Consultancy and Diversity in Mental Health Care Facilities Essay

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Consultancy Case Study: Hispanics


General Stages of Consultation

Koff (1988) discusses a problem-solving process in consultation as consisting of four components, rather than stages. These are problem identification, problem analysis, intervention, and evaluation. In the first component, the consultation determines the client's or consultee's problem. She makes sure that it is the client's or consultee's problem and nobody else's. When done, they proceed to the second component. They analyze and try to understand the problem thoroughly in order to avoid misinterpretations.. At this point, the consultee or client may or may not decide to continue with the consultation. If he does, the analysis shifts to her professional knowledge, skill, confidence, objectiveness, and interpersonal reactions with everyone involved and determining how she herself may be the cause of the problem. When this is accomplished, the intervention component sets in, wherein the consultant suggests tailor-made programs or approaches to solve, eliminate or reduce the problem, whatever the cause. The evaluation component follows and concludes the process with an assessment of the consultee's satisfaction with the intervention and its beneficial effects on the problem (Koff).

2. Problem Identification

Dr. Claire Bell is the director of the Concord Health Clinic in Beverley Hills to whom I was recommended by a common friend, a social worker of Mexican origin but born in the United States like I was. Dr. Bell or Claire is a native of Michigan told me that their company is expanding and setting up another clinic in East Los Angeles to extend their services to the populations in that area the following month. She would be moved to that new location for the same position She expressed concern that her counselors to be assigned with her in the new clinic did not possess the skills to deal with the predominantly Hispanic populations in the area. Their clients in Beverley Hills have been Caucasian. She thought that being Mexican by blood and thoroughly trained as a consultant in the United States, I would best suited for the task. I do not only keep in constant touch with my family, friends and people in the United States but also in Mexico. I also make it a point to remain updated on developments in the field of mental health and frequently work with my fellow Hispanics.

3. Problem Analysis

Having identified the problem, we proceeded to the second stage, which considers the consultees' -- the counselors -- professional knowledge, skills, confidence, objectiveness and interpersonal interactions and the probability of their causing the problem themselves (Knoff, 1988). Claire's four counselors joined us at this point at this stage for the analysis task. They are Gale Evans, Charles Moore, Joan Thompson, and Mildred Parker. All of them are social work graduates with counseling experience of more than 8 years but with Caucasians in the Beverley clinic and other clinics in California. They have demonstrated professional skills, objectiveness and harmonious interpersonal relationships with clients, with one another and with the public. But these clients and the people-at-large they have successfully and professionally dealt with are Caucasians like themselves. Their new clients have an entirely different culture that will put their proven professional competence, objectiveness, and interpersonal skills to a real test. In order to pass that test, they need to be thoroughly knowledgeable about their new clients. I deemed that Claire and her counselors needed to undergo a consultee-centered process, which would address their lack of knowledge, skill, self-confidence, and lack of professional objectivity (Knoff 1988). The nature of our engagement was to be an organizational consultation and collaboration from a behavioral perspective as Hispanics typically do not feel free or easy in expressing their feelings. Yet the very essence of the service is to produce concrete and predictable results, which entirely depend on the accuracy of the expression of these feelings. I performed the four steps required in education and training of this kind, i.e., assessment of the counselors' needs, planning the activities, performing the education and training program, and its evaluation. I recommended a full week's educational and training program with the four counselors on Hispanic culture with emphasis on overall Hispanic mental health status and Claire agreed. I offered to send information materials about Hispanics in advance for the counselors and for Claire to read in preparation for the education and training program and to familiarize them in advance. I delivered brochures and other information materials about Hispanics a few days before the start of the scheduled program.

4. Intervention and Evaluation


I conducted three-hour lectures and question-and-answer sessions with the counselors and with Claire at their Beverley Hills clinic every day for the whole week after their clinic work hours. I shared with them and we discussed recent findings on the mental health status of Hispanics. Depression, anxiety and substance abuse are common among Latinos, which make them a high-risk group (CNPAAEMI, 2003). Latinas are more prone to depression at 46% as against Latinos at 19.%, according to the Common Wealth Fund survey. Comparing them with African-Americans, Latino girls are 1 1/2 times more capable of attempting suicide than African-Americans, as studies reveal that almost one out of every 3 Latina high school students or 30.3% had deliberately made such attempt. Those who have lived for some time in the U.S. are also likelier to attempt suicide than recent migrants. Those who have stayed long also develop mental disorders, corresponding to an increase in substance abuse. In contrast, Mexican-Americans born outside the United States had low suicide attempts rates than those born in the United States (CNPAAEMI). I also used illustrations, graphs and tabulations to demonstrate these data. Likewise, I shared that other major studies conducted among Mexican-Americans, Puerto Ricans and Cubans showed that the mental disorders Hispanics develop are major depression, panic disorder, phobia and alcohol use (Guarnaccia et al., 2003). Hispanic children, youth and older adults were found to develop mental health problems more than their white counterparts. The symptoms exhibited by these populations are usually somatization, and culture-bound syndromes (Office of the Surgeon General 2001). Other high-risk groups identified by other studies are those incarcerated, Vietnam war veterans, refugees, and alcohol and drug abusers (Office of the Surgeon General).

The counselors and Claire participated well during the question-and-answer portion of our program. Using the copies of the Surgeon General's Report (2001) on the mental health of young Latinos I earlier brought to their clinic, we discussed that young Latinos are at a great risk of mental disorders. Findings disclose that these young Latinos tend to drop out of school because of depression and anxiety and then contemplate suicide. Sociological research provides evidence for the differences in mental health and mental health disorders among sub-groups. It indicates that Central Americans are at the highest risk for post-traumatic stress disorder. Mental disorders and distress may develop and exist in many levels: from molecular to social. Psychosis may develop from the malfunctioning of neurotransmitters or a bruising personal loss or defeat (Office of the Surgeon General).


Claire and her counselors felt great enthusiasm after acquiring new knowledge about the Hispanic culture and mental health status. The surge of new knowledge, skill and confidence reduced their apprehensions but they expressed the need for continued supervision and consultation when they begin actual work with the Hispanics in East Los Angeles in two weeks' time. I agreed to provide continued service from an organizational perspective. I also recommended that, in the two weeks preceding the opening of the new clinic, they conduct ocular visitations in the site in order to be exposed to the Hispanic community and gain overall familiarity with the residents.

I found the counselors and Claire to be sincerely interested in learning about the Hispanic culture. She had plans of employing more counselors to accommodate more patients but they will share what they learned with these newcomers

5. Potential Barriers to Problem Resolution

The first and likeliest barriers were consultee resistance and reluctance (Guarnaccia et al., 2005). Resistance occurs when the consultee or the organization fails or refuses to constructively participate in the consultation process. And reluctance is the consultee's hesitation to engage in consultation itself. Resistance can come from the system level or from the consultee itself. It is at systems level when the need to change is absent because of a lack of insight about it. And it is from the consultee itself from many sources, including the consultee's lack of knowledge or misconception about the nature and value of consultation (Guarnaccia et al.). Proactively, I endeavored to create and maintain strong bond of trust with the counselors, showed them my deep familiarity with the ways of their client, collaborated with the counselors in all aspects of their training and clinic work when possible, and, in all other extraneous ways, demonstrated that consulting with me was valuable and satisfying.

Another barrier is the counselors' inherent tendency to discriminate racially, which cannot be eliminated in a few weeks' or even a few months or years. The counselors need…[continue]

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