Issues of Diversity

THERE IS EVIDENCE THAT MANY MENTAL HEALTH PROBLEMS EXPERIENCED BY MEMBERS OF ETHNIC AND CULTURAL MINORITY GROUPS ARE RELATED TO PREJUDICE, DISCRIMMINATION, CULTURAL DIFFERENCES AND OTHER EXPERIENCES ASSOCIATED WITH MINORITY GROUP STATUS.

SELF AWARENESS ABOUT ONE’S OWN ATTITUDES, VALUES AND BELIEFS ABOUT CULTURAL DIFFERENCES AND A WILLINGNESS TO ACKNOWLEDGE RACIAL/CULTURAL DIFFERENCES ARE CRITICAL FACTORS FOR THE SOCIAL WORKER IN WORKING WITH DIVERSE POPULATIONS.

THERAPIST-CLIENT MATCHING

MATCHING CULTURE, RACE, ETHNICITY-REDUCE PREMATURE DROPOUT RATES BUT DOES NOT HAVE A PREDICTABLE EFFECT ON THERAPY OUTCOME (ATKINSON, 1986; SUE, ET AL., 1991)

ACCULURATION, TRUST OF WHITES, ETHNIC IDENTITY-IMPACTS THE EFFECT OF MATCHING

Common Traits of Ethnic Groups

ASIAN

●   CONFUCIAN/BUDDHIST PHILOSOPHIES

●    Percived as the “successful” or “model minority”

●    Family is the basic unit.  Family needs, prestige and welfare are deemed more important than Individual success.

●    PATRIARCHAL SYSTEM- The father or the oldest male in the family is afforded the most respect.

●    Often reluctant to share personal matters with strangers.

●    COMMUNICATION-INDIRECT Communication is commonly used to avoid direct confrontation.  There are more reserved, they show less emotional expressiveness.

●    Seek help from the family or cultural community-mental health problem is highly stigmatized because family is viewed as less acceptable and less likely to arrange marriages for their children.

●  Emotional problems are expressed through physical complaints; tend to come to treatment with somatic complaints.   Regard professional as person who has expert advice to solve a problem. May use a combination of traditional and Western Medicine (Lee, 1996)

●  Common Presenting Problems: Family conflicts. Among refugees traumatized by war, PTSD and dissociative disorders are common.

●   Effective Approaches: Problem- focused, directed, goal oriented, structured, problem solving approach and symptom relieving approaches. A psychoeducational approach is congruent with Asian values. Social support and resources (Lee, 1996)

●   Asian patients respond to psychotropic drugs differently than Caucasian patients. They typically require lower doses of medication than others and will experience more side effects from regular doses given to other patients.

●   Family therapy, encourage parents to communicate with Children openly. However, children may be perceived as “talking back” and insolent. (Hepworth, et. Al., 1997)

● Be aware of the role of shame and guilt in Asian cultures (i.e. reinforce adherence to prescribed obligations and responsibilities). 

Need to know the degree of assimilation and ethnic identity when working with Asian clients.

“SOCIAL DISPLACEMENT THEORY”- Research on Asian refugees found they had a pattern of Optimism upon arriving to the U.S which is followed by frustration, depression and confusion.  Refugees and immigrants are expected to exhibit the most severe mental health problems at the end of the first year through the third year after arriving in the U.S

 Intergenerational conflict is one main source of stress; resulting from different degrees of acculturation by family members (with the younger members adapting more quickly and rejecting of their family’s cultural traditions).

BLACK

●   Multigenerational family systems. STRONG KINSHIP BONDS; EXTENDED FAMILIES AND RELATIVES WITHOUT BLOOD TIES.

●   High Value placed on Religion (CHURCH) COMMUNITY, education and work.

●   Flexible family roles, parentified child common. Egalitarian marital relationship, Great respect for the Elderly

● will seek help from community representatives and organization for problems and mutual support

● High Tolerance for suffering.

● Due to slavery they may exhibit signs of “healthy cultural paranoia”. Tend to self disclose to BLACK therapist and not disclose to an Anglo therapist due to reaction to racism that is based in the past.
 

●   Physical punishment sometimes used as a way of disciplining children.

●   Black woman is viewed as being “all sacrificing” and the strength of the family”

●   Higher percentage of blacks living in poverty and vulnerable to health problems.

●  Reason for treatment: poor school adjustment, acting out behavior, depression, psychosis, drug addiction and alcoholism.  Schizophrenia is diagnosed most in blacks.

● Identified patient: child referred by another agency or school.  

●   Non verbal communication very common: less eye contact, higher level of emotional expressive ness, and brief to the point communications.

●Effective Treatment: ethnically sensitive; time limited, problem-focused, directive techniques, child focused, family therapy.  RESPECT-Making eye contact and building rapport is critical to establishing trust, use last name until client gives permission for less formality.

   

NATIVE AMERICAN

●  The TRIBE IS THE SUPREME. It is responsible for raising children and making all major decisions.

● Complex Family Organizations that include without blood ties, strong kinship bonds, multigenerational, extended families. GROUP takes preference over individual.   Husband and wives show a tendency to communicate more with their gender group than with each other.

●   When a Native American child is being placed in foster care or adopted; a social worker must contact the administrative office of the child’s tribe. The Indian Child Welfare Act of 1978 (P.L. 95-6087) gives jurisdiction to tribal authorities in these cases.

●   Native American tribes operate under their own rules and laws.  

●   Tribal customs and rituals must be respected.

● Respect for elders who are culture bearers that hand down traditions, legends, history. Tradition of oral story telling.

●   Spirituality: fundamental part of life: interconnectedness of all living things; sacredness of all creation: animism.

● Use OF TRADITIONAL  & Western healing practices: medicine man, shaman, or spiritual leaders are traditional healers.

● Communication: indirectness; being still and quiet: comfortable with silence: value listening. Non-verbal  communication common.

●    Native Americans may avoid making direct eye contact as a show of respect when talking to a higher status person.

●    Reason for seeking help: suicide, alcoholism, family problems, conflicts arising from living in two worlds (Attneave, 1982)

●    Effective Treatment: culturally sensitive, nondirective, collaborative approaches, problem solving approach, Network therapy: use of metaphors, story telling, paradoxical interventions; networking and use of rituals. Family therapy is consistent with the Indian value of working together to solve problems. (Sutton and Broken Nose, 1996)  Social worker should use active listening skills. Increase his/her tolerance for silent pauses, and show patience with a slower pace interview. Identify the client’s degree of acculturation and tribal identity and worldview.

 ● Consider incorporating elders, medicine people, and other traditional healers into the treatment process.

HISPANIC

● Largest minority group in the U.S.

● Need to know the degree of acculturation and world view when working with Hispanics.

●   Roman Catholic-Emphasis on spiritual values.

●    Family is of great importance.  They rely on family for support before going to outside sources during times of economic, emotional, and social hardship. INTERDEPENDENCE viewed as healthy and necessary and highly valued connectedness and sharing.  

●   Families are patriarchal.  Men characterized as machismo.

●   Use of native language and non-verbal communication can be critical to successful communication.

●   “PERSONALISM”-Personalized way of relating that imparts self worth. Display varied emotional expressiveness depending on language being spoken. When speaking Spanish, client may be more expansive, friendly, and playful but in switching to English, speech may be more businesslike, rational and guarded. (Hepworth, 1997)  

●   Lack adequate access to health care and experience more health problems than non-Hispanic whites: diabetes, hypertension, alcoholism, tuberculosis, AIDS, lead poisoning, injuries, and violent deaths. (Hepworth, 1997)

●   Most important reasons to seek help: wanting to improve their life circumstances. Locked into a cycle of poverty due to inability to access resources. They also feel isolated and pressured to change in order to adjust to a new culture. Culture shock and conflicting cultural values are pervading issues.

●    Effective Approach: Elicit, listen, and validate the “cultural journey” they are experiencing. Help them build bridges between old and new worlds. Short-Term treatment more effective than long term, in-sight oriented interventions. 

● Emphasize formalism in therapy (e.g., address family members in a way that reflects their status, respect conservational distances)

● Hispanics are least likely to differentiate between emotional and physical problems. They go to doctor with psychological complaints instead of mental health professional.

 ELDERLY

●Accurately assess and diagnose disorders of aging, knowledge of services to the elderly and appropriate clinical skills.

● Reminiscences common

● Identity transition problems- reason why they come therapy.  These involve physical, psychological and social changes they are experiencing.

● SW workers goal is to help the elderly adapt to new roles and changes in life style.  This involves setting specific treatment goals, helping with retirement and activity planning, and making appropriate referrals to other professionals and services.

●DEPRESSION: Result of loss, for example widowhood is associated with increased mortality and hospitalization for depression.  SYPTOMS OF DEPRESSION VARY IN ELDERLY THAN THE YOUNG; LOOK FOR FEELINGS OF USELESSNESS, PESSISMISM, APATHY, SOMATIC COMPLAINTS ARE VERY COMMON IN ELDERLY.

●Must differentiate between Dementia and Depression.

●SW must have awareness about his/her own feelings of death.

●It is presumed that the elderly come to therapy because of the dying process when they actually seek treatment to achieve a specific goal or a sense of meaning in their lives.

●SW must also be aware of their own values regarding institutionalization. The clinician’s role is to facilitate discussions of institutionalizations in a non judgmental manner. Provide ongoing support, once the elderly is placed is essential in coordinating treatment with the nursing home staff and assisting the caregivers to deal with feeling of loss, guilt etc.

THERAPY FOR THE ELDERY:

Reality orientation

Reminiscence therapy

Validation Therapy-

Genuineness, accurate empathy, unconditional regard will foster the therapeutic relationship.

Supportive therapy good-for stressors and losses.

Patients with HIV Disease

●Lack support from others

●Internalization of the social stigma

●Hopelessness

●Lack of information about HIV Disease

●NEUROLOGICAL DISORDER: DEMENTIA, DELIRIUM, AIDS DEMENTIA COMPLEX.

●Fear of developing visible symptoms, deteriorating completely.

●Social worker must be trained in crisis intervention and methods for dealing with life-threatening illnesses.

●SW must be knowledgeable about HIV

Encourage client to disclose their condition to their sexual partners

●SELF AWARENESS ON THE PART OF THE SOCIAL WORKER IN REGARDS TO HIV POPOULATION, STIGMAS “GAY DISESASE”

TREATMENT FOR HIV PATIENT:

●Crisis intervention

●Problem solving, support therapy

●Brief psychotherapy and group intervention

●HERE AND NOW

SW ROLE:

HELP CLIENT HANDLE DIAGNOSIS

Improve the Quality of the Client’s life

Empower the client

Deal with the client’s Impending death. 

Reference :

Social Work - A profession of many faces