简介
The growing Latino population of the United States stands poised to shape the nation鈥檚 future throughout the twenty-first century, yet serious obstacles hinder the full participation of the Latino community in American society.聽 Access to mental health care poses a particular challenge for many segments of the population.聽 Although significant scholarship has focused on the delivery of culturally competent practice, few academic resources address systemic issues that affect the actual delivery of services to Latino clients.聽 In response, Creating Infrastructures for Latino Mental Health provides the first interdisciplinary guide aimed at improving access to mental health services.聽 Experts from several specialties provide state-of-the-art analyses and innovative strategies for tackling the structural, organizational, and linguistic issues that contribute to service inequities.聽 Collectively, the book chapters call attention to clinical, geographical, and social contexts, as well as to populations as varied as breast cancer survivors, rural 鈥渘ew growth communities,鈥?and unaccompanied immigrant youth. 聽The authors provide an exquisite array of intersecting topics linked by a common theme: the need for a broad social response to transform mental health service for Latinos.聽 Among the topics covered: 聽路聽聽聽聽聽聽聽聽 Infrastructure development aimed at specific dimensions of structural inequality 路聽聽聽聽聽聽聽聽 The role of government in facilitating the development of infrastructures 路聽聽聽聽聽聽聽聽 The need for federal policy to protect immigrants and aid in their incorporation聽聽 路聽聽聽聽聽聽聽聽 Building local infrastructures attuned to the specific needs of communities 路聽聽聽聽聽聽聽聽 Developing a bilingual workforce through interdisciplinary collaboration, organizational planning, and training of staff and interpreters 路聽聽聽聽聽聽聽聽 Addressing the mental health needs of Latino youth in the juvenile justice system 路聽聽聽聽聽聽聽聽 Expanding educational opportunities for first-generation college students 路聽聽聽聽聽聽聽聽 Supporting Latino families caring for persons with serious mental illness "An extraordinary contribution to multiple stakeholders.鈥Provides guideposts for policy-makers, administrators, researchers and clinicians alike.鈥?-- Patricia Arredondo, EdD, Associate Vice Chancellor for Academic Affairs, University of WI-Milwaukee 聽鈥淭his book's comprehensive compendium of knowledge of Latino mental health makes it indispensable reading not only for mental health professionals, social workers and educators but for all those interested in the psychology and culture of the fastest growing population in America.鈥?-- Pastora San Juan Cafferty, PhD, Professor Emerita, School of Social Service Administration, University of Chicago 聽鈥淭his book addresses tremendous gaps in the fields of Latino mental health and healthcare. Packed with useful information, innovative perspectives, and actionable policy recommendations, this interdisciplinary effort undoubtedly will become a 鈥済o-to鈥?resource in meeting the mental-health needs of Latinos.鈥?-- Glenn Flores, MD, FAAP, Director, Division of General Pediatrics, Professor of Pediatrics, Clinical Sciences, and Public Health, The Judith and Charles Ginsburg Chair in Pediatrics, UT Southwestern Medical Center and Children's Medical Center Dallas
目录
Foreword 5
Preface 7
Acknowledgements 13
Contents 15
About the Authors 17
Contributors 24
Part I 26
Forces Shaping Service Provision 26
Chapter-1 27
Latinos and the Changing Demographic Landscape: Key Dimensions for Infrastructure Building 27
The Construction of the Latino Pan-Ethnic Category 28
Latino Origins 29
Mexicans 30
Puerto Ricans 31
Cubans 32
Dominicans 33
Central Americans 34
South Americans 35
Summary 35
The Demographic Growth of the Latino Population in the United States 36
Age Composition 36
Nativity and Citizenship 37
English Proficiency and Language Spoken at Home 38
Spatial Dispersion of the Latino Population in the United States 39
Socioeconomic Conditions 41
Educational Disadvantage 41
Employment and Occupation 43
Income/Poverty 44
Health Status and Access to Health Care 45
Recommendations 47
Summary and Conclusion 48
References 50
Chapter-2 55
Latino Mental Health: Acculturation Challenges in Service Provision 55
Theories of Second-Culture Acquisition 57
Factors Affecting Acculturation 59
Macro-Level Factors 59
Context of Reception 60
Case Study: Cubans and Central Americans 60
Geographic Effects and Local Tensions 61
Micro-Level Factors Affecting Acculturation 63
Language 63
Skills 64
Factors That Influence Acculturation Stress 65
Cultural Frame of Reference 65
Discrimination 66
Cultural Assimilation or Retention 66
Changing Roles 67
Family Support 67
Segmented Assimilation 67
Toward Greater Incorporation of Immigrants 68
The Role of the Federal Government 69
Building Stronger Infrastructures for Latino Mental Health at the Local Level 71
Regions Where Supply Meets Demand 71
Regions Where Demand Exceeds Supply 72
Conclusion 73
References 74
Chapter-3 79
Building Response Capacity: The Need for Universally Available Language Services 79
Demographic Trends in the Latino Population: Language Implications for Services 80
Latinos with LEP and Their Children 81
Growing Older Adult Population 82
New-Growth Communities 82
The Influence of Language Barriers on Access to Mental Health and Health Care 83
Sociopolitical Context of Language Services 84
Legal Framework for Language Services 85
Barriers to the Provision of Linguistically Accessible Mental Health and Health Care 86
The Triad Relationship 87
The Importance of Assessing Language Skills 88
Consequences of the Unreflective Use of Interpreters 88
Building Response Capacity for Language Accessibility 89
Communicative Competence 90
Organizational Support for Communicative Competence 91
A Coordinated System of Interpretation 92
Organizational Climate That Encourages a Proactive Use of Interpreters 93
Planning for the Future 93
Conclusion 94
References 95
Part II 100
Building Infrastructures Across Service Sectors 100
Chapter-4 101
Increasing Service Parity Through Organizational Cultural Competence 101
Component One: Community Context 104
Component Two: Cultural Characteristics of Local Populations 104
Action-Oriented Community Diagnosis 105
Rapid Assessment 106
Rapid Ethnographic Assessment 108
Community Readiness Assessments 108
Component Three: Organizational Infrastructure 109
Planning and Evaluation 110
Organizational Cultural Competence Assessment 110
Organizational Readiness Assessment 111
Organizational Values 111
Communication 112
Community Participation 113
Governance 114
Human Resources 114
Service Array 115
Technical Support 115
Component Four: Direct Service Support 116
Service Availability 116
Accessibility 116
Utilization 117
Conclusions 117
References 118
Chapter-5 121
Building Infrastructure Through Training and Interdisciplinary Collaboration 121
Structural Issues in Mental Health Service Training 122
Challenges Related to Training a Bicultural and Bilingual Workforce 125
Opportunities Offered through Bilingual Training Programs 127
The Imperative for Interdisciplinary Work 128
Untapped Resources for Latino Mental Health 130
Recommendations for Building Infrastructure 131
Conclusions 134
References 134
Chapter-6 139
Investing in the Future: Expanding Educational Opportunities for First-Generation Latino College Students 139
Educational Barriers for First-Generation Latino Students 141
Major Hurdles: Undergraduate Admissions, Retention, and Graduation 142
The Two-Year College Preference 142
Challenges in Applying to Four-Year Institutions 143
Legal Status: The Plight of Undocumented Students 144
Psychological Challenges to Educational Success 145
Financial Needs 146
The Sociopolitical Context of Higher Education 146
Race-Neutral Percentage Programs 147
Strategies to Increase Enrollment 148
Strategy 1: Expand TRIO 148
Strategy 2: The DREAM Act 150
Strategy 3: Institutional Practices That Facilitate Retention 151
Latino Family Visit Day 151
First-Generation College Student Program at UCF 152
Fostering Support Networks through Counseling, Outreach, and the Internet 152
Conclusion 154
Appendix A 154
Pre-College Programs 154
References 156
Chapter-7 160
Putting Students to Work: Spanish Community Service Learning as a Countervailing Force 160
Spanish Community Service Learning: An Example of a Mutually Beneficial Partnership 161
Spanish: Challenges and Solutions for Mental Health Providers and Foreign-Language Educators 163
A Spanish Community Service Learning Model: The University of Illinois, Urbana-Champaign 165
Recommendations for the Development of a Spanish CSL Program 166
Ensure that Students Receive Academic Oversight and Credit for their CSL Work 166
Build Community\u2013Campus Partnerships That Are Mutually Beneficial 168
Use Teaching Materials That Build the Specific Skills Students Need in the Community and Strengthen Their Critical Thinking 169
Leverage Technology to Facilitate CSL Administration and to Build Sustainable Solutions to Human Service Needs 171
Transportation: A Specific Case of a Spanish CSL Student\u2019s Supporting Role 173
References 174
Part III 177
Priority Contexts for Infrastructure Development: Vulnerable Populations 177
Chapter-8 178
Serving Latino Families Caring for a Person with Serious Mental Illness 178
The Caregiving Ideology Characteristic of Latino Families 179
Cultural Issues that Affect Latino Family Participation in Services 180
Family Involvement in Services in the Early Stages of the Illness 182
Psychoeducational Approaches with Latino Families 184
La CLAve: Promoting Early Entry into Mental Health Treatment 185
CFIMA: A Manualized, Multifamily Intervention for Latino Families 186
Conclusion 190
References 191
Chapter-9 195
The Plight of Latino Youth in the Juvenile Justice System: Considerations for Mental Health Treatment 195
Latino Youth in the Juvenile Justice System 196
Disproportionate Minority Contact 197
Mental Health and Juvenile Justice 198
The Impact of Acculturative Stress on Mental Health 199
Barriers to Access and Utilization of Services 199
Juvenile Justice Involvement 200
Arrest and Intake 201
Petitions 201
Court Process/Adjudication 202
Probation 203
Secure Confinement 204
Solutions and Recommendations 204
Conclusion 207
References 208
Chapter-10 212
Promoting the Well-Being of Unaccompanied Immigrant Minors 212
Unaccompanied Immigrant Minors and Their Journey to the United States 213
Unaccompanied Immigrant Minors Around the World 217
The Mental Health of Unaccompanied Immigrant Minors 218
Resiliency in Unaccompanied Immigrant Minors 220
Government Responses to the Needs of Unaccompanied Immigrant Minors 222
US Government\u2019s Response 223
Building Infrastructure to Promote the Well-being of Unaccompanied Immigrant Minors: The Immigrant Children Legal and Service Partnership 226
Conclusion 228
References 229
Chapter-11 232
Latinos in Rural Areas: Addressing Mental Health Disparities in New Growth Communities 232
Challenges in Meeting the Mental Health Needs of Latino Immigrants in the Rural United States 233
Rural Health Care Landscape 235
Research Model and Key Findings with Mental Health Infrastructure Implications 236
Assessment Phase: Key Findings 238
Implementation Phase 239
Recommendations for Infrastructure Improvements 241
Prevention Activities 241
Treatment and Maintenance Activities 242
Program Administration 243
Conclusions 244
References 244
Part IV 249
Reflections on Service Opportunities in Latino Mental Health 249
Chapter-12 250
Life During and After Breast Cancer 250
Psychological Concerns Among Latina Breast Cancer Survivors 252
Depression 252
Body Image Concerns 253
Social Support 254
Mental Health Service Gap 255
The Role of Nonprofits in Provision of Breast Cancer Psychosocial Services 255
Meeting the Psychosocial Needs of Latina Breast Cancer Survivors: Nueva Vida 257
Structure of Nueva Vida 258
Structure of the Mental Health Support Program 259
Recommendations for Infrastructure Building 260
Conclusion 262
References 262
Chapter-13 266
Lessons Learned from HIV Service Provision: Using a Targeted Behavioral Health Approach 266
HIV/AIDS in Latinos: Statistics and Geographic Distribution 267
Latino MSM 268
Major Challenges in Service Provision 268
Governmental Funding Barriers for Program Development 269
Addressing the Challenges and New Opportunities 270
Social Capital Development: Building Infrastructures from the Ground Up 271
Essential Elements for Harnessing Social Capital in Behavioral Health 272
Building and Engaging Community-level Social Networks 272
Institutional Network Building and Engagement 273
Examples of Behavioral Health Interventions That Rely on Social Capital 274
Mpowerment: Intervention for Building and Engaging Social Networks 274
El Ambiente: An HIV Prevention Program at AGUILAS 275
Moving Forward 276
References 277
Chapter-14 279
Private Practice with Latinos: Brief Reflections and Suggestions 279
Epilogue 283
What Does Politics Have to Do with It? Policy and Mental Health Services Access for Latino Populatio 1
Political Context for Mental Health 284
Immigration Policy Reform 285
Conclusion 286
References 287
Index 288
Preface 7
Acknowledgements 13
Contents 15
About the Authors 17
Contributors 24
Part I 26
Forces Shaping Service Provision 26
Chapter-1 27
Latinos and the Changing Demographic Landscape: Key Dimensions for Infrastructure Building 27
The Construction of the Latino Pan-Ethnic Category 28
Latino Origins 29
Mexicans 30
Puerto Ricans 31
Cubans 32
Dominicans 33
Central Americans 34
South Americans 35
Summary 35
The Demographic Growth of the Latino Population in the United States 36
Age Composition 36
Nativity and Citizenship 37
English Proficiency and Language Spoken at Home 38
Spatial Dispersion of the Latino Population in the United States 39
Socioeconomic Conditions 41
Educational Disadvantage 41
Employment and Occupation 43
Income/Poverty 44
Health Status and Access to Health Care 45
Recommendations 47
Summary and Conclusion 48
References 50
Chapter-2 55
Latino Mental Health: Acculturation Challenges in Service Provision 55
Theories of Second-Culture Acquisition 57
Factors Affecting Acculturation 59
Macro-Level Factors 59
Context of Reception 60
Case Study: Cubans and Central Americans 60
Geographic Effects and Local Tensions 61
Micro-Level Factors Affecting Acculturation 63
Language 63
Skills 64
Factors That Influence Acculturation Stress 65
Cultural Frame of Reference 65
Discrimination 66
Cultural Assimilation or Retention 66
Changing Roles 67
Family Support 67
Segmented Assimilation 67
Toward Greater Incorporation of Immigrants 68
The Role of the Federal Government 69
Building Stronger Infrastructures for Latino Mental Health at the Local Level 71
Regions Where Supply Meets Demand 71
Regions Where Demand Exceeds Supply 72
Conclusion 73
References 74
Chapter-3 79
Building Response Capacity: The Need for Universally Available Language Services 79
Demographic Trends in the Latino Population: Language Implications for Services 80
Latinos with LEP and Their Children 81
Growing Older Adult Population 82
New-Growth Communities 82
The Influence of Language Barriers on Access to Mental Health and Health Care 83
Sociopolitical Context of Language Services 84
Legal Framework for Language Services 85
Barriers to the Provision of Linguistically Accessible Mental Health and Health Care 86
The Triad Relationship 87
The Importance of Assessing Language Skills 88
Consequences of the Unreflective Use of Interpreters 88
Building Response Capacity for Language Accessibility 89
Communicative Competence 90
Organizational Support for Communicative Competence 91
A Coordinated System of Interpretation 92
Organizational Climate That Encourages a Proactive Use of Interpreters 93
Planning for the Future 93
Conclusion 94
References 95
Part II 100
Building Infrastructures Across Service Sectors 100
Chapter-4 101
Increasing Service Parity Through Organizational Cultural Competence 101
Component One: Community Context 104
Component Two: Cultural Characteristics of Local Populations 104
Action-Oriented Community Diagnosis 105
Rapid Assessment 106
Rapid Ethnographic Assessment 108
Community Readiness Assessments 108
Component Three: Organizational Infrastructure 109
Planning and Evaluation 110
Organizational Cultural Competence Assessment 110
Organizational Readiness Assessment 111
Organizational Values 111
Communication 112
Community Participation 113
Governance 114
Human Resources 114
Service Array 115
Technical Support 115
Component Four: Direct Service Support 116
Service Availability 116
Accessibility 116
Utilization 117
Conclusions 117
References 118
Chapter-5 121
Building Infrastructure Through Training and Interdisciplinary Collaboration 121
Structural Issues in Mental Health Service Training 122
Challenges Related to Training a Bicultural and Bilingual Workforce 125
Opportunities Offered through Bilingual Training Programs 127
The Imperative for Interdisciplinary Work 128
Untapped Resources for Latino Mental Health 130
Recommendations for Building Infrastructure 131
Conclusions 134
References 134
Chapter-6 139
Investing in the Future: Expanding Educational Opportunities for First-Generation Latino College Students 139
Educational Barriers for First-Generation Latino Students 141
Major Hurdles: Undergraduate Admissions, Retention, and Graduation 142
The Two-Year College Preference 142
Challenges in Applying to Four-Year Institutions 143
Legal Status: The Plight of Undocumented Students 144
Psychological Challenges to Educational Success 145
Financial Needs 146
The Sociopolitical Context of Higher Education 146
Race-Neutral Percentage Programs 147
Strategies to Increase Enrollment 148
Strategy 1: Expand TRIO 148
Strategy 2: The DREAM Act 150
Strategy 3: Institutional Practices That Facilitate Retention 151
Latino Family Visit Day 151
First-Generation College Student Program at UCF 152
Fostering Support Networks through Counseling, Outreach, and the Internet 152
Conclusion 154
Appendix A 154
Pre-College Programs 154
References 156
Chapter-7 160
Putting Students to Work: Spanish Community Service Learning as a Countervailing Force 160
Spanish Community Service Learning: An Example of a Mutually Beneficial Partnership 161
Spanish: Challenges and Solutions for Mental Health Providers and Foreign-Language Educators 163
A Spanish Community Service Learning Model: The University of Illinois, Urbana-Champaign 165
Recommendations for the Development of a Spanish CSL Program 166
Ensure that Students Receive Academic Oversight and Credit for their CSL Work 166
Build Community\u2013Campus Partnerships That Are Mutually Beneficial 168
Use Teaching Materials That Build the Specific Skills Students Need in the Community and Strengthen Their Critical Thinking 169
Leverage Technology to Facilitate CSL Administration and to Build Sustainable Solutions to Human Service Needs 171
Transportation: A Specific Case of a Spanish CSL Student\u2019s Supporting Role 173
References 174
Part III 177
Priority Contexts for Infrastructure Development: Vulnerable Populations 177
Chapter-8 178
Serving Latino Families Caring for a Person with Serious Mental Illness 178
The Caregiving Ideology Characteristic of Latino Families 179
Cultural Issues that Affect Latino Family Participation in Services 180
Family Involvement in Services in the Early Stages of the Illness 182
Psychoeducational Approaches with Latino Families 184
La CLAve: Promoting Early Entry into Mental Health Treatment 185
CFIMA: A Manualized, Multifamily Intervention for Latino Families 186
Conclusion 190
References 191
Chapter-9 195
The Plight of Latino Youth in the Juvenile Justice System: Considerations for Mental Health Treatment 195
Latino Youth in the Juvenile Justice System 196
Disproportionate Minority Contact 197
Mental Health and Juvenile Justice 198
The Impact of Acculturative Stress on Mental Health 199
Barriers to Access and Utilization of Services 199
Juvenile Justice Involvement 200
Arrest and Intake 201
Petitions 201
Court Process/Adjudication 202
Probation 203
Secure Confinement 204
Solutions and Recommendations 204
Conclusion 207
References 208
Chapter-10 212
Promoting the Well-Being of Unaccompanied Immigrant Minors 212
Unaccompanied Immigrant Minors and Their Journey to the United States 213
Unaccompanied Immigrant Minors Around the World 217
The Mental Health of Unaccompanied Immigrant Minors 218
Resiliency in Unaccompanied Immigrant Minors 220
Government Responses to the Needs of Unaccompanied Immigrant Minors 222
US Government\u2019s Response 223
Building Infrastructure to Promote the Well-being of Unaccompanied Immigrant Minors: The Immigrant Children Legal and Service Partnership 226
Conclusion 228
References 229
Chapter-11 232
Latinos in Rural Areas: Addressing Mental Health Disparities in New Growth Communities 232
Challenges in Meeting the Mental Health Needs of Latino Immigrants in the Rural United States 233
Rural Health Care Landscape 235
Research Model and Key Findings with Mental Health Infrastructure Implications 236
Assessment Phase: Key Findings 238
Implementation Phase 239
Recommendations for Infrastructure Improvements 241
Prevention Activities 241
Treatment and Maintenance Activities 242
Program Administration 243
Conclusions 244
References 244
Part IV 249
Reflections on Service Opportunities in Latino Mental Health 249
Chapter-12 250
Life During and After Breast Cancer 250
Psychological Concerns Among Latina Breast Cancer Survivors 252
Depression 252
Body Image Concerns 253
Social Support 254
Mental Health Service Gap 255
The Role of Nonprofits in Provision of Breast Cancer Psychosocial Services 255
Meeting the Psychosocial Needs of Latina Breast Cancer Survivors: Nueva Vida 257
Structure of Nueva Vida 258
Structure of the Mental Health Support Program 259
Recommendations for Infrastructure Building 260
Conclusion 262
References 262
Chapter-13 266
Lessons Learned from HIV Service Provision: Using a Targeted Behavioral Health Approach 266
HIV/AIDS in Latinos: Statistics and Geographic Distribution 267
Latino MSM 268
Major Challenges in Service Provision 268
Governmental Funding Barriers for Program Development 269
Addressing the Challenges and New Opportunities 270
Social Capital Development: Building Infrastructures from the Ground Up 271
Essential Elements for Harnessing Social Capital in Behavioral Health 272
Building and Engaging Community-level Social Networks 272
Institutional Network Building and Engagement 273
Examples of Behavioral Health Interventions That Rely on Social Capital 274
Mpowerment: Intervention for Building and Engaging Social Networks 274
El Ambiente: An HIV Prevention Program at AGUILAS 275
Moving Forward 276
References 277
Chapter-14 279
Private Practice with Latinos: Brief Reflections and Suggestions 279
Epilogue 283
What Does Politics Have to Do with It? Policy and Mental Health Services Access for Latino Populatio 1
Political Context for Mental Health 284
Immigration Policy Reform 285
Conclusion 286
References 287
Index 288
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