Cultural issues in the rehabilitation of Hispanics.

This article identifies five issues that are important for rehabilitation counselors to keep in mind as they provide services to persons of Hispanic origin: (a) developing greater sensitivity and respect for individual differences among Hispanic clients, (b) separating the effects of culture from the effects of socio-economic status, (c) exercising caution in interpreting and generalizing research findings, (d) exercising caution in the use of standardized tests, and (e) obtaining the best written and spoken language translation. These recommendations are based upon a review of some 60 references. Implications for rehabilitation practice are drawn.

The Hispanic population of the United States is one of the fastest growing segments of the nation (Cuban American Policy Center, 1989). Immigration, together with high fertility rates (Schreiber & Homiak, 1981), has led to an increase of 90% (Bean, Stephen, & Optiz, 1985) in the past decade. Furthermore, by the year 2000, Hispanics will be the largest minority population in the nation (Ponterotto, 1987). In addition, Hispanics are a youthful population and according to Cordova (1991): "By 1992 over 50% of all people under age 30 in the Southwest will be Hispanic" (p. C1). Brown (1990), in describing rehabilitation needs for the year 2000, noted the changing demographics of the U.S. workforce, and in particular, the increased population of Hispanics.

Not only does the growth of the Hispanic population increase the demand for services, but so also does the fact that Hispanics experience a proportionally higher rate of physical, mental, and emotional disabilities (Angel, 1985; Bowe, 1981, 1984; DeJong & Lifchez, 1983; National Institute on Disability and Rehabilitation Research, 1989). Also, it is apparent that Hispanics experience a cluster of problems including low income, discrimination, lack of education, employment in physically demanding and dangerous jobs, unemployment, poor health, poor health care utilization, and lack of insurance coverage (Angel, 1985; Angel & Cleary, 1984; Bean, Stephen, & Optiz, 1985; Betances, 1981; Castillo, 1983; Dicker & Dicker, 1982; Dixon & Bridges, 1979; Fierro & Leal, 1988; Garcia, 1984; McLemore & Romo, 1985; Schreiber & Homiak, 1981; Suazo, 1986).

While the number of Hispanics in the higher income levels increased in the 1980s, economic indicators pointed to an overall decline in Hispanic affluence. A dual Hispanic reality began to emerge -- one in which a few Hispanics were becoming well-off while most were dropping below the national average income level (Cuba American Policy Center, 1989, p. 12). O'Brien (1990) noted that the median family income of Hispanics fell 5.7% from 1979 to 1988 compared to increases of 2.5% and 1.8% for black and white families, respectively. In addition, Hispanics were 23% more likely to be poor in 1988 than in 1979, and more than 1 in 4 (26.9%) Hispanic Americans lived in poverty in 1988. Fierro and Leal (1988) report that Hispanics have the lowest educational achievement

of any ethnic group in the United States.

Rehabilitationists have long known that the presence of a disability predisposes an individual to lower levels of income (Bowe, 1981, 1984). It is also known that membership in an ethnic minority compounds the effect of disability upon economic status. If the minority individual with the disability is a woman, she belongs to three categories which predispose her to poverty: disability, ethnic group, and sex.

Further adding to the need for high quality and accessible rehabilitation services for Hispanics is the serious shortage of qualified bilingual, bicultural rehabilitation counselors (Linskey, Arnold, & Hancock, 1983). Further, there is an even greater need for women bilingual, bicultural rehabilitation counselors. Public and private rehabilitation compete for the few Hispanic rehabilitation professionals. Shay (1982) in discussing these issues concluded: "nationally, we have almost twice as many Asian American students in the rehabilitation profession than Hispanics" (p. 40). In response to Shay's observation, Hidalgo (cited in Shay, 1982) offered this as a partial explanation: "When somebody with bilingual qualities takes the civil service exam, their [sic] bilingual abilities are not reflected in their [sic] exams" (p. 41).

This lack of bilingual, bicultural rehabilitation professionals may also be due to the lack of Hispanic bilingual, bicultural rehabilitation faculty members in universities. In discussing mental health counseling curricula, Ponce and Atkinson (1989) observed that non-minority faculty members "may be training minority counselors in the counseling styles that minority clients find less than desirable" (p. 207). If this is also true of the rehabilitation training programs, failure to teach culturally relevant and sensitive techniques compounds the effects of the shortage of bilingual, bicultural counselors.

In addition, there has been little research conducted that has sought to investigate the Hispanic client's experience in rehabilitation programs (Fierro & Leal, 1988). Moreover, this research has suffered from a lack of integration and collaboration and very little dissemination of results and exchange of information because there is no central Hispanic study center for rehabilitation. In mental health counseling, there are two such research centers, the Spanish-speaking Mental Health Research Center at the University of California at Los Angeles and the Hispanic Research Center at Fordham University. There is no such clearing-house in rehabilitation.

There is an obvious need for non-Hispanic counselors to develop culturally relevant and sensitive counseling skills. To meet these challenges, the current literature suggests the need for the improvement of five specific aspects of the rehabilitation process: (a) Increased respect for individual differences among Hispanic clients; (b) A separation of the effects of culture from the effects of socio-economic status; (c) Greater caution in interpreting and generalizing research findings; (d) Greater caution in the use of standardized tests; and (e) Reduction of language barriers. This article will describe each of these needs in greater detail and draw implications for rehabilitation practice.

I. Develop Greater Sensitivity and Respect for Individual Differences Among Hispanic Clients

The mere placement of individuals into groups enhances the tendency to exaggerate the differences between the groups and to minimize the distinctions of individuals within the group (Sue, 1983). Although the rehabilitation counselor must make some judgments as to which behaviors are culturally determined and which are unique to each individual, the counselor must avoid the pitfall of ascribing to all Hispanics monolithic, blind stereotypes. Otherwise, the individual needs and unique human characteristics of each client will be lost, overshadowed by the stereotypes of the Hispanic culture in general. Recognizing individual differences may sound like an easy task, but it has nevertheless been a stumbling block for the dominant culture for generations and does not easily yield to change.

An example of such stereotyping was observed in the course of data gathering for a Switzer research project. One bilingual, bicultural rehabilitation counselor in a state program asserted that Anglo clients are often asked if they would be willing to relocate in order to facilitate job placement, but Hispanic clients are routinely assumed to be unwilling to do so and, therefore, are not asked about the possibility of relocation. If such examples are widespread, some counselors are making the mistake of assuming that all Hispanics hold certain attitudes and exhibit certain behaviors all the time.

There is great intracultural variability among Hispanics. Individuals may differ greatly because they belong to different socio-economic classes, demonstrate differing levels of acculturation, have different educational levels, and may descend from different generations of residence in the United States. These differences are both real and considerable.

No culture is static. Changes in demographics, immigration patterns, labor market conditions, together with lifestyles and economic changes (such as a greater number of women in the workforce), impact the Hispanic culture (Plata, 1989). The Hispanic population and culture in the United States have experienced particularly great changes in the last 20 years. An additional influence which has brought change is the fact that cultures are interactive, with the Anglo American culture influencing the Hispanic culture and the Hispanic culture influencing the Anglo culture. Therefore, culturally sensitive rehabilitation services will require ongoing review and modification.

Although Hispanics share a language and a common heritage dating back to the Spanish Empire, there are many distinct, separate subgroups within the Hispanic culture. The Hispanic subcultures include: Mexican Americans, Puerto Ricans, Cuban Americans, and those who trace their origins to Central America, South America, or Spain. The failure to distinguish among the various subcultures of any ethnic groups is referred to as "racial lumping." Racial lumping ignores significant differences among groups and violates the individual's self-identity. The tendency to view the Hispanic culture as monolithic is probably due to three factors: (a) their common history dating back to the Spanish Empire, (b) their use of the Spanish language and the great language loyalty that all the subgroups demonstrate, and (c) many customs and world views which the subcultures share. However, after the decline of the Spanish Empire, each subculture experienced a different history and emanated from a different region.

There are important differences among the Hispanic subcultures which are critical to the rehabilitation process. Some of these differences are: (a) Hispanics can be of any race. (b) Many Hispanics of Central American origin consider themselves to be political or economic refugees and wish to return to their native country when conditions permit while many mexican Americans report centuries of citizenship in the United States. (d) Cuban American report the highest income figures of any Hispanic subculture because they do not experience the unequal occupational distribution that other Hispanic groups do and Cuban Americans are far more likely to report dual income families. (e) Of all the Hispanic subcultures, Mexican Americans are most likely to live outside metropolitan areas. While more and more Mexican Americans are moving to urban areas, many still report farming and ranching as their occupations. (f) Most Hispanic subcultures are located within a specific region of the United States, e.g., New York City, Florida, Los Angeles, or the Southwest. (g) There are different health problems among the Hispanic subcultures. (h) There are great language variations. Just as there are many words and expressions in British English that Americans would find difficult to understand, there are difference in the Spanish spoken by each Hispanic subculture. For example, Cuban Americans have a tendency to use the familiar form much more often than Mexican Americans. This could be interpreted as disrespectful and patronizing by Mexican Americans who reserve the use of the familiar form for children, pets, and close friends. Likewise, sensitivity to regional differences in the same ethnic group must be developed (Arbona, 1990; De la Cancela, & Martinez, 1983; Fierro & Leal, 1988; Leal, 1990; Moore, 1990; Padilla & Lindholm, 1984; Rivera & Cespedes, 1983; Winkler, 1990). While the various subgroups of Hispanics should unite for political and economic purposes, rehabilitation researchers and practitioners should be aware of the great intercultural diversity among Hispanics and treat each client or subject as an individual.

Implications for Rehabilitation Training and Practice:

In an attempt to ameliorate some of these cultural issues in service delivery in both public and private programs, and addition to the rehabilitation counselor or curriculum is needed. The Council on Rehabilitation Education (C.O.R.E.) does not require any course or training in multicultural rehabilitation counseling in its accreditation curriculum (Leal, 1990). The addition of such a course in counseling and case management for the culturally diverse with both theoretical and clinical components is, thus, recommended. In the clinical component of this course, students should work under supervision with rehabilitation clients of various ethnic backgrounds and differing degrees of acculturation. This course should include both theory and application components. In the absence of such a course in accredited training programs, rehabilitation workers should assume the responsibility to seek such education on their own. Such training should be sought by means of workships, institutes, and other continuing education offerings wherever they are offered. However, it should be noted that some lectures and weekend workshops on Hispanics may have a tendency to exaggerate and emphasize the more unusual or "exotic" elements of this culture and/or fail to discuss the positive aspects.

Another consideration for rehabilitation practitioners is the generational level of the individual. The individual who has just migrated to the United States may be without a support group and will have this stress added to the stresses of a disability, financial problems, lack of English proficiency, and an uncertain future. Rehabilitationists should monitor for depression. Hispanics are subject to great environmental stresses (both the physical and the social environment) and may feel a lack of control and powerlessness.

There is a need to monitor the medical compliance of some Hispanic clients. Demographic information clearly indicates that Hispanics, especially Mexican Americans, tend to delay treatment, to drop out of treatment when symptoms disappear, have low rates of physician and dentist use, have few limited activity days, and have poor health insurance coverage. For the great majority of Hispanics, these characteristics are due to the fact that they do not feel that there are any alternatives. Rehabilitationists should refer clients to Spanish-language health education classes and actively monitor the health care of clients.

Rehabilitationists should be clear on the distinction between ethnicity and acculturation. Ethnicity is biological and racial while acculturation is, to a great degree, a decision of the individual. Acculturation is the individual's adaptation of the customs, behaviors, and attitudes of a new culture. Sophisticated acculturation instruments, with sound psychometric principles, have allowed the measurement of acculturation. Level of acculturation affects the rehabilitation process in many ways including vocational evaluation procedures, job-placement, and adherence to medical regimens.

Many Hispanics in farm and ranch work regard their jobs as a large part of their lifestyle. When they become physically disabled and can no longer engage in outdoor, physically demanding work, they feel a loss of a way of life. Indeed, many of our clients have reported an entire lifetime in such a job/lifestyle, having begun as young children. Another example of the impact of level of acculturation on the rehabilitation process is the need for assertion training. Many Hispanics believe "El consejero (la consejera) sabe mejor" (The counselor knows best) or "Como digan ustedes" (As you say"). Assertion training not only helps in the adjustment to disability, but also teaches the client how to negotiate complex bureaucratic helping agencies and helps the client to become aware of his or her right to question and object to procedures when necessary.

Hispanics have demonstrated a desire to be bicultural. Simply stated, Hispanics want to retain their native culture and add the American culture. Hispanics want full equality and participation in the economic and political life of the United States and yet, at the same time, retain their mother culture. Indeed, many are truly bicultural, with the ability to negotiate both cultures equally well.

II. Separate the Effects of Culture from the Effects of Socio-Economic Status

Closely related to the danger of seeing all Hispanics as part of a monolithic culture is the danger of confusing culture with socio-economic level. Much of what is thought to be culturally derived is actually a result of economic conditions. Zavela Martinez (1980) concluded that socio-economic and cultural factors are often confused. For example, a Hispanic client, like any other client, may appear to be indecisive and uncooperative when, in fact, he or she may feel helpless, powerless, and frustrated due to economic deprivation and all its resulting disadvantages. Such a client may expect differential treatment, negative outcomes, and the possibility of dropping out of the rehabilitation system, not because of any particular cultural characteristics, but because of the lack of economic resources. This may be especially true for migrant workers who have no power or stability because of their forced mobility and economic struggles.

Some of the Hispanic client's problems might be mistakenly diagnosed as internal in origin, such as anxiety and passivity, when in reality the problem is external -- the harsh living conditions which limit the client's range of choices (Garza & Lipton, 1982; Rivera & Cespedes, 1983). Indeed, poverty may lie at the root of many behaviors which could be misdiagnosed as having an internal locus (Castro, Furth, & Karlow, 1984).

Limited life experience, lack of transferable skills, little education, and limited English proficiency -- all could contribute to the image of the uncooperative client who is "not really trying" to make use of rehabilitation services. Upon closer inspection, however, it becomes apparent that "free" services are costly when the client must leave work, pay for child-care, pay transportation costs, and provide an interpreter, all problems with an economic basis rather than a cultural or psychogenic basis. Acceptance of services also assumes, of course, that the individual is aware of the available services and has an understanding of their potential value, again often a matter of economic sophistication rather than of cultural background (Acosta, Yamamoto, Evans, & Skilbeck, 1983; Vargas-Willis & Cervantes, 1987).

Rehabilitation practitioners work in the dominant culture and, therefore, not only face issues of cross-cultural counseling, but must also address the attitudes and practices of the dominant culture. The following three examples, all from bilingual, bicultural rehabilitation counselors in public agencies illustrate this point. One counselor reported that in the small community in which she works, only one rehabilitation goal is considered to be acceptable for Hispanics by the non-Hispanic citizens of the town -- that of placement in a janitorial job. According to her, there is little or no public support for other job placement or training and education for Hispanics. Another counselor reported that in his metropolitan community, he often felt that it was only acceptable to refer Hispanic clients to public helping agencies expressly designated for Hispanics, such as Migrant Health Services. A third bilingual, bicultural counselor spoke of discouragement and frustration with the medical establishment because, of all the helping professions, medicine and dentistry are the least likely to have interpreting services. The danger exists that if the medical services are not culturally sensitive, including the provision of interpretation services, they will have and adverse effect upon the rehabilitation process since successful rehabilitation plans depend to a great extent on accurate and complete medical information.

Implication for Rehabilitation Practice:

From these impressionistic observations of practitioners in the field, two conclusions may be drawn: First, counselors must take a strong advocacy position for their Hispanic clients. Good case management which includes marshaling a wide array of the available social services is necessary. Counselors must also understand that it may be difficult for some Hispanic clients to access these services. The opportunity to learn English should be provided to the client. Care must be taken to insure that the client understands all aspects of his or her medical treatment. The side effects of drugs, including the addictive potential of some painkillers, must be communicated to the client as well as alternative pain control measures.

Second, counselors must be aware that the rehabilitation process takes place in a nation that is still struggling to achieve a true pluralistic society. The Hispanic client probably knows more about discrimination than the non-minority rehabilitation counselor. To illustrate, it is known (McLemore & Romo, 1985) that certain advantages, such as education, do not bring the same economic benefits to individuals of Hispanic origin as do these same advantages bring to non-minority individuals. Preliminary research (Rivera, 1973; Ross & Biggi, 1986) has also indicated that rehabilitation services may not have the same economic and vocational benefits for Hispanics.

Third, rehabilitation workers must understand that by changing the client's socio-economic status, many of the stressors in his or her life may be ameliorated. For example, there has been much speculation that acceptance of disability is related to the Hispanic culture. This lack of adaptation to disability may be more related to the fact that many Hispanics are forced by circumstances to perform physical labor and, thus, a physical disability robs the individual of the opportunity to work (Angel, 1984, 1985; Garcia, 1984; Rivera, 1983). If the rehabilitationist can provide vocational opportunities to the client that do not require physical strength and stamina, acceptance of disability may increase.

III. Exercise Caution in Interpreting and Generalizing Research Findings

Rehabilitation research seeks to inform rehabilitation practice. In the field of rehabilitation, there has been little research conducted with any population of Hispanics. Fierro and Leal (1988), in speaking of Mexican Americans, a subgroup of Hispanics, stated:

The need for both qualitative and quantitative data on U.S. minority groups in general and specifically Mexican origin people with disabilities is especially acute.... For the most part, Mexican origin people in the United States remain invisible in terms of rehabilitation research, including both the area of specific disabilities, and rehabilitation counseling service delivery. (p. 35)

While there is more research and study on Hispanics in the other behavioral sciences, such as psychology and social work much of this research is also of questionable value, having violated research assumptions and cross-cultural ethnical guidelines. Arbona (1990) and Mendoza and Martinez (1981) characterize the majority of this research as disunified and as lacking a theoretical base. It is difficult, if not impossible, to draw firm conclusions from the existing body of research on Hispanics because of poor research design or inadequate definition of research variables. For example, many researchers have failed to distinguish the various subgroups of the Hispanic population, obscuring important differences between such groups (Angel, 1984; Angel & Cleary, 1984; Cervantes & Castro, 1985; Padilla & Lindholm, 1984; Winkler, 1990). Different definitions of the terms "Hispanic," "Latino," and "Mexican American" have yielded different samples, each with varying socio-demographic characteristics (Caetano, 1986).

Because different methods have been used in defining and taking census of Hispanics, the basic descriptive research processes, such as that of making meaningful and relevant comparisons are fraught with difficulty. Two difficulties have been encountered by those who attempt to formulate a basic demographic profile of Hispanics. First, some data are available only for the total Hispanic population, thus obscuring true and important differences. Second, comparisons are difficult to make when one subgroup, such as Mexican Americans is compared to "Total Hispanic" and "Total U.S. Population" because Mexican Americans are themselves included in each of the other two groups to whom they are being compared. Thus, they are, to some degree, being compared to themselves.

Research variables have lacked clarity because widely differing definitions of the operational procedures used to define variables such as "machismo," "fatalism," and "family stability" have made comparison or replication of studies impossible (Castro, Furth, & Karlow, 1984; De La Cancela, & Martinez, 1983; Garza & Lipton, 1982). Further, in many cases, the effects of poverty and other socio-demographic characteristics have been confused with the effects of culture. The beliefs and values of the culture or subculture have been confounded with the functional adaptation to the environment (Mainous, 1989).

The overall designs of many Hispanic studies have lacked rigor and have contained flaws. A great number of these works were impressionistic, often taken from rural samples, and are now outdated. Furthermore, the samples of these studies were often small. Some research studies on Hispanics have used clinical populations, such as psychiatric inpatients, residents of detoxification facilities, or prison inmates as subjects. Generalizations from these studies cannot be made to non-clinical Hispanics. It is doubtful if results from small rural samples can be generalized to the whole population and studies that have not been completed recently fail to reflect the great demographic changes that this population has experienced in the last 20 years.

In addition to these problems in research design, research procedures have been flawed because ethical standards of cross-cultural research have often been violated (Ibrahim & Arredondo, 1986). These violations have included the use of data-gatherers from the dominant culture and the comparison of results to normative or standardization groups made up of individuals of the dominant group (Olmedo, 1977; Padilla & Lindholm, 1984; Padilla & Ruiz, 1975; Padilla, Olmedo, & Loya, 1982).

Implications for Rehabilitation Research and Practice:

Perhaps the most pressing need in studying the rehabilitation of any ethnic minority is not basic research but is more appropriately termed program evaluation. Application rates, drop-out rates, the need for an ethnically similar counselor, success rates of culturally relevant services, outcome measures, and client satisfaction all merit study (Ross & Biggi, 1986). A first step toward a unified, systematic, and comprehensive evaluation and research program investigating the experience of Hispanics in rehabilitation programs should begin with training doctoral students in cross-cultural research methods and ethical guidelines.

Valid and useful research should begin with the formulation of a few (seemingly) simple research questions, such as determining the predictors of rehabilitation success with specific subgroups of Hispanics. Multivariate designs would allow the exploration of many factors simultaneously. The effects of such variables as socio-economic status, generational level, self-identity, and level of acculturation could then be taken into account. Coordinated efforts could be undertaken with the pooling of data and wide dissemination of findings with implications and suggestions for practice. The practitioner, as ultimate consumer of such research, must assume the responsibility to read and understand research publications and to inform that continuing cycle of new research with insights gained from practice and the application of the previous round of research studies. The clinical judgment and observations of counselors can serve to supply researchers with meaningful and important research questions and hypotheses.

IV. Exercise Caution in the Use of Standardized Tests

Since 1931 (Anastasi, 1988) there have been cautions regarding the interpretation of standardized test scores of test-takers of differing ethnic backgrounds than the individuals of the standardization, validation, or norm groups. Of course, the ideal solution would be to develop instruments initially in Spanish instead of translating English-language instruments into the Spanish language. Such an ideal situation would also include validating the instruments against the specific educational and vocational criteria they are constructed to predict and using only local norms. In so doing, there would be no cross-cultural comparisons because the instrument would be used within a single culture. This approach would be difficult not only because of the skill, time, and expense required to develop such instruments, but also because the individual test-taker is most likely contemplating education, vocational placement, and/or rehabilitation in the dominant culture of the United States. The use of tests of verbal and quantitative content to assess one's "intelligence" or potential for education or for productive work is fraught with perils. The issue of culture-free and culture-fair tests has been widely discussed and merits consideration (Arnold & Orozco, 1989; Berry, 1972, 1983; Olmedo, 1977). For example, Arnold and Orozco (1989) point out that intelligence tests contain items which require high verbal functioning and items which tap skills that are not taught in all cultures.

The adaptation and application of English-language personality tests for use in Hispanic cultures also present difficulties. At least two questions can be raised in this regard: (a) Is the translation of the test equivalent? and (b) Does the corresponding psychological variable under consideration even exist in the Hispanic culture? Brislin (1970), Butcher and Garcia, 1978; and La Val, Gomez, and Ruiz (1988) have emphasized the importance of the translation process in test adaptation and have provided cautions and guidelines for test translators. The linguistic problems which arise in translation involve idiomatic speech, as well as grammar and syntax. For example, tense and gender are more precisely employed in Spanish than in English. To overcome this problem, it is suggested that two tenses be used in the Spanish translation, with one tense printed in parentheses in order to achieve an equivalent translation. The use of double negatives, common in English language tests, may not be well understood in Spanish.

Regarding the second point, even with a well-translated personality or clinical test, the question still remains as to the existence of equivalent psychological constructs in the Hispanic culture. At a minimum, tests which employ such psychiatric or personality nomenclature must be standardized and validated on Hispanic groups before they can be used with Hispanic rehabilitation clients.

In addition to the technical aspects of test construction, consideration must be given to testing procedures. For some Hispanics, the whole concept of testing and evaluation is foreign. The phrase, "Choose one item," while it may be a common and accepted instruction to members of the dominant culture, may seem too restrictive and artificial to Hispanics. The assembling of small, colored blocks and the arrangement of pictures in order to compose a coherent story required on performance subscales of tests of intelligence often seem pointless, childish, and impractical to many Hispanics. In addition, test-taking motivation probably differs from culture to culture.

Implications for Rehabilitation Practice

More sensitive testing and evaluation procedures for Hispanics are called for. One example of such an approach is that proposed by Arnold and Orozco (1989) who suggested the use of an acculturation instrument with Hispanic rehabilitation clients during the vocational evaluation phase. This acculturation measure would act as an index of the validity that can be ascribed to all the other vocational evaluation processes. Those who score low and, thus, demonstrate lower acculturation to Anglo American values might not be very comparable to Anglo, white, middle-class, American norm samples. Further support of this proposal for the use of an acculturation instrument in the vocational evaluation process of Hispanics comes from Anastasi (1988) who asserted that culture-specific intelligence tests may be measuring the individual's degree of acculturation rather than his or her intelligence. A low score, according to Anatasi, may simply represent low acculturation, not low intelligence.

Rehabilitation workers should carefully study the standardization groups for each evaluation procedure. While most of these standardization groups will be comprised of non-Hispanic individuals, these norms may have some validity since the Hispanic client may be called upon to function in educational or vocational settings where the majority is non-Hispanic. This is a clinical judgment which requires skills and experience.

In addition, routine evaluation procedures should be supplemented by historical and observational data. For example, many of our Hispanic clients have had well-developed abilities to learn by simply watching a demonstration without the aid of written or verbal instructions. This ability to learn from demonstration is not always tapped in intellectual assessments.

Research (Butcher & Garcia, 1978; Butcher & Pancheri, 1976; Montgomery & Orozco, 1985; Padilla & Ruiz, 1975, Padilla, Olmedo, & Loya, 1982) on the Minnesota Multiphasic Personality Inventory (MMPI), a widely used instrument in the psychological evaluation of rehabilitation clients, has demonstrated that certain subscales tap cultural traits rather than personality traits. Even the Rorshach Inkblot Test, a projective technique, has been found to be culturally biased (Kaplan, Rickers-Ovsiankina, & Joseph, 1956). Practitioners must, therefore, exercise caution in the interpretation of the MMPI and similar personality inventories.

It is recommended that Hispanic clients be given some orientation to and preparation for vocational and psychological assessment processes. Such an orientation should also be geared toward allaying fears, clarifying misconceptions, and building motivation. In addition, the rehabilitation specialist should take pains to inform himself or herself as to the quality and extent of the translation services offered in these evaluations.

V. Obtain the Best Possible Written and Spoken Translation

Hispanics have demonstrated a remarkable language loyalty to Spanish. It appears that Hispanics, and especially Mexican Americans, acculturate in a somewhat different manner than do other groups such as Poles, Germans, Blacks, or Japanese. Many Hispanics have not "de-acculturated" from their native culture as others have. Indeed, the Mexican American culture in the United States has persisted for centuries in some parts of the United States (Fierro & Leal, 1988; Gann & Duignan, 1986; Mendoza & Martinez, 1981; Moore & Pachon, 1976). Unlike grandchildren of other immigrants, Hispanics persist in the use of their native language. As a consequence of this language and cultural loyalty, the number of Spanish-speakers in the United States is increasing while the number of speakers of other non-English languages is decreasing.

Unfortunately, interpretation services in many medical and rehabilitation settings have been traditionally regarded as volunteer work and have suffered from a lack of professional quality. Few clear guidelines and standards for translation are applied and translation and interpretation quality varies greatly from one rehabilitation setting to another. The quality of translation suffers if the source language is poorly stated, if a great number of colloquialisms are used, if a great number of technical terms such as medical nomenclature are used, or if the topic involves the translator personally. Monolinguals have no capability to monitor and evaluate the competence of translators and, in addition, no adequate unit of measurement for assessing translation accuracy currently exists.

Furthermore, the use of family and friends as translators violates the right of privacy of the client. Often, Hispanic children act as intermediaries between the family and the Anglo society (Falicov, 1982; Plata, 1988). When the children of the client are used as translators, the client may be reluctant to fully discuss certain topics or the translator may have a tendency to speak for the client. Use of family members as interpreters alters the family structure (Christensen, 1989). In either case, a complete and accurate exchange of information is hindered.

Marcos (1976) found that Hispanics who were bilingual in Spanish and English were significantly more emotionally detached in their second language (most often English) and lost many of the fine nuances of meaning. De La Cancela (1985), in discussing psychotherapy, observed that difficulties in translation lead to an "unavailability" of areas of the bilingual's intra-psychic world since they are independent of the language system in which therapy was conducted.

Castillo (1970) and Segovia-Price and Cuellar (1981) found that bilingual Mexican American psychiatric patients expressed different symptomatology when interviewed in English than when interviewed in Spanish. The wider the discrepancy in the client's verbal fluency in English and in Spanish, the more likely it was that language had an effect on the expression of psychopathology. In spite of these findings, the linguistic qualities of the language of the interview has received very little attention.

On a positive note, Acosta and Cristo (1981) found that training and supervision of Spanish language interpreters did result in a lowering of both interpreter bias and language distortion. Training included learning psychological terms and material, learning when to ask for clarification, how to balance the need for translating from Spanish to English (the client) and from English to Spanish (the counselor) and how to deal with the emotional pressures of correctly translating sensitive and important information.

It may be said that the simplest solution to this problem would be for everyone to learn English. Most monolingual Spanish-speakers know that English is the language of communication in the United States and want to learn English. However, communication is not the only function that language serves. Two other important aspects are: (a) Language is a repository of culture, and (b) Language comprises a good deal of the individual's self identity. Therefore, Spanish-speakers want to learn English, but they also want to retain their native language of Spanis and, thereby, retain their culture and their self identity.

Implication for Rehabilitation Training and Practice:

A course in the rehabilitation counseling curriculum is proposed in order to minimize the use of untrained and unsupervised interpreters. In this course, bilingual, bicultural paraprofessionals would be taught basic principles of rehabilitation, counseling, and interviewing techniques, and translating and interpreting. Students would work under supervision and receive instructor, client, and peer critiques and evaluations. Just as important, monolingual English-speakers who are also professional rehabilitation counselors would receive training in the best use of these paraprofessional interpreters.

Rehabilitation counselors should separate language ability from language preference. Simply because a Hispanic individual prefers to speak Spanish does not mean that he or she is not fluent in English. Further, it is necessary for the counselor to learn the language history of each Hispanic client. What language did the client speak first? In which language(s) was the client educated? Which language(s) can the client read and write? There is no standardized definition of bilingual. Rehabilitationists should provide opportunities to learn English for the monolingual Spanish-speaking client.

Recognize that the quality of interpreting/translating services varies widely. Simply speaking Spanish does not mean that one is able to read or write Spanish nor that one is a skilled interpreter. High quality interpretation is a learned skill, comprising knowledge of the English and Spanish languages, knowledge of rehabilitation terminology, skill in asking for clarification, avoiding "improving" or changing what has been said, and the ability to elicit valid, accurate responses from both parties.

When non-Hispanic rehabilitation professionals learn some Spanish, they will not only have the means of communication at their disposal, but they will also gain insights and understandings into the Hispanic culture.

The five principles of cultural sensitivity listed here are not beyond the capability of practicing rehabilitation counselors. In fact, each of these principles, at least in a general way, has been a part of rehabilitation work since its inception. Recognition of individual differences, cultural sensitivity, skillful use of tests and assessment procedures, good research design, and accurate communication have, in some form or another, always been a part of the training and practice of rehabilitation. With increasing numbers of minority clients, it is now our challenge to sharpen and adapt these basic skills in a more refined manner as they apply to the Hispanic culture.

LIST OF REFERENCES

Acosta, F.X., & Cristo, M.F. (1981). Development of a bilingual interpreter program and alternate model for Spanish speaking services. Professional Psychology, 12, 474-482.

Acosta, F.X., Yamamoto, J., Evans, L.A., & Skilbeck, W.M. (1983). Preparing low-income Hispanic, black, and white patients for psychotherapy: Evaluation of a new orientation program. Journal of Clinical Psychology, 39(6), 872-877.

Anastasi, A. (1988). Psychological testing (6th ed.). New York:Macmillan.

Angel, R. (1984, June). The costs of disability for Hispanic males. Social Science Quarterly, 65, 426-443.

Angel, R. (1985). The health of the Mexican origin population. In R. O. de la Garza, F.D. Bean, C. M. Bonjean, R. Romo, & R. Alvarez (Eds.), The Mexican American experience: An interdisciplinary anthology. Austin: University of Texas Press.

Angel, R., & Cleary, P.D. (1984, September). The effects of social structure and culture on reported health. Social Science Quarterly, 65, 814-828.

Arbona, C. (1990). Career counseling research and Hispanics: A review of the literature. The Counseling Psychologist, 18(2), 300-318.

Arnold, B.R., & Orozco, S. (1989, Jan.-Mar.). Acculturation and evaluation of Mexican Americans with disabilities. Journal of Rehabilitation, 55, 53-57.

Atkinson, D.R., Morten, G., & Sue. D.W. (1989). Counseling American minorities: A cross cultural perspective (3rd ed.). Dubuque, IA: Brown.

Bean, F.D., Stephen, E.H., & Optiz, W. (1985). The Mexican origin population in the United States: A demographic overview. In R.O. de la Garza, F.D. Bean, C.M. Bonjean, R. Romo, & R. Alvarez (Eds.), The Mexican American experience: An interdisciplinary anthology. Austin: University of Texas Press. Berry, J.W. (1972). Radical cultural relativism and the concept of intelligence. In L.J. Cronbach & P.J.D. Drenth (Eds.), Mental tests and cultural adaptations. The Hague: Mounton.

Berry, J.W. (1983). Textured contexts: Systems and situations in cross-cultural psychology. In S.H. Irvine & J.W. Berry (Eds.),

Human assessment and cultural factors. Beverly Hills, CA: Sage.

Betances, S. (1981). Hispanic characteristics that impact upon vocational rehabilitation. In Rehabilitation in the 80's: Understanding the Hispanic disabled resource manual (18-31). Bethesda, MD: Association for Cross Cultural Education and Social Studies.

Bowe, F. (1981). Demography and disability: A chartbook for rehabilitation. Hot Springs: Arkansas Rehabilitation and Training Center.

Bowe, F. (1984). U.S. census and disabled adults. Hot Springs: Arkansas Rehabilitation Research and Training Center.

Brislin, R.W. (1970). Back-translation for cross-cultural research. Journal of Cross-Cultural Psychology, 1(3), 185-216.

Brown, D. (1990). Facing the future: Readying rehabilitation for the year 2000. Journal of Rehabilitation, 56, 17-20.

Butcher, J.N., & Garcia, R.E. (1978). Cross national application of psychological tests. Personnel and Guidance Journal, 56(8), 472-475.

Butcher, J.N., & Pancheri, P. (1976). A handbook of cross-national MMPI research. Minneapolis: University of Minnesota Press.

Caetano, R. (1986). Alternative definitions of Hispanics: Consequence in an alcohol survey. Hispanic Journal of Behavioral Sciences, 8(4), 331-344. @ REFOUTDENT = Castillo, J. (1983). The Hispanic population: An overview. In The special rehabilitation and research needs of disabled Hispanic persons. Edinburg, TX: National Institute of Handicapped Research and President's Committee on Employment of the Handicapped.

Castillo, J.C. (1970). The influence of language upon symptomatology in foreign-born patients. American Journal of Psychiatry, 127(2), 160-162.

Castro, F.G., Furth, P., & Karlow, H. (1984). The health beliefs of Mexican American, and Anglo American women. Hispanic Journal of Behavioral Sciences, 6(4), 365-383.

Cervantes, R.C., & Castro, F.G. (1985). Stress, coping, and Mexican American mental health. Hispanic Journal of Behavioral Sciences, 7,(1), 1-73.

Christensen, E.W. (1989). Counseling Puerto Ricans. In D.R. Atkinson, G. Morten, & D.W. Sue (Eds.), Counseling American minorities: A cross cultural perspective (3rd ed.), (256-264). Dubuque, IA: Brown.

Cordova, R. (1991, June 23). Interpreting the language. American legal system demands Spanish understanding. Greeley Tribune, p. C1.

Cuban American Policy Center. (1989). The elusive decade of the Hispanics. Miami: Cuban American National Council.

DeJong, G., & Lifchez, R. (1983). Physical disability and public policy. Scientific American, 248(6), 40-49.

De La Cancela, V. (1985). Toward a sociocultural psychotherapy for low income ethnic minorities. Psychotherapy, 22(2), S.

De La Cancela, V., & Martinez, I.Z. (1983). An analysis of culturalism in Latino mental health: Folk medicine as a case in point. Hispanic Journal of Behavioral Sciences, 5(3), 251-274.

Dicker, L., & Dicker, M. (1982). Occupational health hazards faced by Hispanic workers: An exploratory discussion. Journal of Latin Community Health, 1, 101-107.

Dixon, G., & Bridges, C. (Eds.). (1979). On being Hispanic and disabled: The special challenge of an underserved population. Conference Report. Springfield: Illinois State Board of Vocational Education and Rehabilitation, Washington, DC: Partners of the Americas. (ERIC Document Reproduction Service No. 210 983)

Falicov, C. (1982). Mexican families. In W. McGoldrick, J. Pearce, & J. Giordano (Eds.), Ethnicity and family therapy. New York: Guilford Press.

Fierro, R.J., & Leal, A. (1988). Psychological effects of early versus later referral to the vocational rehabilitation process: The case of Mexican origin industrially injured workers. Journal of Applied Rehabilitation Counseling, 19, 35-39.

Gann, L.H., & Duignan, P.J. (1986). The Hispanics in the United States: A history. Boulder, CO and London: Westview Press.

Garcia, P.I. (1984). Stress responses among physically injured Spanish speaking/surnamed workers. Hispanic Journal of Behavioral Sciences, 6(3), 225-246.

Garza, R.T., & Lipton, J.P. (1982). Theoretical perspectives on Chicano personality development. Hispanic Journal of Behavioral Sciences, 4, 407-432.

Ibrahim, F.A., & Arredondo, P.M. (1986). Ethical standards for cross-cultural counseling: Counselor preparation, practice, assessment, and research. Journal of Counseling and Development, 64, 349-352.

Kaplan, B., Rickers-Ovsiankina, M.A., & Joseph, A. (1956). An attempt to sort Rorschach records from four cultures. Journal of Projective Techniques, 20, 172-180.

Laval, R.A., Gomez, E.A., & Ruiz, P. (1988). A language minority: Hispanic Americans and mental health care. In D.R. Atkinson, G. Morten, & D.W. Sue (Eds.), Counseling American minorities: A cross cultural perspective. Dubuque, IA: Brown.

Leal, A. (1990). Hispanics and substance abuse: Implications for rehabilitation counselors. Journal of Applied Rehabilitation Counseling, 21(3), 52-54.

Linskey, A., Arnold, B., & Hancock, S. (1983). Barriers to access and utilization of services by the handicapped Hispanic. In The special rehabilitation and research needs of disabled Hispanic persons (27-38). Edinburg, TX: National Institute of Handicapped Research and President's Committee on Employment of the Handicapped.

Marcos, L.R. (1976). Bilinguals and psychotherapy: Language as an emotional barrier. American Journal of Psychotherapy, 30, 552-560.

McLemore, S.D., & Romo, R. (1985). The origins and development of the Mexican American people. In R. de la Garza, F.D. Bean, C.M. Bonjean, R. Romo, & R. Alvarez (Eds.), The Mexican American experience: An interdisciplinary anthology. Austin: University of Texas Press.

Mendoza, R. H., & Martinez, J.D. (1981). The measurement of acculturation. In A. Baron, Jr. (Ed.), Explorations in Chicano psychology. New York: Praeger.

Moore, J. (1990). Hispanic/Latino: Imposed label or real identity? Latino Studies Journal, l(2), 33-47.

Moore, J.W., & Pachon, H. (1976). Mexican Americans (2nd ed.). Englewood Cliffs, NJ: Prentice Hall.

Montgomery, G.T., & Orozco, S. (1985). Mexican Americans' performance on the MMPI as a function of level of acculturation. Journal of Clinical Psychology, 41(2), 203-212.

National Institute on Disability and Rehabilitation Research. (1989). Chartbook on disability in the United States. Washington, DC: U.S. Department of Education.

O'Brien, E.M. (1990). Social, political gains obtained by Hispanics in '80s overshadowed by harsh economic slide, study says. Black Issues in Higher Education, 6(21), 1, 13.

Olmedo, E.L. (1977). Psychological testing and the Chicano: A reassessment. In J.L. Martinez, Jr. (Ed.), Chicano psychology. New York: Academic Press.

Padilla, A.M., & Lindholm, K.D. (1984). Hispanic behavioral science research: Recommendations for further research. Hispanic Journal of Behavioral Sciences, 6, 13-32.

Padilla, A.M., & Ruiz, R.A. (1975). Latino mental health: A review of the literature. Washington, DC: U.S. Government Printing Office.

Padilla, E.R., Olmedo, E.L., & Loya, F. (1982). Acculturation and MMPI performance of Chicano and Anglo college students. Hispanic Journal of Behavioral Sciences, 4, 451-466.

Plata, M. (1989). Multicultural considerations in conferring with Hispanic parents. Journal of Instructional Psychology, 16(2), 85-90.

Ponce, F.Q., & Atkinson, D.R. (1989). Mexican-American acculturation, counselor ethnicity, counseling style, and perceived counselor credibility. Journal of Counseling Psychology, 36, 203-208.

Rivera, O.A. (1973). Vocational rehabilitation of disabled Chicanos (Doctoral dissertation, University of Utah, 1974). Dissertation Abstracts International, 35, 2059-2060A. (University Microfilms No. 74-22, 707)

Rivera, O.A., & Cespedes, R. (1983). Rehabilitation counseling with disabled Hispanics. Journal of Applied Rehabilitation Counseling, 4(3), 65-70.

Ross, M.G., & Biggi, I.M. (1986). Critical vocational rehabilitation service delivery issues at referral (02) and closure (08, 26, 28, 30) in serving select disabled persons. In S. Walker, F.Z. Belgrave, A.M. Banner, & S. Nicholls (Eds.), Equal to the challenge: Perspectives, problems and strategies in the rehabilitation of the nonwhite disabled. Washington, DC: The Bureau of Educational Research, School of Education, Howard University. (ERIC Document Reproduction Service No. ED 276 196)

Schreiber, J.M., & Homiak, J.P. (1981). Mexican Americans. In A. Harwood (Ed.), Ethnicity and medical care. Cambridge, MA: Harvard University Press.

Segovia-Price, C., & Cuellar, I. (1981). Effects of language and related variables on the expression of psychopathology in Mexican American psychiatric patients. Hispanic Journal of Behavioral Sciences, 3(2), 145-160.

Shay, H. (1982). Special communication requirements of paragraph 1361.15 RCSSD amendments. In Rehabilitation in the 80's: Understanding the Hispanic disabled resource manual. Bethesda, MD: Association for Cross Cultural Education and Social Studies, Inc.

Suazo, A. (1986). The emerging role of disabled Hispanics. In S. Walker, F.Z. Belgrave, A.M. Banner, & S. Nicholls (Eds.), Equal to the challenge: Perspectives, problems, and strategies in the rehabilitation of the nonwhite disabled. Washington, DC: The Bureau of Educational Research, School of Education, Howard University. (ERIC Document Reproduction Service No. ED 276 196)

Sue, S. (1983). Ethnic issues in psychology. A reexamination. American Psychologist, 38(5), 583-592.

Vargas-Willis, G., & Cervantes, R.C. (1987). Consideration of psychosocial stress in the treatment of the Latina immigrant. Hispanic Journal of Behavioral Sciences, 9(3), 315-329.

Winkler, K.J. (1990). Scholars say issues of diversity have revolutionized field of Chicano studies. The Chronicle of Higher Education, 37(4), 4-9.

Zavala Martinez, I. (1980). Cross cultural counseling and psychotherapy: A critical overview. Unpublished manuscript. Cited in De La Cancela.