(May 2007)

On March 27, NASW-NYC convened a focus group of 10 social workers, including direct service practitioners, program directors, clinical supervisors and a policy maker, each of whom deliver services to Puerto Rican, Dominican, Cuban, Mexican and other Central and South American populations.  In order to ensure a diverse mix of perspectives, the focus group engaged Latino social workers from a wide range of neighborhoods, ethnic backgrounds, service delivery systems and practice areas.

Participants were asked to highlight the value and contributions of social workers in the Latino community across service delivery systems and to uncover the major opportunities and challenges to effective practice, advocacy and systems change.  They were asked to share personal experiences about how their work made a significant and unique difference in the lives of their clients.

When asked to share whether their work had been a matter of “life and death” for the Latino clients they served, there was an outpouring of responses. Some focused on the dichotomous nature of being both a social worker and a person of Latino descent, others described the service modalities employed and the barriers faced, while others shared the various cultural and linguistic factors that influenced their work.  And, whether discussing how to best address the effects of immigration and acculturation in their interventions or deciding the delicate balance between a sense of “personalismo” or the value of “familismo” with which they would approach their worker-client relationships, the social workers who participated in the focus group spoke passionately about the unique contributions they brought to the profession. 

There was clear agreement from the start, for example, that a comprehensive appreciation of social workers in the Latino community necessitates the understanding that while Latinos share many cultural characteristics, they are not a monolithic group nor can one assume that they share the same language, citizenship or experience. 

The Shortage of Social Workers

Another major issue at the heart of the focus group discussion was the understanding that although New York City is becoming increasingly diverse, there remains an existing dearth of bicultural/bilingual social workers, and that this shortage puts an enormous amount of pressure on the few that have the background.  In some cases, being the lone Latino social worker in an agency was seen as a help, in other cases it was a hindrance. Some resented being coined the “go to” or the “unofficial in-house expert” for every Latino issue, while others understood that their presence was sometimes the only thing connecting the neediest in their communities to essential services.

When asked what the focus group participants experienced when social work was not present or when they had not been available in agencies to provide critical services, their responses were  extremely revealing.  The absence of Latino social workers, they professed, not only limits service delivery to the Latino population, but in its worst stages may even lead to the imprisonment, deportation, needless institutionalization or otherwise avoidable familial break up for clients.  One social worker said, “Latino social workers try hard to keep clients out of the system, not to support their entry.”

Strengthening Assessments in Addictions/Drug Detox

One clinical supervisor and his LMSW colleague, who collectively had over 15 years experience working with clients in mental health counseling, drug rehabilitation and corrections, recounted examples of the effects that manifest when Latino social workers are absent.  Someone once referred a client of Mexican descent to me for a psychosocial assessment. Her whole referral was based on the fact that the client was disheveled. Had I not been there, he would have ended up with an unwarranted psychiatric diagnosis.  If people don’t know the roots of drug and alcohol consumption in the Latino community, they’ve missed half the equation for effective treatment”.

These two social workers also spoke about a South American client who was court mandated to receive social services.  He was at the verge of spending time in prison because he did not understand the language.  “Before I came into contact with him, no one took the time to find out if the client even understood the directives he was being given and the consequences of noncompliance, so his alcoholism and the absence of a social worker almost cost him his freedom and his family.” The social workers described how often clients, like this one, were superficially served.  The facility thought they were providing services, but they really weren’t because the clients did not understand anything being said to them. They were just going along to get along, and in this case, the implications were far reaching.  In another scenario, given the absence of a translator and the client’s inability to communicate his needs, fourteen days had gone by and no services were delivered. The client was finally referred to the social worker’s program because it was the only bilingual twenty-eight day rehab.  Many clients simply leave the facilities frustrated.  Participants in the focus group believed that Latino social workers play a significant role in helping Latino clients to understand and execute their options, rather than responding to systems out of fear, obligation or default.

Effects of Immigration and Acculturation

Latino social workers emphasized the importance of sensitivity and understanding of the immigration and acculturation issues impacting Latino clients being served by their agencies.  One social worker said, “As Latino social workers, we understand the value of one of the cardinal rules of social work, which is to meet clients where they are.  Many of our colleagues abandon this core principal in their practice.” The focus group participants underscored how often lack of knowledge around the socioeconomic and political conditions of a client’s country of origin, feelings about leaving one’s family or native country, and the resulting trauma get in the way of effective social work service delivery.  It was the group’s view that Latino social workers, through their unique sensitivity to these concerns, help to reduce the distress experienced, especially among immigrant populations. 

One social worker described, that during the period of the Gulf War, while working in an outpatient mental health clinic in Bushwick, she had experienced working with two core groups of clients: one of Puerto Rican descent who grew up during the turmoil in Vieques, and the other of Dominican descent who witnessed the US invasion in the 1960s. None of her peers recognized the significance of these events in the lives of the clients, and they had no sensitivity to the fact that the current symptoms of the clients were the result of post traumatic stress.  Furthermore, they made no connection to an even worse reality of what being both Dominican and Puerto Rican meant for these clients and many of their needs went unaddressed.  “From that time on”, she said, “I started asking every client: where were you in 1965?” 

Another social worker, in children services, spoke with candor about the effects of immigration and acculturation on family and social interaction.  He discussed the intrinsic role that Latino social workers play in bridging the gap between the “mixed status” among Latino families, including various combinations of US born citizens and immigrants, as well as the differing acculturation processes amongst elderly and youth.  He described the unique way that Latino social workers have interceded using creative, culturally inspired interventions, such as the use of intergenerational idioms, proverbs, biblical and cultural expressions to foster greater communication between grand parents, parents, and children whose interaction was otherwise limited.  “As a Latino social worker, I bring this unique understanding to my work and was able to engender effective dialogue and education where there was none.”

To further illuminate the needs of the Latino community and the value of the social work presence, one social worker shared a story about an addictions in-patient who had a history of domestic violence.  The patient was a recent immigrant who, being the “macho” of his family, had plans to bring his thirteen year old daughter over to the US from his native country.  Without the counsel of a social worker he would have never understood the possible ramifications this would have for his family.  “As a Latino social worker, I understood the impact the separation from his native country and his family was having on him.  I helped him to realize what it would mean to reunite with a teenager he left at the age of four without all the necessary supports of housing, income, citizenship, etc. in place. It’s not so simple and the child welfare system would be all over this.”

Implications for Service Utilization

A social worker, who once worked in a mental health clinic in Brooklyn, discussed her experiences working with the HIV and AIDS populations.  She reviewed how her colleagues would deny the prevalence of the disease among the Latino clients enrolled in their programs.  They would misconstrue the ofttimes insular and self-reliant nature of the Latino culture and forgo conducting more comprehensive assessments at the risk of being viewed as intrusive.  Her purpose as a Latina social worker was reinforced when she was told by one of her colleagues that, “no one in their programs had the disease, and if they did, we would refer them out”.  Upon hearing this, and knowing the pervasiveness of the AIDS epidemic in the Latino community, the social worker recommended that her colleagues ask very pointed, yet culturally sensitive questions about HIV and AIDS.  The social worker said, “one client was receiving long term grief counseling and individual psychotherapy from their program but, prior to her engagement, the client had never disclosed that her husband died of AIDS.”  Latino social workers help to ensure that the underutilization of services, due to a lack of understanding, occurs less frequently for those in need.  

Cultural Competence

For many social workers in the field, cultural competence has been diminished to what is now often recognized as just an overused buzz word to validate sensitivity to the cross-section of issues where race and ethnicity meet. But, for Latino social workers, it’s a topic that could not be discussed enough. Participants in the focus group underscored through their stories the importance of cultural competence in the workplace and the unique expertise that Latino social workers bring to their institutions and their communities as cultural educators, cultural brokers, equalizers, and agents for change.  One social worker of Puerto Rican descent who spoke about how the interplay of race and ethnicity impact on professional relations, said, “I find myself educating my colleagues all the time about the culture.” Another social worker offered, “just because I’m Latino doesn’t mean I have all the answers.” “Often”, one participant shared, “it is assumed that because we are Latino, we will be able to effectively communicate with or to ‘fix’ the issues affecting all Latino clients.”

The focus group participants said that social workers who are not from the culture had difficulty helping clients and often misdiagnosed, mistreated or neglected things that needed to be treated.  They viewed presenting problems as “part of the culture.” One social worker, with more than 17 years experience in mental health and child welfare, found herself being designated by others as the “Dominican expert”. Her institution would often hire Caucasian workers who spoke Spanish, but who did not understand the culture. She said, “My hair would stand on my head, witnessing the lack of understanding among my colleagues as they tried to distinguish what was of the culture and what was not. When handling assessments regarding parenting issues, the role that Latino women play in the household, and how child rearing and discipline is handled, critical mental health and child welfare issues would be overlooked.  Colleagues would say, ‘oh, that’s just Dominican, right?’ ”   

Misleading assumptions, they agreed, were one of the major issues they had to fight against among their colleagues and within their agencies.  Whether clinicians or community organizers they recognized the importance of confronting the tendency for racism to color their environments, even among the most well-intentioned of organizations.  One social worker said, “agencies with the most access to cultural competence training still overlook critical issues affecting the Latino client, so we end up trying to make up for the shortcomings of our less competent colleagues.”    

Language as Broker or Barrier

Similar to culture competence, the complex intricacies around the use of language and the effects of language barriers are significant to understanding the important contribution of Latino social workers.  The focus group participants reinforced how essential it is for service providers to be cognizant of the distinct linguistic issues that impede outreach and service delivery.  They articulated that the solutions must go beyond the usual discussion of the shortage of bilingual workers or the absence of service delivery in Spanish.  They must include a focus on the nuances within language as well as the different needs of monolingual and bilingual Latinos. 

One social worker described how a Puerto Rican practitioner said to a client, “te veo ahorita”, meaning I’ll see you later, but to another social worker of Mexican or South American descent, “te veo ahorita”, means I’ll see you right now. The client walked away thinking the practitioner dismissed her.  If this had not been discovered, she would have not realized the benefits of services she sorely needed. 

A social worker, who worked with seniors in a Naturally Occurring Retirement Community (NORC) program, explained that she had experienced working with an addictions client who asked for “Coca”, which her colleagues might otherwise have recognized as being a request for “cocaine” and would have had implications for future treatment plans. “Being a Latino social worker”, she said, “I understood what this meant, so I didn’t misinterpret it. I knew automatically that what she was asking for was a container.” 

Another social worker concluded, “So many Latino clients do not receive services because they do not speak English.  Although it was not in my job description, I became a defacto translator”. 

In lending their linguistic skills, Latino social workers help to transcend barriers and to serve as an essential bridge to services where there are critical gaps.

Worker-Client Relationships   

One of the areas in which the distinct role of Latino social workers can be seen is in the worker-client relationship.  It was the general consensus among the focus group participants that there is a stark difference between the services delivered by social workers from the Latino culture versus those who are not.  Many purported that Latino social workers are able to build the trust and “respeto” of Latino clients in a way that others cannot.  From the simple knowledge of the importance of when to extend a hug or a handshake or to acknowledge a particular religious belief system to whether to call someone of the lesbian community “Senora”, goes a long way to softening the lines of communication, equalizing the worker-client relationship and raising comfort levels to strengthen engagement.

According to the focus group participants, Latino social workers, who understood the value of leveraging informal support systems in their relationships with clients, were viewed as invaluable resources.  These workers recognized that confidentiality for non-English speaking Latino clients, whose only link to services might be through the translation of family members, was often at risk of being compromised.

The presence of Latino social workers enabled clients, who otherwise would not have been helped, to stay out of jail, get sober, secure health benefits, connect clients to ancillary referral services, get proper treatment and empower themselves.

Solutions and Challenges for Future Service Delivery

Some of the most informative topics addressed were the views shared at the end of the discussion around the challenges facing Latino social workers and what could be done to improve social work services in the Latino community.  Among these included recommendations for policy makers, funders, non-profit leaders and public officials to:

•   Recruit more bilingual/bicultural social workers

•   Identify and develop more bilingual programs in order to facilitate referrals

•   Advocate for the passage of legislation to support increased scholarships and loan

     forgiveness for Latino social workers

•   Engage the schools of social work in more intensive recruitment efforts

•   Encourage agencies to build Latino social work recruitment into their mission

•   Develop guidelines, practice standards and funding incentives to encourage and hold

    agencies accountable for culturally and linguistically competent practice

•   Increase salary opportunities, including pay differentials, in support of bilingual

    workers who carry a greater share of their agencies workload