Q & A Webinar Meet your New Clients: Hispanics and Latinos by: Dr. Luis Torres 1. I have struggled with convincing parents that their adolescent may need to be evaluated for meds for depression, in part because the parent 'heard' from others that meds were addictive. Besides giving them education about meds, how do you get past the misinformation sometimes shared in the Latino community? This is an important question. For Hispanics/Latinos/as, community is important, and word of mouth carries a lot of weight. A family friend who has had a negative experience with medication can indeed adversely influence many others. First, it is important to validate the parent’s concerns, to acknowledge that some medications are indeed addictive, to explain that finding the right medication for a mental health issue is often a “trial and error” process rather than an exact science, and to recognize that sometimes people have side effects, and this is true for all meds, not just psychiatric meds. Second, it is necessary to provide information to the parent that shows that medication does help many people. Statistics are important here, but again, word of mouth is critical. Encourage the parent to seek out folks in the community for whom medication has worked well, families who have had a positive experience, and encourage the parent to speak with these folks and ask lots of questions. Lastly, and this is critical, it is important to understand that for many Hispanics medical decisions are shared decisions. Thus, the parents may be the “legal guardians” of the child or adolescent and may make the final decision, but this decision may be heavily influenced by what the rest of the family thinks. Thus, the information you provide and the steps outlined above should be done with the entire family, not just with the parents. Ask the parents who they listen to, who they go to for support or advice or guidance, and let them know it’s OK for these folks to come with them when they come to meet with you; in fact, encourage it. 2. How do we deal with the belief concept that when our people "help" someone else is in fact solapar/enabling the person i.e. "help your brother so he does not go to jail”. Sometimes, when we help somebody, we are enabling them. This doesn’t mean, however, that we shouldn’t help. There are many Hispanic cultural values that make it difficult for some Hispanic families to take a “tough love” approach with family members that are struggling with drugs and alcohol (or other issues). The importance of family, respect for others, the belief that everyone has dignity regardless of how low they have sunk, and religious beliefs all come together at times and make it hard to take a firm stance. It’s important to work with the family to find some measure of balance. We can be supportive of the person and still challenge the behavior, show our love for the family member and still insist that they seek treatment. And it’s OK to waver at times when an ultimatum is given, as long as the family understands that wavering dilutes their leverage. The last thing we want as a provider is for a family to “put out” one of its members because he “convinced” them that tough love was the way to go, and
then for the family to lose that member to an overdose or street crime or some other horrible situation. Being culturally competent means working with the challenges and resilience of our clients and their families, understanding and respecting their cultural values and beliefs even when—especially when—they are counter to ours. If it was easy to do we wouldn’t need training and supervision and personal work. 3. Have you see differences between Puerto Rican citizens in US and other Latinos? Hispanics are an amazingly diverse and heterogeneous group, tracing their roots to over two dozen countries, and bringing with them varied languages, cultures, religions, political histories, immigration journeys, and relationships to the U.S. Yes, there are characteristics that cut across all groups: Hispanics are overwhelmingly Christian (most Catholic) regardless of country of origin or ancestry; Spanish is a unifying language for most; family is paramount; and the immigrant generation always comes seeking a better life (like all immigrants). But there are also differences. Puerto Ricans are U.S. citizens by birth regardless of where they are born. Hispanics of other ancestries are U.S. citizens if they are born in the U.S., but if they are born abroad they have varied legal statuses, including unauthorized citizens (i.e., “undocumented”), refugees, Temporary Protected Status (TPS), legal residents, and naturalized citizens. These various statuses impact access to services. Puerto Ricans also tend to be more acculturated than other Hispanics, given the penetration of U.S. culture on the island of Puerto Rico. Puerto Ricans have higher prevalence rates than many other groups for certain drugs of abuse, like injection heroin use. These and other differences impact outreach efforts and service delivery. It’s important to understand our target population and to tailor our services to that population.