Download Comparison OF the English and Spanish Version*s of The Wechsler

MENTAL HEALTH CARE FOR HISPANICS WITH
CHRONIC HEALTH & TERMINAL CONDITIONS
ANTONIO N. PUENTE
GEORGE WASHINGTON UNIVERSITY
&
ANTONIO E. PUENTE
UNIVERSITY OF NORTH CAROLINA WILMINGTON
National Hispanic Medical Association
Washington, DC
05.05.17
Hispanics in the U.S.
 Any individual with Spanishspeaking background
 Central and South America,
Mexico, and Spain
Share of the Total Change of
the U.S. Population between
2000 and 2012
6%
 53 million individuals
16%
Hispanic
White
 11 million undocumented Hispanic
immigrants
Black
55%
15%
Asian
Other
 Hispanics are the largest minority
8%
group
 17% of the US population
Source: Pew Research Center, 2009; U.S. Census Bureau, 2014
Hispanic Population in the
US
 Hispanic population – a key driver of US population
growth since at least 2000
 In 2014 55.4 million or 17.4%
US Census data
Defining Culture &
Appreciating the Universal and
the Indigenous
 Dictates the way in which a group of individuals live
 Sharing beliefs and practices to physically and socially survive
 Allows for an individual to identify with a particular group
 Sharing common ideas, purposes, and social norms, such as religion,
economics and politics
 Dictate what is important for survival and what is crucial in the
development and use of specific cognitive and behavior skills.
Culture & Acculturation
 Adaptation of an individual to a new culture through prolonged
contact - learning language, values, & cognitive style
 Impact construct validity more than true population differences
 Relevance to patient; consider daily routine & life experiences
 Outcomes may misclassify neurocognitive skills
 Spanish-speakers tend to underperform on non-verbal measures
 No test or intervention is free of cultural or educational influences
Complexities
Hispanics/Latino/a s
ARE NOT THE SAME
Healthcare Disparities
With Hispanics
 Access to Mental Health services for Hispanics is limited
 Majority of professionals are unable to provide clinical care in
Spanish or another language of origin than English
 Lack of well normed, appropriately translated tools
 Major disparities exist particularly within the sub-specialty of health
and neuropsychology
 Available empirical knowledge to support the science and practice
with ethnic groups has not kept pace with demographic shifts
Educational Issues
 Some countries have standards & regulations
 Many small towns & cities in Central & South America do
not
 Poverty, limited academic resources (i.e., few or no textbooks),
& few or no qualified instructors
 Elementary level of education
 Poor attendance; academic advancement by age
 High relevance - lower end of continuum
Socio-economic Status
 Income, education, & occupation
 Both SES & relative deprivation affect health
 HS completion: Cuban 80%, Puerto Ricans 74%, Mexicans 54%
 BA/BS: Cuban-Americans three times the rate of Mexican Americans
 Hispanic children more likely to have parents with lower education &
less likely to use a computer
 Income disparities persist at every level
Linguistic Issues
 Difficult task because of the linguistic and cultural diversity of
this population
 Over 20 Spanish-speaking nations represented in the U.S.
 Get categorized together because they have the Spanish
language in common
 Each Spanish-speaking country have their own distinctions
regarding customs, words, and expressions
Bilingualism
 35 million (74%) ages 5 & over speak Spanish at home
 “Spanglish” borrowing & code-switching
 Screen for level of mastery; dominant language assessment: most
valid results
 Comparison against American norms if in reference to Englishlanguage environment; both languages (e.g., aphasia)
 The challenge of self-report
Language Complexities
 Tacos
 Pinche
 Molinillo
Assessment & Intervention
Practices for Spanish-speakers
 Practices have not matched demographic expansion
 Problems with translations, cultural adaptations, reliability
& validity
 In-house translations & poor use of available tools
Clinical Interview &
Observation
 Determine language dominance





Country of origin
Initial language exposure
Language spoken at home, school/work & socially
Music, television programs and/or books read
Individual’s preference - caution
 Asking questions in both languages; rate speed, length &
quality
Practical Concerns for the Assessment
& Intervention of Hispanics
 Bilingual vs. Bicultural
 Between Hispanic Subgroup Variability
 Translators & Translations
 Accommodation VS. Modification
Positive Interpretation of
Illness by Hispanics
 Appreciation of the role of the “doctor”
 Acceptance of a social unit, especially the family, in
health care
 Compliance as acceptance of authority
 The concept that illness could be leave
 Good social skills and cognition in the ”grey” areas of
disease and medicine
Hispanics Interpretation of Chronic &
Terminal Conditions
 Often interpreted as either mystical (e.g., Santeros in
Cuba) or religious (e.g., God’s will)
 Misunderstanding or mistrust of the medical/health
professional and process
 Poor appreciation of complex compliance
 Limited appreciation of the role of lifestyle and stress
with health and disease
Summary
 Hispanics are not all alike
 Differences involve more than linguistic differences
 Limited personnel and knowledge base
 Hispanics interpret chronic conditions differently
 Terminal situations are often interpreted in mystical
and/or religious terms
 Clinician should place themselves in the position of the
patient to understand and guide them through the
assessment and intervention process
Resources
 American Psychological Association
 Ethical Standards for Psychologists
 Standards for Educational and Psychological
Tests & Assessments
 Guidelines on Multicultural Education,
Training, Research, Practice, and
Organizational Change for Psychologists
 Available book chapters & articles
 www.antonioepuente.com
GRACIAS!
PREGUNTAS?
[email protected]
antonioepuente.com