CECILY RODRIGUEZ

1
Ensuring Quality Service Provision for the Latino
Community A Cultural Context

• CECILY RODRIGUEZ
• DIRECTOR,
• OFFICE OF CULTURAL AND LINGUISTIC COMPETENCY
• DEPARTMENT OF MENTAL HEALTH, MENTAL RETARDATION,
  SUBSTANCE ABUSE SERVICES

2
Learning Objectives

• I. Understand the general demographic history of
  Latin America and its implications for
  contemporary Latin American culture.

3
Learning Objectives

• II. Acquire an understanding of some fundamental
  characteristics of the Latino population in the US

4
Learning Objectives

• III. Identify some central cultural traits and
  their origins in Latin American/Latino
  populations, including the roles of Catholicism,
  language, social class and deference, and gender.

5
Learning Objectives

• IV. Introduction to some of the mandates,
  standards, and recommendations related to working
  with Latinos who are limited English proficient.

6
A Word about Cultural Competence.

• There are five abilities that are considered
  necessary to achieve individual cultural
  competence
• We value diversity
• We are able to understand our own cultural views
  (and those of our affiliated organizations and
  systems)
• We are aware of how culture may be affecting a
  life situation
• We are willing and able to learn about other
  cultures
• We are able to change our behavior to meet the
  needs of others and other cultures

7
I. demographic history

• Indo-America
• Highlands, home of densest pre-C. populations
• parts of Mexico, Guatemala, Ecuador, Peru, Bolivia

8
I. demographic history

• Euro-America
• Sparse pre-C. population destroyed or removed
• European immigration
• Argentina, Uruguay, Costa Rica

9
I. demographic history

• Afro-America
• pre-C population destroyed or removed
• African migrations
• Brazil, Caribbean islands and coasts, U.S.

10
I. demographic history

• Mestizo-America
• Assimilation of pre-C population
• Northern Mexico, parts of Central America,
  Colombia, Venezuela, Paraguay, Chile

11
Push and Pull Factors

• Most large migrations are the result of both
  pressures to leave the point of departure and
  attraction towards the destination.

12
Push Factors may be

• Political. Warfare, violence, persecution,
  forced migration, marginalization.
• Economic. Poverty, lack of opportunities, land
  scarcity.
• Climatic/environmental.

13
Pull Factors may be

• Political
• Economic
• Cultural/linguistic ties
• Kinship/social networks
• Labor recruitment

14
Changing Communities

• Migration brings people, languages, cultures, and
  religions into contact.
• There are many possible outcomes, from hostility
  and violence, to peaceful co-existence.
• Contact with other ways of being challenges both
  individual and collective identities.

15
A young population

• 35 under 18 years old
• (compare with 23 non-Hispanic white rate)
• 5 65 years or older
• (compare with 14 non-Hispanic white rate)

16
A disadvantaged population

• More likely to be unemployed
• More likely to work in service or labor
• More likely to earn less
• More likely to live in poverty (23 v. 8)
• Less likely to have finished high school

17
U.S. vs. Foreign Born

• 60 of the Hispanic population was born in the
  United States
• Of the 40 foreign born
• 27 arrived before 1980
• 30 arrived in the 1980s
• 43 arrived in the 1990s

18
Distribution by origin
19
Limited English Proficiency
20
Length of Residence in U.S.

• Very important to consider length of residence in
  the U.S. among Hispanics to fully understand many
  trends. Census data does not take in this
  information. If data on recent arrivals is mixed
  in with data on residents, the total results will
  be skewed.

21
Length of Residence in U.S.

• When we separate out the data on foreign-born
  Hispanics, the data, on earnings for example,
  approximate the majority population.
• Statistics on immigrants show that within 10-20
  years, earning gaps disappear.

22
Who is Hispanic/Latino?

• Term conflates diverse populations
• History of Mexicans in Southwest distinct from
  Puerto Rico
• Long-term residents with recent arrivals
• Émigrés from El Salvador vs. émigrés from Cuba
• Term homogenizes class experiences and neglects
  many different linguistic, racial, and ethnic
  groups (Delgado Stefancic)

23
Who is Hispanic/Latino?

• A person is of Spanish/Hispanic origin if the
  persons origin (ancestry) is Mexican,
  Mexican-American, Chicano, Puerto Rican,
  Dominican, Ecuadorian, Guatemalan, Honduran,
  Nicaraguan, Peruvian, Salvadoran from other
  Spanish-speaking countries of the Caribbean or
  Central or South America or from Spain.
• (U.S. Bureau of the Census, Population Division,
  DEVELOPMENT OF THE RACE AND ETHNIC ITEMS FOR THE
  1990 CENSUS 51 New Orleans Population
  Association of American, 1998 cited by Oboler in
  Delgado Stefancic, 1998)

24
Definition 2

• A Hispanic is a person who descends from Spanish
  forebears or from one of the many cultures in the
  world that owe their origins to Spain. The term
  comes from Hispania, the Latin word for Spain
  used by the ancient Romans, who conquered that
  region in the second century BC. A Hispanic
  American is a Hispanic who is a citizen or
  resident of the United States.
• (Ochoa, G. Amazing Hispanic American History, New
  York John Wiley Sons, 1998)

25
Definition 3

• The vague concept of Hispanicity depends on an
  often-unarticulated agreement among users of the
  terms (Latino and Hispanic) that different
  Hispanic national cultures share experiences,
  which is not always the case. We do believe that
  there exists a limited, shared Hispanic or Latino
  experience, consisting of linguist background
  (Castilian Spanish), cultural mythography
  (Catholicism and pre-Columbian folklore), and
  political disaffection (discrimination and
  disempowerment).
• (Augenbraum Stavans, Growing Up Latino, 1993,
  p. xxii.)

26
Latino vs. Hispanic

• Both terms are commonly used and to a large
  degree are interchangeable. The use of Hispanic
  is probably more institutional, conservative and
  external, while Latino/a is used in more
  individual, liberal and internal contexts.
  According to Ochoa (1998) Latino/a has been
  championed as preferable to Hispanic for two
  reasons

27
Reason 1

• Hispanic is an invented word in English with a
  pseudo-scientific sound to it, with the ic
  ending, like metric system or sulfuric acid.
  Latino/a is a Spanish word, and is already used
  by many people to describe themselves.

28
Reason 2

• Others say that Hispanic is derived from Spanish
  word, hispano, meaning derived from Spain. Some
  feel that this direct reference to Spain is
  misleading, since the cultural and historical
  link is stronger to Latin America. However,
  Latin ultimately comes from the Romans, the
  cultural ancestors of the Spaniards, so
  ultimately, there seems no clear solution.
  Currently both terms are used interchangeably,
  with preference given to Latino/a.

29
Chicano

• Synonymous with Mexican-American, and is derived
  from the Spanish word for Mexican,
  mexicano/mejicano. Originally a derogatory
  term used by non-Chicanos, it has since been
  appropriated by Chicanos as a term of pride.

30
Religion

• Spanish and Portuguese brought Roman Catholicism,
  which overlaid, accommodated and blended with
  local indigenous and later, African practices.
• Examples
• Santería
• Condomblé
• Costumbre

31
Santería
32
Condomblé
33
Costumbre
34
Catholism
35
The Religious Marketplace

• Rates of Protestant conversion have grown rapidly
  in the last 20 years.
• Brazil, Guatemala and Puerto Rico have some of
  the highest rates.
• Charismatic Catholicism responds to the growing
  appeal of Protestant churches.

36
Language

• Spanish (or Portuguese) is the official national
  language of most countries.
• Indigenous Languages
• Experts report between 550 and 700 indigenous
  languages for the whole region today, from about
  1,750 before the European invasions.

37
Indigenous Languages

• Examples include
• Nahuatl Mexico
• Mayan languages Mexico and Guatemala
• Mixtec Oaxaca, Mexico
• Purépecha Michoacán, Mexico
• Quechua Ecuador, Peru, Bolivia

38
African Language Impact

• Creole languages spoken in the Caribbean Basin
• Vocabulary of African origin in Spanish and
  Portuguese in Latin America.

39
Social Class

• Latin America and the Caribbean have the greatest
  disparities in income distribution in the world.
• The correlation between race/ethnicity and social
  class is significant but not uniform.

40
Deference

• Deference and politeness are highly valued in
  social interactions, especially in the highlands,
  and manifest in behavior (especially language).
• Courtesy
• Prelude and Indirectness

41
Gender Roles

• In general, gender roles are both more rigid and
  more complementary in Latin America than in North
  America.
• Most economic indicators of gender equality (e.g.
  education, employment, salary rates) reveal
  gender disparities.

42
Machismo

• American anthropologists define as "The cult of
  virility, the chief characteristics of which are
  exaggerated aggressiveness and intransigence in
  male-to-male interpersonal relationships and
  arrogance and sexual aggression in male-to-female
  relations" (Stevens 1973).
• In Latin America, the term macho usually must be
  distinguished from that of machismo.
• Macho has different meanings in different social
  circumstances sometimes it refers simply to the
  male of a species, whether animal or plant. In
  other cultural contexts "to be macho" can have
  contradictory connotations
• for older generations this may refer to something
  positive for men to emulate, so that a macho man
  is one who is responsible for the financial
  welfare of his family

43
Marianismo

• Is an aspect of the female gender role in the
  machismo of Latin American folk culture. It is
  the veneration for feminine virtues like purity,
  moral strength, etc., e.g. it represents the
  "virgin" aspect of the virgin-whore dichotomy.
  Evelyn Stevens states "it teaches that women are
  semi divine, morally superior to and spiritually
  stronger than men.
• It is a stereotyped, class based, gender role of
  the Latina. A woman's reputation is determined by
  how well she lives up to the example of feminine
  virtue. In some circles, it has now evolved into
  a term used to describe the feminine spiritual
  superiority, moral superiority and spiritual
  strength of the modern Latina.

44
Examples of differences in Macro and Micro
Culture related to Disabilities

• Micro Culture
• Sees disability as caused by a spiritual crisis
  (blessing or punishment). May blame an event like
  a susto
• May take a wait and see approach. They may
  feel that the disability is there for a purpose
  and should not try to cure it.
• May respond through prayer, talisman, rebalancing
  of the body (through food or drink). Use
  acupuncture or ceremonies to deal with or heal
  the disability.

• Macro Culture
• Sees disability caused by medical problems or
  physical trauma perhaps during pregnancy
• Assumes it is best to do something about the
  disability. The focus in on improving the
  situation
• Response to disability is to provide treatment
  and research.

45
Federal Mandates, Standards, and Recommendations
for Providing Services for Latinos in Health and
Human Services

• Title VI Civil Rights Act of 1964- requires all
  agencies and organizations that receive federal
  funding ensure that recipients of their services
  are free from discrimination. Not having access
  to public services because of a language barrier
  equals discrimination.
• Executive Order 13166 (2000)- Is an extension of
  Title VI, which was created to improve access to
  federally conducted and federally assisted
  programs and activities for persons who, as a
  result of national origin, are limited in their
  English proficiency. It requires that all
  organizations that receive federal dollars
  develop a language access plan that provides
  guidance for working with the LEP community.

46
Federal Mandates, Standards, and Recommendations
for Providing Services for Latinos in Health and
Human Services

• Institute of Medicine Unequal Treatment
  Report concluded that even when members of
  minority groups have the same incomes, insurance
  coverage and medical conditions as whites, they
  receive notably poorer care. Biases, prejudices
  and negative racial stereotypes, the panel
  concludes, may be misleading doctors and other
  health professionals.
• Office of Civil Rights (OCR)- enforces Title VI
  and LEP discrimination laws and helps to ensure
  that eligible individuals are not denied or
  deterred from obtaining benefits on the basis of
  their national origin and provides technical
  assistance to healthcare and human services
  providers. OCR conducts investigations to
  determine whether neutral policies or practices
  have a disparate impact on the basis of national
  origin.

47
Federal Mandates, Standards, and Recommendations
for Providing Services for Latinos in Health and
Human Services

• The Standards on Culturally Linguistically
• Appropriate Services
• CLAS mandates are current Federal requirements
  for all recipients of Federal funds (Standards 4,
  5, 6, and 7).
• CLAS guidelines are activities recommended by OMH
  for adoption as mandates by Federal, State, and
  national accrediting agencies (Standards 1, 2, 3,
  8, 9, 10, 11, 12, and 13).
• CLAS recommendations are suggested by OMH for
  voluntary adoption by health care organizations
  (Standard 14).

48
Federal Mandates, Standards and Recommendations
for Providing Services for Latinos in Health and
Human Services

• The National Council on Interpreting in Health
  Care (NCIHC) - Outlined the first National
  Standards for Medical Interpreters in November,
  2005. The NCIHC's National Standards of Practice
  are designed to help improve the quality and
  consistency of interpreting in health care. Just
  like clinical protocols for physicians, these new
  standards will provide guidance as to what is
  expected of health care interpreters and what
  constitutes good practice. There are 32 standards.

49
Principles of Community Engagement

• Learn about the specific cultures present in the
  community as well as the needs and issues that
  impact them.
• Engage cultural brokers as a way to introduce you
  to key community informants.
• Be flexible with your agenda and expectations.
• Ensure that partnerships are reciprocal.
• Be present in the community.
• Understand that relationships take time to be
  built and that just one negative event can
  destroy them.

50

• Parts of this presentation has been adapted from
  the work of
• R. McKenna Brown, PhD
• Exec. Director, Office of International Education
• Virginia Commonwealth University
• In a presentation at Western State Hospital
• February 11, 2009

51
For More Information

• The Office of Cultural and Linguistic Competency
• DMHMRSAS
• http//www.dmhmrsas.virginia.gov/OHRDM-CLC.htm
• To be on our email list of publications, research
  and items of interest- contact me at
• cecily.rodriguez_at_co.dmhmrsas.virginia.gov