Treating Bicultural Children/Adolescents

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Treating Bicultural Children/Adolescents

• Clinica Latina
• Cultural Rounds
• By
• Ingrid Ortiz, LCSW

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Case Review

• 17 yr Old Latina girl, who has presented with
  psychiatric symptoms since the age of 13.
• Family denial regarding the psychiatric
  condition, and sent back to native country to
  get fixed and saved from American influences
• Symptomology perceived as behavioral, and sent to
  the paternal figure for assistance (Patriarchal
  perspective).

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Assigned role of immigrant Children/Adolescents

• Particularly in first generation immigrant
  families, children are the conduit of information
  between family and outside world, due to language
  barrier
• Expected to be the success and pride of the
  family, and not forget cultural and ethnic
  identity and elements

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Adolescent Latino Patients

• It is important to understand the pressures of
  the dual, Latino adolescent experience
• Stresses of adhering to the expectations of the
  culture and family, as well as being accepted to
  the mainstream culture.
• Studies confirm high rates of illicit drug use,
  alcohol consumption and tobacco use among Latino
  adolescents, as well as high rates of sexual
  activity, teen pregnancy, and sexually
  transmitted diseases (Flores, 2001)

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• Privacy and confidentiality helps in treatment,
  since without it, they would not agree or seek
  treatment ( Reddy, 2002)
• It is important to inform both the parent as well
  as the adolescent, when confidentiality applies,
  to further engage the adolescent client, and
  address parental resistance

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Understanding the Latino Parent

• Typically, providers will be treated with
  respect, because they are perceived as an
  authority figure
• Authority figures are expected to present with a
  positive, warm and formal friendliness, which
  enhance compliance and adherence (Flores
  Sheehan, 2001)

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• Studies show that Latino mothers feel betrayed by
  clinicians, because clinicians and the U.S.
  instill independence, individuation, and is
  overly permissive children out of control or la
  vida loca (Quiñones-Mayo, 2005)
• Children are perceived as the property of the
  parents, and they will do whatever necessary to
  ensure positive outcomes. (such as sending back
  to native country, corporal punishment, etc.)

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• Typically, corporal punishment is the behavioral
  modification of choice, and at times parents
  become indignant at the suggestion of more
  effective methods
• Privacy and confidentiality is almost
  inconceivable to parent, when their child is
  still a minor

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• Parents will try to coerce information from
  clinician regarding the minor, in spite of HIPPA
  rights
• Parental attempt of coercion, is not perceived as
  a violation, but rather an alliance to ensure
  resolution to the presenting problem

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Reconciliation of Differences

• Provider needs to understand the need to become
  part of the solution, and not overly emphasize
  the problem.
• Provider will have the added role of bridging the
  gap between cultures.
• Psychoeducation is key to validate
  condition/diagnosis, and some of the
  acculturation issues (attire, etc.)

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• Explain that some acculturation does not mean
  abandonment of culture of origin.
• Clarify that treatment is not a sign of failure
  as parents, and their children are not
  necessarily the victims of the Anglo culture.