Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Culturally Appropriate Social Support Services
One of the fundamental requirements of culturally appropriate
services is for mental health providers to identify and then to work in concert
with natural support systems within the diverse communities they serve (Greenbaum,
1998). (Background information on cultural diversity and culturally competent
services is provided in Chapter 2.) If they are culturally appropriate, services
can transcend mental health’s focus on the “identified client” to embrace the
community, cultural, and family context of a client (Szapocznik & Kurtines,
1993; Hernandez et al., 1998). According to Greenbaum (1998), considering a
client’s context is important because people who live close to each other
frequently have developed ways of coping with similar personal problems.
Becoming aware of these natural systems and adapting formal services to be
congruent with them are ways to make services more accessible and useful to
diverse populations.
Community- and neighborhood-based social net- works act as important resources
for easing emotional stress and for facilitating the process of seeking
professional help (Saunders, 1996). Often natural social supports ameliorate
emotional distress and have been found to reduce the need for formal mental
health treatment (Linn & McGranahan, 1980; Birkel & Reppucci, 1983; Cohen &
Wills, 1985). According to Saunders (1996), obtaining social support is not a
single event but rather an ongoing process. In general, people use their
neighborhood and familial supports many times before they decide they have a
problem and determine what type of help they will seek (Rew et al., 1997). A key
to the success of mental health programs is how well they use and are connected
with established, accepted, credible community supports. The more this is the
case, the less likely families view such help as threatening and as carrying
stigma; this is particularly true for families who are members of racial and
ethnic minority groups (Bentelspacher et al., 1994).
Minority parents are more likely than nonminority parents to seek input
regarding their children from family and community contacts (Briones et al.,
1990; Hoberman, 1992). In a study by McMiller and Weisz (1996), two-thirds of
the parents of minority children did not seek help from professionals and
agencies as their first choice. For example, in Hispanic/Latino families,
important decisions related to health and mental health are often made by the
entire family network rather than by individuals (Council of Scientific Affairs,
1991). According to Ruiz (1993), health care settings that are not modified to
work with Hispanic/Latino family networks find that their clients do not comply
with medical advice; as a result, their health status can be compromised.
In sum, mental health programs attempting to serve diverse populations must
incorporate an understanding of culture, traditions, beliefs, and
culture-specific family interactions into their design (Dasen et al., 1988) and
form working partnerships with communities in order to become successful (Kretzman
& McKnight, 1993). Ultimately, the solution offered by professionals and the
process of problem resolution or treatment should be consistent with, or at
least tolerable to, the natural supportive environments that reflect clients’
values and help-seeking behaviors (Lee, 1996).
Such partnerships sometimes fail, however, because they concentrate on
neighborhood and community problems. According to Kretzman and McKnight (1993),
this approach often reinforces the negative stereotypes of violent, drug- and
gang-ridden, and poverty-stricken communities. A more effective alternative
approach to working with communities is to focus on community strengths (Kretzman
& McKnight, 1993). This approach works best when community residents themselves
are interested in participating in the partnership. Mental health providers who
approach minority communities in a paternalistic manner fail to engage residents
and fail to recognize whether the community wants their assistance (Gutierrez-Mayka
& Contreras-Neira, 1998). Service providers who attend to the wishes of
community residents are more likely to be respectful in their delivery of
services, a respect that is a prerequisite to cultural responsiveness and
competence in service planning and delivery to diverse communities (Gutierrez-Mayka
& Contreras-Neira, 1998).
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