MENTAL HEALTH CARE FOR HISPANICS WITH CHRONIC HEALTH & TERMINAL CONDITIONS ANTONIO N. PUENTE GEORGE WASHINGTON UNIVERSITY & ANTONIO E. PUENTE UNIVERSITY OF NORTH CAROLINA WILMINGTON National Hispanic Medical Association Washington, DC 05.05.17

Hispanics in the U.S. Any individual with Spanish- speaking background Central and South America, Mexico, and Spain 53 million individuals 11 million undocumented Hispanic immigrants Hispanics are the largest minority group 17% of the US population Source: Pew Research Center, 2009; U.S. Census Bureau, 2014

Hispanic Population in the US Hispanic population – a key driver of US population growth since at least 2000 In 2014 55.4 million or 17.4% US Census data

Defining Culture & Appreciating the Universal and the Indigenous Dictates the way in which a group of individuals live Sharing beliefs and practices to physically and socially survive Allows for an individual to identify with a particular group Sharing common ideas, purposes, and social norms, such as religion, economics and politics Dictate what is important for survival and what is crucial in the development and use of specific cognitive and behavior skills. In the past 20 years, there have been increasing efforts in understanding The role of culture in an individual’s life is multifaceted

Culture & Acculturation Adaptation of an individual to a new culture through prolonged contact - learning language, values, & cognitive style Impact construct validity more than true population differences Relevance to patient; consider daily routine & life experiences Outcomes may misclassify neurocognitive skills Spanish-speakers tend to underperform on non-verbal measures No test or intervention is free of cultural or educational influences

Hispanics/Latino/a s ARE NOT THE SAME Complexities Hispanics/Latino/a s ARE NOT THE SAME

Healthcare Disparities With Hispanics Access to Mental Health services for Hispanics is limited Majority of professionals are unable to provide clinical care in Spanish or another language of origin than English Lack of well normed, appropriately translated tools Major disparities exist particularly within the sub-specialty of health and neuropsychology Available empirical knowledge to support the science and practice with ethnic groups has not kept pace with demographic shifts

Educational Issues Some countries have standards & regulations Many small towns & cities in Central & South America do not Poverty, limited academic resources (i.e., few or no textbooks), & few or no qualified instructors Elementary level of education Poor attendance; academic advancement by age High relevance - lower end of continuum

Socio-economic Status Income, education, & occupation Both SES & relative deprivation affect health HS completion: Cuban 80%, Puerto Ricans 74%, Mexicans 54% BA/BS: Cuban-Americans three times the rate of Mexican Americans Hispanic children more likely to have parents with lower education & less likely to use a computer Income disparities persist at every level

Linguistic Issues Difficult task because of the linguistic and cultural diversity of this population Over 20 Spanish-speaking nations represented in the U.S. Get categorized together because they have the Spanish language in common Each Spanish-speaking country have their own distinctions regarding customs, words, and expressions as well as particular communication styles, music, and religious traditions –

Bilingualism 35 million (74%) ages 5 & over speak Spanish at home “Spanglish” borrowing & code-switching Screen for level of mastery; dominant language assessment: most valid results Comparison against American norms if in reference to English- language environment; both languages (e.g., aphasia) The challenge of self-report

Language Complexities Tacos Pinche Molinillo

Assessment & Intervention Practices for Spanish-speakers Practices have not matched demographic expansion Problems with translations, cultural adaptations, reliability & validity In-house translations & poor use of available tools

Clinical Interview & Observation Determine language dominance Country of origin Initial language exposure Language spoken at home, school/work & socially Music, television programs and/or books read Individual’s preference - caution Asking questions in both languages; rate speed, length & quality

Practical Concerns for the Assessment & Intervention of Hispanics Bilingual vs. Bicultural Between Hispanic Subgroup Variability Translators & Translations Accommodation VS. Modification

Positive Interpretation of Illness by Hispanics Appreciation of the role of the “doctor” Acceptance of a social unit, especially the family, in health care Compliance as acceptance of authority The concept that illness could be leave Good social skills and cognition in the ”grey” areas of disease and medicine

Hispanics Interpretation of Chronic & Terminal Conditions Often interpreted as either mystical (e.g., Santeros in Cuba) or religious (e.g., God’s will) Misunderstanding or mistrust of the medical/health professional and process Poor appreciation of complex compliance Limited appreciation of the role of lifestyle and stress with health and disease

Summary Hispanics are not all alike Differences involve more than linguistic differences Limited personnel and knowledge base Hispanics interpret chronic conditions differently Terminal situations are often interpreted in mystical and/or religious terms Clinician should place themselves in the position of the patient to understand and guide them through the assessment and intervention process

Resources American Psychological Association Ethical Standards for Psychologists Standards for Educational and Psychological Tests & Assessments Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists Available book chapters & articles www.antonioepuente.com

GRACIAS! PREGUNTAS? puente@uncw.edu antonioepuente.com