Over the last three years, NASW-NYC has been conducting focus groups to learn about the contributions of social workers in various settings such as health, child welfare, and mental health. Recently, the Chapter made a decision to look at the work of social workers in different communities, including communities of African descent and the Latino community. This article reflects the first of these efforts in examining social work with the numerous Asian communities in New York City.

In order to understand the needs of the Asian community and the way in which social workers are making a unique contribution, a focus group was held on March 29th, 2006. The group included 10 attendees, including five direct service practitioners, four program directors/practitioners, and one researcher. These social work professionals deliver services to East Asian, Central Asian, and South Asian populations.

Participants were asked about issues within Asian communities that present unique challenges, such as the impact of cultural and ethnic beliefs on practice. As they described the populations being served, they spoke of interventions that were shaped by cultural traditions and experiences.

The focus group participants said that many Asian groups have similar ways of perceiving experiences, but that these perceptions are expressed in many different ways. Even with such varied expressions among different Asian groups, the participants said that the widest gap in cultural differences is between Asian populations and Western ones. These differences influence the way in which Asians seek (or do not seek) services in the United States.

Social workers who work with Asian populations have had to tailor their interventions in order to reach clients and help them.

The social workers discussed some of the significant struggles of the people they serve. One worker related a story about a child of immigrant parents. She shared that the child, a five year old boy, was acting out. The social worker found it significant that the parents had masters degrees in China, but had to take low-paying jobs because they had difficulty speaking English. While the father’s job was perhaps closer to the position he had held in China, the mother worked as a seamstress in a factory.

Since the parents spoke little English, they depended on their son to act as a translator. This raised questions about the role relationship between the parents and their son. When they lived in China, the family roles were well defined and based on Confucian principles. According to Confucius, the father should be kind and the son obedient; the husband should be righteous and the wife accepting of his decisions.

The social worker recognized that there were a number of issues that were influenced by the cultural background of the family. An immediate issue was the trust factor. In China, people believe that families are responsible for their members and do not seek help outside the extended family circle. Thus the social worker was not surprised when the mother called her “sister” and the boy called her “aunt”, and accepted this in order to allow the relationship to develop.

The worker said that it was fortunate that she spoke the family’s language, and listened carefully as the parents described their difficulties in setting up a new home in a foreign country. She described the balance between the nature of the professional relationship with allowing the use of the terms “sister” and “aunt” to help build trust.

The social worker helped the parents to see how their difficulties arose from their changed circumstances and uncertainty in the ways of their adopted country. She taught them how to make use of services in their community so that their family life would be as good as it was in the old country. As a result, the parents re-established their roles and the worker reported that the son’s behavior improved.

The social worker said that although the parents had initially felt embarrassed about talking with her, their ease in the relationship and their son’s improvement gave them hope that they would continue to make a good adjustment in their new homeland.

This example illustrates the importance of cultural competence. The social worker understood that the traditional Asian way of coping with problems is to struggle without complaining. She also understood that some of the family’s problems were brought on by the stress of trying to adapt to living in a new country with its foreign language and customs.

Issues Arising from Immigration

The focus group participants spoke of problems experienced by immigrants who speak little English. Many Asians are reduced to low paying jobs because of language difficulties. Some are unable to obtain professional licenses to practice in their professions.

Focus group participants said that in addition to their tendency not to seek help outside of their families, some immigrants have other concerns. Some fear that talking about their problems may bring them to the attention of immigration authorities and put them at risk for detainment or deportation.

Participants also said that some immigrants suffer in silence, feeling isolated and depressed. Refugees, who often have endured harrowing experiences to get to the U.S., are particularly at risk for depression and trauma. “Often people with such problems are referred to treatment providers who do not understand cultural issues and this compounds the problem,” said one social worker.

The participants also discussed issues involving the children of immigrants. The parent-child relationship is in some ways the most important familial relationship in Asian cultures. Immigrant parents often place high expectations for success upon their children. If the children cannot meet these expectations, they may suffer from feelings of low self-esteem.

Some children born in the U.S. are sent back to the home country to live with extended family because their parents work long hours and cannot afford child care. This separation may cause trauma for both children and parents. When the children return to the U.S. for schooling, they may re-experience trauma because they are separated from early caregivers.

Stigma Related to Seeking Help

Focus group participants said that Asians traditionally do not seek mental health services. Culturally, “they do not separate mind from body,” and find it easier to accept physical symptoms rather than mental ones. In addition, emotional and psychological pain is often experienced as a pain in the body. Seeing a psychiatrist means that one is “crazy,” said one worker.

They said that, besides emotional support, Asians rely on family members for financial help if necessary. Immigrants in low-paying jobs who have to rely on help outside of the family often feel intense shame. There are other cultural factors that may influence family finances. In some Asian countries, the man controls the finances. If the marital relationship is difficult, or if the man objects to paying for certain services, family members may not be able to get help.

9/11, Deportation and Domestic Violence

Social workers brought up the problems caused by the events of 9/11. Residents of Chinatown were hit hard because they live 10 blocks from the trade center site. Social workers found that those who were especially affected were the young, the elderly, and the unemployed. Businesses have closed, people have lost their jobs, and many continue to suffer from depression and even physical reactions.

The researcher in the group said that a recent study cited that the majority of 9/11 victims were between 30-50 years of age, with children and families. Of the 2,743 who died in the attacks, 184 were Asians. Although many volunteers offered services after 9/11, most were not bilingual workers or trained professionals. Few Asians from the affected areas have received ongoing culturally appropriate mental health care in response to the aftermath of 9/11.

One focus group member said that after 9/11, a number of Muslims and South Asians have been detained and even deported. She said that families of some men who have been detained need financial and other assistance but are reluctant to seek it. Some of this reluctance is due to feelings of shame at not being able to support their families.

Another problem that may result in deportation is domestic violence. While abuse of family members is a punishable offense for anyone, those who are not U.S. citizens may be deported. One social worker worked with a South Asian client on issues of the abuse of her daughter by the daughter’s husband. The client was afraid to report the abuse for fear that her son-in-law might be deported and also because of the Asian prohibition against women being too assertive. The social worker said that she walked a fine line between advocating for the client and fearing that the client might leave treatment.

Shaping Interventions

Focus group members described interventions that were influenced by their understanding of their clients’ cultural backgrounds. A South Asian social worker, recognizing that Muslim clients need to feel that workers respect the importance of spirituality in their daily lives, posted some of her favorite verses from the Koran in her office.

The social workers said they are quite pro-active with Asian parents, helping them to obtain resources and to learn English. Workers reported that this helps parents maintain their roles and smoothes family functioning.

Other workers spoke of the need to place services where immigrants get together, such as temples and shopping areas. They also said it is crucial to train Asians to provide outreach, perform screenings, provide education on mental health services, and make referrals. In addition, it is necessary to coordinate services with the clients’ medical doctors because clients are likely to be compliant with medical treatment.

Challenges in Service Provision

The participants raised a number of issues related to language and cultural barriers. Foremost was the limited number of bilingual/bicultural Asian social workers. They also said that social workers from Asian countries have difficulties in gaining work permits or in getting their driver’s licenses. This is frustrating, given the level of education that such workers have before they come to the U.S. As with many immigrants, social workers from Asian countries also face barriers in obtaining professional licenses and getting jobs for which they are qualified.

A sensitive issue that the group discussed is that of mental illness. Because of the stigma of mental illness, Asian families often endure years of hardship in dealing with a mentally ill family member before bringing the patient for treatment. The implication is that patients may have suffered for a long time and that it will take longer to achieve positive outcomes. In addition, Asian patients often resist taking medication. Moreover, Asian immigrants often must cope with the stress of caring for a mentally ill family member without the support of extended families.

Another issue discussed was related to the systems that provide services. One worker pointed out that programs that serve Asians typically have long waiting lists. In Chinatown, for example, there are over 90,000 seniors and only 125 outpatient mental health slots, too few given the need.

Focus group participants said that managed care may limit the time needed for bilingual workers to conduct thorough assessments. Insurance companies do not provide explanations of coverage and benefits in Asian languages. In addition, Asians who have come to the U.S. for specific treatments,  such as for HIV/AIDS, need legal help to file documents stating that they must remain in this country to get treatment.

Lastly, some participants said their organizations have funding and reimbursement issues. Some agencies offer support and counseling services in Asian languages that immigrants find more acceptable than mental health services. However, such agencies may not be eligible for funding that is earmarked for mental health treatment.

At the conclusion of the focus group, participants agreed that although there are differences within the Asian community, Asian populations share many ways of thinking and feeling. Overall, the participants tended to discuss commonalities during the meeting.