1. 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

2. 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

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

4. 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

5. 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

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

7. 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

8. 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

9. 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

10. 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 –

11. 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

12. Language Complexities
Tacos
Pinche
Molinillo

15. 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

16. 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

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

18. 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

19. 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

20. 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

21. 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

22. GRACIAS!
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