provider/client settings is

a relatively simple task in which much of

the information can be gathered by

‘scientific, objective’ means and much of

the meaning can be conveyed by gestures.

● Anyone with any level of bilingualism is

capable of providing effective translation

and/or interpretation.

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●Untranslatable terms

●Dialectal variations

●Accent

●Regionalisms

●Expressions

●Gestures and body language

●Level of education

●Cultural awareness and sensitivity

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●Translation vs. Interpretation

●Forms of Interpreting■ Simultaneous

■ Consecutive

■ Paraphrasing

●Types of Interpreters■ On-site Professional

● Training, Code of ethics

■ Remote Professional● Training, Code of ethics

■ Nonprofessional (staff, family, friend)

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How do we transmit the message?

●When should I use an interpreter?

●If I use an interpreter, do I relinquish all

control?

●How do I work with an interpreter?

●What do I do if no professional

interpreters are available?

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Putting it all together

•Key Concepts

–Client as expert

–Self-Awareness

–Know the laws

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Resources•Social Work Practice with Latinos: Key Issues for Social

Workers. Retrieved from:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861823/

• Culturally Competent Practice with Latino Families: Georgia

Department of Family Services:

http://dfcs.dhr.georgia.gov/sites/dfcs.dhs.georgia.gov/files/imp

orted/DHR-DFCS/DHR_DFCS-

Edu/Files/Latino%20Module%201%20participant%20guide%204

-25-07.pdf

•Enhancing Cultural Competence in Social Service Agencies:

https://www.acf.hhs.gov/sites/default/files/opre/brief_enhancing

_cultural_competence_final_022114.pdf

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861823/

http://dfcs.dhr.georgia.gov/sites/dfcs.dhs.georgia.gov/files/imported/DHR-DFCS/DHR_DFCS-Edu/Files/Latino Module 1 participant guide 4-25-07.pdf

https://www.acf.hhs.gov/sites/default/files/opre/brief_enhancing_cultural_competence_final_022114.pdf


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Contact

Lillian Wichinsky Ph.D., LMSW

Associate Professor of Social Work

Executive Director, Community Connection Center

[email protected]

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code of ethics · 5/27/2016 · common misconceptions communication in provider/client settings is...

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