Lost in translation? Communication challenges in minority families’ and healthcare workers’ interactions

A fundamental principal in the Norwegian welfare system is to provide equal access to healthcare services for all residents, regardless of their ethnicity, language, knowledge, function, or belief. However, many service recipients experience a gap between these ideals and everyday realities. In this article I investigate how this gap affects minority families of disabled children who do not master the majority language and healthcare workers. The data I use in my investigation draw on a qualitative study of minority families of disabled children and healthcare workers. The findings that emerge out of these data are categorized into: linguistic difficulties, expectations and assumptions, and culture-bound services. I use these findings to illuminate how language difficulties and stereotypical assumptions within the Norwegian healthcare system make it difficult for minority families to access healthcare services, and how healthcare services lack an effective way to meet minority families’ needs.     

The Development of a Black and Ethnic minority health policy at the department of health

Britain is a truly multiracial and multicultural society. Immigration into Britain in 1960s and 1970s was mainly fiom South East Asia, Africa and the West Indies. A large number of immigrants have now become residents of Britain and we have a second generation of Black and ethnic minority groups in this country who were bom in Britain. More recently we have been joined by a number of refugee groups and asylum seekers. In the last 10 years, there have been a number of initiatives which have been taken to develop appropriate policies to improve access to health services by ethnic groups and to understand their health and disease patterns. The main issues are: (1) What policies have been developed? (2) The main areas of concern. (3) The differing health and disease patterns among ethnic minority groups. (4) How the policies are being implemented at the health service level and the lessons learned. (5) How the health professionals are being trained to deliver appropriate services to these groups. (6) How volunteer groups are invoked in planning services. (7) The national health services have recently been reformed and have introduced the idea of separating the delivery of health care from its planning and of the purchasing of services by health authorities. It is important to examine whether these have an impact in changing health services to make them more accessible to ethnic minority groups. (8) What the future plans in this area of work are.     

School-based interventions with depressed minority adolescents

School-based approaches to intervention with depressed minority adolescents is discussed within a preventive framework. The symptomatology and epidemiology of depression is presented as it pertains to minority group adolescents. Specific suggestions for school-based services, the uses of school-based mental health professionals, and for coordination with mental health agencies are provided.     

Minority Language Proficiency of Adolescent Immigrant Children in England,Germany, the Netherlands,and Sweden

We study minority language proficiency of adolescent immigrant children in England, Germany, the Netherlands and Sweden. We elaborate on theoretical mechanisms of exposure, efficiency and non-economic incentives of minority language acquisition. Using data from adolescent immigrant children in England, Germany, the Netherlands and Sweden, we find evidence for the role of exposure in that immigrant children who were born abroad were more proficient than those born in the host country. Exposure via the percentage of co-ethnics at school is positively related to minority proficiency, whereas parental proficiency in the destination language is negatively associated. Also belonging to a larger immigrant group increases exposure to the minority language and results in language retention. Efficiency in terms of cognitive abilities does not play a role. Non-economic incentives to retain the minority language, indicated by the ethnic identification of parents, is positively related to the child’s minority language proficiency and this relationship is stronger when the quality of the parent-child relationship is higher.     

Young African American Males: Barriers to Access to Health Care

African American males continue to experience an unacceptable and disproportionate number of health disparities when compared with other racial and ethnic groups. Young African American males can expect to live the least amount of time when compared to any other ethnic minority or racial sub-group. Understanding the obstacles and barriers that impede access to health care and wellness services among young African American males is essential to begin the process of decreasing health disparities. The goal of this qualitative study was to explore and identify the barriers experienced by young African American males in accessing health care services while also creating a rare opportunity to give voice to young African American males. The study results indicate that young African American males have multiple perceptions of barriers to health care services. Their perceptions fell into three categories: the negative impact of environment or community, lack of finances or no insurance, and distrust of medical practices associated with race history resulting in accessing healthcare as a last resort. Additional research is needed to craft community-based programs to: a) educate young African American males on the importance of preventative strategies to maintain wellness; and b) ensure that the appropriate medical and wellness services are available and reaching young African American males in need.     

Organizational structure,leadership and readiness for change and the implementation of organizational cultural competence in addiction health services

Increasing representation of racial and ethnic minorities in the health care system and on-going concerns about existing health disparities have pressured addiction health services programs to enhance their cultural competence. This study examines the extent to which organizational factors, such as structure, leadership and readiness for change contribute to the implementation of community, policy and staffing domains representing organizational cultural competence. Analysis of a randomly selected sample of 122 organizations located in primarily Latino and African American communities showed that programs with public funding and Medicaid reimbursement were positively associated with implementing policies and procedures, while leadership was associated with staff having greater knowledge of minority communities and developing a diverse workforce. Moreover, program climate was positively associated with staff knowledge of communities and having supportive policies and procedures, while programs with graduate staff and parent organizations were negatively associated with knowledge of and involvement in these communities. By investing in funding, leadership skills and a strategic climate, addiction health services programs may develop greater understanding and responsiveness of the service needs of minority communities. Implications for future research and program planning in an era of health care reform in the United States are discussed.     

From Fragmentation to Integration

Abstract

Within the mental health field, there is an increased attention to issues of diversity. However, this awareness has not yet been applied to racially and culturally diverse gays and lesbians who are chronically mentally ill. Some of the reasons for this include the long history of homogeneity of American institutions; the underutilization of mental health services by minority groups; the stigmatization of the mentally ill; and homophobia, within both the psychiatric community and society at large. As a result, there is a need for mental health professionals to acknowledge minority gays and lesbians with chronic mental illness, and begin to provide programs that affirm their sexual orientation, race, and cultural identities.     

Partnering for Mental Health Promotion: Implementing Evidence Based Mental Health Services Within a Maternal and Child Home Health Visiting Program

This article details the clinical foundations of a social work focused community-based participatory research project promoting women’s mental health during and around the time of pregnancy. Specifically, we discuss the theoretical, empirical and organizational implementation of an enhanced engagement model of mental health service delivery that integrates evidenced based practices into the structure and services of an existing non-profit maternal and child health home visiting agency. The model is grounded in literature addressing barriers to accessing mental health care among minority women living in low-income communities. We discuss informing the intervention through direct consumer involvement, as well the rationale supporting the inclusion of Interpersonal Psychotherapy and Cognitive Behavioral Therapy into the design and implementation of the model which emphasizes adequate training of staff with varying levels of mental health experience. Finally, we describe typical client situations and responses reflected by the Enhanced Engagement model and discuss future implications of this approach as a way to offer meaningful intervention to women and families who may not have access or eligibility to utilize specialty mental health services.     

Culturally Competent Practice with African American Juvenile Sex Offenders

African American juveniles adjudicated for sexual offenses may struggle with the mistrust of both the judicial and treatment systems. Unlike general mental health services, juvenile sex offender treatment is often mandated by the court or child welfare services, thus these youths and their families must engage in the treatment process. Without clinicians and services that can acknowledge and respond to a minority youth’s experience in a sensitive, culturally competent manner, there could be significant resistance to treatment. Traditional treatment approaches fail to prioritize issues involving cultural competence. This article addresses the unique challenges of African American juvenile sex offenders and makes recommendations for creating culturally competent practice for these youth and their families.     

Can we talk about the right to healthcare without language? A critique of key international human rights law,drawing on the experiences of a Deaf woman in Cape Town,South Africa

A case study in Cape Town, South Africa, explores the right to health for signing Deaf ¹ 1. By Deaf (capitalised) we understand those permanently sensorily disabled people who are born deaf or who become deaf as children and whose first language is sign – South African Sign Language (SASL) in this country. View all notes patients attending health services and who are unable to communicate in a language they understand. It argues that, without language, Deaf South Africans’ dignity and right to health is violated, resulting in serious consequences such as incorrect diagnosis, improper treatment and standard of care not being applied. It critiques the provisions of the Convention on the Rights of Persons with Disabilities (CRPD) and the limits of General Comment 14 of the International Covenant on Economic, Social and Cultural Rights. The paper demonstrates that Deaf patients do not have informational access to healthcare. It argues that language via professional interpreter services is essential to their South African constitutional right of access to healthcare. General Comment 14 addresses informational accessibility, but this is insufficient without addressing language as a pre-requisite. The CRPD imposes on the South African government human rights obligations to provide professional interpreter services for Deaf people, but unfortunately it allows a loophole by enabling cost to serve as reasonable grounds to defer action.     

Ethnic Diversity and Child Protection

SUMMARY: Black and minority ethnic children in need of protection receive a poor response from health and social services. Practitioners are reluctant to intervene, and when intervention does take place it reflects a eurocentric approach that fails to engage with the ethnic diversity of vulnerable children. Increasing the levels of safety far all children, black and white, suffering or likely to suffer significant harm, requires taking positive action: collecting ethnically relevant data, a commitment to an equitable distribution of resources, consulting children and parents and involving them in planning and designing services.     

Promoting the mental well-being of older people from black and minority ethnic communities in United Kingdom rural areas: Findings from an interview study

Drawing from 81 interviews with practitioners in social care and housing with care services in the United Kingdom, this paper explores practice issues in rural areas when supporting the mental health and well-being of older people from Black and minority ethnic groups. The paper begins with a review of the literature which provides evidence that BME older people are likely to be increasingly part of the populations of rural areas. Next it presents interview data revealing that while practitioners are aware of such demographic changes in general terms; some feel that they lack training and skills in adapting their professional practice to support all older people. Others express feelings of professional isolation in seeking to support older people from minority groups and are concerned that older people from minority groups may be at risk of isolation and loneliness. The paper concludes with a discussion of the study's implications for rural practice, policy and research.     

Migrants' minority‐language newspeakerism: The pervasiveness of nation‐state monolingual regimes in transnational contexts

From a critical sociolinguistics perspective, this paper investigates processes of minority‐language newspeakerism among 23 migrants from heterogeneous socioeconomic and language backgrounds. Informants networked in a cybercafé and a bench in Catalonia, a European society with a majority and a minority language, Spanish and Catalan. Drawing on audio‐recorded interviews, naturally‐occurring interactions and four‐year ethnographic data, I analyze how informants' language practices and ideologies interplay with self‐/other‐ascribed Catalan newspeakerhood. The results show that migrants do not envision themselves as Catalan newspeakers. They employ ethnicist constructions of Catalan as ‘the locals’’ language, and inhabit fluid identities whereby ‘Catalanness’ is vindicated through global Spanish. They invest in Spanish newspeakerhood instead, presenting Spanish as the language of ‘integration’. I conclude that newspeakerism contributes to understanding migrants’ roles in the linguistic conflicts of minority‐language societies; particularly, the ways in which they invest in majority languages, following nation‐state monolingual regimes which pervade as gatekeepers to post‐national citizenship.     

Health status,health problems and practices among refugees from the Middle East,Eastern Europe and Southeast Asia

Recent refugees from Poland, Romania, Iraq, and Vietnam were extensively interviewed to assess their health, health care utilization, and health services use barriers. 277 recent arrivals from these countries and 63 previously arrived Laotians comprised the 1983-1985 sample from the Detroit metropolitan area. Results from a 195-item bilingual questionnaire indicated good overall health and little evidence of serious physical health symptoms. Dental health was the area of greatest reported need. Prenatal care and mental health services were additional areas of need noted by researchers. Barriers to health service utilization were primarily language related. There were major differences in both health problems and health service utilization among the 4 groups surveyed.     

An Evaluation of Mental Health Services for the Culturally Diverse

ABSTRACT

The purpose of this project was to examine the needs of multicultural populations in the mental health system, and see how these needs get addressed in current policies. As a social worker in the mental health system, I wanted to investigate the strengths and weaknesses of service providers in their ability to meet the needs of diverse populations. In doing this research, I hoped to make a space for people whose families have had to deal with mental health services, and explore the experiences of those who have not had the opportunity to discuss them. In addition, the purpose of this paper is to contribute to a body of increased knowledge on how the mental health system treats people who belong to a cultural minority.     

Perceived Stigma and Depression among Black Adolescents in Outpatient Treatment

Despite the high prevalence of depression among children and adolescents, most that need mental health treatment do not seek care. This is especially true for ethnic minority adolescents. Prior research has shown that perceived stigma may act as a barrier to the initiation of and adherence to depression treatment, yet few studies have examined the relationship between stigma and depression among Black adolescents. This exploratory study examined the relationship between Black adolescents' depression severity and their current level of perceived stigma in an outpatient sample. Face-to-face interviews were conducted with a clinical sample of adolescents referred for mental health services at a community-based outpatient clinic (n =108), participating in a prospective pilot study on adolescents' patterns of mental health service use. The analyses revealed that greater depression severity was significantly associated with higher perceived stigma (p < .05), particularly among females. The results also suggest that Black adolescents appear to exhibit an appropriate level of self-assessment regarding their need for mental health services. These results are interpreted in relation to previous literature, and limitations and directions for future research are discussed.     

The mother market

Giving a woman good prenatal and maternity care can capture the health-care spending of her entire family for life. The next decade will bring several challenges to those who market maternity products and services, including fewer new moms, fewer babies in many markets, more minority mothers, and the end of childbearing for the baby-boom generation. The biggest challenge will be to provide a wide range of high-quality childbirth options in the cost-conscious world of managed health care.     

Chinese families in transition: Cultural conflicts and adjustment problems

Challenged to cope with two different cultures, Chinese American immigrant families face many stressors and conflicts. Such difficulties faced by these individuals usually stem from language, religious, and value differences. Furthermore, family members are faced with role and status changes due to differing rates and levels of acculturation. As a result, there is a great need for mental health services. However, due to cultural barriers, mental health services are not accessible nor acceptable to many Chinese Americans. Effective intervention strategies which integrate the Chinese cultural values and norms with psychotherapy are recommended.     

Chinese Families in Transition: Cultural Conflicts and Adjustment Problems

Challenged to cope with two different cultures, Chinese American immigrant families face many stressors and conflicts. Such difficulties faced by these individuals usually stem from language, religious, and value differences. Furthermore, family members are faced with role and status changes due to differing rates and levels of acculturation. As a result, there is a great need for mental health services. However, due to cultural barriers, mental health services are not accessible nor acceptable to many Chinese Americans. Effective intervention strategies which integrate the Chinese cultural values and norms with psychotherapy are recommended.