Latino access to rehabilitation services: evidence from Michigan.

With the diversity of cultures represented in the United States, healthcare, rehabilitation, and educational specialists are confronted with the task of providing services to families who hold different belief systems regarding perception and causes of disability and, therefore, have different preferences for treatment. As Anderson and Feniche (1989; p. 7) underscore, "There are cultural and situational influences which, if ignored, may from the onset, doom to failure even the best intentioned programs for culturally diverse persons with disabilities and their families." Therefore, it is imperative that health delivery systems be structured in congruence with a variety of beliefs regarding the etiology and treatment of disabling conditions.

The significance of this congruence for Latinos becomes more apparent when national demographic changes are considered. According to the U.S. Census (1991), 7 percent of Americans with work disabilities were Latino. The disabled adult Latino population has been estimated to number 2.5 million -- approximately 17 percent of the Latino working-age population (Suazo, 1986). The proportion of Latinos with disabilities is only slightly higher than for non-Latino whites. However, the number of Latinos with disabilities is expected to rise dramatically in the coming years as a result of sustained high levels of population growth within the Latino population and greater exposure to health and occupation risks.

Yet, relatively few Latinos participate in rehabilitation services. Only one-tenth of 1 percent of all working age Latinos with disabilities were rehabilitated by public programs in 1981 (Suazo,1986). Wakabayashi, Ayers, Rivera, Saylor, and Steward (1977) assert that a general unresponsiveness by rehabilitation and other social service delivery systems deters the successful rehabilitation of minority persons with disabilities. As a result, Latinos and other ethnic minorities are underrepresented in the service delivery system and do not fare as well as non-Latinos and other nonminorities in relation to rehabilitation outcomes, access to services, and the quality and quantity of services (Ross & Biggi, 1986; Santiago, 1989; Wright, 1988).

The limited utilization of rehabilitation services by Latinos and other ethnic minorities cannot be solely attributed to the lack of service providers or community outreach efforts. Cultural practices, medical beliefs, and customs of the ethnic group may play a significant role in the conceptualization of normalcy, beliefs regarding causation, tolerance and acceptance of disability, and group attitudes toward the use of the government or other community resources (Cuellar & Arnold, 1983; Wilson, 1986). Furthermore, the lack of recruitment programs targeted at Latinos, the lack of adequate public transportation, and institutional devaluation of Latino culture tend to diminish participation in existing programs (Ubarry & Santiago, 1988).

Unfortunately, the paucity of information regarding services to Latinos and other minorities impedes our ability to identify fully the causes and consequences of the overall lack of participation in various rehabilitation programs. Yet, we know that Latinos with disabilities experience extreme levels of deprivation. Bowe (1985) reports that three out of four disabled Latinos have less than a high school education. Approximately 75 percent have annual earnings which are less than $8,000; and nearly 60 percent earn less than $4,000. Moreover, relatively few Latinos with disabilities (17 percent of Latina women and 42 percent of Latino men) participate in the labor force (Rehab Brief, 1984). For those disabled Latinos who do enter the labor force, the chances of being unemployed are high: 22 percent of Latina women and 24 percent of Latino men were unemployed (Bowe, 1985).

Existing studies suggest that the problems facing minorities with disabilities are exacerbated by the social inequities of multiple minority status (e.g., Arnold, 1983). For Latinos with disabilities, this means having to cope with other positions of disadvantage based upon ethnic, racial, and linguistic differences in addition to coping with the inequities they encounter as a result of their disabilities. Being disadvantaged may lead to differences in the degree to which physical impairments and disabilities become handicaps for the individual. Moreover, differential access to available services deprives Latinos of healthcare, education, and training. Continued barriers to these services further exacerbate the precarious status of Latinos with disabilities.

As Baldwin and Smith (1984) report, most research on minority people with disabilities has focused on mental illness or substance abuse. This has been particularly true for Latinos, with relatively few studies examining the nature or extent of physical disabilities among Latinos (Luetka, 1976; Kirchner & Peterson, 1980, 1981; Arnold & Orozco, 1987; Santiago, 1988). Perhaps one of the most serious issues facing service providers is the scarcity of information about Latinos with disabilities. Extremely limited information exists about the types and incidence rates of disabilities affecting this population. Moreover, relatively little is known about the impact of the existing service delivery system on the rehabilitation of Latinos, especially since so few are being served. These limitations appear to have substantially hampered the development and implementation of programs designed for Latinos with disabilities.

For the most part, research on Latinos has focused on describing cultural differences that affect their utilization of rehabilitation services (Arnold, 1983; Rivera & Cespedes, 1983; Kunce & Vales, 1984; Gomez, 1987; Cooney, 1988; Cuellar & Arnold, 1988). These studies have provided useful cues for service providers regarding Latino perceptions of disability, values, communication norms, and the need for pluralistic counseling strategies (see Medina et al., 1988). From this work, the cultural values and norms of the client emerge as crucial elements in determining rehabilitation outcomes. For Latinos, this means that service providers need to understand the role of the family and include the family in treatment programs; practitioners must attempt to personalize the service delivery system; treatment should be goal-oriented; and counselors should be aware of protocols regarding verbal and nonverbal communication with clients. The development and acceptance of programs that are culturally sensitive to Latinos appears to foster the rehabilitation process (Ubarry & Santiago, 1988).

However, with one exception (Baldwin & Smith, 1984), these studies have generally failed to assess empirically the factors which shape demands for, and access to, rehabilitative opportunities. Specifically, Baldwin and Smith argue that access to rehabilitation is conditioned by the limitations and capacities of the individual; the individual's motivation towards work; the vocational skills of the individual; the physical, mental, and skill requirements of the job; and the environmental factors that make employment accessible or inaccessible. As they emphasize, rehabilitation in the United States can be a very selective process whereby only individuals identified as being most likely to succeed are referred to, and participate in, services. Different perceptions regarding the potential for success may result in unequal access to services encountered by racial or ethnic minorities, the poor, those with limited education or skills, and older individuals with disabilities. While these inequities have been well documented for minority recipients of mental health services, little comparable research has been undertaken to examine the inequities of service to individuals with other disabilities (Baldwin & Smith, 1984, p. 301).

In this article, factors that are associated with the access to and utilization of rehabilitation services by Latinos with disabilities are examined. The data used in this study were obtained from a 1990-91 pilot survey of 124 disabled working-age Latino adults residing in the three largest Latino communities in Michigan. The objectives of this research are to (1) identify patterns of service utilization by Latinos using the metropolitan areas of Detroit, Grand Rapids, and Lansing as test sites; and (2) identify factors associated with service utilization by Latinos with disabilities.

Method

Respondents were selected from a listing of Latino households from the metropolitan areas of Detroit, Grand Rapids, and Lansing, Michigan. A master listing of these households was generated by the authors from the telephone and city directories of these communities and was augmented with information obtained from service providers based in these communities. From this listing, a sample of approximately 2,500 telephone exchanges was drawn at random. Each interviewer obtained a listing of approximately 200 exchanges. Each household was screened to verify Latino heritage as well as to determine if at least one member of the household was identified as having a handicap, disability, or health condition that limited daily activities. Utilizing this process, a total of 225 households were identified. From this total, 186, or 83 percent, of eligible households responded to the survey. In this study, we restrict our sample to the 124 respondents who were between the ages of 16 and 65 at the time of the interview.

Characteristics of Respondents

Approximately 66 percent of all respondents were of Mexican descent, another 17 percent were Puerto Rican, and the remainder were Cuban and Central or South American. Slightly less than half of the respondents lived in the Detroit metropolitan area. Nearly one-quarter of the households had two or more persons with disabilities. The median age of onset of the disability was 29 years, and the median age at time of interview was 44.5 years. Half of the respondents were married. Approximately 53 percent of the respondents had not completed high school. Three out of every ten households had incomes below $15,000 in 1989.

Instrument

For the purpose of this study, we designed a questionnaire that would be sensitive to issues related to the disability as well as to the cultural identity of the individual respondent. Information about the nature and extent of disabilities within the household was obtained using a detailed disability checklist developed and utilized by Michigan Rehabilitation Services (MRS), the public rehabilitation agency in the State of Michigan. Severity of disability was assessed using the MRS screener which identifies the ability to perform seven activities vital to independent having. In addition, open-ended questions were used to probe for respondent self-identification of their disability status as well as cultural and religious beliefs which shape individual attitudes toward their disabilities.

Additional questions focused on the sources of support available to respondents and their use of existing services. Particular attention was given to examining access to rehabilitation services. Service utilization was measured through respondent self-reports of program participation at the time of the interview. Respondents were then asked to identify and describe the types of services received. Included in this section was an item regarding use of public rehabilitation services. A final set of questions focused on respondent assessments of service needs.[1]

The survey instrument was administered by a trained team of 12 (9 female and 3 male), bilingual/bicultural interviewers who were recruited from the three communities. A total of 4 months was devoted to the data collection.

Whenever possible, the interviewers administered the survey instrument to the household member who was identified as being handicapped or disabled. In the cases where this was not possible, an adult member of the household was asked to provide information about the family member with disabilities. If more than one member of the household was disabled, information was solicited first for any adults. General information about the types of disabilities was collected for all members of the household, but more detailed information was collected for only one of the household members who was randomly selected by the interviewer. Although both in person and telephone interviewing techniques were tested in the study, 96 percent of the interviews were conducted over the telephone. Approximately 43 percent of the interviews were conducted in Spanish. The average length of the interview was 30 minutes.

Types of Disabling Conditions

The MRS checklist identifies 29 categories of physical conditions ranging from vision problems to paralysis to heart disease and AIDS. Respondents could identify more than one condition but were then asked to self-identify their primary disability. These conditions were then collapsed into six categories: chronic illness, mobility impairment, sensory impairment, neurological disease, cancer, and mental retardation and learning disabilities. In this analysis, psychological problems were excluded from our checklist because we wanted to examine the extent of physical disabilities.[2]

Chronic illnesses, such as diabetes and heart disease, were identified as the primary disability among Latino adults (43 percent). Another 26 percent were mobility impaired (e.g., loss of limb, paralysis). Ten percent of the respondents had sensory impairments (e.g., blindness; deafness). Neurological diseases, such as stroke and epilepsy, affected 10 percent of the respondents. Approximately 6 percent of the respondents had cancer and 6 percent were mentally retarded or had learning disabilities. Nearly half the respondents cited disease as the cause of their disabling condition, 22 percent cited birth defects, and 30 percent cited injuries. Of those who were injured, 50 percent received their injuries on the job.

Latino Definitions of Disability

In order to further probe into respondent perceptions of disability, a number of open-ended questions were included in the interview process. Specifically, respondents were asked to identify and define their preferred term

Dr. Santiago is an associate research scientist at the University of Michigan, Dr. Villarruel is an assistant professor of family and child ecology at Michigan State University, and Dr. Leahy is an associate professor of rehabilitation counseling at Michigan State University. of identification (disability or handicap) and provide any reasons, if applicable, for not seeking assistance in relation to their personal, social, financial, vocational, and independent living needs. Responses to these questions were recorded verbatim by the interviewers, and then reviewed, sorted, and categorized to provide a qualitative analysis of responses provided by an 124 respondents.

When asked to identify the term they preferred for self-identification, 41 percent (45/110) selected the term "disability," and 46 percent (50/110) selected the term "handicap." Responses to each of these preferred terms did not vary by Latino heritage (e.g., Mexican, Puerto Rican, Cuban). Furthermore, when asked to provide definitions of disability and handicap, respondents had similar patterns of responses. As shown in Table 1, one category, labeled severity of condition," appeared to capture the majority response for both terms (55 and 64 percent, respectively). Of interest, respondents who provided definitions for these terms using severity of condition criteria appeared to be assigning a distinction in the severity between the two. For example, some felt that the term disability connoted a condition that was more severe and permanent than a handicap, while others felt just the reverse, that is, that a handicap meant something that you live with the rest of your life and disability meant you are more limited.

Table 1 Respondent Definitions of Disability and Handicap

                                            Definitions
                                 Disability             Handicap
Criteria                         N        %             N      %

Severity of Condition            46      55.2           49    63.6
Mobility or Limb Impairment       1       1.2           11    14.3
Duration or Permanency           10      11.5            7     8.0
Ability to Work                   9      11.5            6     7.8
Communication Impairment          9      10.3            1     1.3
Limitations of Cognitive Skills   9      10.3            1     1.3
Other                             1       1.2            3     3.9

   Total                         87     100.0           77   100.0

NOTE: Due to rounding errors, percent may not total 100.

The only categories where there were clearly apparent differences in definitions were the mobility and cognition areas. Here, respondents felt that mobility impairments constituted a handicapping condition, where cognitive limitations were identified as a disability rather than a handicap. It appears quite clear upon review of all of these responses that there is great variety in how people personally define these terms and what they perceive as the impact of impairment in terms of function and capacities. This again seems to underscore the need for education and outreach to these communities in order to provide assistance in dealing with the impact of disability for the individual and the family.

Disability Status: Self-reports v.

Program Measures

Although all of our respondents reported some type of health condition that limited their daily activity, approximately 54 percent indicated that their health condition prevented them from going to work, school, or doing housework. Further, 6 out of 10 respondents stated that their condition limited social and recreational activities. Yet, only 65 patient considered themselves to be disabled (see Table 2). Of interest, when asked if other Latinos would consider the respondents to have disabilities, a slightly smaller percentage (61 percent) indicated that other Latinos would identify them in that way. Identification from outside the community was less certain: About 57 percent of the respondents thought that non-latinos would consider them to be disabled.

Table 2 Self-Reports v. MRS Indicators of Disability Status

Self-Reports of Disability Status                       N      % of Total

Consider yourself disabled                              81        65.3
Other Latinos consider you disabled                     75        60.5
Non-Latinos consider you disabled                       71        57.3

Self-Perceptions of Severity of Disability Status
Consider self to be slightly disabled                   26        22.0
Consider self to be mildly disabled                     42        33.9
Consider self to be severely disabled                   46        37.1

MRS Disability Criteria
Cannot work 6 or more hours                             52        41.9
Cannot climb 1 flight of stairs                         49        39.5
Cannot walk 100 yards without pausing                   38        30.7
Cannot button buttons                                   15        12.1
Cannot wind watch                                       13        10.5
Cannot write with pen or pencil                         15        12.1
Cannot use mass transit                                 33        22.6
Severely disabled according to MRS criteria             68        55.7

According to the MRS criteria used for determining the severity of the disability, approximately 56 percent of the respondents would have been classified as severely disabled. Yet, only 37 percent of the respondents indicated that they considered themselves to be severely disabled. This suggests that there is a significant difference in how Latinos view the severity of their conditions relative to official definitions. Thus, it may very well be that respondents are not seeking and using services partially because they do not consider themselves to be severely disabled or eligible for services.

Patterns of Service Utilization

Relatively few Latino adults with disabilities were receiving rehabilitation services from the Michigan Rehabilitation Services, the public rehabilitation program and the primary agency providing these types of services in the state. Only 18 percent of the respondents reported that they were MRS clients at the time of the interview -- a proportion that seems to mirror national patterns of limited service utilization by Latinos. Another 18 percent indicated that they had been former clients of MRS but were not currently receiving service. Unfortunately, the survey instrument did not include followup questions regarding the reasons for closure. When asked if they received services from other agencies, 34 percent of the respondents stated that they were obtaining other types of services. These included services from local community-based agencies offering services targeted to the Latino community; governmental agencies (e.g., Department of Social Services); private agencies (e.g., Catholic Social Services); and local churches, food banks/shelters, or places of employment.

Perceived Barriers to Services

Respondents were asked to identify their reasons for not seeking assistance. Table 3 provides a summary of the reasons given by respondents. Clearly a significant barrier reflects the belief that these services are neither needed nor desired: 27 percent of the respondents indicated that services were not necessary. Further, there was a degree of skepticism regarding how useful these services would be. This feeling was captured by one respondent who states "No necesito ayuda. Remedios solo son temporeros (I don't need help. Remedies are only temporary)."

Table 3 Reasons for Not Seeking Rehabilitation Services

Reason                                             N      % of Total

Does not want or feel need for service             24        26.4
Family disapproval                                 20        22.0
Relative / friends disapproval                    16        17.6
Cost of services                                    8         8.8
Limited English proficiency                         5         5.5
Lack of transportation                              5         5.5
Does not know where to go                           3         3.3
Other                                              10        11.0

N = 91.

The disapproval of family members or friends was identified by 22 percent of the respondents as a significant deterrent to seeking professional assistance. As one respondent succinctly stated, "I'm scared to tell anyone what is wrong with me." Another reported, "I'm interested in getting help as long as I could be sure my family wouldn't find out." The help-seeking behaviors of Latinos with disabilities in part reflects individual perceptions of what constitutes culturally acceptable channels for resolving Problems within the family. "(The) family tries to help first. Extended family is next. If we can't do it, which is rare, then we forget it. We don't want outsiders." Indeed, two-thirds of the respondents reported that relatives or friends provided the most help for meeting their needs. This is partially attributable to the limited financial resources and services available within the Latino community. "(The) Hispanic community doesn't have money. Not enough resources in the Hispanic community. There is only one Hispanic treatment center and too many people go there."

Yet, the reliance on informal support networks from within the family unit or larger Latino community transcends financial considerations. As one respondent noted, "I would never do that -- ask white people for help. I'd feel embarrassed." The use of outsiders was viewed by some to be" ... an admission that something is wrong." Another respondent highlighted perceptions of how the Latino client is received within the larger community:" ... when I was a kid, I was not welcomed in the (white) community."

Past research (Cuellar & Arnold, 1983; Wilson, 1986) has documented the importance of group attitudes regarding the use of government or other community resources on help-seeking behaviors. If Latinos are socialized into believing that there is something wrong with them or their families if they cannot meet their family needs and that the majority community will not welcome them or would treat them badly, it is no wonder that they are reluctant to look beyond the confines of existing informal support networks. Therefore, it is clear that client perceptions of how they will be treated both inside and outside the community are still important considerations that must be addressed by service delivery agents attempting to provide service to Latinos with disabilities.

Limited accessibility in terms of cost, transportation, knowledge about services, and availability of bilingual services, were reported as barriers by nearly one-quarter of the respondents. In the survey, 9 percent of the respondents mentioned cost of services as a deterrent. As one respondent mentioned, "If the doctor doesn't take insurance, you may not wish to try another." The lack of transportation to and from services was also a factor reported by 6 percent of the respondents. As one respondent described, "If she had to go by herself, she couldn't get there because she can't drive." Access can also be hampered by a lack of knowledge regarding the availability of existing services. Several respondents simply stated, "I don't know where to look for help."

The limited availability of bilingual/bicultural services hindered about 6 percent of Spanish-dominant respondents from seeking service, highlighting the continued importance of Spanish speaking staff to provide a bridge between clients and service providers. Previous studies have documented the ongoing need for bilingual/bicultural direct service staff as well as sensitivity training for English speaking staff in order to better understand client needs and concerns (Medina, et al., 1988; Ubarry & Santiago, 1988).

Factors Mitigating Participation

in Rehabilitation Services

In a multivariate analysis summarized here, we examine how participation in rehabilitation services was affected by factors such as geographic accessibility, the severity of disability, the existence of alternative belief and support networks, and respondent characteristics.(3) This analysis reveals that differences in the demographic characteristics of respondents and cultural factors were significant predictors of the receipt of rehabilitative services. The odds of receiving services were about 86 percent lower for Puerto Ricans relative to Mexican respondents. Further, respondents who had higher levels of educational attainment also had higher odds of service receipt. Respondents who were high school graduates had 4 times higher odds of receiving MRS services than respondents with less than high school degrees. There was also a significant age effect: younger adults were more likely than older adults to receive services. For each additional year in age, the odds of receiving rehabilitative services declined by 7 percent.

Cultural belief systems significantly impacted the receipt of rehabilitation services although not in the expected manner. Respondents who indicated having strong cultural beliefs that would limit service utilization had 10 times greater odds of receiving services than those who did not indicate cultural limits to service utilization. Thus, although a fraction of our respondents indicate that they reside in families with strong cultural values discouraging the use of outside help, these beliefs were not enough to prevent the use of services. This would suggest that although these beliefs may be strong, respondents may not be in a position to adhere to them. In other words, Latinos may state a preference to seek help from within their informal support networks or alternatively from community-based organizations, but the severity of the disabling condition or the lack of resources within the Latino community will compromise these beliefs.

Discussion

The purpose of this study was to investigate how the support systems available to Latinos with disabling conditions affect their utilization of rehabilitation or other services. Several observations can be made from the findings of this study which have direct implications for rehabilitation service providers and other related health professionals. First, relatively few Latino adults with disabilities in the sample were actively receiving rehabilitation services at the time of the study. In fact, only 18 percent were served by the public rehabilitation program in 1991. An additional 18 percent indicated they had formerly received vocational rehabilitation services from the state agency, and approximately 34 percent of the sample were currently receiving various support services from other community agencies. When considering the general characteristics of this sample, these utilization rates take on great importance. Clearly, a gap between service utilization and the need for services exists for Latino adults with disabilities in this sample.

While this pattern of underutilization may be perceived as somewhat surprising, it is similar to findings reported in previous research. Anderson, Zelman, Giacnello, Aday, and Chiu (1981), for example, reported that even when adjusted for medical need, Mexican Americans were less likely to visit doctors and to have preventive health examinations than non-Mexican Americans. Similar patterns of underutilization of health facilities for Puerto Ricans and low-income patients in New York have been reported by Alers (1978).

In order to probe those factors contributing to this gap in service utilization, the patterns and determinants of service utilization were also examined. Age of respondent, educational attainment, Latino heritage, and cultural limitations were found to be the most significant predictors of service utilization by Latinos with disabilities. Increasing age and being Puerto Rican were associated with lower odds of receiving vocational rehabilitation services. Conversely, those individuals with disabilities who have higher skill levels were more likely to receive rehabilitation services. Ironically, individuals that indicated cultural belief systems limiting the use of outside services had higher odds of receiving services than those who did not have these restrictions.

It is important to note, however, that the patterns of underutilization noted within this investigation may in fact be related to self-perceptions and levels of acceptance of the severity of the particular handicapping condition. Specifically, only 37 percent of the 124 respondents in this investigation viewed themselves as having a severe disabling condition. Yet, when the information from the MRS screener was reviewed, 56 percent of these persons were considered to have a severe disabling condition. As previously mentioned, one possible explanation for the differing interpretations may he in the fact that the term disability" covers a broad range of physical and mental impairments.

Unfortunately, the pattern of underutilization noted herein indicates that, despite efforts, characteristics of Latino social life and subcultural values continue to deter professional services for Latinos. Information provided in previous research suggests that several factors, which are possibly related to the underutilization of services, are subsumed under the categories of cultural support systems (i.e., as characteristics of Latino social life and subcultural values that make professional services unattractive to Latinos), as well as institutional factors, such as the characteristics of agencies and of the social welfare system that discourage Latinos from using these services. As evidenced within the current investigation, however, it is clear the issue is not one or the other but, rather, a combination of both factors.

In terms of implications for service providers, these data would support the need for creative outreach efforts within the Latino community in order to enhance service utilization by adults with disabilities, particularly those who are least likely to be aware of and to independently pursue available services. The notion that service utilization is significantly affected by the cultural beliefs and values of the Latino community was supported in this study although the relationship was not what was expected. As the literature has consistently indicated over the past decade, cultural factors may indeed have an important impact on the client's rehabilitation process if not on utilization directly once services have commenced. Responding to these issues, the field of rehabilitation has generally agreed on the importance of rehabilitation counselors and the service delivery system to be aware and sensitive to the client's cultural and family background in the selection of service and intervention efforts that enhance rehabilitation outcomes for this population. In this regard, more emphasis has been placed in recent years on attracting bilingual and culturally sensitive counselors into the system to provide needed services. However, in addition to these critical needs, the findings of this study underscore the importance of developing mechanisms to educate the Latino community about the nature, extent, benefits, and availability of rehabilitation services as well as to design outreach efforts efforts that enhance accessibility to these services in order to increase the participation of Latino adults with disabilities in the rehabilitation process.

Bibliography

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Please direct correspondence to Anna M. Santiago, University of Michigan, Population Studies Center, 1225 S. University Avenue, Ann Arbor, MI 48104-2590.

Earlier versions of this paper were presented at the Fourth Annual Conference on Latino Issues, Detroit, MI, November 1991, and at the NICHD Workshop on Ethnically and Diverse Families with Retarded, Developmentally Disabled and Physically Disabled Members, Bethesda, MD, April 13-16, 1992. This research was partially supported by a College of Education Research Initiation grant and by an All-University Research Initiation grant from Michigan State University whose support is gratefully acknowledged. Additional support for this project was provided through an NICHD postdoctoral fellowship at the Population Studies Center, University of Michigan; the Institute for Children, Youth, and Families; the Julian Samora Research Institute; the Department of Counseling, Educational Psychology, and Special Education at Michigan State University and through a grant from the W K. Kellogg Foundation. The authors would like to thank our Detroit, Grand Rapids, and Lansing interviewing teams for their assistance in data collection; Laura Counts and Alissa Friedman-Torres for research assistance on this project; and Debbie Johnson and Donna Satterlee who provided clerical assistance. Special thanks to Nan Johnson, Richard M. Lerner, and the anonymous reviewers for their comments and suggestions on earlier drafts of this manuscript. We are also indebted to the Michigan Rehabilitation Service for granting us the permission to utilize their disability checklist and screener.

Notes

(1.) Copies of the survey instrument, disability checklist, and MRS screener utilized in this study are available from the authors upon request. All instruments were initially developed in English and then translated into Spanish. In order to assure that the items were conceptually and structurally equivalent, the Spanish instrument was then translated back into English. Both instruments were pretested with small, nonrandom samples of Latino individuals with disabilities.

(2.) The decision to exclude psychological problems from the checklist was predicated on the assumption that helpseeking behavior would be vastly different for the two broad types of disabling conditions. We suspected that Latinos would be less reluctant to seek help for physical conditions than they would for psychological problems because of the stigma attached to the latter. Further, we believed that it was important to devote attention to physical conditions since the limited research on Latinos has tended to focus almost exclusively on psychological problems.

(3.) A detailed description and results from this analysis are available upon request from the authors.