Cultural Considerations

As liaison between the adolescent, family, and/or treatment team, the mental health clinician must evaluate culturally defined characteristics of each family. Some important areas to explore in this regard include 1) how the family's ethnic, cultural, or national background impacts their experience in the hospital and with caregivers; 2) whether the family is a member of the dominant ethnicity in the medical environment or is in the minority (special attention should be directed to immigrant and minority families); 3) whether cultural or linguistic barriers, overt or covert, may affect their experience; 4) what their beliefs and values are in relation to childhood illness, death, medical care, and family involvement; and 5) what unique roles the patient/family and extended community play in their culture.

It remains questionable whether the prevailing principles of Western culture are as relevant to children and families of different cultural origins. Although open communication is emphasized in Western medical practice, other cultures exclude children from discussion of disease diagnosis and death (Liben et al. 2008). In Chinese culture, for example, discussion about the possibility of death in the presence of a sick person can be perceived as a curse or effort to hasten death. Some cultures perceive that honest discussions about dying deprive children of the sense of safety and security associated with the innocence of childhood and rob parents of their role as protectors from harm.

Culturally defined health beliefs and practices can significantly influence acceptance of and adherence to prescribed therapies, the degree and quality of parental involvement in patient care, and the family's relationship with health care staff. Behavior that is viewed in isolation without consideration of the cultural context is often misinterpreted by treatment providers. For example, "resistances" observed among many Asian Americans (e.g., hesitancy to open up, tendency to give limited information) may be mislabeled (Lee 1982). Whereas openness may be embraced by European Americans, many Asian Americans have been taught that premature disclosure of emotions to a stranger is an indication of lack of self-control, immaturity, and a cause for shame. A mother from a patriarchal sociocultural system may be regarded by a medical team as passive or unin-volved due to her silence during discussions about medical treatment or her refusal to consent to procedures in the absence of her husband. According to her cultural norms, however, such behavior may be considered reprehensible. As a cultural broker, the mental health clinician can raise awareness of cultural influences, thereby facilitating understanding, communication, and development of a treatment plan that is congruent with a family's cultural heritage (Trill and Kovalcik 1997).

In geographic areas with a complex mix of ethnicities and cultures, care providers cannot be expected to be experts in the background of all the families they serve. However, through sensitive and thorough inquiry, the mental health clinician can glean important information that promotes therapeutic relationships based on mutual understanding and respect.

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