Culturally Competent Social Work Practice With Latino Clients

By: Amy Seipel, MSW, LSW, and Ineke Way, Ph.D., ACSW, LMSW

As the United States becomes increasingly diverse, social workers’ competence in serving diverse populations is critical. Sue, Arredondo, and McDavis (1992) point out that social workers are products of society and will default to perspective and opinions learned during childhood. They contend that to the extent that services support the status quo, social workers participate in oppression and discrimination. Because social workers often work with people who have little power and influence, it is important to examine issues of unconscious oppression. This requires culturally competent practice. This article discusses the components of competent practice with those of Latino ethnicity.

Latino Ethnicity

“Latino” defines a cultural or ethnic group, not a racial category. While the U.S. Census defines this population as “Hispanic,” Garrison, Roy, and Azar (1999) argue for the term “Latino,” because it conveys the population’s diversity. Gutierrez, Yeakley, and Ortega (2000) also use the term Latino, contending it better reflects the Latin American origin of the people, but advise caution to avoid the assumption that all Latinos share the same language, same citizenship, or same experience. Latino Culture

Despite many differences, Latino individuals do share cultural characteristics. One such characteristic is the importance of family, and feelings of loyalty to one’s family. Familismo is a term used to describe a strong connection with one’s family, and involves a sense of loyalty and obedience (Gelman, 2004). Family is considered to include nuclear family, extended family, friends, and neighbors who are strongly bonded to the family (Anderson & Sabatelli, 1999). Within families, there are typical roles for mothers, fathers, and children. Machismo is a term used to describe the belief that men are to be providers and it is their duty to keep families safe (Comas-Díaz, 1995). Marianismo describes women as spiritually superior to men, and, therefore, capable of enduring great suffering, while hembrismo describes women’s strength and perseverance. The degree of machismo and marianismo present within families varies (Anderson & Sabatelli, 1999). These roles influence family dynamics and need to be considered during social work interventions. For example, Puerto Rican women may display marianismo at home and hembrismo at work (Comas-Díaz, 1995); this awareness can help social workers understand apparently contradictory behavior.

Children also have traditional roles in Latino families and are expected to behave and obey adults (Comas-Díaz, 1995). Children may be seen as symbols of fertility and future. It may be expected that parents will sacrifice for their children (Anderson & Sabatelli, 1999). Some Latino parents do not use positive reinforcement because of fear that it would lead to their children’s loss of respect. There are also possible implications of a “power inversion” (Garrison et al., 1999, p. 205) within families, whereby the children assume adult roles as a result of their better understanding of American culture and language (Garrison et al., 1999).

Religious worship and church activities are part of Latino cultural socialization. Spirituality is important for Latinos and is a source of emotional support (Gelman, 2004). While many Latinos are Catholic, one should not assume all families are Catholic or particularly devout. Some Latinos believe in spirits and folk healing, termed curanderismo. Latino clients may also seek healing through folk medicine while receiving professional health/mental health care (Comas-Díaz, 1995).

Nonverbal behavior and time awareness are important traits. Many Latinos are comfortable with close interpersonal space (Gutierrez et al., 2000) and have a “present-time orientation” (Gelman, 2004, p. 86). This may result in confusion regarding appointment times and scheduling. Again, the social worker’s cultural awareness is critical to preventing misunderstanding.

Effects of Immigration and Acculturation

Immigration and acculturation may be stressful and even traumatizing. Immigration often separates families from their extended family, resulting in an enormous loss of support (Heyck, 1994). U.S. immigration policies and practices may be intimidating, unwelcoming, and even violent (Gutierrez et al., 2000); this may lead to a generalized fear or distrust of social services.

Upon arrival in the U.S., families must adapt to a different culture, a process termed acculturation. This process involves changing one’s cultural practices while learning a new culture and discarding parts of a previous culture. This process results in changed attitudes, values, and behaviors (Garrison et al., 1999). This may alter family roles. For example, Latino women may more easily find work than do Latino men, which can reverse traditional dynamics of males as providers. Children often adapt to the new culture more quickly and are adept at learning the language, which may result in children assisting their parents in “adult” tasks. This results in a stressful shift of power away from men and parents. Workers may need to help empower parents to resume parental roles (Garrison et al., 1999).

Individuals’ immigration and acculturation experiences vary based on country of origin and individual circumstances (Garrison et al., 1999). When the U.S. took over much of the Southwest, Mexican families were given a choice to leave the area or become part of the United States. As more European American settlers arrived, the U.S. created new laws that resulted in displacement and loss of land for native Mexicans (Heyck, 1994). In contrast, Puerto Rican Americans have a history of colonization and political oppression (Comas-Díaz, 1995), while Cuban Americans have varied experiences based on whether they left Cuba by choice or by force (Heyck, 1994).

Cultural Competence

In research, education, and practice of social work, European American, middle-class values and treatment goals have been assumed to apply to everyone. In mental health practice, this is evident in the emphasis on individuals, insight into oneself, personal growth, and expression of feelings. This differs from what diverse cultures may prefer, including working with the family system (including extended family), changing the environment, and receiving concrete advice from the worker (Pinderhughes, 1989).

Without cultural awareness, social workers contribute to oppression when working with clients from other cultures. This is unethical practice and can cause clients great harm (Sue et al., 1992). Social workers need skills to assess clients’ entire systems. If ignored, social workers may echo society’s oppression by assuming that clients need to change, rather than working for societal change (Pinderhughes, 1989). On the other hand, lack of cultural competence can also lead to overcompensation by social workers; clinicians may spend too much time focusing on culture or may excuse dysfunctional behavior (Comas-Díaz, 1995).

Race and ethnicity have an impact on professional relations, and inadequate cultural competence results in less effective services. Davis and Proctor (1989) contend that most people correlate differences in skin color with differences in beliefs and viewpoints. A client with a worker of a different ethnicity may assume that the worker will not understand the client’s world. This decreases the likelihood that the client will continue services. The reverse is also true. Workers often have a poorer opinion of those clients whom they see as having significantly different views from themselves. This dynamic is less common in less prejudiced individuals (Davis & Proctor, 1989).

Underutilization and premature termination of mental health services are frequent in the Latino population because therapy is viewed as not meeting clients’ needs (Pinderhughes, 1989). Underutilization of services may also be due to lack of understanding within the Latino population about the possible causes of emotional problems (Yeh, Hough, McCabe, Lau, & Garland, 2004). Culturally sensitive community education may help more Latinos realize the potential benefits of services.

There are specific actions to achieve cultural competence (see Table 1). For example, learning and self-examination are critical when developing cultural competence. Reading books about Latino history and culture, attending ethnic festivals, taking courses, or attending conferences broaden one’s awareness. Supervision from a Latino practitioner can be helpful. It is also important to examine one’s own beliefs, values, and culture, and to determine to what extent clinical interventions are based in Western, middle-class, European American values.

Worker-Client Relationship Issues

Multicultural awareness is critical for worker-client relationships. Some researchers recommend that matching be done between client and worker (e.g., a Latino client is paired with a Latino worker). Gelman (2004) argues that shared goals and understanding are more important than ethnic matching. He suggests that matching can “jump start a therapeutic relationship but isn’t necessary” (Gelman, 2004, p. 93). Fontes (1996) recommends matching at the client’s request.

Developing a strong therapeutic relationship remains crucial. Personalismo refers to the value that Latinos place on interpersonal relationships. Non-Latino workers must be sensitive to this, and may need to adapt their style to the expectations of a Latino client. Some modifications may include an increased amount of self-disclosure, accepting gifts (often food), and more physical contact (e.g., handshakes, pats on the back), as well as being closer spatially (Gelman, 2004). In addition, interventions may need to be more solution-focused, directive, and active (Gelman, 2004). Because Latinos value respect, social workers need to understand the hierarchy of power within a family system. It is also important to develop personal relationships before proceeding to a professional relationship (Gutierrez et al., 2000). Part of this process involves workers and clients learning about each other’s belief systems. Disparities in belief systems should be addressed, so that treatment can begin with a mutual understanding (Yeh et al., 2004).

When assessing clients, individually or with their families, workers need to explore ethnicity. Assessments should include the influence of culture and how the person’s community can be helpful. The assessment should also include issues of national origin, birthplace, immigration experience, length of time in the country, language preference, and the meaning of being Latino. The culturagram (Congress, 2004) is an assessment guide for understanding immigrant populations. Workers also need to educate themselves on Latino culture terms for treatment issues, such as ataque de nervios or susto (Gutierrez et al., 2000). Workers also need to recognize that a behavior or coping mechanism is not dysfunctional simply because it does not match dominant culture patterns (Anderson & Sabatelli, 1999).

When providing interventions, social workers need to include empowerment as a goal. This includes helping clients understand their oppression, as well as ways to be involved in resolving those issues (Gutierrez et al., 2000). Group and family inteventions may be helpful, particularly with the involvement of extended family (Waites, Macgowan, Pennell, Carlton-LaNey, & Weil, 2004). Administrators and policymakers should learn the history of Latinos and identify how current services could be redesigned to better serve them (Gutierrez et al., 2000).

Finally, outreach to the Latino community is an important part of any social worker’s practice. Because of cultural differences, Latinos may not have been exposed to how social work services can be helpful. It is important for social workers to attempt to educate the Latino community on the potential benefit that can come from social work services with an understanding of different belief systems about the causes of individual difficulties or mental health problems (Yeh et al., 2004). Also, when developing new programs or assessing current programs, focus groups with the Latino community can guide modification of programs to become increasingly culturally competent (Waites et al., 2004).

By becoming increasingly culturally competent, social workers can better support their clients’ individual growth and adaptation. As Latino clients constitute a larger proportion of social service consumers, cultural competence will become an increasingly important skill for social workers.

References

Anderson, S. & Sabatelli, R. (1999). Family interaction: A multigenerational developmental perspective. (2nd ed.). Needham Heights, MA: Allyn & Bacon.

Comas-Díaz, L. (1995). Puerto Ricans and sexual child abuse. In L.A. Fontes (Ed.), Sexual abuse in nine North American cultures: Treatment and prevention (pp. 31-66). Thousand Oaks, CA: Sage Publications.

Congress, E. P. (2004). Cultural and ethical issues in working with culturally diverse patients and their families: The use of the culturagram to promote cultural competent practice in health care settings. Social Work in Health Care, 39, 249-262.

Davis, L., & Proctor, E. (1989). Race as an issue in practice. In Race, gender & class: Guidelines for practice with individuals, families, and groups (pp. 1-9). Englewood Cliffs, NJ: Prentice-Hall, Inc.

Fontes, L. (1996). Culturally informed interventions for child sexual abuse. In L.A. Fontes (Ed.), Sexual abuse in nine North American cultures: Treatment and prevention (pp. 259-266). Thousand Oaks, CA: Sage Publications.

Garrison, E., Roy, I., & Azar, V. (1999). Responding to the mental health needs of Latino children and families through school-based services. Clinical Psychology Review, 19, 199-219.

Gelman, C. (2004). Empirically-based principles for culturally competent practice with Latinos. Journal of Ethnic & Cultural Diversity, 13(1), 83-108.

Gutierrez, L, Yeakley, A., & Ortega, R. (2000). Educating students for social work with Latinos: Issues for the new millenium. Journal of Social Work Education, 36, 541-557.

Heyck, D. (1994). Barrios and borderlands: Cultures of Latinos and Latinas in the United States. New York: Routledge.

Kataoka, S., Stein, B., Jaycox, L., Wong, M., Escudero, P., Tu, W., Zaragoza, C., & Fink, A. (2003). A school-based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 311-319.

Pinderhughes, E. (1989). Culture, social interaction, and the human services. In Race, ethnicity, & power: The key to efficacy in clinical practice (pp. 13-20). New York: The Free Press.

Sue, D., Arredondo, P., & McDavis, R. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of Counseling and Development, 70(4), 477-486.

Waites, C., Macgowan, M., Pennell, J., Carlton-LaNey, I., & Weil, M. (2004). Increasing the cultural responsiveness of family group conferencing. Social Work, 49, 291-301.

Yeh, M., Hough, R., McCabe, K., Lau, A., & Garland, A. (2004). Parental beliefs about the causes of child problems: Exploring racial/ethnic patterns. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 605-613.

Amy Seipel, MSW, LSW, is a graduate of Western Michigan University’s School of Social Work. She works with children and parents at a community mental health agency.Ineke Way, Ph.D., ACSW, LMSW, is an Associate Professor at the School of Social Work, Western Michigan University. She teaches practice and research courses. Her research focus is adjustment following childhood maltreatment, development of sexually abusive behaviors in adolescents, and vicarious trauma in clinicians who provide sexual abuse treatment.