Culturally competent mental health care for Puerto Rican children

Journal of Child and Adolescent Psychiatric Nursing, Jul-Sep 2003 by Berrios, Carmen

TOPIC. Mental health care for Puerto Rican children.

PURPOSE. To explore the cultural background of Hispanics, present relevant definitions, and review and critique selected literature relevant to culturally competent mental health care of Puerto Rican children.

SOURCES OF DATA. Published literature.

CONCLUSIONS. Cross-cultural research is important to raise the consciousness of nursing professionals, expose them to other realities, and provide opportunities to establish culturally relevant treatment modalities.

Search terms: Children, culturally competent care, Hispanics

Culturally competent mental health care is an essential element for all individuals in a properly functioning pluralistic society. Although it is widely accepted that excellence in mental healthcare delivery requires sensitivity to all patterns shaping family reaction to emotional illness, there is a dearth of research exploring the relationship between cultural and ethnic factors to ways in which families cope with emotional distress. Moreover, there is a paucity of research evaluating culturally competent treatment outcomes for ethnic populations (Rogler, Malgady, Constantino, & Blumenthal, 1983; Rogler, Malgady, & Rodriguez, 1987). A challenge to mental health professionals to provide culturally competent care has been demanded for more than a decade (Campinha-Bacote, 1995; Leininger, 1996; Meleis, 1996). Nurses must be able to recognize, respect, and intervene in a manner that is congruent with the values of the client while recognizing their own cultural values and beliefs (Leininger; Meleis; Campinha-Bacote).

A population that clearly illustrates the need for culturally competent mental health care is the Hispanic population. Knowledge gained from studying the efficacy of culturally competent mental health care for Puerto Rican children will be an invaluable contribution to the area of cross-cultural psychiatry and nursing in particular. The purpose of this article is to explore the cultural background of Hispanics, present relevant definitions, and review and critique selected literature relevant to culturally competent mental health care of Puerto Rican children.

According to the U.S. Census Bureau (2000), there are approximately 32.8 million Hispanics, representing 12% of the total population, in the United States. Should current trends in immigration, birth rate, and lower mortality persist, the Hispanic presence by the year 2020 will increase to an estimated 55.2 million in the United States, representing 17% of the total population. At this rate, Hispanics will be the largest minority group in the United States. Of the 2.9 million Hispanics living in New York state, 36.6% are Puerto Ricans. Additionally, of the 9.3 million Hispanics residing in the New York, New Jersey, and Connecticut tri-state area, 35.8% are Puerto Ricans, making them the largest Hispanic minority group in this area (U.S. Census Bureau).

Demographic studies indicate trends within the Hispanic community that differ from national trends. Significant sociodemographics (U.S. Census Bureau, 2000) include that Hispanics are twice as likely as non-Hispanic whites to be unemployed (6.8% compared with 3.4%), are poorer (22.8% below the poverty level compared with 7%, and are less educated and drop out of high school (43% compared with 11.6%). Overall, the Hispanic population is younger than the non-Hispanic population, 35.7% of Hispanics and 23.5% of non-Hispanic whites being under 18 years of age. The difference is attributed largely to a higher birth rate among Hispanics. Language differences also permeate the group, as a majority of Hispanics speak Spanish at home and regard English as their second language, while a significant percentage speaks little or no English at all (U.S. Census Bureau).

Given the sociodemographic characteristics listed above, vast differences in cultural values, misinterpretation between traditional American and Hispanic cultural values, and the problems Hispanics face in adjusting to the host culture, it is easy to understand that Hispanics suffer great stress, making them vulnerable to mental health problems that require psychotherapeutic services (Rodriguez, 1987; Rogler et al., 1987; Ruiz, 1995). Such problems affect not only the adult population but also Hispanic children (Constantino, Malgady, & Rogler, 1994; Rotheram-Borus, 1990). Despite the need for mental health services, disadvantaged Hispanics underutilize the services available. Among the obstacles cited by Hispanics are geographic inaccessibility to the site where services are rendered, racial discrimination, language barriers, and conflicts with traditional Anglo-American middle-class value orientation. Psychocultural distance between patients and clinicians, caused by unfamiliarity with significant cultural values, is the primary reason for aborting treatment (Rodriguez; Rogler et al., 1983).

Definitions

Leininger (1996) defines culture as that which embodies the interactions among a people, including the behaviors of a particular group, incorporating values, beliefs, norms, patterns, and practices. These practices are learned, shared between members of the group, and passed down from generation to generation to strongly influence health and illness states.