1. Ingrid Ramos, MA Charlottesville League of Therapists April 8 th, 2010

2. Mental Health as a Vehicle for Cultural Understanding

3. Events in Latino Migration Issues of Poverty: food, safety, shelter, education Migration : Legal: Reunite with family, work, opp. Illegal: Crossing the border Expectation in USA: Work, comfort, School, Reconnect with Family Reality: -No Familism -No Personalism -No work/ no dignity -No Language und. -NO status Coping Mechanism: - “God’’s will -Aguantarse/Controlarse - Family (in country of origin)

4. Events in Latino Migration Emotional Symptoms: -Worthless- being no body -Lost “What am I doing here? -Paranoid (If) - Women: Depressed, over-reactive - Men: Out of control Anger/ abuse of alcohol/ drugs - Nostalgia: Issues of grief and loss Increased Stress and Emotional Symptoms when the Dominant Culture intervenes through: -School System - Department of Social Services - Police - Legal System

5. Events in Latino Migration Latinos’ Values and Beliefs System:Dominant Culture Values and Systems Confronted with

6. Case Rosy is a 6 year old girl referred by Social Services. Her school teacher made a report to CPS due to Rosy having a mark on her face and reporting that Dad hit her. The school counselor, social worker and family support worker addressed this issues with her parents, but they denied the child’s version and reacted angrily with school staff. They expressed feeling discriminated and misunderstood by personnel involved. They threaten to take the child out of the school.

7. Case – Family Background Andrea and Julian have been together for 10 years. They migrated to the USA using the help of “coyotes” when they were single, 17 and 18 years old. The woman traveled from Honduras to the USA to reunite with her parents who left her 5 years ago. In her journey she was raped and had to fight for her life with the coyote. At the border, people rescued her and contacted her family in the USA. The husband was sent by his parents to the USA to join other family members as a way to run away from a “brujeria’s work” (bewitchment) that a women put on him.

8. Case – Family Background The couple met in Texas. The intensity of the domestic violence and husband’s drug addiction deteriorated the relationship and the wife’s family members tried to protect her. The attempts were in vain and the family decided to abandon her to her luck and decisions. The woman reported suffering “ataque de nervios”.

9. Common Family Patterns: 1. Significant trauma in country of origin (war, poverty, parents’ migration ) 2. Trauma at the border crossing, especially for women (raped, starvation, long walks, stolen, unwanted pregnancy, etc.) 3. Domestic violence and alcohol consumption (or drug) usually by men 4. Isolation and lack of support system (even if having family around, economic issues raise stress among family members).

10. Common Family Patterns: 5. Women overwhelmed by parental responsibility because of lack of support from partner and family; Women trapped in abusive relationship 6. Issues of spirituality, beliefs influencing emotional state or decision making 7. Overreaction to any encounter with community services due to experience of perceived or real racism (prejudice based on community rumors or personal experience) as well as fear because of lack of understanding of the system.

11. Common Family Patterns: 8. Difficulty finding a job due to legal status 9. Difficulty maintaining job stability due to seasonal changes in the economy and inability to save on minimum salary wages. 10. High risks of being homeless, malnourished, and getting in trouble with legal system

12. Common Family Patterns: 11. High stress levels lead to common health issues or symptoms: stomachache, headache, chest pain, etc. 12. Grief and loss due to missing support of family and friends and feeling out of context in a different culture. 13. Parents don’t speak English and are illiterate in Spanish. 14. Children dealing with language and/or developmental delays.

13. Therapeutic Approach 1. Intervention by a native speaking therapist and an American Therapist 2. Getting to know the family, interest in understanding their lives and views, and validation of their experience allowed space for increased trust and joining. 3. Education about the American School System and parental responsibility in the USA. 4. Mediation between the family, social services and school. 5. Case Management to support client’s acculturation process and support in crisis (housing, health, school, food, etc.)

14. Outcome: Stabilization of home environment Preserving the family Learning by modeling: Social skills, parenting skills, etc. Integrating the family with the community (introducing them to services, developing confidence, referring, etc.) Contribution to their acculturation process: appreciating their own culture while assimilating dominant culture

15. Challenges In Therapeutic Sessions 1. Latinos’ stigma about Mental Health 2. Sense of “Pride” limits disclosure in sessions 3. Sense of “Politeness” 4. Identification of authority/ powers in decision making in the family 5. Language barriers between parent and children/ sense of children’s identity.

16. Challenges in Providing Adequate Comprehensive Services The complexity of Hispanic cases or refugees tend to create high stress level in the therapists providing services: Limitation in funding sources Limited access to bilingual therapists in the community Limitation in case management compared with the magnitude of the family’s needs

17. What can you do? Identify the need for services Behaviors/ Symptoms/ Level of Stress Level of functioning (work, school, home, community) Level of Risks Know the Resources Support Groups Church Mental Health Providers in the area Emergency Phone number at Region 10

18. Provide a Bridge for Cultural Understanding

19. Thanks!!