Providing clinical services to diverse patient populations
The following is an update from a Diversity Special Interest Group conference call discussion.
The Division 54 Diversity Special Interest Group (SIG) hosts periodic conference calls open to all SIG members to discuss diversity-related topics of interest. In this article, we outline the primary points raised during a call on providing clinical services to diverse patient populations, including within centers that specialize in working with individuals of particular ethnicities (i.e., “parallel” treatment centers; Yeh, Takeuchi, & Sue, 1994). Yeh and colleague’s (1994) article on treatment outcomes for Asian-American families seeking psychological services for children in parallel versus mainstream centers provided a starting point for the discussion.
Benefits and Challenges
There are a number of benefits and challenges associated with providing services in such centers. Benefits of parallel centers include that families can more easily schedule and receive psychological services in their native language, thatfamilies may be more willing to obtain services from a center that is located within their community, and that providers within these centers are familiar with the cultural attitudes, values, and communication styles (beyond language) of the populations served. Parallel centers could be integrated with other trusted community services (e.g., centers that provide health screening, resources for low-income families, English-as-a-second-language services) as a way to help families meet their needs and reduce barriers to mental health care access due to stigma.
Challenges to providing psychological services through parallel centers include that providers may have dual relationships with families due to the size of ethnic communities in some areas, that providers may not be equipped to manage more specialized concerns involving medical issues (e.g., medical regimen adherence, pain management), and that parallel centers often are located in large urban areas and may not be available in smaller communities. Although parallel service centers are a valuable resource for families, more research should be conducted on the implementation of and outcomes associated with such centers in diverse communities.
Given the benefits associated with parallel service centers, it is important to also consider how best to train psychologists providing clinical services to diverse patients and families. Language can be a major barrier to psychologists’ ability to provide services to some diverse patients and families. Although there is a paucity of resources and limited mentorship for individuals conducting bilingual therapy and assessment, exciting training opportunities in linguistic diversity exist, such as certificates and specializations in bilingual therapy (e.g., through the University of Miami Counseling Program), structured linguistic competency seminars in internship/postdoctoral training (e.g., Children’s Hospital of Orange County), and informal coursework and supervision groups developed by faculty with an interest in therapy with ethnically diverse populations.
However, there are barriers to developing such programs, such as needing a sufficient number of established professionals who can provide supervision in languages other than English. For trainees or professionals who are non-heritage speakers, many may have achieved proficiency to provide therapy in another language by studying a foreign language in school or by pursuing language immersion opportunities (e.g., study abroad course, volunteer opportunities). Though challenging, trainees interested in providing therapy in another language might seek out graduate programs that serve the populations trainees want to work with and that have a supervisor that will help the trainee navigate the linguistic and cultural intricacies of those populations.
Even if psychologists are able to provide therapy in a family’s language, there may be other differences between therapists and patients/families, such as cultural and socioeconomic backgrounds. For example, one SIG member, Dr. Mery Taylor shared that as a bilingual/bicultural psychologist born in Uruguay, she made efforts to learn about shared and varied values/beliefs and the history of the Mexican families she works with in California.
The material discussed on the conference call provides several ideas for future directions for pediatric psychologists.
First, pediatric psychologists should consider how clinical services (e.g., location of services, interventions themselves) can be tailored to be more accessible to diverse families, including pursuing partnerships with parallel service centers or community agencies.
Second, it will be important to initiate and support existing programs which provide cultural and linguistic competency training opportunities.
Third, continued efforts to recruit heritage and non-heritage speakers of languages other than English who are interested in providing therapy to diverse populations will ensure that our field is able to meet the clinical needs of underserved populations.
Visit Diversity SIG for additional information, including how to join future conference calls.
Yeh, M., Takeuchi, D. T., and Sue, S. (1994). Asian-American children treated in the mental health system: A comparison of parallel and mainstream outpatient service centers. Journal of Clinical Child Psychology, 23, 5-12.