In early childhood mental health, bilingual counselors in short supply

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Amanda Rios is a psychologist and therapist who works with Latino youth at the Center of Relational Empowerment, where cultural competency training is required.

Photo by Michelle Kanaar

Amanda Rios is a psychologist and therapist who works with Latino youth at the Center of Relational Empowerment, where cultural competency training is required.

Dr. Virginia Quiñónez first realized the urgent need for bilingual mental health care providers after it took her weeks to find a psychiatrist for one Latino family in Chicago – a city where over a quarter of the population identifies as Latino.

Quiñónez is the director of educational effectiveness at the Chicago School of Professional Psychology. She’s seen firsthand the impact of having – or not having – mental health providers who clients can relate to.

“We need to get mental health providers who understand their clients, and that starts with getting someone who speaks their language,” Quiñónez said.

But in a recent survey of Illinois’ early childhood mental health consultants, only 19 percent said they used a language other than English in their work.

The shortage of bilingual mental health providers in the state particularly hurts Latinos, the demographic group most likely to speak a language other than English at home, and who are nationally almost twenty percent less likely to access mental health services than non-Latinos when facing serious psychological distress.

This gap isn’t just caused by a language barrier. For many, there’s a cultural barrier as well.

According to the survey, 77 percent of consultants were white. Cultural competency training, which Quiñónez describes as “learning about others groups so you can understand their reality and approach it from their point of view,” is often not required.

Some of Quiñónez’s Latino clients have previously tried, unsuccessfully, to work with providers of another ethnicity who have not received this training. At best, it led to frustration. At worst, they were misdiagnosed.

“Clients saying that they saw a spirit can lead them to be diagnosed with a serious mental health disorder, when it is common with Latinos to see this as a way of being connected to relatives who may have passed away,” she said. “It is a misdiagnosis because of the lack of understanding.”

Dr. Amanda Rios is a psychologist and therapist who works with Latino youth at the Center of Relational Empowerment, where cultural competency training is a requirement. Half-Venezuelan, her familiar last name has drawn in young clients looking for a therapist they can relate to.

She says even something as seemingly innocuous as being able to correctly pronounce a last name during an intake can make or break a client’s trust.

“If their therapist doesn’t understand the neighborhood that they live in, family structure and rituals, then when that child talks to the therapist they’re not going to be convinced that this person has any idea where they are coming from,” Rios said.

Like Quiñónez, she’s seen her fair share of misdiagnoses and misinterpretations. A kid acting up in school gets labeled with ADHD when its anxiety.  A student’s learning disability gets written off as a behavioral problem.

And when these diagnosis are brought up to families, the need for bilingual and culturally competent providers reveals itself even more.

During Rios’ time working at elementary schools, she saw Spanish-speaking guardians struggling to comprehend meetings conducted in English about their child’s behavior.

This was compounded by teachers and school staff’s misunderstandings of a family’s actions. When a guardian was reluctant or unavailable to meet it was interpreted as apathy. In reality, many were embarrassed of their limited English skills or were unable to take any time off of work.

Without a correct diagnosis and the ability to involve the family, kids who need help fall through the cracks, with slipping grades and an increased risk for high-risk behaviors and violence.

Even with these factors, many mental health services are located outside of the neighborhood, putting money and time for travel into the equation. If there is a center with affordable, quality services within a family’s neighborhood the waitlist often spans for weeks.

“Without proper mental health services, kids seek out other ways of getting help, not always in a healthy way,” Rios said.

In recent year there has been a push to increase Latino access to mental health services throughout Illinois.

Quiñónez’s school’s Center for Latino Mental Health received a grant from the Chicago Community Trust in 2009. The grant was used to launch a new initiative, the Latino Mental Health Providers Network, which works to increase the number of culturally competent mental health providers through workshops and mentorship programs.

More recently, a state-wide early-childhood mental health plan was proposed by Chicago’s Irving Harris Foundation. At the top of the plan’s priority list: increase the number of mental health consultants of color. It will provide incentives for people of color to go into the mental health field; with more consultants of color naturally comes a wider spectrum of lingual and cultural backgrounds.

Additionally, the plan will spend the next two years analyzing and utilizing the best ways to reach marginalized groups that currently do not have easily accessible and affordable mental health care. This is more than simply translating current resources into Spanish.

“Different cultures view mental health differently, and we need to be aware of that,” said Denise Castillo Dell Isola, a Program Officer at Irving Harris. “The hope is that we bring more people of color into the workforce so that the workforce is reflecting the population of people who are served.”