Addressing the field's cultural drought: suggestions for attracting and retaining bilingual and bicultural staff.

"I am sorry, but our current wait for services is approximately four weeks. We will have someone give you a call when an opening becomes available."

"I am sorry, but we do not have any providers who speak Spanish. I can refer you to another agency."

All too often individuals needing mental health services hear such statements when they seek help. Bilingual and bicultural certified professionals are in high demand, but agencies often do not have enough qualified providers to meet growing racial/ethnic populations' needs. Thus, organizations struggle nor only to find highly qualified certified staff, but also staff proficient within specific languages and cultures. As agencies identify specific groups' needs and begin the hiring process, they discover the dearth of qualified, culturally competent, bilingual behavioral and mental health providers.

Although professionals of all racial/ ethnic backgrounds with proficiencies in all languages are needed, the exponential growth of the United States' Latino population highlights the need for Spanishspeaking and/or Latino providers. According to the Census Bureau's 2007 American Community Survey, Spanish is the primary language spoken at home by more than 34 million people age 5 and older. (1) In 2007, the country's Latino population reached 45.5 million--approximately 15.1% of the total population. Nationally, Latinos are the fastest-growing racial/ethnic minority group. The Census Bureau projects that by 2050, Latinos will make up 30% of the population. (2)

As the national Latino population has grown, the number of behavioral and mental health providers specializing in this group has not kept up, resulting in an "implosion" within the field. In fact, few behavioral and mental health providers are Hispanic or speak Spanish: Only 1% of licensed clinical psychologists identified themselves as Latino in a national survey. (3) In addition, the U.S. Department of Health and Human Services reports that for every 100,000 Latinos, there are only 29 Latino mental health providers. (4) Consequentially, the need for bilingual and bicultural providers and front-office staff has resulted in competition for the small pool of individuals meeting these qualifications.

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Our experience

Mattie Rhodes Center (MRC) has been serving Greater Kansas City youths and adults from diverse populations since 1894. MRC has five locations and offers programming focused on mental health, family education and support, youth development, domestic violence, and substance abuse, as well as Latino cultural arts and arts education. Approximately 94% of MRC's mental health and social service clients identify as Latino, and MRC strives to be a leader on Latino issues and cultural competency.

Hiring competent bilingual and bicultural staff is a consistent challenge for MRC. The pool of bilingual and bicultural service providers in Kansas City is relatively small. Applicants often are acquaintances of current staff, as word of mouth drives most applications. Seventy-five percent of MRC's approximately 40 staff members are Latino, and all are fully bilingual (Spanish and English). Based on our experience, below we identify some challenges to hiring bilingual and bicultural staff, as well as some tips for hiring success.

Challenges

Agencies often face challenges influenced by geography. For example, organizations in the Midwest face different challenges than those in coastal regions such as California and Florida, which have larger concentrations of racial/ethnic minorities. However, several factors should be considered when attracting and hiring bilingual and bicultural staff--independent of location.

Cultural proficiency. Professionals able to formally speak a language may not be fully aware of the nuances needed to fully understand a client's concerns. The provider might not be able to fully comprehend a particular region's cultural norms. For example, people from Latin America have varying values and cultural attributes. Providers must understand different areas' customs and traditions, as the customs of someone from Mexico City can be very different from those of someone from Bogota, Colombia.

Gender. Social service providers are predominantly female: According to a September 2007 U.S. Bureau of Labor Statistics report, approximately 62% of individuals within the social service field are women. (5) The same can be said for bilingual and bicultural individuals entering the social service field. Unfortunately, this creates difficulties for clients who maintain traditional values and beliefs that place women in a subservient role.

Compensation. The nonprofit sector faces additional challenges when recruiting providers, as salary is a strong factor for mental and behavioral health professionals to consider when seeking employment. The nonprofit sector typically has been a place for providers to begin their careers to achieve appropriate licensure or educational attainment. Then the private sector lures many providers away with the attraction of achieving a greater income or self-sustainability.

Cultural beliefs. Some people may be reluctant to enter the social service field because of their cultural beliefs and values. One common adage that helps to explain this reluctance is the saying, No se lava la ropa en casa ajena (One must not wash their dirty clothes in someone else's home). Simply put, Latinos prefer to take care of their problems within the family and not with outside help. (6) Many feel that seeking employment within the social service field is inappropriate, as it goes against the grain of family traditions and/or cultural beliefs.

Authenticity. Latino clients need a treatment philosophy based on person-alismo, the need to relate in personal terms with more warmth and less clinical detachment. However, from intake to discharge, most mainstream service delivery is characterized by detachment and a process orientation, often a major source of dissatisfaction among Latinos. (7) It is important to recruit and train providers who can understand and provide the personalismo needed to reach these clients.

Tips for successful hiring

Agencies serving a racial/ethnic clientele, who may not speak English, need to find creative solutions to meet the ever-increasing demand for services. Many avenues can help to identify and recruit bilingual and bicultural qualified professionals.

Work with local universities. Establishing relationships with local colleges and universities is crucial to cultivating bilingual individuals within social services. Whether at the undergraduate or graduate level, creating attractive opportunities for bilingual students to complete internships and practicums at your agency is a must. By creating these opportunities, agencies meet two purposes: filling the immediate need for services and training potential employees.

Solicit employee referrals. Creating an agency culture that fosters good employee relations and openness is central to instilling the desire of past and existing employees to refer their friends and acquaintances. In locations short on bilingual providers the pool of applicants within a certain radius usually is limited. Promoting employee referrals is one approach to breach this limited radius.

Consider asking local governments for help. The importance of working with county and city administrators cannot be overstated. Counties and cities often offer incentives and training to encourage more bilingual and bicultural individuals to enter certain fields.

For example, in 1990 Jackson County, Missouri, dedicated a portion of its Community Backed Anti-Drug Tax (COMBAT) to assist minorities with becoming certified substance abuse counselors. The Minority Substance Abuse Counselor Program was established to prepare and assist selected candidates to become certified, increase the number of minority substance abuse professionals, and promote cultural diversity.

Promote growth from within. Grooming competent agency employees is a long-term approach to meet ever-increasing personnel needs. An organization's budget size and priorities often will determine whether educational reimbursement is an appropriate incentive. Regardless, agencies can provide the necessary flexibility for employees' personal and educational growth. In addition, providing opportunities for staff to experience or be exposed to areas of the organization outside their job assignments assists in sparking interest.

Conclusion

As racial/ethnic minority populations and the number of non-English and bilingual speakers continue to grow, the demand for services moves in tandem. Attracting bilingual and bicultural professionals requires a concerted plan that includes offering an excellent employment package, recruiting young professionals, and preparing undergraduate and graduate students for work with minority and non-English-speaking clients. Finally, whether or not an agency is able to attract and retain qualified bilingual and bicultural providers, the agency should make it a priority to train all employees on culrural competency and provide services that respect and incorporate the cultural beliefs, values, and customs that shape clients' lives.

RELATED ARTICLE: MATTIE RHODES CENTER

* Established in 1894

* Serves greater Kansas City

* Approximately 1,000 clients served annually through therapeutic and social ser vices (more than 10,000 come through art center and gallery)

* Staff size: 40 (all fully bilingual in English and Spanish)

* Budget: $1.9 M (Jan.-Dec. '09)

RELATED ARTICLE: Mattie Rhodes Center has produced two reports on Latino mental health issues and the unique challenges facing this community: Cultural Competency and Mental Health in the Hispanic Community of Jackson County, Missouri(June 2003) and Closing the Mental Health Gap: Eliminating Disparities in Treatment for Latinos (May 2008). To read Closing the Mental Health Gap, visit www.mattierhodes.org/web/ english/Reports.html.

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References

(1.) U.S. Census Bureau. American Community Survey, Washington, D.C.; 2007.

(2.) U.S. Census Bureau. An older and more diverse nation by midcentury [press release]. Washing ton, D.C.; August 14, 2008. www.census.gov/ Press-Release/www/releases/archives/population/012496.html.

(3.) Williams S, Kohout JL. A survey of licensed practitioners or psychology: Activities, roles, and services. Washington, D.C.: American Psycho logical Association; 1999.

(4.) U.S. Department of Health and Human Services. Mental Health: Culture, Race, and Ethnicity. A Supplement to Mental Health; A Report of the Surgeon General Rockville, Md.; 2001. www.surgeongencrahgov/fibrary/mentalhealth/cre/sma-01-3613.pdf.

(5.) U.S. Bureau of Labor Statistics. Women in the Labor Force: A Databook. Washington, D.C.; September 2007. www.bls.gov/cps/wlfdatabook-2007.pdf.

(7.) Mecting the health promotion needs of Hispanic communities. Policy and Research, National Coalition of Hispanic Health and Human Services Organizations (COSSMHO). Am J Health Promot 1995;9(4):300-11.

(6.) National Council of La Raza, California State University, Long Beach, Center for Latino Community Health, Evaluation, and Leader ship Training. Critical Disparities in Latino Mental Health: Transforming Research Into Action. Washington, D.C.; 2005-www.nclr.org/ntWpublkanons/download/34795.

BY DAVID STADLER, LPC, LCPC, NCC; LUIS CORDOVA, MS, CSAC, II; AND MARCELLA McMURRAY, BA

David Stadler, LPC, LCPC, NCC, is Director of Administration at Mattie Rhodes Center in Kansas City, Missouri.

Luis Cordova, MS,CSAC II, is Director of Community Programs at Mattie Rhodes Center.

Marcella McMurray, BA, is the Development Associate at Mattie Rhodes Center.

To contact the authors, e-mail [e-mail], [e-mail], and [e-mail].