Cultural competency training for Hispanic mental health clients

Consultancy Case Study: Hispanics

A DIVERSITY ISSUE

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

Evaluation

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 to be constantly aware of their clients' different culture and see them always according to that culture at least in an official way.

A third barrier is the counselors' need to be more adequate in the Spanish language. Having only English speaking Caucasians as their clients in the previous clinic and being English-speaking Caucasians themselves who have not learned Spanish make verbal communication with their clients very difficult. I recommended that they complete a crash program in Spanish. I recommended a bilingual friend who speaks both English and Spanish fluently.

The time element presents another barrier. A month's preparation for an encounter with a culture, which is completely alien to the counselors, did not seem sufficient. They are likely to keep falling back to old prejudices and perspectives, especially in the diagnosis stage of clinic work.

And a last barrier is the need to hire more counselors to accommodate the growing number of Hispanics in the area. This requires additional funding for the new clinic and additional training and education for every additional counselor and clinic personnel as they will deal with the Hispanic clients directly. I recommended constant upgrade of knowledge and skills and behavioral adjustments on the consultees' part.

6. The Resolution

Acting on my recommendations, Claire was able to obtain the approval of the clinic owners to postpone the opening of the new branch in East Los Angeles for two months. In those two months, she hired the bilingual teacher to teach Spanish to her counselors. At the same time, they asked me and my friend who recommended me to perform weekly ocular visitation of the site and the Hispanic community. My friend and I introduced the counselors to some residents in the area. The counselors tried using their newly-learned behaviors and Spanish words, sentences and idioms in speaking with the residents.

Three months later, the clinic was already operating for a month and I arrived for my continued consultative service. The clinic teemed with patients, mostly young Latinas. The counselors enthusiastically conversed with the patients and were speaking the Spanish language with some adequacy, although with difficulty with pronunciation. Claire told me that they were now able to read the gestures and decipher the unexpressed feelings of their Hispanic patients. The patients, for their part, also felt more comfortable seeing me at the clinic. My presence and assistance in interviews and treatment made them feel that they were in the hands of one of them.

I felt confident that the barriers of resistance and reluctance were substantially dealt with by the fourth month of operation. I saw the counselors in sustained enthusiasm and exhibiting competence in handling the mental health problems of the clients. They have become proficient in reading through the patients' gestures and speaking to them in their idioms. With a demonstrably enhanced understanding and handling of the mental health problems of the residents, their overall mental health situation consequently improved.

Racial discrimination is not an easy problem to resolve as it has remained embedded in American culture for centuries. However, Claire and her counselors are well aware of the negating effects of discriminating against the race of their clients and they certainly want to succeed by improving their mental health levels. A positive consequence has been broadening of their perspective about race and the dynamism of the human personality itself.

In the fifth month of my consultation visit, Claire has employed two Hispanic clinic assistants: one as a clerk who keeps their records. The other is a receptionist who welcomes patients at the lobby. I felt that these are convincing signs of improvement. Patients feel much more welcomed at the clinic with one of them meeting them right at the lobby. These two new employees live in the neighborhood. They spread the word in the community not only about the competence of Claire's counselors in dealing with their mental health problems. They also provide testimonials on the sense of acceptance and the absence of discrimination in the clinic.

The sixth month was the final month of my formal consultancy and the time to terminate and disengage. Four counselors were added and will be trained by the four earlier ones on the knowledge they gained and to learn Spanish from the same bilingual teacher. At this point, we all speak Spanish with ease, whether the patients are present or not. Claire proudly told me that the volume of patients has almost doubled since they opened and this has delighted the owners. A source of greater delight to all is the overall mental health benefit that the Hispanic community has gained.