National Hispanic & Latino ATTC

National Hispanic & Latino ATTC

Cultural Change and Family Transformation Module 2 New England ATTC Haner Hernndez, Ph.D., CPS, CADCII, LADCI Disclosures The development of these training materials were supported by grant H79 TI080209 (PI: S. Becker) from the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, United States

Department of Health and Human Services. The views and opinions contained within this document do not necessarily reflect those of the US Department of Health and Human Services, and should not be construed as such. Goal To transfer the knowledge in the Cultural Elements in treating Hispanic and Latino populations to frontline clinicians thereby initiating application of culturally competent approaches to the treatment of Hispanic and

Latino clients with substance use disorders. Objectives Demonstrate understanding of how culture change affects Hispanics and Latinos and their substance use.

Identify and address barriers faced by Hispanics and Latinos around access and readiness for treatment and recovery. Explain the relationship between culture and treatment.

Objectives Describe common themes among Hispanic and Latino populations. Explain how family transformation influences the ability of Hispanics and Latinos to access,

participate, complete and sustain recovery. Cultural Competence Includes being able to recognize and respond to healthrelated beliefs and cultural values, disease incidence and prevalence, and treatment efficacy. Source: OMH, 2001 Addiction Counseling Competencies (TAP 21)

Disciplines that center on addiction are based on four common foundations 1. Understanding addiction 2. Knowledge about treatment 3. Application into practice 4. Professional education and training Source: CSAT, 2006 Culture and Treatment

Considerations of common culture characteristics for Hispanics and Latinos in the U.S. in the context of substance use disorders treatment. Culture and Treatment Distinguish the content of a clients history from the environment in which their recovery occurs.

Culture and Treatment Understand the importance of culture by inquiring about it. Principles for Culturally Competent Treatment Services for Hispanic and Latino Populations Culture plays a key role in our ability to influence behavior in a patient. However, we cannot afford to let cultural barriers limit our ability to meet the

needs of our patients, or reduce their opportunity to benefit from the services we can provide. Common Cultural Themes for Hispanic and Latinos in the United States Family or familia (familismo) Respect or respeto Personal relationships or personalismo Trust or confianza

Spirituality or espiritualidad Source: Falicov, 1998; Santiago-Rivera et.al, 2002, Pajewski & Enriquez, 1996 & Bracero, 1998 Familismo-Definition A cultural value that involves individuals strong identification with and attachment to their nuclear and extended families, and strong feelings of loyalty, reciprocity, and solidarity among members of the same family

Source: Marn & Marn, 1991 Familismo I do not belong to the culture of 911, there is always a relative I can depend on to rescue me. A Hispanic client Source: Falicov, 1998 Familismo

Traditionally, Hispanic and Latinos include many people in their extended families, not only parents and siblings, but grandparents, aunts, uncles, cousins, close friends, and godparents of the family's children.

Family involvement often is critical in the health care of the patient. Source: Santiago-Rivera, Arredondo & Gallardo-Cooper, 2002 Familismo Flexible boundaries Avoid pathologizing closeness

Respect Defer to those in positions of authority Reciprocal Respect Implies a mutual and reciprocal deference, and dictates appropriate deferential behavior towards others based on age, sex, social

position, economic status, and authority. Older adults expect respect from those younger, men from women, adults from children, teachers from students, employers from employees. Source: Santiago-Rivera, Arredondo & Gallardo-Cooper, 2002 Personalismo/Personal Relationships Formal friendliness

Simpata- kindness Personal Relationships/Personalismo Hispanic and Latinos expect health providers to be warm, friendly, and personal, and to take an active interest in the patient's life. Source: Santiago-Rivera, Arredondo & Gallardo-Cooper, 2002 Trust

Building trust has been described as the earliest developmental task and the foundation on which all others are built Establishing trust is broadly accepted as fundamental to the development of a therapeutic relationship Source: Erickson, 1980 Trust

Over time, by respecting the patient's culture and showing personal interest, a treatment provider can expect to win a patient's trust. Spirituality Personal relationship that is transcendent or beyond the self Powerful instrument for recovery Recognized as a protective factor

Spirituality Spirituality is strong with Hispanics and Latinos and combing faith with science is not uncommon. Faith is a key component of recovery. Hispanics and Latinos respect mainstream medicine and will rarely question recommendations. Instead, they might augment the medical treatment they are receiving with herbal remedies by going to a (Yerbero) which is an herbalist.

Curanderismo Curanderismo is a form of folk healing that includes various techniques such as prayer, herbal medicine, healing rituals, spiritualism, massage and psychic healing. It is a system of traditional beliefs that are common in Latino communities. It is practiced in several Latin American countries, as well as in the U.S., particularly in the southwest. This is according to the American Cancer Society.

Therefore, this is something that is utilized in all health related fields including behavioral health. Spirituality Providers often work within the structures of mainstream medicine, which provides separate physical and mental health care.

Hispanic and Latino culture, on the other hand, tends to view health from a holistic point of view. This view implies a continuum of body, mind, and spirit. Pajewinski & Enriquez, 1996 Other Culture-Related Issues in

Treatment Immigration Family difficulties Gender roles Language selection and recovery Adolescents LGBTTQ Immigration

May represent two major sources of stress: 1. Family dislocation, fragmentation, and reconstruction. 2. Culture change for individuals and across generations. Family Difficulties Family conflicts (including

intergenerational conflicts). Neglect and physical abuse.

Domestic violence and sexual abuse. Latino Adolescents and Substance Use Acculturation gaps Gender Roles May be particularly difficult cases to treat primarily because families stigmatize women in

a more complete and isolating manner than they do male family members. Motherhood and Associated Roles The expectation of self-sacrifice of a mother on behalf of her children is prescribed by cultural convention and reinforced through families, social networks, religion, and public imagery in mass media. This concept is also known as marianismo.

Machismo Significantly influences behavior and attitudes of adolescent males during time of identity formation. Distinction between the sexes. Includes dignity in personal conduct, respect and respect for others. Source: Rivera. & Rogers-Adkinson, 1997

Machismo Gender specific value that applies to Hispanics and refers to a mans responsibility to provide for, protect and defend his family. Source: Morales, 1996 LGBTTQ 17% of LGBTTQ Americans are Hispanic

Acceptance increases through immigrant generations Higher levels of substance use among Hispanic LGBTTQ Immigration and homophobia Source: Pew Hispanic Research Center, 2011, 2013; Daz & Ayala, 2001; Hunt, 2012 Language Selection and Recovery Spanish speaking or highly bilingual clients can be assumed to

possess more knowledge about Hispanic and Latino culture and this may provide some cultural information for more accurate interpretation of information. Never assume that a patient that speaks some Spanish is knowledgeable about Hispanic and Latino culture. Culturally Competent Treatment Services Involve family members Show respect

Get personal Respect traditional healing approaches Encourage the asking of questions. Involve Family Members Allow for several family and friends to participate in a consultation, and communicate with the group. The patient may not be the key decision-maker for describing symptoms, deciding among treatment options, or complying with recommended treatment.

Show Respect Always be respectful, and explain without condescending. Health providers, as authority figures, need to take seriously the responsibility and respect conferred on them by many Hispanic and Latino patients. Get Personal Lean forward Be comforting

Use gestures that indicate interest Respect Traditional Healing Practices Hispanic and Latino patients may combine respect for the benefits of mainstream medicine, tradition, and traditional healing, with a strong

religious component. They may bring a broad definition of health to the clinical or diagnostic setting. Respecting and understanding this view can prove beneficial in treating and communicating with the patient. Encourage the Asking of Questions

There is a cultural taboo against expressing negative feelings directly. This taboo may manifest itself in a patient's withholding information, not following treatment orders, or terminating medical care. Remember Common themes among Hispanics and Latinos

may play a part in terms of substance use, access, readiness and recovery. By recognizing and addressing such themes, counselors can be more effective in their interventions with Hispanic and Latino populations.

Explore how cultural circumstances are related to your clients presenting problems. References Bracero, W. (1998). Intimidades: confianza, gender and hierarchy in the construction of Latino-Latina therapeutic relationships. Cultural Diversity and Mental Health, 4(4)264-277 Caribbean Basin and Hispanic Addiction Technology Transfer Center. (2006). Cultural elements in treating Hispanic popultaions: Dialogue on Science and addiction. Bayamn,

PR: Author. Center for Substance Abuse Treatment. Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice. Technical Assistance Publication (TAP) Series 21. DHHS Publication No. (SMA) 06-4171. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2006. Diaz, R., Ayala, G., Hein, J. & Marin, B. (2001). The impact of homophobia, poverty and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. American Journal of Public Health, 91(6)927-932. Falicov, C.J. (1998). Latino families in therapy: a guide in multicultural practice. New York, NY: The Guilford Press.

Marin G, Marin BV. Research with Hispanic populations. Newbury Park, CA: Sage; 1991. Morales, E. (1996). Gender roles among Latino gay and bisexual men: Implications for family and couples relationships. In J. Laird & R.J. Green (Eds.), Lesbians and gays in couples and families: A handbook for therapists (pp. 272-297). San Francisco: Jossey-Bass. National Hispanic and Latino ATTC. (2013). Cultural elements in treating Hispanic and Latino populations (revision 2013). Bayamn, PR: Universidad Central del Caribe. Pajewski, A., & Enriquez, L. (1996). Teaching from a Hispanic perspective: A handbook for non-Hispanic adult educators. Phoenix, AZ: Arizona Adult Literacy and Technology Resource Center. Pew Hispanic Research Center (2013)

References Pew Hispanic Reseach Center (2011). Latinos changing views on same sex marriage. Rivera, B.D., & Rogers-Adkinson, D. (1997). Culturally sensitive interventions: Social skills training with children and parents from culturally and linguistically diverse backgrounds. Intervention in School and Clinic. 33(2), 75-80. Santiago-Rivera, A.L., Arredondo, P. & Gallardo-Cooper, M. (2002). Counseling Latinos and la familia: A practical guide. Thousand Oaks, CA: Sage Publications. Substance Abuse and Mental Health Services Administration, Leading Change: A Plan for SAMHSAs Roles and Actions 2011-2014. HHS Publication No. (SMA) 11-4629. Rockville,

MD: Substance Abuse and Mental Health Services Administration, 2011. U.S. Department of Health and Human Services, Office of Minority Health. (2013). National Standards for CLAS in Health and Health Care: A Blueprint for Advancing and Sustaining CLAS Policy and Practice. Retrieved from: www.ThinkCulturalHealth.hhs.gov U.S. Department of Health and Human Services, Office of Minority Health. (2005). What is cultural competency? Retrieved from http://minorityhealth.hhs.gov/templates/browse.aspx? lvl=2&lvlID=11

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