Working with Latino Children and their Families – Fabiola Ekleberry

Working with Latino Children and their Families – Fabiola Ekleberry


(Dr. Lusk) Today’s presentation on working
with Latino and Hispanic children and their families is with Fabiola Ekleberry. Fabiola
is a therapist with the Child Guidance Center of El Paso. She’s also an adjunct faculty
member with the Department of Guidance and Counseling here, at the University of Texas
at El Paso where she completed her education. Her focus in this talk today is on children
and their families, because obviously, as a therapist working with children, you have
to work through their parents, if possible, their mother in particular, and this is an
important relationship for her to explain as she begins to talk about working with Hispanic
youth. This is a very large population of American youth and the fastest growing population
in the United States and one that is significantly underserved by mental health practitioners.
She’s going to talk about culturally modified instruments and assessments which is, I think,
a very valuable adjunct to the presentation because most assessment tools or testing devices
are designed and validated with Anglo populations or with the majority population, so she’s
going to discuss the adaptations of some of these measures and assessments that can be
done with children that have been adjusted and validated with Hispanic youth. She’s also
going to talk about a form of cultural engagement with children and their parents which is adjusted
to their context and to their values. She’s going to close with some discussion about
‘dichos’ and ‘refranes’ which are sayings or expressions, proverbs if you will, that
are used in Hispanic culture and Latino culture to convey certain forms of meaning that can
be drawn into the therapeutic relationship in pivotal moments. I think you’ll find this
to be a very interesting presentation. (Fabiola Ekleberry) Thank you, Dr. Lusk for
that great introduction. I am excited to be here with you and to provide some information on working with my Latinos/Hispanics because I am from Chihuahua, Mexico. As we all know, Latinos
and Hispanics are the fastest growing cultural group. It is expected to increase from 49,726
in 2010 to 57,711 in this year of 2015 according to the U.S. Census Bureau. Mental health problems
for children of ethnic minorities like Latinos and Hispanics and/or with low-income families
range from 34%-50%. Latinos/Hispanics have limited access to psychological services due
to limited English, about 40%, and other challenges that they might have like lack of insurance,
funds, or immigration status, etc. There’s also limited availability of psychosocial
interventions in Spanish and that are culturally relevant for Latinos and Hispanics. We want
to conduct a thoroughly culturally modified assessment. Despite that Latinos/Hispanics
are the largest growing minority group, 1 in 5 children are Latino or Hispanic, they
are also under-studied and under-treated. More studies are needed. Therefore, most interventions
will need to be developed for Latino/Hispanics instead of that they are developed for the
non-Hispanic White families. This contributes to the under-utilization of services by Latinos/Hispanics, and if they do participate they end up eventually dropping out. It’s also important that to
provide a culturally sensitive treatment to Latino and Hispanic families, mental health
professionals are encouraged to learn about their individual clients, and their families,
and their respective cultural characteristics. Again, cultural diversity warrants consideration
when working this population. Some of the most widely used questionnaires for screening
behavioral problems in young children are: one that is widely known is the Child Behavior
Checklist. They have 2 sets, one for toddlers from ages 1.5-5 and one for school-aged children
and adolescents 6-18. It includes 99 behavioral items asking parents to rate the extent to
which they believe their child exhibits. The CBCL also has demonstrated good reliability
and validity, but a lot of times, like in my agency, we do not use this very often because
it just covers behavioral. Even though Hispanics do like that it is covering just children
behavior versus focusing on emotional or other mental health disorders. Another widely used
assessment with young children is the Eyberg Child Behavior Inventory, the ECBI. It assesses
children ages 2-16 years old. The studies have suggested what the ECBI–that parents
prefer the ECBI because it does not contain items that ask about children’s sexual behavior
or playing with their feces, so questions that might be a little more uncomfortable
for parents. They prefer that these assessments in the Hispanic because, again, it’s just
focusing on externalizing behavior instead of the internalizing–not wanting to think
that there might be something wrong with their children, and, again, Hispanics tend to focus
on more of behavior and behaving. We’ll talk about a little bit here in a little bit. Also,
parents find questionnaires useful and they felt that these assessments are comprehensible,
are relevant, and culturally sensitive. So, yes, it is used–the Child Behavior Checklist,
CBCL and the Eyberg Child Behavior Inventory, the ECBI. The translation of these questions
are useful to talk about the intent. Even though you give the assessment, it is very
important that you review, with the parent, the intent of some of the questions because,
for example, on the CBCL number 95 which is asking the child’s propensity to wander off.
The parent might find that to become offensive or like they’re being negligent, so you want
to clarify that with the parent and get more information. Again, some concerns that might
be are the words or idioms are difficult to translate and could lead to misunderstanding.
I’ll give an example here in a little bit. Again, it’s important to review results with
the family and ask more questions. Other assessments that we utilize is the Trauma Symptom Checklist
for Young Children, the TSCYC, which assesses trauma symptoms in children ages 3-12. Also,
there is a Trauma Symptom for Children, TSCC, for ages 8-16. Usually the children ages 8-16
do their own self report and the parents as well do an assessment for the adolescent or
the older child. Another assessment that we utilize at the Child Guidance Center is the
Trauma History Questionnaire. Does the child endorse any traumatic events? Something I’ve
learned is that unless you ask sometimes the families will not provide that information, so
it’s real important that you ask questions–something so simple as, I had an example of a client
that I had been working for a while and I decided to give him the Trauma History Questionnaire.
In doing so, I found out that questions so simple as, “Has he ever been bitten by an
animal or a dog?” He was able to tell me his story and how traumatic it was for him when
he was bitten by this dog and I had never known that this child had had this trauma
behind that simple–being bit by a dog. Again, you need to ask the questions, and, again,
if you don’t ask sometimes they will not–the families won’t give you that information.
Another assessment that we use that is very adapted is the Behavior Assessment System
for Children-Second Edition, the BASC-2, which was designed to assess numerous aspects of
behavior in children. Again, this goes well with Hispanics and adolescents and children
ages 2-21. The BASC-2 includes adaptive and maladaptive behavior. BASC-2 also has 3 different
versions for different ages: 2-4, 6-11, and 12-21. Children starting at the age of 18
do their own self reports. Also, there is a teacher version for this, so you’re getting
from multiple resources information. So, again, this assesses both competencies, and presenting
problems, strengths, and weaknesses. The BASC has been translated into Spanish and it was
based on the norming–is based on the current US Census population. A question about the
BASC assessment in my experience is that I always have to, again, ask the families is
if the child tends to eat things that aren’t food. It’s understand not (inaudible), but
in Spanish, when you ask that question, “Come cosas que no son comida?” All the Hispanics
will say yes. They are thinking of what we call ‘chatara’ or junk food. So, the parents
will always say, “Yes,” to that, but that’s why you have to go back and ask the questions
and clarify that with them so that they can tell you that, “No, the child does not have
an eating disorder and does not tend to eat fecus, or paper, or other–dirt, paint, or
other non-food items.” Again, another assessment that you might be able to use is what’s called
the Parent Stress Index. This also will see that maybe–the questions will see how a child’s
behavior how problematic is it for them. Sometimes, something that we might consider that might
be problematic might not be in the Hispanic culture, so you want to look at that Parent
Stress Index. They might see that as normal behavior in their child, and then there’s
other areas that you’ll see that they are behavioral. Another questionnaire we have
is the SNAP-4, which is the parent or teacher questionnaire to assess for ADHD. Again, it’s
just a questionnaire that you can provide to the parents. It’s also been translated
in Spanish. You can give it to them to give to the teachers and it’s also giving you more
information. At this point, I haven’t found any–using these assessments with the exception
of a few couple of questions that I need to clarify with my families, most parents feel
very comfortable with the questions. They understand the questions and if they don’t,
they will ask or it’s a good time for getting more clarification and getting more history
when it comes to the families. Also, we want to provide that we adapt the psychosocial
interventions. When you’re doing your initial psychosocial evaluation, your IPE, it’s important
that you provide culturally sensitive treatment to Latino Hispanic families. Some recommendations
are: first, you want to make a good impression. Offer a warm and genuine greeting. You have
to go back and if we think of familismo and personalismo, the warmth that is in the Hispanic
and Latino culture, we want to offer that warmth and genuine greeting so that families
from the very first time that they meet you, they get that warmth. Also, clarify your role.
A lot of times it’s very–if they’re referred they might be confused as to why they’re there,
or what is your role, so you want to clarify your role as to who you are–if you’re a therapist,
a social worker, or a psychologist, or any kind of clinician, because a lot of times
families don’t differentiate the differences between the different. They might think you’re
a ‘psicologo’, a psychologist, not knowing you’re a counselor or a licensed professional
counselor or a Master of Social Work, so clarify your role versus a psychiatrist. Also, differentiating
yourself between what is your role. They might be expecting that you’re there like Child
Protective Services. You’re there to get them–you know, split the family apart, so clarify your
role with them. It’s very important. That puts them at ease. Also, take acculturation
into account. Explore what the family’s world–look through their eyes. Take the acculturation–look
at the differences between each family member because one parent might be the first generation
here or they migrated here versus the adolescent that was born here and is much more acculturated.
Again, you also have to look that into consideration. A lot of times, for example, I had a teenager
that was brought by me and the parents had difficulty with the behavior, so it was very
important for this child that he was very–he was much more acculturated and more into the
American culture so the parents were having a difficult time. Get their perspective on
how–where are they when it comes to acculturation. Also, the family has experienced stress or
traumatic events in their lifetime or while they’re immigrating here. You want to also
conduct a thorough culturally modified assessment, again, making sure that you take your time,
break the assessment into parts. Something that I have experienced with Latino families
coming to see me is, a lot of times they’ve already been to another therapist or another
agency and they feel they don’t connect with the counselor because they are already rushing
through the assessment and ‘boom’ starting with therapy. When I ask the families, “What
was the–what were you diagnosed,” they say, “I don’t know.” “What was your treatment goals?
What did you guys come up with?” “I don’t know. We never talked about it.” So, it surprises
me that families will be discouraged and not stay in treatment. Again, take your time in
breaking that assessment, making it more than the one or two sessions, and just taking your
time in getting to take all the information and making the family feel welcome. A lot
of times that even though I, as a clinician in my early days, I was quick to get through
the IPE, the psychosocial assessment and evaluation, and start treatment, and ‘boom’ get going.
When I didn’t really take my time to get to know the family, to build that rapport. Now,
I know that I take my time and that–even in just that listening and getting that information
even parents from one session to another already are telling about benefits and the symptoms
are coming down. You might think, “Oh, I haven’t even started treatment,” and yet, they’re
already voicing benefits from coming to you. So, again, it just shows you to just trust
the process-the therapeutic process of just listening and making them feel welcome and
that there is hope. Take your time when doing your assessment. Also, it’s very important
that you have your forms in Spanish and you go through them. A lot of times families feel
like they have to sign papers and they aren’t clarified as to what’s on those forms, so
take your time to explain it, and that sets the ground rules for the therapeutic process
and your role. Some key areas that you want to assess during initial assessment, again,
but are not limited to are: what are their beliefs about the cause of the presenting
problem. A lot of times, especially with older children and teenagers, when you ask them
why are they here, they’ll say, “No se. I don’t know.” Again, I ask them, “What is it–your
perception as to what you think they’re there, or what does Mom or Dad, Mama o Papa, think
that they should be there?” Again, you’re getting their belief about the cause of the
presenting problem. Also, what are their attitudes and expectations related to therapy? Again,
clarifying your role and what do they expect to get from therapy. A lot of times I like
to ask the kid–I tell the kids that my role is I’m the kid helper. I don’t tell them I’m
a counselor. They might hear that word that I’m the counselor, or the therapist, and when
I ask them what that means, they’re not too sure, so, I just tell them and I basically
put it, “I’m the kid helper.” I put it back onto them, “How would you want me, Fabiola,
the kid helper to help you in you coming here to therapy?” Explore with them their attitudes
and expectations. What are they expecting–especially the parents. What are their expectations?
Are they expecting you to fix them like ‘un carro nuevo’, a new car and send them home
shiny, or what is their expectation? Also, what is their cultural identity? How do they
see themselves? Again, you can’t just assume that you call, “Oh, he’s Latino,” or, “She’s
Hispanic,” because they want to be identified a certain way. They might say, “I’m Mexican,”
so, again, how do they see themselves? Other things to take into consideration are, transgenerational
immigration experiences and generational acculturation differences between the adult members and
the children. What are their experiences? So, again, taking that time. What are the
cultural values? What’s important to them? What are their beliefs? Does the family have
a support system? I see this as a very key element. Do they have any kind of support
system. We want to make sure that if they don’t have any other support systems that
you’re going to be one of those support systems. You’re going to be there to support them.
Have the experienced any discrimination? Are they currently experiencing any discrimination?
Are there any other factors of fear that might be prevalent or currently with this family.
You’re getting their experiences. What is their religious preference? What do they believe
in. What is their faith? How do they see that and how is that going to come into play? You
can always respect that; you might not know much, but, again, your families are going
to be very helpful and very grateful to be able to educate you on that. Conduct–find history
if there’s any traumatic events. I use the Trauma History Questionnaire. It’s very simple.
You can download that off the internet. It just has some basic questions. If you don’t
ask they won’t give you that information. I find also, very helpful, is conducting timelines
and genograms. They will give you a lot of information and also things that maybe the
family has forgotten. So, by conducting these timelines and genograms, you get to see the
events that have played a major role in this family, and also genograms, the dynamics within
the family. We want to integrate cultural values into the therapeutic process. Cultural
values provide added layers of meaning. Therapist understanding of these cultural values in order
to be effective in treatment and for families to feel understood and accepted. For example,
in the Hispanic it’s very–they’re very, again, personalismo, the warmth. They’ll come in
and give you a hug like you’re part of the family, so you have to accept that and go
with how they feel in their gestures of warmth. You have to go with it. Maybe somebody who
has not worked with Latinos might find it uncomfortable that somebody who is not related
to you come up to you and give you that hug or that kiss, but you have to understand it
and accept it as part of the therapeutic process, feeling that you value that. Engaging
the families–spend a little extra time on engaging the family at the beginning of therapy.
Like I said, just take your time with the assessment, getting information, building
that rapport is crucial for the therapeutic process so they continue to stay in therapy.
It’s very common, especially adolescent and Latino males and females, they don’t
want to be there. It’s very obvious and the parents get on to them about like, “Conteste
le, answer her,” and I say, “No, don’t worry about it.” It’s my job to connect with that
child and, again, that might be my initial goal, just building that rapport and gaining
the trust of that adolescent. So, you want to take your time and finding something to
connect with that child and connecting with the family. We want to incorporate evidence-based
practices and we’re going to see a couple. I’ll share one with you. You’re going to provide
psycho-education in the process of therapy. A lot of times, even with the psycho-education
on the forms, in Spanish, you’re already building rapport. They’re understanding what is it
like. They have a big clear picture of how this is going to help them, so they’re getting
hopeful of how you’re able to bring help to the family. Identifying and clarifying treatment
goals–they have to be part of that treatment. A lot of times I find that with working with
Hispanic and Latinos, they don’t feel like they are part of the treatment or of the process,
so it’s very important that you engage them. Have that conversation. What is it that they
want to get from coming here with you? What is it and how are you going to go about doing
that? What might work with one client might not work with another, so it’s very important
you bring in that conversation with them as to what’s important to them and do they expect
you because–another example when I was a new clinician is I was ready, doing CBT, I
got my journal out, and I gave this adolescent this homework to write to journal. The family
put in a complaint that they wanted another therapist because the young lady was uncomfortable
having to journal. Again, you got to, as new clinicians or as clinicians, sometimes we
forget that it’s not our agenda. We have to go with what they want to or what they feel
comfortable, so, again, getting time to know them and having that conversation. You’re
showing them to have that conversation. Relating to children through the mechanism of play,
helping the child to feel relaxed and safe. Children, we know, communicate through play,
so it’s very important you have toys around and crayons. Even though you’re asking questions
with Mom or Dad or Grandma, that the kid is able to play and you’re still assessing the
child. Are they feeling comfortable in your room? Are they exploring? Do they ask for
help when they need something? That’s giving you a lot more information. How are they coming
and going from Mom’s side. Are they asking Mom for help? You’re getting a lot of information
from the child playing in your room while you continue to assess the family. You want
to work with the timeframe of the family. What works best with them? Sometimes you have
to work with them on when is it going to be a good time for them to come, their schedules
and work with them as much as you can so that you have–that they’ll stay in treatment.
If they feel that you are not trying to work with them, they will drop out. Also, focus
therapy on being in tune with the client and the family. Go beyond what I call the ‘COWs’,
the Crisis Of the Week. Yes, the families will bring their COWs in every week, but even
those COWs, those crises of the week, you can utilize them in treatment and focus on
the short and the long term needs of this family. Be flexible to use procedures, taking
into account families’ cultural needs without sacrificing the evidence-based treatment fidelity.
So, again, take your time. Sometimes, you might have to modify the protocol to fit the
family or the family’s cultural needs. Do the adjustments, but staying within the fidelity
is okay. I have found that it’s still okay. Using other cultural forms of engagement,
as we had previously emphasized–when you’re working with Latinos and Hispanics, familismo,
the emphasis of family relates to the very close ties that are common in Latino families
and how those ties are likely to extend beyond the nuclear family, so beyond mother, father,
that includes sometimes the grandparents, uncles and cousins, as well as other family
members or other family friends como compadre and comadre. I find it’s very important that
family is very important when you’re working with Latinos, so I try to include as much
as I can of the family unit. I always tell them the family is a family system. What the
child does affects the family and what the family does affects the child. You need to
bring in the family when it comes to working with children–children and adolescents. A
lot of times also, in my experience, I’ve seen that when I get families that are coming
from other agencies or other clinicians, one of the questions I ask them is, “What didn’t
work for them?” A lot of times what they will tell me is that the therapist just came, would
take the child and do play therapy and they were not part of the process, so they would
just wait outside and not engage with the parents. They felt left out and they didn’t–that
just didn’t go with them. Again, you got to make sure you’re including the parents in
the process or the family and having–doing individual but also family therapy. Remember
that what the child does affects the family and what the family is doing affects the child.
I feel that if we’re not doing–engaging the family, it doesn’t matter how much therapy
I do with the child in session, the child goes home to a different environment and then
it just doesn’t work and there’s no changes. One of the forms of engagement with the families
is ‘sacrificios’. This refers to the mental state of struggle and sacrifice in the interest
of enhancing the child’s educational and developmental well being above their own, sacrificios. Sacrificios
appear to organized especially around beliefs around the gender roles, specifically the
marianismo, the woman making sacrifices emphasizing their children’s needs and sometimes the husband’s
above their own. Here, is an example, “Una madre escapas de hacer cual quiera cosa por
sus hijos.” You see here a mother without any feathers just pulling them off and giving
them to her children to cover them and keep them warm. That’s a cute picture that I think
embodies what I see how a mother sees herself in the Hispanic and Latino culture. Mothers,
when talking to them about their children, they talk about these sacrificios with a sense
of pride and a sense of hope. This is their job and when it’s not going how they feel
like they’re not important. For example, the other day I had a child that’s coming to me.
Andrew is about probably like 6 years old. Parents are divorced. Father lives in Mexico.
He goes and visits the father on weekends. When Andrew came into my office one session,
Mom was telling me that Andrew has been throwing tantrums and crying. Currently, Mom is pregnant
and has remarried and Andrew’s having a hard time adjusting to the changes, but when they
take Andrew out to wherever he wants to go and they seem to buy him things and he’s still
having these tantrums Mom started crying in my office. I asked Mom, “What’s behind those
tears?” Mom told me that it felt like no matter what she’s doing–she’s doing all these things
for her son, Andrew, and Andrew seems to not appreciate what she’s doing. Again, Mom is
making sacrificios and yet, Andrew is not responding. She was very tearful and felt
very hurt like she’s not making a difference in her child, that no matter what she does,
Andrew is not happy. Again, this goes to show the sacrificios in the Hispanic mothers. They
feel that they have to do all these things for their good and for their happiness. By
doing–by having sacrificios the child will also correspond to them as well. Another form
of engagement when you’re working with Latinos is consejos. This refers to the advice parents
give their children that reinforces values such as resiliency and perseverance. These
consejos or consejos practicos are organized around the belief about–mostly around education,
encompassing more than educational knowledge as well as training in modales, manners, also
morals, morales, and interpersonal relationships so the children can have a better life. So,
parents, in my experience, even when I’m interviewing the family and getting information on the
presenting problems, I ask the parent, “What have they done to try to solve these problems?”
Most all my Hispanic/Latino families will say, “I tried talking to them. I try explaining
to them,” so again, they value the consejos. They feel that is their role to give consejos
all the time. A lot of times, it doesn’t work as children, especially if they’ve been already more
acculturated. It’s not going to go. They don’t want to be told what to do and how to do it.
Parents feel like they’re not doing a very good job. Here, is an example that I find
even on social media as to how consejos are always important. Consejos de mi abuelita,
“No vaya a donde no lo inviten. Don’t go where you’re not invited. No hable de lo que no
sepa. Don’t talk about what you don’t know. No se meta en lo que no le importa. Don’t
get involved in what you don’t know.” Basically, it’s none of your business. Consejos of abuelita
or of mama, it’s very important. Here’s another one, “You respond with ‘mande’ instead of
‘que’ because if you use the wrong word one of your parents will kill you,” so, again,
using a little bit of sarcasm to show how kids are expected to have manners along with
the consejos, utilizing consejos as a way to teach the children how to behave. Another
form of engagement refers to apoyo–refers to the emotional and moral support parents
offer their children to boost their self-esteem and encourage the perseverance to do well
in life. This derives from familismo, the value that emphasizes family bonds. Using
cultural forms of engagement like apoyo, you want to bring in the family. A lot of times,
the grandmother or grandparents might be a second parent to the child or as important to
the child as the mother or the father. We want to bring in those forms of apoyo for
the family, that emotional support into the therapy. Without it, there will be no changes
because the child goes back to the same old same old stuff. Family provides instrumental
and emotional support and the commitment of family needs even above their individuals. It’s
more about the child than it goes above their own individual needs as parents, showing that
we’re there for the family. They show apoyo with physical warm gestures hug and kiss when
you see, even in a lot of Latino cultures, even if you’re not–don’t know somebody, but
you’re introduced to somebody you have those warm gestures of a kiss or a hug embracing
you. These are ways that they show the personalismo and apoyo in the families is by doing all
these gestures. By providing this, they feel the parents can build their child’s self confidence
and get rid of the child’s insecurities. Other cultural relevant is the parenting practices.
Latino/Hispanic mothers are the primary care provider. In some cases, I can say probably
like 50 of my cases, working with Latinos, the primary care provider is the grandmother,
la abuelita. We have to look at that and how do they see their role. They see that they
usually are the main caretakers and they try to meet the children’s emotional needs with
high levels of involvement in their academics even though we think they don’t, despite that
in some cases lack of English, they’re still very involved in their children’s academics.
They highly value the academics. Fathers have the same role as a caretaker, but because
they are usually working outside of the house, they’re seen more as the breadwinners and
are not as close to the children, so they are seen more as the breadwinners. Communication
is an important element in the Hispanic/Latino families. Mothers see themselves as a parent
and as a friend. They want to be–soy su amigo. Quierro ser su amigo. They see themselves
that when the child misbehaves they will try to talk with them, just like I said earlier,
most of the time that’s the way the parents try to solve it. Mothers, once that talking
is not working, they will–they do revert to–some of them to physical or corporal punishment,
thinking that it’s okay. So, you got to ask the Latino families how do they see the corporal
punishment or how does a child view the discipline? How does the parent discipline the child when
they misbehave? You’ll get information there because we might, in this culture, view as
abusive neither the child or the mom sees it as abuse. We want to get their perception
as to what–the ways they’re being disciplined, how do they see it. Is it abusive or do they
see it as it’s part of my mom’s job to do this or my grandma’s job to do this. Parents
are trying to use talking as a way to understand and to educate the children on negative and
positives of life and a way to teach those corrective behaviors. Like I said, physical/corporal
punishment is a way of disciplining children as well as shaming and belittling are also
used to stop the disrespectful behavior, but many times, if they feel that they’re not
being heard or it’s not working, they will revert to the physical/corporal. For example,
in the Mexican the joke is, “You know you’re Mexican when you’ve been raised by la chancla,”
very direct. So, moms can be very loving, but at the same time they can be very authoritarian
parenting style, like in this picture here, it’s also just a cute picture that says, “Te
calmas o te calmo.” Calm yourself down or I’m going to calm you down. Parents might
be very subtle, but then they can go to the other extreme. They believe that they are
stricter than the Hispanic or Latinos, having more rules and they see themselves as having
more of the authoritarian parenting style. “If I were your grandmother, you would not
have any teeth by now.” Those might be some sayings that you might hear within the Hispanic/Latino
family. A lot of times they might threaten these, but I don’t see them–a lot of the
mothers don’t implement corporal punishment. I know they threat, but they don’t follow through.
Here’s just some examples of some other phrases or refranes that Mom might say that we all
know in the Latino or Hispanic culture. Example, “Por que soy tu madre,” is an answer. There’s
no reason just because I’m your mother. You better do it. “Te lo dije.” Again, here’s
some examples of phrases that Mom or even Grandma might say or aunts. Refranes and dichos
populares–dichos are Spanish proverbs or sayings that capture and validate the sabiduria
and address the problem & dilemmas of life. Dichos are also known as refranes. They teach
in a succinct and effective way. “El que canta sus penas espanta.” The person who sings scares
their sorrows away. Dichos, again, these are culturally acceptable when society discourages
direct expression. We use, in the Latino and Hispanics, we will use dichos
as a way to say things without really being direct, because in the culture, it’s discouraged
to have those direct expressions of negative feelings. Dichos are a way of saying that.
It also can be a way to illustrate how thoughts gradually affects one’s view of life and depression.
For example, “La gota de agua libra la piedra.” One drop of water can erode the stone. You’re
able to see how with time things affect you and how you become depressed. It also shows
a connection between adversity and opportunity. “Cuando una puerta se cierra otra se abre.”
When one door closes, another one opens. There’s many dichos and refranes in the Hispanic and
Latino culture because this is the way they communicate in a very indirect way. It also
can be used as a form of communication tool to do some cognitive restructuring. “No hay
mal que por bien no venga.” There’s no bad that good doesn’t come from. This gives hope
for the family. If you use a lot of these refranas or dichos in your session, the parents
can relate to that and will remember these sayings–or they already know them, but they
can relate to them and understand what you’re trying to convey or communicate to them. It’s
a way of using a little bit of satire, sarcasm. “Tienes frio?” Are you cold? “Ponete a barrer
vas a ver como entras en calor.” You’ll see how by working you’re going to become warmed quick.
It’s just a way of saying things in a sarcastic way. When we’re working with Latinos, we want
to incorporate evidence-based practices. One of my experiences is using the parent child
interaction therapy, PCIT, because I like using it and I find that it’s becoming very
effective in my therapy because PCIT is a very intensive short-term parent education
program developed to assist children with disruptive behavior. It was developed by Sheila
Eyberg for children ages 2-7. It’s based on a two stage operant model. In the first stage
you’ll see that the Child Directed Interaction, CDI, parents are taught differential attention
skills which are praise, reflect, imitate, describe behavior, and enjoyment. These are
parent positive attending skills. Well, we’re going to ignore disruptive behavior. The goal
is to increase the positive interactions between the child and the parent in the first phase.
We’re enhancing the parent-child relationship. In the second phase, we’re in the parent directed
interaction. PDI involves compliance training with the goal to reduce disruptive and aggressive
behaviors. How do we do this by using–now, we’re giving short commands and reverting
to other–now that the relationship has been enhanced, the child is more quick to comply
with the parents’ small requests and reinforcing those behaviors with the label praises and
reflecting and many ways of encouraging the child to continue doing what he’s doing that
is positive and ignoring negative behavior. Parents also learn how to use–avoid using
negative words and implementing more positive words versus, “No peges. Don’t hit,” to,
“Keep your hands to yourself.” “No grites. Don’t yell,” to, “Please use your in-house
voice.” During the PCIT, both child and parent are present during the treatment sessions,
so it’s done together. PCIT has different components that may be culturally appropriate
for Latinos and Hispanics because it fits with many of their values. For example, familismo
value because the focus is on enhancing the parent-child relationships, again the family.
The parents are in the room with the child playing and interacting with the child directly.
This focuses on the family and their part of the therapy. The parent becomes the extension
of the therapist. They’re continuing–they’re the therapist while they play with their child
and they continue to do so even when they go home and they have the 5 minute fun time
or fun homework where the parent has to practice their skills during 5 minutes of playtime
with the child, so the kids–again, they’re working on the relationship the family is
involved. The parents are directly involved through play and are taught the skills to
be practiced at home. Personalismo, developing that warm relationship and simpatia go along
with PCIT attending skills because we’re teaching them praise–label praise. What is the child
doing correct, going beyond the, “Great job! Great job for staying in your seat. Excellent
work doing what I asked you to do.” So, it’s going above describing what the child is
doing. Reflecting reflects what the child is saying, so the child feels hurt, imitating
what the child is doing, so the child feels what they’re doing is important and it’s validated
that what they’re doing is correct. Describing the appropriate behaviors and, again, enjoyment
is the other skill that the parents is teaching them how to have that warmth relationship
with the child just with small gestures as a high-five or rub on the arm, leaning in
giving eye contact. These go along with personalismo, developing that warm relationship with the
child. Because Latinos believe that children are expected to be well educated, ser educados,
and have socially acceptable social behaviors. PCIT also goes with that because we’re focusing
the behaviors of the young child that are appropriate. It goes right along with what
Latinos want from their children for them to be well mannered, ser educados. PCIT also
emphasizes on compliance to adults’ requests in a consistent with the value of respeto, respect.
You do what your parents tell you. You do it without question. You just do it. This
goes, again, PCIT goes along with respeto or value because we’re teaching the child
to comply within a 5 second rule. Giving the command like, “Beto, pasa me la sal. Please
pass me the salt.” Having 5 seconds to comply. When they do, we go back to label praising,
“Gracias por pasar me la sal.” So, again, we’re going along with the values that Latinos
and Hispanics have for their children. I had an experience working with a Puerto Rican
young lady, Alexandra. She was 6 at the time when I started. This child was diagnosed with
OCD, with anxiety, and ADHD, had seen 4 psychiatrists, and was on multiple meds. They, at school,
they were calling everyday. The parent didn’t know what else to do. By the time they had
already been to the previous therapies that weren’t working. I took on Alexandra and her
mom, Erica for the PCIT. It was at the beginning, difficult for Mom because at this point, she
was feeling very hopeless–that nothing was going to change and even the sister would
cry and ask, “How come Ale,” as they call her, “Is so unhappy? When is she going to
be happy? Nothing is good enough. She’s always having these meltdowns.” Basically, the older
sister and mom were hopeless by the time they came to me. I started working with Alejandra,
or Ale, on the PCIT and Mom, Erica. At first, they felt very uncomfortable, as her testimony
goes. They could not even see how they would be able to go out on outings or with families.
Of course, families with good intentions would say negative comments like, “Just give her
a good spanking. She just needs a good spanking. Or just lock her in her room.” All these well
intentioned families, but that were not very supportive of Erica and Alejandra. We started
PCIT and these changes started to become–as Mom started focusing on the pride skills–attending
to the positive behaviors that Ale was doing, even during playtime like staying in her seat
and using her in-house voice and staying calm and focusing on what she was doing, Alejandra
started making changes even at home and at school. The teachers started to see a difference
in Ale, that she was controlling her moods and was able to start learning how to express
herself using her words–appropriate words versus everything in a meltdown. The family
really benefitted from PCIT in that they were able to meet their needs. Mom felt very much
involved and she was starting to apply it not only during our sessions, as I coached
them live, that now it was being over-generalized to other areas in life at school and at home.
Right before therapy was completed with Ale because she–I gave her the ECBI, the assessment
that I gave all the scores were within normal. Same thing with the BASC, all her scores were
within the normal. She was about where we were–the parent was happy with where Ale
was. Right before we closed, they took a trip to San Francisco with the family and they
had the best time. Mom came back reporting that even family members were very surprised
as to how Ale had changed so much just using the PCIT. She was more confident, was expressing
herself, was learning how to calm herself all because of Mom’s going along with her
feeling like her sacrifices and coming to therapy and doing the things she’s doing
were helping Ale directly. This was a very good therapy for this Puerto Rican family.
Other evidence-based treatments that I utilize in my therapy are, of course there’s the cognitive
behavior therapy which has been also validated and adjusted. I use the trauma focus cognitive
behavior therapy because I do have a lot of children that have gone through abuse or some
kind of trauma. Trauma focus has been–also goes along with familismo because the families
are also part of the therapy. I do have individual sessions with the parents separately because
it’s important that I work with them and get them to process their own feelings about what
happened. A lot of times, even things that they haven’t disclosed before they will disclose
to me–that maybe they were abused or other events that were traumatic for them. So, I
help working with them and processing their own issues because with trauma focus–the
protocol one of is that they will–the child will tell their story and the parent will
have to be there when the child has finished, written their trauma narrative, and talk about
processing the story with the parent. That brings in the family. Also, a lot of psycho
education, so with the family, bringing the whole family in as to like–for example, what
is sexual abuse, so that we normalize the feeling. We’re bringing in the family. They’re
part of the treatment and how they can help the child whether it be with relaxation skills,
bedtime with their children, teaching them calm safe place, or tummy breathing–things
like that will help them in the process. Parents are very involved. Another therapy that I
use that’s been also translated and seems to be very effective is the Eye Movement Desensitization and Reprocessing, EMDR. Again, it has been translated and it also brings in the parents.
I’ve had small young children as young as like lap-age children, Mom can tell the story
and we’re processing, using either buzzies in the children’s shoes or tapping while Mom
is telling the story as to what happened with the child. EMDR is also another therapy that
I find has been very effective working with Latinos and Hispanics, again, modifying everything
according to their culture and to their values. Another psycho education program is called Crianza
con Carino. It’s more of a parenting–it’s working with the parents and the children.
It’s a 12 week program on parenting skills called, Crianza con Carino. There’s a lot
of evidence base and validity to this program as well. The nurturing program by Steven Bavolec
is another program that I have worked with and have found very effective in working with
Latinos and Hispanic children. I really want to thank you. Any questions that you might
have please email us. I’d be happy to answer those questions or have a discussion about
the questions. Thank you so much and I hope this was helpful for you in working with Latinos
and Hispanics. I enjoy them and I hope you are enjoying it too. Thank you.

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