Transcript Serving Border Communities - National Child Traumatic Stress

“The Traumatic Experiences of
Children and Families Living on the
U.S.-Mexico Border
Luis E. Flores, M.A., LPC, LCDC, RPT-S
Executive Vice President
Serving Children and Adolescents in Need Inc.
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The Case of Veronica
Referred to OPT Substance
Abuse Treatment
 14 years
 Father is U.S. citizen and mother
is legal immigrant
 Veronica is U.S. citizen
 Sexual Assault
 Anger (Arranques)
 Risky behaviors
 Conflict at home
 Supporting Parents
 Not the focus of treatment
Mother: “Yo quiero que lo
saque…”“No lo ha superado
todavia”
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Question? Email: [email protected]
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The United States-Mexico Border
Distant Neighbors
 Triumph/Defeat
 Border between two cultures:
Protestant Anglo-Saxon/Ibero-Indian Catholic
 Developed/Third World
 Language
 Precision/Improvisation
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Question? Email: [email protected]
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Views on the
United States Mexico Border
La Frontera
Question? Email: [email protected]
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Dynamic Transnational Interaction
Daily Crossings
21,917 pedestrians -- 35,468 vehicles -- 8,216 trucks
(Texas Center for Economic and Enterprise Development, 2005)
Question? Email: [email protected]
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One Area
Question? Email: [email protected]
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The Border
“physical isolation, frontier conditions,
transnational frictions, ethnic rivalries and a
sense of separation from heartland areas have
contributed… to the identity of people from
the…borderlands” (Oscar J. Martinez)
Question? Email: [email protected]
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What affects one
side affects the
other. We’re
literally one region
with a fence down
the middle.”
(San Diego Mayor Jerry Sanders,
USA Today Feb.6, 2007, referring
to the violence in Tijuana)
Question? Email: [email protected]
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Views of the Border:
Mexico looks at their Border
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Succumbing to
“Agringamiento”
Permissive moral
climate
Image of the “Pocho”
Lost cultural identify
Violence
Disconnected from
Mexico
Question? Email: [email protected]
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Views of the Border:
U.S. looks at their Border
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Undocumented
migration
Drug Smuggling
Violence
Poverty
Terrorism
Belonging more to
Mexico than the U.S.
Springbreakers
Question? Email: [email protected]
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Living in the Periphery
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Border, inner cities, Indian reservations and the failure to
assimilate
Both centers of power focus on problems, differences,
contradictions: Borderlanders/fronterizos focus on living
Devising homemade approaches to problems
What appears problematic (mainstream irritation) is
normal to Borderlanders/fronterizos
Own identity: learning to adapt in an alien cultural
environment
Physical proximity with Mexico: Choque, Herida Abierta
Disparity of power between the two countries
Feelings of superiority and contempt
Creation of a fence
Question? Email: [email protected]
11
The South Also Exists
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NAFTA and migration
Maquiladoras
Immigrants repeat poverty experiences in the
U.S., but with racism and discrimination
Having hope makes possible enduring poverty
To locals the border is concrete, not a metaphor
Border also as a comfort zone for people from
the borderlands
Question? Email: [email protected]
12
U.S. Stereotypes About Mexicans:
Internalization and Over-identification
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Frontier Threats
Lazy
Taking jobs Welfare
and Healthcare
Leeches
Not trustworthy
Immature
Aggressive
Oversexed
Immoral
Above all: Mexicans are
Dirty
•Ingrained in mainstream psyche
•Internalization
•Over-identification or
•Ethnic self-hate
Question? Email: [email protected]
13
Mexican Stereotypes about U.S.
citizens
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Blond, blue eyed
Gullible
Easily Amused
Tourist
Does not care what
others think of him/her
Intelligent
Business savvy
Cold
Educated
Dry
Question? Email: [email protected]
14
Understanding the
Experiences of Border Families
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Importance of understanding the context of the border
and how it affects borderlanders/fronterizos
Fluidity
Economic interdependence
Diversity within borderlanders: Americanos, MexicoAmericanos, border crossers & invisible populations
The effects of acculturation
Confounding experiences about identify
Assimilation is not the end of discrimination
Nowhere to go: Border only identity?
Safety of the border
Question? Email: [email protected]
15
Understanding The Experiences
of Border Families
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Disconnection from mainland
Borderlanders/fronterizos adapting to an alien cultural
environment
Migration
Separation from loved ones
Lack of understanding of systems and institutions
Grieving the loss of home
Uprooting of meaning in physical, social and cultural
domains
Colonias
Question? Email: [email protected]
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Understanding The Experiences
of Border Families
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Getting stuck
between the two
cultures
Mainstream
institutions
Pressure to
Acculturate or retain
values
Poverty and Racism
Guilt over becoming
too American
Constant connection
Change and
adapt/ lose
identity
Stay the same
and resist
retain identity
Question? Email: [email protected]
17
Can we transform an enchilada
into a hamburger?
Question? Email: [email protected]
18
SCAN’s Border Traumatic
Stress Response Center
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Webb County
Webb- Laredo
Estimated
Population:
224,695*
*U.S. Census Bureau (2004). Annual
Estimates of the Population for
Counties of Texas: April 1, 2000 to July
1, 2003 (CO-EST2003-01-48). :
Population Division, U.S. Census
Bureau. Release Date: April 9, 2004
Question? Email: [email protected]
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Targeted Community
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94% people of Mexican
descent
Primarily Spanish
speaking or bilingual
Own language:
(Spanglish) Code
Switching
Low acculturated
Close ties with Mexico
Recent Immigrants
Primarily Medically
Indigent
Question? Email: [email protected]
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Characteristics
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Poverty Rate 26.8% Compared to the
state’s 16.2%
Child Poverty rate is 36.1% Compared to
state’s 22.7%
Laredo Lowest Per Capita Income in US
(54.2%)
48.2% HS Diploma (75.3%)
9.6% bachelor’s degree (23.2%)
Question? Email: [email protected]
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Community Needs
Medically Underserved Area and
Population
 Medical Self-Treatment
 Health Personnel Shortage Area
 Extremely Limited Publicly Funded
Mental Health Services for Children
and Adults
 Dearth of Mental Health Professionals
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Question? Email: [email protected]
22
Community Needs
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Environmental Safety in Neighborhood
Higher substance use problems in youth
and adults
Border violence: Drug Traffic Wars
HIDTA since 1990
Great availability of drugs
Availability of psychotropic medications in
Mexico
Question? Email: [email protected]
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Community Needs
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Higher rates of youth alcohol use
Slightly higher rates of life use of inhalants
in Elementary Schools, with greater
differences in 5th and 6th grades
More likely to report being offered
Marijuana
Higher rates of use of tobacco, Inhalants,
Cocaine, Crack and Rohypnol
Border Communities may not fit the
“Latino Paradox”
Question? Email: [email protected]
24
Juan
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Juan is 16 years of age
Multiple unsuccessful treatment episodes
Second generation Mexican American: Parents
are bilingual
Difficulties controlling aggression
Long history of substance abuse
Long history of witnessing domestic violence
Diagnosed with ADHD and Depression, currently
taking medication
Parental substance abuse
Community violence
Question? Email: [email protected]
25
Juan’s story
Question? Email: [email protected]
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Infrastructure Gaps
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Scarcity of Master level
therapists
No counseling services for
children with no coverage
No trauma specific
services before grant
Surveyed Private
Providers before grant : No
trauma specific services
No therapy services for
medically indigent adults
Laredo MSA with highest
rate of uninsured (36%) in
Texas
Question? Email: [email protected]
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Youth Substance Abuse and
Trauma
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Data from Three
Projects operated
by SCAN
Juvenile Drug
Court
 Motivational
Enhancement
Program
 Youth Recovery
Home
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Question? Email: [email protected]
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Comparison Between Three
Programs
80
60
MEP
Drug Court
40
YRH
20
0
MEP
Drug Court
YRH
Internal
External
Both
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61
34
33.6
52.3
27.3
52
66.7
42.9
Question? Email: [email protected]
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Victimization MEP
Curr.worry
22
90 Days
19
Past Year
35
Acute.Vict
45
Hx.worry
58
HX.Vic
55
0
20
40
60
80
Question? Email: [email protected]
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Victimization Drug Court
70
64.1
60
50
46.1
44.5
40
30
21.9
20
10
0
Past Yr
Past 90
Acute
Any Hx.CW
Question? Email: [email protected]
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Victimization Drug Court and
MEP
70
60
50
40
30
20
10
0
Drug Court
MEP
Past Yr
Past 90
Acute
Any Hx.CW
44.5
21.9
46.1
64.1
35
19
45
58
Question? Email: [email protected]
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Border Traumatic Stress
Response Center
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Cover wide range of age
and traumatic stress
experiences
Adoption, Adaptation and
Diffusion of Evidence
Based-Practices
EBT’s and Best Practices
taking root in the community
EBT’s work with border
populations.
Systems Change: Impact as
Many Systems as Possible
Becoming a Trauma
Informed Organization
Public Awareness
Question? Email: [email protected]
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Border Traumatic Stress
Response Center
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Children 2 to 18
All types of traumatic experiences
Adding new services rather than only
strengthening our existing programs
TF-CBT/CM-TFT
PCIT
TST-SA
TAP
Question? Email: [email protected]
34
Gender Ethnicity & Language
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49% Male
51% Female
100% Mexican
American
94% born in US
6% were born in
Mexico
62% prefer to speak
Spanish at home
Gender of Clients
49%
Male
51%
Female
Preferred Language
38%
English
62%
Spanish
Question? Email: [email protected]
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40
37.8
35
30
27.2
24.5
25
20
15
11.6
10
5
0.9
0
2 to 5
6 to 9
10 to 12
10 to 17
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Children's Ages
Question? Email: [email protected]
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Trauma Types (N=116)
Sex Abuse
70
Sex. As.
63.9
Phys.ab.
60
Assault
54.6
Emoti. Ab.
N eglect
50
D omestic V
38.9
40
Medical
32.4
Accident
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D isaster
21.3
20
15.7
13.9
21.3
0
Kidnap.
15.7
10.2
10
Terrorism
5.6
15.7
14.8
11.1
10.5
9.3
1.93.7
Tr. Loss
Imp.Careg.
Ext. Int.V.
Com.Viol.
Sch. Viol.
Other
Question? Email: [email protected]
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Serving Border Communities
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Service Barriers: scheduling, border fluidity, treatment
adherence, instability, lack of transportation, fear of CPS,
waiting lists
Service model that target several areas of need, address
common barriers and are integrated in community.
Challenges in treatment adherence
Process of culture information
Impact as many systems as possible
Utilize evidence-based approaches that can be adapted
to meet the cultural and linguistic needs of the population
Foster the Development of culturally sensitive
interventions: awareness, acquisition, distinguish and
integrate
Question? Email: [email protected]
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Serving Border Communities
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Language values and the
potential for misdiagnosis
Hire Bilingual, bicultural staff
and staff who are open to
embrace other cultures
Process of self-discovery
Non-evaluative introspection
From the specific to the
universal
Support staff’s attempts to
Find other cultures’
worldviews and translating
them into therapeutic values:
create bridges of meaning
Question? Email: [email protected]
39
Serving Border Communities
Assess level of acculturation
and stress related to
acculturation pressures
 Ecological context: poverty,
race, class subordination,
class exploitation and social
injustice
 Distinguish between culture
and effects of isolation poverty
and discrimination;
 Racism and discrimination
within Mexican Americans
 Undocumented or medically
indigent immigrants do not
have access to MH services:
how do they cope with stress/
uprooting?
 No pensar, aguantar,
sobreponerse, controlarse
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Question? Email: [email protected]
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Serving Border Communities
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Parents are focused on the
future
Become aware of the changes
in Traditional Family Values and
the Costs of “Getting Ahead” of
Hispanic families
Individual responsibility and the
idea of the leveled playing field
Understand that families may
be having problems maintaining
family connections
Families may have increased
job pressures with less external
support and less time to devote
to one another
Conflict between their own set
of values and the adjustments
they need to make.
Question? Email: [email protected]
41
Serving Border Communities
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Therapist’s personal values
and level of acculturation
Staff become aware of their
stereotypes and cultural biases
Staff receive ongoing guidance
and training on recognizing
cultural values: value
multiculturalism
Be aware of acculturation can
impact family communication:
parents may be figuring out
how to function in a new
culture
Consequences of not paying
attention to cultural values:
Personalismo and Fatalismo:
(Señora Maria).
Question? Email: [email protected]
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Serving Border Communities
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Culture is Dynamic
Great diversity among Hispanic
Populations and among Mexican
American populations/ Border
Communities
Mexican cultural values: are
metaphors to guide you in your
discovery of new cultures.
Do not reduce cultural values to
basic concepts: become more
aware of the affective components
Make an effort to understand and
discover these values in your
interaction with individuals
Question? Email: [email protected]
43
Serving Border Communities
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Gather information about
past and present
separations from loved
ones and family: Become
aware that separations as
well as reunions can be
tense and painful
Obtain information about
significant others left in
native country and assess
for guilt, shame or worry
Question? Email: [email protected]
44
Serving Border Communities
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Loss of language
Uprooting of meaning:
physical, social and
cultural
MH gender differences in
immigrants
History of possible
traumatic experiences in
journey to cross the U.S.
(exploitation, extreme
physical hardships,
abuse, violence,
witnessing violence or
accidents)
Buried Where?
Question? Email: [email protected]
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Serving Border Communities
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Drug Trafficking and its impact on Border
Traumatic Stress: Dealing with kidnappings,
violence and reaction to perceived
environmental danger
Be aware of how to help families integrate
cultural values, especially when affecting family
relations
Be aware of the impact of disadvantaged
neighborhoods on collective efficacy and
emotional bonds with family members.
Question? Email: [email protected]
46
Serving Border Communities
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Orientation to treatment: Accept that low
acculturated Hispanics/recent immigrants
may not understand “therapy” and may
lack sophistication interacting with U.S.
services systems
Understand that views towards children is
sometimes to placate them, not push them
towards developmental and achievement
milestones
Question? Email: [email protected]
47
Serving Border Communities
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Decrease stigma about counseling
 Assess (cultural) beliefs regarding mental
health treatment
 Assess client’s expectations of treatment
 Assess client’s expectations of the
therapist
Engage clients from the first contact
Place close attention to engaging father
whenever possible
Question? Email: [email protected]
48
Serving Border Communities
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Foster Biculturalism: retaining language, cultural
ties and rituals while learning the new language
and customs
Longer resident and acculturation, the greater
risk for negative health outcomes
Strengthen protective factors
It is ok to have two perspectives, languages and
cultures
Acculturation oriented therapists may create
more emotional distress by stripping the family
too quickly of the protection of the old culture
Question? Email: [email protected]
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Serving Border Communities
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Cultural Imperialism or Isolation: Focus on the development of
coping skills that can help families increase their proficiency
regarding intercultural and intracultural issues: Build their abilities to
achieve bifocality.
Examining how Hispanics use cultural adaptation skills
Facilitate basic and practical information about developing and
achieving goals for adaptation
Question? Email: [email protected]
50
Serving Border Communities
FATALISMO:
Accepting: Taking what life gives you
 PERSONALISMO:
Importance and significance on personal interactions:
warmth and importance of connections. The need to
develop trust. Interpersonal conflict is discouraged.
Personal relationships must be based on simpatía and
respeto.
 FAMILISMO:
Family is more important than the Individual: It is the
center for social support: harmony, solidarity,
cooperation, strong emotional ties and reciprocal kinship
obligations
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Question? Email: [email protected]
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Personalismo
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The glue that maintains
relationships: striving for
meaning and connection in
relationships
“The degree of reality an
in interpersonal relationship is
dependent on the frequency,
quality and warmth of the
interpersonal relationship that
can be lived in a determined
period of time” (Diaz-Guerrero)
Interpersonal conflict is
discouraged: Disagreement is
not expected
Pleasantry in interactions “para
servirle,” “ a sus ordenes,” “en
su casa,” Sin agraviar a los
presentes,” mande?
No expressions of anger or
irritation
Question? Email: [email protected]
52
Serving Border Communities
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Assess readiness for cultural information
Make it a point to immerse your staff in the
culture
Assessment, Clinical Supervision and training
includes issues related to culture, acculturation,
environment and immigration experiences
Being aware of cultural borderlands
Recognizing how cultural values guide/influence
interventions
Building bridges between cultural meanings
Immersed in the culture: process of introspection
Staff at different levels of acculturation
Question? Email: [email protected]
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Familismo: The healing and
protection provided by family networks
Valuing families over
individuality
 Supremacy of the
father and
abnegation of the
mother
 Complete
responsibility of
raising children goes
to the mother: she
transmits the values
 Loyalty
to the family 54
Question?
Email: [email protected]
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Building Bridges of Cultural
Meaning
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Respeto
(obeyed or
loved?)
Simpatía
Machismo
Marianismo
Question? Email: [email protected]
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Acculturation and the
breakdown of values
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A comment on familismo and personalismo
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Poverty and Acculturation have an impact
on traditional family values
Family Conflict is often a result of
uprooting and disconnectedness
Area may reflect who you are but the
institutions and the values are mainstream
What are the consequences of having
values that you cannot honor anymore?
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Question? Email: [email protected]
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Building Bridges of Cultural
Meaning
Pay Attention to Differences
 Contextualize Differences
 Reframe the Problems/needs as a
dilemma of co-existing values
 Preview future family patterns and
cultural blends
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Question? Email: [email protected]
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The Case of Mario
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10 years of age
Second generation
Family Spanish-speaking
Father was from Mexico,
died in car accident
Sister was sexually
abused
Cousin Disappeared in
Nuevo Laredo
Symptoms of PTSD
CM-TFT
Question? Email: [email protected]
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Meeting the Needs of Communities
along the U.S.-Mexico Border
Question? Email: [email protected]
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