Cultural characteristics of Mexican Americans: issues in rehabilitation counseling and services.

Rehabilitation counselors are being challenged to provide appropriate services to a clientele which is becoming increasingly diverse in terms of ethnicity and culture. As a result rehabilitation counselor education programs are being challenged to implement multicultural counseling in their curricula (Medina, Marshall, & Fried, 1988). In order to provide appropriate rehabilitation services to a wide range of individuals, rehabilitation counselors need to integrate cultural pluralism into their practice. Otherwise, their stereotypes, biases, and culturebound attitudes toward ethnic minorities will make it difficult if not impossible to serve them effectively (Wright, 1980; Wright, 1988).

One of the largest and fastest growing minority groups in the United States today is Hispanics, and they have been identified as being of particular concern to rehabilitation counselors (Leal, Leung, Martin, & Harrison, 1988). Of the 20.8 million Hispanics in the United States, 13.3 million are Mexican American, 2.2 million are Puerto Rican, 1.1 million are Cuban, 2.8 million are Central and South American, and 1.4 million are other Hispanic groups (U.S. Bureau of the Census, 1991). Each Hispanic group is unique in important ways that can influence rehabilitation services.

As indicated in the statistics cited above, Mexican Americans comprise the majority of all Hispanics. Other terms synonymous to Mexican American are Chicano and Mexican (U.S.Census, 1991). Mexican Americans share a common culture and value system which is unique in a number of ways. They have experienced widespread discrimination, prejudice, and unequal opportunity in education, employment, income, and housing; futhermore, they are considered to be at-risk for the onset of disabilities and for many other significant problems (Fierro & Leal, 1988; Karno & Edgerton, 1970; Romo, 1985).

The purpose of this paper is to discuss issues relevant to the provision of rehabilitation counseling and services to Mexican Americans with disabilities. More specifically, three topics are explored (a) cultural characteristics of Mexican Americans, (b) the influence of characteristics identified on the delivery of rehabilitation counseling services, and (c) recommendations for improved services to Mexican Americans with disabilities.

Cultural Characteristics of Mexican Americans

Sociocultural Characteristics

Among the characteristics of Mexican Americans which can influence the provision of rehabilitation services are the sociocultural characteristics of language preference, family traditions, socioeconomic status, and levels of acculturation. The Spanish language is a strong communication link among Mexican Americans. Sue and Sue (1990) report Spanish to be spoken in over half of the homes of Hispanics. Spanish remains the language of emotion (Leal, 1990) and provides "Chicanos an essential link to their heritage - to the value they place on family, and the value they place on cooperative relationships" (Medina et al., 1988, p.41).

Many Mexican American families include extended relatives who often live in the same household (Sue & Sue, 1990). Cooperation, loyalty, and respect are emphasized within the family unit. A hierachy of authority is set giving decision making privileges to elderly family members, parents, and males. Within the family unit are clearly defined gender roles. Fathers assume primary responsibility over the family, while mothers are nurturing and self sacrificing in caring for their husbands and children (Sue & Sue, 1990). Males are raised to be autonomous and females are raised to be dependent (Sue & Sue, 1990; Smart & Smart, 1991); further, neither males nor females are permitted to challenge their assigned roles and responsibilities To some extend, the traditional family unit and associated values are changing due to increasing urbanization and mobility (Stoddart, 1973). In any event, family dynamics depends substantially on the level of acculturation in the home.

Within Mexican American culture, interaction with a large network of family and friends is encouraged; futhermore friends are highly esteemed and mutual support is cherished (Kunce & Vales, 1984). Interactions are extended to include maintenance of religious beliefs, and great importance is placed on practicing religious traditions (Sue & Sue (1990), including sacrifice, charity, and the enduring of wrongs (Yamamoto & Acosta, 1982).

The socioeconomic status of Mexican Americans is frequently characterized by poverty; in fact, 25.7% of Mexican American families live below the poverty level (U.S. Census 1991). Consequently, many families receive some form of government support, such as food stamps and other types of public assistance (Slesinger & Ofstead, 1990).

Finally, Mexican Americans are characterzied by varying levels of acculturation. The customs and values range from "very Mexican" to a "cultural blend" to "very Anglicized". A study by Keefe and Padilla (1987) on cultural awareness and ethnic loyalty revealed five well-defined and homogeneous clusters in terms of acculturation. The first cluster, Type I (25%), was comprised of primarily Mexican Americans, first generation, mostly immigrants, and clearly unacculturated who identified with Mexicans and Mexican culture. The second cluster, Type II (14%), was comprised of individuals who were as unacculturated as those in Type I, but who identified only moderately with Mexicans. The third cluster, Type III (35%), constituted the largest group with moderate ethnic awareness of and loyalty to both the Mexican and Anglo culture, which was characterized as a culture blend. The fourth cluster, Type IV (21%), was comprised of individuals who were more acculturated but identified less with others of Mexican descent. The final cluster, Type V (5%), was described as very Anglicized, and knowing little about the Mexican culture. Level of acculturation is significant in influencing both formal and informal interactions and must be considered to be important cultural factor distinguishing Mexican Americans.

Health

The health care characteristics of Mexican Americans are greatly affected by culture, and living conditions contribute to many of their common medical problems (Sue & Sue, 1990). Burma (1970) reported that Mexican Americans showed above average rates for tuberculosis, infant mortality, chronic disease and other illnesses associated with poverty and lack of medical care. More recently, over the past 15 years, studies on the most common physical health problems of migrant agricultural workers have found similar results. These problems include minor to severe orthopedic, gastrointestinal, cardiovascular, and respiratory illness (Fernandez & Folkman, 1975; Slesinger, 1988; Slesinger & Ofstead, 1990). Many of the illnesses expericenced are directly linked to the work performed and working conditions. Other medical conditions are associated with the extended use and abuse of alcohol and other drugs (Leal, 1990), especially among youth (Gilbert & Cervantes, 1986).

Several other mental health conditions which are prevalent among Mexican Americans are also related to culture and circumstances. For example, Palacios and Franco (1986) reported a high incidence of stress and depression resulting from "unfavorable conditions of poverty" (p.127) and problems associated with acculturation and immigration. Ruiz (1981) described a migrant agricultural worker with symptoms of auditory hallucinations, possibly resulting from exposure to pesticides and other agricultural chemicals. "Nervousness" was reported by Slesinger and Ofstead (1990) as a serious mental health condition which was found to be prevalent among a sample of agricultural workers in Wisconsin.

The most unique culturally related health conditions, however, are folk illnesses (called curanderismo). Many Mexican Americans regard folk illnesses as serious to the point of requiring professional care. Curanderismo consists of a set of "folk/medical beliefs, rituals, and practices that seem to address the psychological, spiritual, and social needs of traditional Chicano people" (Trotter & Chavirra, 1975). Folkillnesses are more prevalent among traditional Mexican Americans, but are not exclusive to them (Keefe, 1981), varying according to the degree of acceptance on the acculturation continum. Common folk illnesses of a spiritual nature include, but are not limited to, "mal ojo" (evil eye), "susto" (magical fright), and "embrujo" (hex). Other folk illnesses which take on a physical nature, but are not likely to be cured by physicians are "empacho" (surfeit), "bilis" (bile), and "caida de mollera" (fallen fontanel) (Arenas, Cross & Willard, 1980; Keefe, 1981; Madsen, 1970; Slesinger & Richards, 1981; Trotter & Chavirra, 1980). The use of folk healers by Mexican Americans (called Curanderos) is common - Curanderos provide remedies for ailments that are either not recognized by American practitioners or that take too long for the restoration process to take effect. It is crucial to note that Mexican Americans, to varying degrees, utilize traditional folk therapies, as well as modern clinical medical therapies (Madsen, 1970; Slesinger & Richards, 1981). The health care conditions of Mexican Americans are too important to ignore, as they result in higher risk of permanent disability (Gilbert, 1980).

Vocational Characteristics

In describing vocational characteristics of Mexican Americans, language differences which lead to low levels of educational attainment are particularly important (Cummins, 1984; Cummins, 1986; Cummins & Swain, 1986). Limited education, in turn, leads to limited occupational opportunities (Stoddard, 1973).

Keefe and Padilla's (1987) study on cultural awareness and ethnic identity revealed certain vocational characteristics associated with level of acculturation. The two least acculturated groups were found to have the lowest educational and vocational attainment, with 47% and 57% of each of the two groups, respectively, working as laborers. The group characterized by cultural blend, was found to be better educated, and 20% held white collar occupations. The next higher acculturated group was also found to have higher levels of education and 30% were found to hold white collar occupation. Finally, the group considered to be highly Anglicized had the highest education and income, but only 26% held white collar occupations. Although Mexican Americans are found throughout the vocational spectrum, Carillo (1982) reported that most hold semiskilled and unskilled occupations.

With a poor educational history and low levels of acculturation, Mexican Americans often seek jobs requiring physical labor, such as agricultural and factory work. Slesinger and Richards (1981) reported that over 7,000 Mexican Americans in Wisconsin were employed as migrant agricultural and factory workers. Slesinger and Ofstead (1990) reported that migrant workers had performed that type of work on a seasonal basis for an average of six years; more specifically, 51% of the workers were engaged in field work, 42% in cannery and food proccessing plants, and 7% in both field and factory work. Thus, many Mexican Americans continue to hold occupations that require hard physical labor, long hours, and menial pay with no health insurance or fringe benefits, and many may be candidates for rehabilitation and other related programs in order to facilitate improved vocational attainment.

Characteristics of Mexican Americans and the Rehabilitation system

Sociocultural Chacteristics and Rehabilitation

Assessment is a vitual step in a successful rehabilitation programs. In order to assess client needs, rehabilitation counselors must overcome language barriers and improve their communication with Mexican American clients. A cooperative effort between the client and counselor is needed to develop a rehabilitation service plan, and cooperation will not occur if language differences present substantial barriers. For example, in a study on vocational rehabilitation services to Hispanics with visual impairments, Santiago (1988) reported that over 70% of the clients studied lacked proficiency in the English language. Although the ultimate goal would be to have trained bilingual/ bicultural service providers available, it also possible to utilize professional interpreters with allied health training to assist in obtaining intake information and in providing support for ongoing counseling and guidance throughout the rehabilitation process.

The family is also a potential source of assessment information. Collection of information from the family also encourages family participation, which can be a crucial factor in a successful rehabilitation program (Lindenberg, 1977). In additional, involvement of the family can also encourage maintenance of the family unit which is important in Mexican American culture. In a study on Mexican American family interaction Arnold and Orozco (1988) reported that families assisted their family members with disabilities in reaching their vocational goals by encouraging assertiveness and promoting autonomy. To facilitate a successful rehabilitation outcome, the counselor, the client, and the client's family need to understand and accept the rehabilitation plan, clearly delineating the roles and responsibilities of each individual. To develop a workable plan, the counselor needs to learn and respect the culture and values of both the client and family. Family counseling and guidance should become a standard component of rehabilitation services, being provided at the begining, middle, and end of the process.

Other client assessment information is often provided through psychological and vocational tests. In using tests, it is important to assure that they are language appropriate. Samuda (1975) discussed some of the issues and consequences in using inappropriate psychometric tests with minorities. Moreover, cultural differences should not be misinterpreted as lack of motivation, but should be noted by psychometrists as observations, which may be attributable to socioculture factors.

Health Characteristics and Rehabilitation

The health care characteristics of Mexican Americans are greatly on the services they receive. Rehabilitation counselors need to be aware that many medical conditions experienced by Mexican Americans reflect their low incomes, poor nutrition, and substandard housing. Further, many of these medical conditions can often be alleviated, and possibly eliminated, through preventative care methods such as immunizations and regular physical examinations.

In addressing a client's medical problems, rehabilitation counselors typically request a general physical examination in order to assess disabilities and general health. It is important to use physicians in the community who are sensitive to and aware of the health conditions common among Mexican Americans. A counselor should be selective in finding a clinic where the staff is supportive and physicians are friendly, non-authoritarian, protective of the individual's strong sense of modesty, and able to treat individuals with respect and dignity. A physician who can speak Spanish and show respect for the Mexican culture can offer a rehabilitation counselor much helpful medical information.

The same strategy can be applied in selecting psychiatrists and psychologists to address the mental health problems of Mexican American clients. Unfortunately, traditional specialists may not be helpful in meeting spiritual/emotional needs. Thus, rehabilitation counselors should inquire about the roles that folk illnesses and folk healing might have played in the lives of clients. Rehabilitation counselors should be cautious not to judge, ridicule, or discourage an individual's belief as superstitions. If a folk healer has interacted in a significant way with a client, then the rehabilitation counselor should request to meet with the folk healer. To many Mexican Americans both traditional health services and folk healing are important, each addressing different needs in different ways (Slesinger & Richards, 1981). Rehabilitation counselors who serve many Mexican Americans should seriously consider building relations with folk healers. After all, they may be viewed as simply another allied health profession offering rehabilitation services from a different cultural perspective.

It may appear that the changes in rehabilitation services recommended above for Mexican Americans may require considerable additional effort. However, these changes will be well worth the effort if the ultimate goal of a successful rehabilitation is faciliated.

Recommendations to Improve Rehabilitation Services

Education and Training

One method to improve rehabilitation counseling and services to Mexican Americans is to improve the training of rehabilitation counselors. Two previous articles have discussed issues on the integration of cultural diversity in rehabilitation counselor education curricula (Medina, Marshall, & Fried, 1988) and in preparing rehabilitation counselor professionals to serve ethnic minorities (Wright, 1988). The Council on Rehabilitation Education (CORE) has provided standards for the inclusion of multicultural issues in rehabilitation counselor education programs as a part of its accreditation standards (CORE, 1991). One strategy to promote sensitivity to multicultural issues is to require faculty to attend periodic conferences or workshops on multicultural concerns, specifically in those areas related to disability and vocational rehabilitation. A strategy to provide coverage of multi-cultural content is the use of guest lecturers or scholars, as well as lay people, to provide modules on multicultural issues in various courses in the curriculum. These guest speakers could challenge students to raise questions, present issues, and use problem solving strategies to improve rehabilitation service delivery systems. Furthermore, students can identify new and better methods of counseling multicultural populations.

Responsibilities of Rehabilitation Professionals

Rehabilitation counselors are responsible for dealing with clients both directly and indirectly. Direct responsibilities include the building of rapport with clients and their families, showing understanding and sensitivity to cultural beliefs and value systems, and providing appropriate services. Indirect responsibilities include professional development activities, such as participation in conferences and workshops, and workshops, and keeping up with current literature on issues related to the improvement of rehabilitation services to all clients served, including Mexican Americans.

Accommodation in Community Settings

Community services need to allow Mexican Americans to bring their culture into rehabilitation programs and services. Consideration to the levels of acculturation of Mexican Americans, socioeconomic status, and place of residence is crucial in making services effective. Flexible hours and appointments should be made available. Further, the building where programs are located should be accessible by available transportation and should not appear threatening or intimidating to barrio residents. Several studies indicate the importance of making rehabilitation facilities more accessible to all people living in poverty (Burma, 1970; Flaskerud, 1986; Wright, 1980). Rehabilitation counselors working with Mexican Americans need to build working relationships with other rehabilitation professionals who are also providing services to them. Increased accessibility and availability of rehabilitation services and programs to Mexican Americans are critical in providing improved vocational rehabilitation services.

Conclusion

In reviewing the literature it is evident that rehabilitation counselor education programs and rehabilitation counselors are challenged with providing services to a growing number of Hispanics, including Mexican Americans, the largest and least educated Hispanic group in the United States (U.S. Census, 1990). Mexican Americans are heterogeneous, with varying cultural beliefs expressed through sociocultural backgrounds, health conditions, and vocational aspirations. These characteristics interface with the rehabilitation service delivery system. The challenge of providing appropriate education and training programs, service delivery, information dissemination, and research to address the rehabilitation needs of Mexican Americans should receive high priority. Mexican Americans represent an economically disadvantaged group, making them more susceptible to sustaining disabilities. Thus, many would need rehabilitation services in order to live full, productive lives, and their unique needs must be considered if services are to be effective.

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