Providing Culturally Sensitive Services

by Richard Bermack

Dec. 2001

Alameda County Social Worker Yi Cheng (right, facing camera) works with Asian Community Mental Health Services Family Counselor Dorothea Ho (left) to provide culturally sensitive services in the family’s native dialect.

Imagine moving to a foreign country where you don’t speak the language, and your child gets hurt playing with another child. The injury doesn’t seem major, so you go to a traditional doctor, who treats it with herbs. When the injury doesn’t seem to be getting better, you take the child to a hospital. The doctors want to know why you didn’t get the child appropriate medical aid sooner. When you are unable to explain because of the language barrier, they become very upset. You are accused of being medically neglectful, and children’s protective services is called in.

The authorities want to know how the child got injured. And because they don’t speak your language, they use an AT&T translator over the telephone. It is very hard to communicate through a translator over the phone. You have no idea how the child was hurt. She was playing. Children get hurt playing. You become frustrated with them, and they become frustrated with you. They threaten to take your child away. You go into shock. You become hysterical and break down crying, which just convinces the authorities that you are not a fit parent.

Fortunately in this case Alameda County was able to refer the Chinese family to social worker Yi Cheng. When Cheng got the case, the child had been placed with one of the family’s relatives. Social workers had first tried to provide voluntary services, so the child wouldn’t have to be removed from the parents’ home, but a worker had described the parents as uncooperative and the mother as mentally unstable. After working with the family, Cheng found it was all a matter of communication. And the parents, who were first assessed in very negative terms, turned out to be model clients and model parents.
Cheng understands what immigrant parents are going through. She emigrated from China when she was 31. She is now in her mid-40s and has a teenage son. These facts may not seem important to mainstream clients, but they are very important to many of her Asian clients. “Chinese people will ask you how old you are, unlike people from this culture, who would think it is rude to ask a woman her age. Age is very important—that I am older and have raised a child. If I didn’t have that experience they would think that what I was telling them was useless,” she explains. They would be offended that a younger social worker who wasn’t a parent would have any right to tell them how to raise their child. But that was only one of many complex cultural issues.
Even though Cheng is Chinese, language was still a barrier. Cheng’s primary dialect is Mandarin and the parents’ primary dialect is Cantonese. According to Cheng, there are nearly 10,000 Chinese dialects. She also gets clients who are Vietnamese, Cambodian, Laotian, and Filipino, to name a few other nationalities.

Dorothea Ho, Asian Community Mental Health Services

Cheng brought in Asian Community Mental Health Services. The community agency provides comprehensive services in over 20 different Asian languages. Working together, Cheng and Cantonese- speaking Asian Mental Health family counselor Dorothea Ho were able to get through to the family and piece together what happened.
The two daughters were playing when the older one pushed the younger one, who fell and broke her arm. The parents didn’t realize the arm was broken until they took the child to the hospital and the arm was x-rayed. However, hospital personnel felt that because the family didn’t speak English and had failed to respond to the injury correctly, the child was at risk of medical neglect. Ho speculates that the AT&T translation was inadequate and led to even deeper misunderstandings, creating complications with the case. “A lot of times the translator will translate exactly what the parents say to the worker and the worker will put it down exactly, and peoples’ emotional reactions and gestures are lost,” Ho says.

What happened next is not uncommon, according to Cheng. “It is very difficult to get an accurate translation, and sometimes when Asian immigrants come to the system they get frustrated and very emotional. They don’t know how to act appropriately, and the mainstream may interpret their behavior as either psychotic or non-cooperative, and basically describe them as crazy.”

“We had to deal with a lot of trust issues. In the beginning the parents were defensive, not wanting to get involved,” Ho recalls. Although most parents are reluctant to have a government agency involved in their personal lives, that is particularly true of immigrants, especially those who came from countries with more authoritarian governments.
The first breakthrough came when Cheng found a school for the older child to attend. At that point the parents started to accept that the social workers were there to help.

Parenting classes were the next breakthrough. Ho recalls, “When they started going to parenting classes, they began to open. They started talking about where they came from in China, and slowly the feeling changed from us being strangers from an agency to friends.”
For many people, there is a lot of confusion about accepting a therapeutic relationship, relating very personal feelings to a stranger whose only interest in them is professional. Many people in our society have come to accept this relationship, and may even have an easier time confiding in someone whose only relationship with them is professional. However, for many immigrants from traditional societies, that type of relationship may seem unnatural.

Cheng explains, “I have had clients say to me, ‘Why do I have to tell this lady every week about my problems? Most of the time she just smiles and says nothing. Why do I have to tell her my private business?’ It is a very western approach and not in their culture.” And if the therapist isn’t fluent in the client’s language, the problems are magnified.

For many of these clients, parenting classes can make all the difference. These clients may feel much more comfortable in a peer-to-peer setting, where they can have more control. It may also be more reminiscent of a village/community, where parents might traditionally go to their older siblings or elders for advice, rather than to government officials.

“The family became very involved in the parenting curriculum,” Ho says.“They would come to class early and actively take part in discussions by sharing their experiences and asking questions.” What particularly impressed Ho was their kindness to the other parents. As they became more comfortable, they even began bringing food to share with the class.

The complexity of the issues confronting immigrants is reflected in the parenting classes. The classes cover everything from the stages in childhood development to cultural differences in schooling and what to expect from the education system. The classes address racism, including both the immigrants’ attitude towards people of other ethnic groups and how to respond when someone makes a racial slur toward them. The parents are given advice on how to differentiate between good and bad American cultural influences and how to help their kids when they get in trouble.

Once the parents realized what the agency had to offer, they went from resisting to actively making use of all the services they could. Not only did they regularly attend family therapy with the daughter who was in the system, but they brought their other daughter to therapy as well.

In the end the parents were very cooperative. The Dragon asked the father to comment on the family’s experience. Ho translated: “We are really thankful for all the help. It was surprising to us to have CPS involved because we thought that having two children playing together and having an injury would be pretty normal. When the children were taken away, the older one was really traumatized. Once they got back together with the family, she got better and the family grew closer together. Mrs. Cheng and Miss Ho were very helpful all along the way, with the legal issues and with home visits, making sure everything was okay.”