Chapter 3. Mental Health Care of Hispanic Immigrant Children

Abstract

This chapter addresses the mental health care of Hispanic immigrant children within a school-based context. The school system is presented as a natural support agent that is psychologically, culturally and geographically accessible for the delivery of culturally competent mental health services. The development of a multifaceted New York City public school-based program created, by the first author of this chapter, in response to the psychosocial needs of Hispanic immigrant children is discussed as a viable approach that may be used in the provision of ethnic-sensitive mental health care.     

Chapter 4. Concepts of Mental Health and Mental Illness in Older Hispanics

Abstract

The effect of cultural context in symptom expression and interpretation among older Hispanics, and how they experience psychological distress are not well-understood. We use the illness representation model to learn about older Puerto Ricans' and Dominicans' conceptions and causes of positive mental health, the causes of emotional problems, the conceptions and causes of depression and anxiety, the distinction between depression and anxiety, and the relationship between age and depression. Greater understanding of the meaning of symptoms and syndromes of depression and anxiety might help to define more culturally-sensitive mental health treatments and service delivery systems.     

Chapter 6. Psychosocial Stressors,Psychiatric Diagnoses and Utilization of Mental Health Services Among Undocumented Immigrant Latinos

Abstract

The combined effects of minority status, specific ethnic group experiences (political, economic, trauma and immigration history), poverty, and illegal status pose a set of unique psychiatric risks for undocumented Latinos in the United States. Restrictive legislation and policy measures have limited access to health care, and other basic human services to undocumented immigrants and their children throughout the nation. However, little is known about the patterns of mental health care use, psychiatric diagnoses and psychosocial problems prevalent among the undocumented who do succeed in presenting to clinical settings and to the mental health sector. To begin to address the need for further understanding in this area, we completed a clinical chart review of 197 outpatient adult psychiatric charts in a Latino mental health outpatient treatment program located in an urban hospital system.

We compared the diagnoses and mental health care use of undocumented Latino immigrants (15%) with that of documented (73%) and US born Latinos (12%) treated in this clinical setting. The undocumented Latinos in our study were more likely to have a diagnosis of anxiety, adjustment and alcohol abuse disorders. The undocumented also had a significantly greater mean number of concurrent psychosocial stressors (mean number = 5, p < .001) ascompared to documented immigrants and US born groups, which both had a mean number of 3 stressors identified at evaluation. The undocumented were more likely to have psychosocial problems related to occupation, access to healthcare and the legal system. However, the undocumented had a lower mean number of total mental health appointments attended (mean visits = 4.3, p < .001) in which to address these stressors as compared to documented immigrants (mean visits = 7.9) and US born (mean visits = 13.3). In terms of other previous mental health service use, the undocumented group had lower rates of lifetime inpatient and outpatient treatment use.

The results of this study suggest the importance of early assessment of psychosocial stressors, substance use and barriers to care when treating undocumented immigrants. Although all Latino groups included in this investigation demonstrated numerable concurrent stressors, our investigation highlights the particular importance of accessible social services and supports for addressing psychosocial stressors in the lives of undocumented patients. Our results stress the importance of reexamining policies, that restrict access to social services and healthcare for the undocumented. Our results also suggest the importance of culturally appropriate evaluation and treatment of substance abuse disorders as well as addressing other psychological and behavioral responses to multiple stressors among undocumented individuals.     

Mental Health Intervention with Hispanic Immigrants

Abstract

The underutilization of mental health services by Hispanic immigrants has been well documented in the literature. Hispanic immigrants encounter numerous obstacles which prevent them from successfully navigating through the mental health system. This reality is further compounded by the fact that research appears to suggest an increased rate of mental health disorders among Hispanics. This article underscores the importance of understanding the influence of a Hispanic client's worldview, language, and religion on the provision of mental health services. A case vignette is presented as a means of illustrating key conceptual points. Practice principles or conclusions drawn from this article should be used as a general guide by mental health practitioners.     

Chapter 7. Mental Health Intervention with Dominican Immigrants

Abstract

Dominicans are a significant force in the changing composition of Hispanic immigration in the United States, and all indications are that they will continue to be in the years to come. A framework has been applied in which Dominican culture, psychosocial strengths and risks, and treatment implications are explored in the context of how Dominicans appear to be similar to and different from other Hispanic groups in the U.S. Much more needs to be done in terms of elaborating this combination of homogeneity and heterogeneity. Mental health practitioners who are open to such inquiry, and to keeping an open mind regarding the possibilities of modifications in therapeutic techniques and modality choices, will find Dominicans to be a clinically responsive, and an enjoyable population to work with.     

Chapter 11. The Future of Culturally Competent Mental Health Care for Latino Immigrants

Abstract

This chapter underscores the importance of cultural competence in the provision of effective mental health services to Latino immigrants. Culturally competent mental health care must be understood within the context of a social-political-economic framework that is changing on a continual basis. Health and mental health care reform for Latino immigrants must be linked to both practice-based research efforts and timely diffusion of best practice innovations. Cultural competence must be integrated as a valued component of the organizational structure of mental health systems of care.     

Health Services Considerations Amongst Immigrant Populations

Abstract

The foreign-born population comprised 11.5% of the U.S. population in 2002. Immigration to the U.S. has grown substantially and continues to grow. A close examination of the immigration data shows that immigrant community in the U.S. is not homogeneous and in fact is very diverse both within itself and from the native-born population. U.S. Census Bureau data reveal that these differences create pockets of divergent populations within the country. How these populations assimilate into the U.S. healthcare system is not clearly understood. Cultural values, beliefs, and practices often juxtapose the immigrant to the healthcare system. Religious differences coupled with educational and income disparities add to the challenge of developing and implementing healthcare programs. This paper concludes with suggestions for more research in healthcare to immigrants.     

An East-West Approach to Serving Chinese Immigrants in a Mental Health Setting

Abstract

This article discusses the unique design of a community day treatment program that addresses the issues of loss and acculturation for a Chinese American immigrant population who suffers from chronic mental illness. The program utilizes an integrated, multi-cultural milieu of staff and clients to create a microcosm of the diversity of American society, and reflects the agency's belief in the affirmation of the clients' cultural heritage as a more effective way of supporting clients in their recovery process. Case vignettes are used to illustrate the importance of helping immigrant clients who are marginalized in society to feel accepted, empowered and hopeful in their lives in a new country.     

Chapter 8. The Mariel and Balsero Cuban Immigrant Experience

Abstract

This chapter focuses on the differential family reunification issues experienced by Cuban Marielitos and balseros upon entrance into the United States. Treatment recommendations, aimed at ameliorating the emotionally laden reunification issues, are presented within a family systems and ecological context. The overall intent of this chapter/article is to assist mental health practitioners in their therapeutic work with members of a relatively small but distinct Hispanic ethnic group. Two case vignettes are presented as a means of illustrating the key family reunifications issues that have impacted-and continue to affect-Cuban Marielitos and balseros.     

Trade Liberalization in Indonesian Health Services: Prospects and Policies

The worldwide increase in demand for health services offers developing countries, like Indonesia, significant opportunities to expand international trade in this area. However, policy aimed at achieving this objective must carefully consider the World Trade Organization's (WTO) General Agreement on Trade in Services (GATS). For signatory nations and those considering becoming signatory nations, the procedural, structural, and other effects of the GATS make it a formidable challenge for national health policy alongside its impact on trade liberalization. Invoking the four GATS health care trade modes, this article develops possible approaches to Indonesian health services in the context of trade liberalization.     

Ethnicity,Language Capacity,and Perception of Ethnic-Specific Services Agencies in Asian American and Pacific Islander Communities

Abstract

This study examined (1) the ethnicity and language similarity between professional staff and service users, and (2) client satisfaction in ethnic-specific services (ESS) agencies serving Asian Americans and Pacific Islanders (AAPI). A combined method of agency survey and focus groups was used to collect the data. Findings indicate that ESS served a diverse AAPI population, although some ethnic and language sub-groups remain to be under served. Service users clearly prefer ESS, which is associated with a higher level of trust than mainstream services. However, staff simply sharing similar language or ethnic background does not automatically warrant trust. Trust is developed through a sense of respect that staff demonstrates within a cultural context. The feeling of trust is likely to determine AAPI clients' commitment to remain in treatment, a prior condition for achieving any desirable outcome.     

An Ethnographic Study on the Indonesian Immigrant Community and its Islamic Radicalization in South Korea

Contrary to popular belief, South Korea is not immune from the growth of Islamic radicalism. Although no serious terrorist attack has yet occurred within the country, some worrisome incidents have been reported. Recently, an Indonesian man was arrested on the grounds that he publicly supported the Al Nusra Front, a known Al Qaeda–affiliated terrorist organization, and even attempted to depart for Syria to join the organization. The current study is a response to such an incident. It investigates whether such an incident is an isolated exception or a harbinger of the Islamic radicalization process within South Korea, particularly within the Muslim immigrant community. The current study focuses primarily on the Indonesian immigrant community within South Korea but also investigates other Muslim communities when needed, as Muslim immigrant communities are often intermingled and share similar features. The study found some worrisome developments of Islamic radicalization within the Indonesian immigrant community in particular and the Muslim immigrant community in general. Using the enculturation stress model, the current study explains that such Islamic radicalization is a pathway of the collective response to cultural adaptation stress that most Indonesian and other Muslim immigrants face within South Korea. To conduct the study, ethnographic qualitative interviews were used. Indonesian immigrants, their Korean spouses, civilian activists, civilian aid workers, government officials, police officers, immigrant agency officials, and security officials were contacted and interviewed. Each interview lasted between approximately one and four hours. The limitations of the study are also discussed.     

New Hispanic Migration and HIV Risk in New York

Abstract

This paper reports on research designed to assess access to care by Latino immigrant populations in the New York area. A qualitative approach and methods were employed, involving focus groups with PWAs and affected men and women from Mexico, the Dominican Republic and Central America to explore the perceptions, beliefs, experience and knowledge of HIV care issues and the issues affecting health-seeking behavior. Among the data collected to provide context, depth and detail to the issue of access and utilization of services, was the detailed information on migration and HIV risk reported here.

A total of 57 men and women participated, ranging in age from 19-61. Results included information on migration patterns, obstacles for Latino immigrants living in the U.S., social networks, community resources, knowledge of HIV/AIDS, risk behavior and access to information. Data support the conclusion that to be effective in reaching and providing services to these immigrant groups, it is crucial to understand the environment from which they come and the impact of immigration. Poverty; repressive governments; lack of education/literacy; ethnicity, class; color-based stigma; and cultural norms are crucial factors in determining their attitudes, motivations, decisions and behavior. The key elements for the provision of services to this population appear to be those which build on cultural norms and which network human and institutional resources.     

Disparities in Infant Mortality Rates Among Immigrant Caribbean Groups in New York City

SUMMARY

This study examined infant mortality rates (IMR) in New York City (NYC) to identify those groups reporting higher IMR concentrations in recent years and to determine what factors and explanations are associated with this new trend.

Analysis of data from NYC Department of Health (DOH) identified infant mortality patterns throughout the City by both maternal birthplace and NYC Health Districts. In addition, infant mortality rates for those NYC populations with the highest concentrations were compared to the most recently available IMR data from their countries of origin. Focus group sessions were conducted with women in the identified groups in New York City in an effort to obtain their perspectives on causality and other factors associated with the new trend.

Strong patterns emerged from this study pointing to a concentration of the City's highest IMR among groups from the circum-Caribbean region. Results of focus group sessions with women in the identified population groups yielded a list of specific barriers faced by this population in the utilization of perinatal care services. In addition, the study resulted in some clearly delineated program and policy approaches that can help to address the disparities in IMR.

Myriad causative factors contribute to the high rates of IMR among Caribbean immigrant groups. Expanding the availability of both successful program models and promising practices is critical to decreasing infant mortality in immigrant communities. Specific recommendations are for the development of a strategic set of interventions designed to eliminate this most serious challenge to the health of new immigrant groups in NYC.

Any references to comparisons between data from NYC and data from the countries of origin were merely to serve as a reference point as it is not often possible to determine the level of scientific rigor applied to the collection and analysis of data external to the United States (U.S.).

Implications for social work practice with immigrant populations include the need for delivery of culturally competent services in general and for cultural sensitivity to health beliefs surrounding maternal child health issues in particular.     

Psy-expertise,therapeutic culture and the politics of the personal in development

Expertise stemming from the psy disciplines is increasingly and explicitly shaping international development policy and practice. Whilst some policy makers see the use of psy expertise as a new way to reduce poverty, increase economic efficiency, and promote wellbeing, others raise concerns that psychocentric development promotes individual over structural change, pathologises poverty, and depoliticises development. This paper specifically analyses four aspects of psy knowledge used in contemporary development policy: child development/developmental psychology, behavioural economics, positive psychology, and global mental health. This analysis illuminates the co-constitutive intellectual and colonial histories of development and psy-expertise: a connection that complicates claims that development has been psychologized; the uses and coloniality of both within a neoliberal project; and the potential for psychopolitics to inform development.     

论我国社区居民健康档案的研究意义

建设社区居民健康档案是社区卫生服务的重要组成部分,社区卫生服务发展又是我国卫生事业改革的重要组成。因此社区居民健康档案建设是国家基本公共卫生服务项目的重要组成部分,是其他社区卫生服务的基础性和关键性工作,它是掌握居民健康状况,变化趋势和决策制度的重要资料。     

Psychosocial Considerations in Working with the Chinese Immigrant

Abstract

Asian Americans have been the fastest growing segment of the United States population. Additionally, there is a continual influx of both legal and undocumented Chinese immigrants as well. Providers of social and health services, particularly in the public sector, have been coming into increasing contact with these individuals who bring with them a complex and multi-faceted history and background. The purpose of this paper is to highlight some of the psychosocial considerations when working with this population and some of the challenges encountered.

The Chinese immigrant's migration history and acculturation experience need to be appreciated within his or her cultural framework. Challenges facing the treatment of the Chinese immigrant include language barrier, shortage of bilingual staff and the associated difficulties in interpretation. Public education and outreach efforts have been targeting stigma reduction and developing primary prevention activities. The predicament service providers face when working with the undocumented aliens is underscored. A case illustration is included.     

Impact of the 1996 Welfare Reform and Illegal Immigration Reform and Immigrant Responsibility Acts on Caribbean Immigrants

SUMMARY

This paper examines the impact of the 1996 Welfare Reform and Illegal Immigration and Immigrant Responsibility Acts on Caribbean immigrants in the United States. Drawing from the conceptual framework posited by Dye's (1984) Elite Preference Modelof policy analysis, the author argues that the three laws have created enormous economic and psychological difficulties among families in the United States. Developing countries in the Caribbean region have been severely impacted by the law since they have had to accommodate returning citizens when they are deported under provisions of immigration policies. The question for consideration by this paper is how may the legal and human rights of deportees be balanced against the rights of the U.S. government to secure its borders and ensure the security of its citizens? The paper also addresses issues of immigration, and international relations particularly the north-south dialogue between powerful developed countries such as the United States and small developing states of the Caribbean.