1. Treating Bicultural Children/Adolescents Clinica Latina Cultural Rounds By Ingrid Ortiz, LCSW

2. 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).

3. 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

4. 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)

5. 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

6. 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)

7. Studies show that Latino mothers feel betrayed by clinician’s, because clinician’s 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.)

8. 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

9. 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

10. 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.)

11. 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.