The Center for Innovative Practices presents a two-part discussion and training entitled, “Working With Latinx Youth and Families and Recovery from Trauma,” with Ramfis L. Marquez, PhD, LPC,, Gisela Diaz, MA, and Francisco J. Cornejo, MSW. The two sessions guide clinicians and caregivers toward a better understanding of the many Latinx cultures and offers approaches, strategies, and tools for when working with Latinx youth and their families. Topics range from the subtleties and diversity of experiences in the many Latinx cultures to the degrees of generational trauma that uniquely affects these families and communities.
THIS TWO-SESSION, SIX-HOUR deep dive into Latinx culture in the United States and the unique challenges presented for behavioral healthcare clinicians and caregivers working with Latinx youth and families is explored in significant detail in a wide-ranging conversation, covering a broad landscape of topics, punctuated with dozens of real-life examples of challenges met and triumphs made along the path of recovery. The collaborative team-approach uses a combination of instruction, intervention, (listen for Uno Therapy in the fifth stanza), and lessons learned. The true-life examples – some amusing, some harrowing, all poignant, if not inspiring – provide a narrative tapestry that connects and engages throughout the training and makes the daily small victories
VIEW SESSION 1 | VIEW SESSION 2 | DOWNLOAD PDF of PRESENTATION
Related Resources: English Language Intense Home Behavioral Treatment (IHBT) Crisis Information Template | Spanish Language Crisis Information and Safety Plan Template
Areas covered include: Corporal punishment; the ‘machismo’ ideals and patriarchal family structure; domestic violence within a cultural context; political neglect versus political violence; gangs and MS-13; narco-terrorism and the drug trade; unaccompanied minors and human trafficking; family separation and Immigration; detention centers; Deferred Action for Childhood Arrivals (DACA); and deportation and raids.
(The majority of the text below is drawn from the presentation.)
“Latinos Are a Multiracial, Multicultural Group”
Latinos/as/ or Hispanics in the United States are a fast growing population, expanding from a small, regionally concentrated group of fewer than 6 million in 1960 to a now widely dispersed population of well more than 50 million (or 16 percent of the nation’s population).
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Latinos are a diverse community. There are many misconceptions and stereotypes about who Latinos are and about the history and presence of Latinos in the United States, including the difference between Latinos and Hispanics.
Some Mexican Americans have been in the US for many generations. In fact, most of California and the Southwest was once part of Mexico. New immigrants from South America, Central America, and the Spanish speaking Caribbean continue to be part of the growing presence of Latinos. However, since 2000, the primary source of Latino population growth has swung from immigration to native births.
Latinos are a growing academic, political, and financial force in the US. One-in-four newborns is Latino. Never before in this country’s history has a minority ethnic group made up so large a share of the youngest Americans. By force of numbers alone,
the kinds of adults these young Latinos become will help shape the kind of society America becomes in the 21st century.
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Diversity within Latin America
Spanish is the official language spoken throughout most of Latin America, but not all Latinos/as speak Spanish. Latinos are a multiracial, multicultural group. Latinos include indigenous people who speak their own native tongues (e.g. Quechua a Native South American language family spoken primarily in the Andes, derived from a common ancestral language). English, French, and Portuguese are also spoke in specific Countries of Latin America an the Caribbean (e.g. Haiti, Brazil, Jamaica).
The prevalence of mental health problems vary among Latino subgroups and
are a reflection of the diversity of experiences and circumstances. Given the tremendous amount of diversity that exists among Latino/Hispanic individuals, it is important to understand the impact that this diversity has on what we understand regarding Latinos seeking or needing treatment. (See PDF section on Differences in Experiences by Region for more detailed descriptions.)
Latino Family System Dynamics
Latino culture is known for its collectivist-family orientation. the importance of “personalismo” (personal connectedness in interactions) and respect for authority. As Latinos reside longer in the U.S. they lose some of the potentially protective effects of their culture.
An increase in rates of psychiatric disorders and suicide is seen with increasing acculturation or assimilation into American culture.
Being bicultural and bilingual is actually protective for youth both academically and for mental health. Being able to communicate in the language of both worlds maximizes the child’s capacity to draw upon available protective resources while at the same time it enables an adaptive response to the language demand. Non-linguistic aspects of bicultural competence in the child, family and extended social environment have an important protective role in Latino children of immigrants and minimize their distress.
The growing Latinx community in the United States hails from a panoramic landscape of different cultures, obstacles, and journeys: Caribbean, Mexican, Central American and South American cultures are all distinct, distinguished by numerous factors from landscape and geo-political and socio-economic factors to religions and individual family heritage and customs.
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Trauma and the Latinx Community
Recent Latinx immigrants are at risk for traumatic exposure both before and after migration, PTSD, depression and stress associated with the immigration experience and the challenges of integration versus marginalization in the US.
Individuals who come from countries with a history of political violence often have multiple traumatic experiences. This suggests a need for systematic screening for trauma and related psychiatric disorders in these populations.
Specific outreach interventions focused on perceptions of need could be helpful for subgroups of Latinos including men who are particularly underrepresented in mental health services but who exhibit significant trauma histories.
Youth from the growing Central American exodus (aka, unaccompanied refugee minors) have high rates of traumatic exposure, PTSD and anxiety. Additionally, US citizen children of undocumented parents are also at risk of anxiety given their parents tenuous legal status and the fear of deportation
A Few Best Practices for Working with Latinx Individuals
Some interventions that have proven useful include: The use of a bio-psycho-social-cultural model of evaluation and treatment. Take the time to develop a cultural formulation, which includes a consideration for acculturation, community and family connection, immigration status/ history, education. Supporting collaborative care with Latinos is important for retention and success of care. Although this is a culture that respects authority, feeling misunderstood and not connected to a therapist often results in dropping out from treatment
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Rapport building is also key to engagement and family buy in. Latinx families are likely to be averse to engaging in services or expect “quick-fixes” to the issues they face. 
Psychoeducation combined with an openness to discuss treatment plans can aid in family engagement. Discuss ways in which the family or client has (or has not) begun engaging in social support and self-care. Focus on education and work may leave individuals reluctant to engage in self-care or social practices.
Beware of misunderstanding of mindfulness and yoga related practices within Latinx community which may be interpreted as spiritual practices. This may result in reluctance to begin meditative and mindfulness practices.
Keys to Engagement (Youth, Family, Extended Family)
Latinx youth will engage much like other youth but language barriers can stifle progress. Make use of art, music and play to build rapport. Its important to also ensure that the children are being properly engaged in school and are receiving ESOL services.
Latinx families are typically collective in nature. The nuclear family are typically extended to include what would be considered extended family members in American culture (Uncles, Aunts,Grandparents, etc.). These family members can be integral at not only building rapport but providing important context and information on family dynamics and things that may be impacting the client.
Safety Planning With Spanish Speaking Families
Mental Health treatment stigma and religion plays a role in the reporting and addressing of suicidal ideation (SI) within the Latinx community. Adults may be less likely to report SI out of fear of judgement from others in the
community and their family. Shame and religious ideologies may also hinder
discussion on SI in the therapeutic setting.
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Children may struggle with many similar reservations about discussing SI with the
resulting shame leading to lack of communication with parents and family. Revelations of SI should be handled with care to prevent adding to the shame felt by the individual.
Caution should also be had when presenting to parents a child’s communication of SI as
there is a potential for them to react in shock and anger. Options should be given to
the children as to how their parents will be presented with the necessary information.
Parents should be reassured using psychoeducation on SI and by presenting ways to
be supportive of their child.
The Family Teaming Model
As a provider, your first goal is that your client does not need you anymore. Clinical Supports versus Natural Supports consists of involving everyone who is interested in the safety and wellbeing of the child. Care providers should be the positive force behind the client and the family, meeting regularly with people who want to support the client. A primary goal is to become the clinical facilitator and an expert on the needs of the client and the family, as well as an advocate for the client and family. Care providers will want to facilitate discussion, yet always leave the table with a plan, ensuring everyone is working out of the same plan of care. Finally, it is helpful to start planning the discharge at the onset of treatment and, eventually before discharging, ensure that the client has the support that they need.
Treatment Planning with Hispanics
As a care provider working with Latinx youth and their families, communities, and support networks it is helpful to keep in mind the following facets a intervention and treatment, and the nuance and subtleties that might impact effective recovery.
– Build Confianza (Trust)
– Familism
– Machismo versus patriarchal versus matriarchal culture
– Inclusion of Spirituality
– Attitudes and Beliefs Regarding Mental Health
– Continued exploration of family Secret
– Education on alternative styles to parenting
– Education on alternative styles to discipline
– The Spanish Language (interpreters, first language providers)
– Somatization
– Inclusion of cultural activities
– Idioms of distress
– Perceived Cultural mismatch
ABOUT THE PRESENTERS
Ramfis L. Marquez, PhD, LPC, is the Director of the Behavioral Health Department. He holds a Doctorate in Clinical Psychology and is a Licensed Professional Counselor in the State of Virginia. Dr. Marquez studied at Walden University and Inter American University of Puerto Rico and has worked in the field of mental health for 17 plus years. He has specialized experience working with Children, Adults, Geriatrics, Individual, Couples and Families in both English and Spanish. Dr. Marquez has developed expertise in the areas of Trauma, ADHD, Asperger’s Disorder (Autism Level 1), Depression, Anxiety and other DSM disorders. Dr. Marquez approaches therapy from a holistic perspective, using techniques from client focused, humanistic, motivational and reality based therapies. In his free time, Dr. Marquez enjoys reading, music, history, stand up paddle boarding, cooking, dancing, playing the guitar, sports cars, martial arts and Science Fiction. Learn More
Gisela Diaz, MA, has worked for over three decades with the Latinx communities in a variety of settings while living in her native Puerto Rico, and later in an externship in La Habana, Cuba. Gisela and her husband Dr. Marquez relocated to the Wahington DC Metropolitan area in late 2000 where she continued her work in the field of mental health and community services in Washington DC and Virginia. Gisela holds a Master’s Degree in School Psychology. She has practiced in the state of Virginia as a Bilingual School Psychologist for the past 18 years. She has worked for decades with Latinx communities in various realms of advocacy, academics, health, the criminal justice system, and the field of social services. She strongly believes in working collaboratively with her student’s families, teachers, and support systems, while providing guidance while respecting each individual journey. Most recently after Hurricane Maria devastated the island of Puerto Rico, Gisela founded Voice of Puerto Rico a platform that gives voice to the people of her island through advocacy, and community support. Gisela also volunteers often in her community with issues associated with immigration, hunger, and advocacy for equal access to education, and health services. She is the mother of two young adults, enjoys crafting, and working with her soon to be a therapy dog, Athena.
Francisco Javier Cornejo MSW, completed his BS in Psychology from Virginia Commonwealth University and continued his education at George Mason University, as he pursued a Master’s degree in Social Work. Francisco has focused his work on trauma and recovery within the Latinx and migrant community by delivering behavioral health services in community health centers located in Prince William County. Francisco additionally has worked to increase the participation and collaboration among various community entities to aid in increasing access to necessary resources for the Latinx community.
ADDITIONAL RESOURCES
Latinx Therapy:
Website and Podcast has various supplemental resources on MH topics. Podcast is recorded in English and Spanish. Visit site
Washburn Center
Translation and definition of various MH related terms to be used with and to aid in explain to a Latinx population. Our mission is to nurture every child and family’s well-being and full potential through transformative children’s mental health care. Visit site
Therapist Aid
Creates and shares worksheets on different modalities that have been translated into Spanish along with videos, guides, and other tools to aid mental health professionals in the course of their work. Visit site
Informed Immigrant
Provides resources for clients and providers on mental health services and complexity of immigrant experience and mental health issues Visit site
Suicide Prevention Resource Center
Information on suicide prevention within the Latinx community. Visit site
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