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Gonzalo Bacigalupe, EdD, MPH Professor University of Massachusetts Boston AN AFFIRMATIVE COLLABORATIVE & RELATIONAL APPROACH TO MENTAL HEALTH INTERVENTIONS.

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Presentation on theme: "Gonzalo Bacigalupe, EdD, MPH Professor University of Massachusetts Boston AN AFFIRMATIVE COLLABORATIVE & RELATIONAL APPROACH TO MENTAL HEALTH INTERVENTIONS."— Presentation transcript:

1 Gonzalo Bacigalupe, EdD, MPH Professor University of Massachusetts Boston AN AFFIRMATIVE COLLABORATIVE & RELATIONAL APPROACH TO MENTAL HEALTH INTERVENTIONS WITH LATINOS

2  Cultural curiosity and collaborative engagement are often absent in the clinical relationship with and other underserved families and communities.  A series of preconceptions and strongly negative and deficit oriented frameworks prevail and limit our capacity to engage with a heterogeneous set of individuals, families, and communities.  To engage ethically and productively with these families, we need to assess our personal stance, to understand the contextual determinants in which these families live, and to evaluate carefully the institutional structures that undermine healthy solutions to their problems.  In this brief presentation, we will review some of the limiting discourses, ask critical questions, and review conceptual frameworks that can advance a better understanding and meeting of the needs of these individuals and families. ABSTRACT 2

3 SIGNIFICANCE Source: APA 3

4 1.To discuss cultural Identity as strength rather than a deficit. 2.To expand their awareness of the bias that exists in the professional and research discourse about the cultural identity. 3.To delineate the therapeutic relationship reframing the clinician and patient relationship as a collaborative process. AIMS 4

5 INTRO: SITUATED KNOWLEDGE 5

6  Rates for most mental disorders among are similar to that of the overall population. However rates vary among Latino sub-groups, and rates for most mental disorders are higher for US-born Latinos than for Latino immigrants. Example, Puerto Ricans may have the highest overall prevalence rate of mental illness among the ethnic groups.  Studies have shown that older adults and Hispanic youth are especially vulnerable to the stresses of immigration and acculturation.  More youth have pervasive feelings of sadness and hopelessness than whites (36% versus 26%) and more attempt suicide (10% versus 6% of whites). youth are less likely than non-Hispanic youth to use alcohol or illicit drugs.  Among with a mental disorder, fewer than 1 in 11 contact a mental health specialist, while fewer than 1 in 5 contact general health care providers. Even fewer Hispanic immigrants seek these mental health services.  Many rely on their extended family, community, traditional healers, and/or churches for help during a mental health crisis. Source: APA (www.psychiatry.org) MENTAL HEALTH EPIDEMIOLOGY 6

7  Latinos: a high-risk group for depression, anxiety, and substance abuse.  Prevalence of depression is higher in Latino women (46%) than Latino men (19.6%).  Among female high-school students in 1997, rate of attempted suicide among Latino girls (14.9%) was one-and-a-half times that of African American (9.0%) and non-Hispanic white (10.3%) girls.v  Close to one out of every three Latino female (30.3%) high-school students in 1997 had seriously considered committing suicide.  There are higher rates of mental illness among U.S. born and long-term residents than among recent Latino immigrants.  Long-term residence in the US significantly increase rates in mental disorders, with particularly dramatic increases in the rates of substance abuse.  Research on suicidal ideation found that foreign-born Mexican Americans are at significantly lower risk of suicide/depression than those born in the US. (www.nami.org) IT MAY EXPLAIN EPI 7

8 8 THOUGHTS?

9  Ethnicity  Historical  Geography  Linguistic  SES  Wealth  Education  Politics  Language  Migration journey  Border  Abroad family  Sexual orientation  Religion  Disabilities IT’S COMPLICATED  Subsistence  Social networks  Neighborhood  Community  Acculturation  Health  Racism  Ethnocentrism  Discrimination  Access/Quality  ELL  Technology Multiple/Evolving Identities 9

10  The discourse about (rights, characteristics, dimensions, census) always in flux.  Pervasive beliefs are misleading and erroneous (examples)  Fears of overutilization of health care by the immigrant population are not supported by epidemiological evidence.  Acculturation is a positive development.  Machismo is a Latino phenomena.  Social determinants of health are central in defining experience of Address them. WHAT DOES IT MEAN? 10

11 RESEARCH CASE: COMPLEXITY 11

12 ACCULTURATION AND FAMILIES  Families often struggle with how to adapt to a culture whose values are very different from their own while attempting to maintain important aspects of their heritage.  Struggle is related to the loss of important social support networks.  Sudden lack of family support and acceptance of traditional cultural practices appear to compromise many ability to effectively and efficiently adapt to their new surroundings. 12

13  Immigrants have their own unique translocation and acculturative process, often questioning:  Which aspects of their culture-of-origin they should maintain and which aspects they could discard?  Which aspects of the new host culture they should adopt, and which aspects they could disregard?  Acculturation can take various forms:  Integration (+)  Assimilation (-)  Separation/Segregation (-)  Marginalization (-) ACCULTURATION DILEMMAS 13

14 To speak of diversity does not necessarily address equity. POWER 14

15 WHY DOES IT MATTER? 15

16 16 QUESTIONS

17  Slides from a presentation by Camara Phyllis Jones. IN HEALTH CARE 17

18 Levels of health intervention 18 Camara Phyllis Jones: Health Equity Talk The Context

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31 Medical care and tertiary prevention Safety net programs and secondary prevention Primary preventionAddressing the social determinants of health 31

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39 Differences in access to care Differences in exposures and opportunities Differences in quality of care (ambulance slow or goes the wrong way) 39

40 Addressing the social determinants of health disparities: Why are there differences in resources along the cliff face? Why are there differences in who is found at different parts of the cliff? 40

41 3 dimensions of health intervention 41

42 3 dimensions of health intervention Health services 42

43 3 dimensions of health intervention Health services Addressing social determinants of health 43

44 3 dimensions of health intervention Health services Addressing social determinants of health Addressing social determinants of health disparities Source: Jones CP et al. J Health Care Poor Underserved

45 BOTH/AND MOST PROFESSIONALS, CLINICIANS, RESEARCHERS THINK FIRST OF INDIVIDUAL SOLUTIONS THE SOLUTION IS IN THE INDIVIDUAL (may be the family) RARE IS THE ASSESSMENT WHERE THE CONTEXT THAT SUSTAINS SOME BEHAVIORS IS AT THE CENTER A FRAMEWORK FOR INTERVENTIONS 45

46  Work to address equity, social justice, social determinants  Are we providing services because those are the ones we have available or because those are the ones the family needs?  Are we treating individuals, families, and communities as citizens and not just as consumers?  Are we modifying the contexts that maintain ill?  Are we addressing health prevention?  Embrace/learn of diversity in communities  Do I know of immigration, language, cultures, nationalities, etc.?  Do I recognize the stereotypes I have internalized?  What do I know about Latino cultures? BOTH/AND 46

47  Migration: Multidimensional  Map the journey  Cultural change  Migration  Ecological context: Systems within Systems  Social context  Family reorganization  Life Cycle transitions  Comparative: Situated Knowledge  The family map  The clinician’s map MECA (FALICOV, 2014) 47

48 MECA FRAMEWORK (FALICOV, 2014) 48

49 MIGRATION 49

50 VIRTUALIZATION OF INTIMACY Photo by Pablo Fernandez 50

51 ICT IMPACT 51

52 ECOLOGY 52

53 FAMILY SYSTEMS 53

54 LIFE CYCLE 54

55 MECA EXAMPLE 55

56 Fundamental Stance  Curiosity  Cultural humility  Clinician as a bridge  Clinician as a resource  Affirming strenghts COLLABORATIVE INTERVENTIONS 56

57  Preponderance of family: Last name versus first.  Solidarity versus indivudualism  Strong community orientation  Connecting through life span  Harmonious relationships  Endurance as a socialization value  Intergenerational responsibility  Separation as sacrifice on behalf of future generations.  Resilience in contexts of adversity  Faith  Cultural traditions  Respect for dignity/wisdom elderly  Celebration in deprivation contexts CULTURAL IDENTITY: STRENGTHS 57

58 Bacigalupe, G. and M. Cámara (2012). Transnational families and social technologies: reassessing immigration psychology. Journal of Ethnic and Migration Studies 38(9): Bacigalupe, G., & Lambe, S. (2011). Virtualizing intimacy: Information communication technologies and transnational families in therapy. Family Process, 50(1), doi: /j x Bacigalupe, G., & Parker, K. (In print, 2015). Staying connected: The immigrant millennial generation. In Carola Suarez-Orozco, Mona Abo Zena & Amy Marks (Eds.), Children of Immigration (2nd ed.). New York: NYU Press Falicov, C.J. (2014) Latino families in therapy. (2 nd Edition). NY: Guilford. Jones, C. P. (2002). Levels of racism: A theoretic framework and a gardener's tale. In T. A. LaVeist (Ed.), A Public Health Reader: Race, Ethnicity, and Health (pp ). San Francisco, CA: Jossey-Bass. Llerena-Quinn, R., & Bacigalupe, G. (2009). Constructions of difference among Latino and Latina immigrants and non-Hispanic White couples. In K.D. Killian (Ed.), Intercultural couples: Exploring diversity in intimate relationships (Pp ). New York: Routledge. ISBN: McGoldrick, M., et al. (2008). Genograms: assessment and intervention. New York, W.W. Norton & Co. Mutchler, J., Bacigalupe, G., Coppin, A., Gottlieb, A. (2010). Language barriers surrounding medication use among older Latinos. In I. Stavans (Ed.), Healthcare BIBLIOGRAPHY 58

59  59 THANKS! Gonzalo Bacigalupe. EdD, MPH University of Massachusetts Boston


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