Transcript Cultural Elements in Treating Hispanic Populations Maria del Mar Garcia, MSW, MHS 22nd Annual Multicultural Symposium June 8-9, 2006

Cultural Elements in Treating
Hispanic Populations
Maria del Mar Garcia, MSW, MHS
22nd Annual Multicultural Symposium
June 8-9, 2006
CBHATTC Headquarters
St. Thomas
Bayamón
CBHATTC Mission
• Help address the drug use problem and its
consequences by developing the
workforce and promoting organizational
change in Puerto Rico, US Virgin Islands
and Hispanic communities in the United
States, utilizing culturally appropriate
activities and products.
Objectives
• Discuss common cultural beliefs, attitudes
and behaviors among Latinos that can
help service providers
• Gain an understanding of how cultural
change among Latinos can influence drug
use
• Discuss helping strategies to treat Latinos
drug users
Introduction
• Hispanics/Latinos (H/L) now comprise the
largest minority group in the United States
(14.2%)
• As a group
• They are young
• 40% are under the age of 21
• Have a disproportionately low-income level
• 23% live below the poverty line
• Have a low level of educational attainment
• More than half of H/L under the age of 25 have not
graduated from high school
Introduction
• Hispanics/Latinos accounted for about 50% of
the national population growth of 2.9 million
between July 1, 2003, and July 1, 2004.
• Hispanic growth rate of 3.6% over a year was
more than 3 times that of total population (1%).
• Over 13 million (32.7%) Hispanics lack health
insurance
Illicit Drug Use in the Past Month and Past
Year Among Hispanics Aged 12 or Older
30
25
20
15.2
15
10
11.1
6.2
11.9
10.1
7.2
6.3
5.3
14.5
7.8
5
0
1999
2000
2001
Past Month
2002
2003
Past Year
U.S. Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. NATIONAL
SURVEY ON DRUG USE AND HEALTH, 1999-2003 [Computer file]. ICPSR version. Research Triangle Park, NC: Research Triangle Institute
[producer], 2004. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2004.
Drug Use among Adolescents
• 12th grade Hispanic students reported the
highest rate of use for some drugs:
– Crack
– Heroin
– Heroin with a needle
– Methamphetamine
– Rohypnol
2004 Monitoring the Future
Treatment Admissions by Hispanic Population 1992-2002
Percent distribution
14
12
10
8
11.3
11
10.5
10.7
11.9
12
12
12.7
10.9
10.4
9.9
6
4
2
0
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) – 3.01.04. U.S.
population: US Bureau of the Census, Population Projections of the United States by Hispanic Origin: 1995 to 2050. Population Electronic
Product#45
Distribution Map by ATTC Region
Hispanic Population
Providers serving Hispanic
< 5%
5-10% > 10%
What is culture?
• Is the conceptual system that structures
the way we view the world
– Beliefs
– Norms
– Values
Ethnicity
• Refers to the social identity and
mutual belongingness that
defines a group of people on the
basis of common origins, shared
beliefs and standards of behavior
Ethnocentrism
• The tendency to view one’s own
culture as best and to judge the
behavior and beliefs of culturally
different people by one’s own
standards
Acculturation
• Process of cultural transformation that
takes place when two different cultures
interact resulting in assimilation, partial or
total, of one of the cultures by the other
one
Diccionario de la Lengua Española
Multicultural Practices
• Key Factors
– Impacts Relationship building
– Communication among people
Multicultural Practices
• Requires three domains
– Awareness of oneself and others
– Knowledge of self and others
– Skills-interpersonal and intervention
Personal Dimensions of Identity
• Dimension A
– Age
– Ethnicity
– Gender
– Race
– Language
– Physical ability/disability
– Sexual orientation
– Social Class
Personal Dimensions of Identity
• Dimension B
–
–
–
–
–
–
–
–
–
Education background
Geographical location
Income
Marital Status or Relationship Status
Religion
Work experience
Citizenship Status
Military experience
Hobbies or recreational habits
Personal Dimensions of Identity
• Dimension C
– Historical Moments
– Historical Eras
How culture change affects Latinos and
their drug use
• Immigration
– Represents two major sources of stress
• 1-Family dislocation-fragmentation and
reconstruction
• 2-Culture Change
Familism in the Latino Culture
• Strong commitment to family life that
values collective goals over individual wellbeing
Indicators of Familism
• Early childbearing
• Higher average fertility levels
• Large family households, often extended
to include grandparents, aunts
Indicators of Familism
• Tendency to live with kin instead of
unrelated individuals or alone
• Patriarchal structure
• Gender roles clearly defined
Familism
• A multidimensional concept
– Structural dimension
– Behavioral dimension
– Attitudinal dimension
How is drug use seen by the
Latino Family?
• Adolescent drug use
– Shock, anger, disappointment, feel betrayed,
embarrassed, sense of failure
– Ungrateful and failing to appreciate parent’s
sacrifices
Females addicts with children
• Experience guilt and shame about
neglecting their children
• Parents will blame her for failing her duties
as a good mother
• Partner may be seen by family the
responsible for woman’s drug use
Cultural Based Evaluation
• Questions that may help
– Information about life in the country of origin
– Immigration history
– Length of time in the USA
– Frequency of traveling between countries
Cultural Based Evaluation
• View about drug use
• Experiences with loss, persecution,
torture, war and deprivation
• What mayor changes have the client
experience as a result of coming to this
country
• Language of preference
Barriers that keep Latino clients away
from treatment
• Language barrier
• Problems with immigration authorities
• Role identification as provider or protector
• Treatment for drug dependence is difficult to access
• Fear to reveal to family their use and consequences
• Shame, stigma
• Feeling of being out of control
Barriers, cont.
• Lack of a continuum of care services that
address the recovering Latino’s needs
• Inability to pay for private care because
lack of insurance
• Fear of “official” inquiries or action by child
protective services
Helping strategies in treatment
• Remedial academic work
• Vocational training
• Emphasis in values of family loyalty and
Spirituality
• Trans-cultural/multicultural approach
• Motivational Intervention approach
Treatment strategies
• Focus on establishing trust (confianza)
• Encourage participation in different
creative activities
• Assess when to involve family members
• Discuss with family the use of medication
in treatment
What concepts from this
presentation can I apply in my
agency?
What concepts from this
presentation I am already
applying in my agency?
• Consider how dull life would
be if we all looked alike,
thought alike, and acted
alike!!!!!!!!!!!
References
• Vega, W.A. (2006). Cultural Elements in
Treating Hispanic Populations.
Universidad Central del Caribe.
• Miller, W.R., & Rollnick, S. (1991)
Motivational Interviewing: Preparing
People to Change Addictive Behaviors.
New York: The Guildford Press