ABSTRACT
In the face of harmful disparities and inequities, it is crucial for researchers to critically reflect on methodologies and research practices that can dismantle systems of oppression, accommodate pluralistic realities, and facilitate opportunities for all communities to thrive. Historically, knowledge production for the sciences has followed a colonial and colonizing approach that continues to silence and decontextualize the lived experiences of people of color. This article acknowledges the harm to people of color communities in the name of research and draws from decolonial and liberation frameworks to advance research practices and psychological science toward equity and social justice. In this article, we propose a lens rooted in decolonial and liberatory principles that researchers can use to rethink and guide their scientific endeavors and collaborations toward more ethical, equitable, inclusive, respectful, and pluralistic research practices. The proposed lens draws on literature from community psychology and our lessons learned from field studies with historically marginalized Latinx communities to highlight six interrelated tensions that are important to address in psychological research from a decolonizing and liberatory lens. These interrelated tensions involve conflicting issues of (a) power, (b) competence, (c) practices and theories, (d) rationale, (e) approach, and (f) trust. In addition, seven practical recommendations and examples for decolonial and liberatory research practices are outlined. The recommendations can assist researchers in identifying ways to ameliorate and address the interrelated tensions to give way to decolonial and liberatory research practices. Community and social justice scientists have the responsibility to decommission oppressive research practices and engage in decolonization and liberation toward a valid, ethical, equitable, and inclusive psychological science. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
ABSTRACT
Latinx individuals are the largest ethnic minoritized group in the United States (US) at 19% of the population. However, they remain underrepresented in clinical research, accounting for less than 8% of clinical trial participants. Consideration of cultural values could help overcome barriers to inclusion in clinical trials and result in better recruitment and retention of Latinx individuals. In this commentary, we describe general guidance on culturally responsive modifications to facilitate the successful recruitment and retention of Spanish-speaking Latinx participants in Randomized Clinical Trials (RCTs) for substance use. We identify five culturally responsive strategies to help enroll participants in RCTs: 1. Create an ethnically diverse research team, 2. Assess available community partners, 3. Familiarize oneself with the target community, 4. Establish confianza (trust) with participants, and 5. Remain visible to participants and staff from recruitment sites. Representation of Latinx individuals in clinical trials is essential to ensure treatments are responsive to their needs and equitydriven. Some of these strategies can further research in helping to promote the participation of Latinx individuals experiencing substance use concerns, including outreach to those not seeking treatment.
Subject(s)
Hispanic or Latino , Patient Selection , Substance-Related Disorders , Adult , Humans , Substance-Related Disorders/therapy , United States , Randomized Controlled Trials as TopicABSTRACT
Psychologists are positioned to help address societal and public health crises in beneficial ways, including collectively working with public sectors to serve marginalized communities. This article highlights the relevance of helping to address societal and public health crises with collectivistic psychological leadership approaches and uses Latinx psychology leaders for addressing the current immigrant needs among Latinx communities. We draw attention to the domains needed for collectivistic psychological leadership that are culturally nuanced and equity, diversity, and inclusion-focused to advance the well-being of historically marginalized immigrant communities. Finally, the article highlights how our collectivistic approach operates in the public sector by describing the creation of the Latinx Immigrant Health Alliance (LIHA) and targeted outcomes. Briefly, the LIHA informally started in 2017 and was founded in 2020 to fill a gap in Latinx immigrant health at the heart of systemic inequalities during the global pandemic, explicit anti-immigrant rhetoric, and anti-Latinx policies. The LIHA aims to collectively work with community organizations to promote Latinx immigration health research, policy, education, training, and effective interventions. We include future directions and opportunities for collectivistic psychological leadership to address today's complex social issues. In particular, we call for the translation of psychological methods and other skills (e.g., research, clinical skills, policy, quantitative and qualitative methodology) into public action for better wellness of our communities, as well as the advancement of social justice, health equity, and inclusion for historically marginalized communities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
ABSTRACT
Within the United States (U.S.), the COVID-19 pandemic highlighted critical inequalities affecting undocumented communities and resulting in particularly heightened stress for members of these communities. In addition to the stress associated to COVID-19, immigrants in the U.S. were more than ever subjected to a hostile anti-immigrant climate under Trump's administration. Given this compounded stress, the impact of the pandemic on mental health is likely to be disproportionately experienced by undocumented immigrants. In response, a group of psychologists partnered with a leading immigrant rights advocacy organization and formed a reciprocal collaboration to support undocumented communities. A major focus of the collaboration is to foster learning, supporting members of the immigrant community to contribute to their own well-being and others in the community. Accordingly, the collaborative developed and delivered a web-based mental health education session to the immigrant community and to practitioners serving this population. The session presented the use of healing circles as a strength-based approach to building resilience and also sought feedback regarding specific features of healing circles that can enhance their effectiveness in managing distress. Survey data and qualitative findings from this study show that those who participated in the web-based program perceived the session as validating and informative. Findings also underscored the need for creating safe spaces for community members to be vulnerable about their lived experiences while promoting ownership of their narratives. We discuss practical implications pertaining to the development and facilitation of social support groups for immigrants led by non-specialist community members trained for this role.
Dentro de los Estados Unidos (EE. UU.), la pandemia de COVID-19 acentuó desigualdades críticas que afectan a las comunidades indocumentadas, provocando un nivel de estrés particularmente alto entre los miembros de estas comunidades. Además del estrés asociado con el COVID-19, los inmigrantes en los EE. UU. estuvieron más que nunca sujetos a un clima antiinmigrante y hostil bajo la administración de Trump. Dado este estrés agravado, es probable que los inmigrantes indocumentados experimenten el impacto de la pandemia en su salud mental de manera desproporcionada. En respuesta, un grupo de psicólogos se unió a una organización líder en defensa de los derechos de los inmigrantes y formó una colaboración recíproca para apoyar a las comunidades indocumentadas. Un enfoque central de esta colaboración ha sido fomentar el aprendizaje, apoyando así a los miembros de la comunidad inmigrante para que contribuyan a su propio bienestar y al de los demás en la comunidad. Por consiguiente y a través de esta colaboración, se desarrolló y presentó una sesión de educación en línea sobre salud mental a la comunidad de inmigrantes, así como a los profesionales que sirven a esta comunidad. La sesión presentó el uso de círculos curativos como una estrategia basada en las capacidades para desarrollar la resiliencia y buscó también obtener retroalimentación sobre características específicas de estos círculos que puedan aumentar su efectividad en el manejo de la angustia. Los hallazgos de la encuesta y cualitativos de este estudio muestran que los participantes percibieron la sesión como validante e informativa. Los hallazgos también destacaron la necesidad de crear espacios seguros para que los miembros de la comunidad puedan ser vulnerables sobre sus experiencias vividas mientras se promueve la propiedad de sus narrativas. Discutimos las implicaciones prácticas relacionadas al desarrollo y la facilitación de grupos de apoyo social para inmigrantes dirigidos por miembros de la comunidad capacitados para asumir dicho rol.
ABSTRACT
BACKGROUND: Alcohol use disorder (AUD) commonly causes hospitalization, particularly for individuals disproportionately impacted by structural racism and other forms of marginalization. The optimal approach for engaging hospitalized patients with AUD in treatment post-hospital discharge is unknown. We describe the rationale, aims, and protocol for Project ENHANCE (ENhancing Hospital-initiated Alcohol TreatmeNt to InCrease Engagement), a clinical trial testing increasingly intensive approaches using a hybrid type 1 effectiveness-implementation approach. METHODS: We are randomizing English and/or Spanish-speaking individuals with untreated AUD (n = 450) from a large, urban, academic hospital in New Haven, CT to: (1) Brief Negotiation Interview (with referral and telephone booster) alone (BNI), (2) BNI plus facilitated initiation of medications for alcohol use disorder (BNI + MAUD), or (3) BNI + MAUD + initiation of computer-based training for cognitive behavioral therapy (CBT4CBT, BNI + MAUD + CBT4CBT). Interventions are delivered by Health Promotion Advocates. The primary outcome is AUD treatment engagement 34 days post-hospital discharge. Secondary outcomes include AUD treatment engagement 90 days post-discharge and changes in self-reported alcohol use and phosphatidylethanol. Exploratory outcomes include health care utilization. We will explore whether the effectiveness of the interventions on AUD treatment engagement and alcohol use outcomes differ across and within racialized and ethnic groups, consistent with disproportionate impacts of AUD. Lastly, we will conduct an implementation-focused process evaluation, including individual-level collection and statistical comparisons between the three conditions of costs to providers and to patients, cost-effectiveness indices (effectiveness/cost ratios), and cost-benefit indices (benefit/cost ratios, net benefit [benefits minus costs). Graphs of individual- and group-level effectiveness x cost, and benefits x costs, will portray relationships between costs and effectiveness and between costs and benefits for the three conditions, in a manner that community representatives also should be able to understand and use. CONCLUSIONS: Project ENHANCE is expected to generate novel findings to inform future hospital-based efforts to promote AUD treatment engagement among diverse patient populations, including those most impacted by AUD. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT05338151.
Subject(s)
Alcoholism , Crisis Intervention , Humans , Alcoholism/therapy , Aftercare , Patient Discharge , Ethanol , Hospitalization , Randomized Controlled Trials as TopicABSTRACT
The mental health burden associated with anti-immigrant rhetoric and ever-changing immigration policies is undeniable, though the psychological and emotional sequalae may remain invisible for years to come. Exclusionary immigration policies, as a form of structural racism, have also led to an epidemic of stress-related health within the Latinx community, particularly the Latinx immigrant community, across the United States. Recent examples of anti-Latinx and anti-immigrant rhetoric and policies include the 45th President's implementation of the Zero Tolerance policy, Migrant Protection Protocols, and Title 42. The recognition of previous and existing anti-immigrant policies, and the impact on Latinx immigrants, is critical in understanding the manifestation of psychological stress to prevent it from becoming chronic. For mental health providers, attention to existing policies that can be detrimental to the Latinx immigrant community is essential to understanding their mental health trajectory and applying frameworks that honor an individual's psychological stress to prevent pathologizing the immigrant experience and negative health outcomes. The objective of the present brief review is to shed light on recent research and offer recommendations for practice (eg, educating the Latinx community about the link between the immigrant experience and psychological stress) and policy (eg, drafting of legislation aimed at rescinding harmful immigration policies) regarding the relation between aggressive anti-immigration rhetoric and psychological stress among Latinx immigrants in the United States.
ABSTRACT
BACKGROUND: Contingency management (CM) is an evidence-based approach for reducing alcohol use; however, its implementation into routine HIV primary care-based settings has been limited. We evaluated perspectives on implementing CM to address unhealthy alcohol use and associated conditions for people with HIV in primary care settings. METHODS: From May 2021 to August 2021, we conducted two focus groups with staff involved in delivering the intervention (n = 5 Social Workers and n = 4 Research Coordinators) and individual interviews (n = 13) with a subset of participants involved in the multi-site Financial Incentives, Randomization, and Stepped Treatment (FIRST) trial. Qualitative data collection and analyses were informed by the Promoting Action on Research Implementation in Health Service (PARIHS) implementation science framework, including evidence (perception of CM), context (HIV primary care clinic and CM procedures), and facilitation (feasibility outside the research setting). RESULTS: Several major themes were identified. Regarding the evidence, participants lacked prior experience with CM, but the intervention was well received and, by some, perceived to lead to lasting behavior change. Regarding the clinical context for the reward schedule, the use of biochemical testing, specifically fingerstick phosphatidylethanol testing, and the reward process were perceived to be engaging and gratifying for both staff and patients. Participants indicated that the intervention was enhanced by its co-location within the HIV clinic. Regarding facilitation, participants suggested addressing the intervention's feasibility for non-research use, simplifying the reward structure, and rewarding non-abstinence in alcohol use. CONCLUSIONS: Among patients and staff involved in a clinical trial, CM was viewed as a helpful, positive, and feasible approach to addressing unhealthy alcohol use and related conditions. To enhance implementation, future efforts may consider simplified approaches to the reward structure and expanding rewards to non-abstinent reductions in alcohol consumption.
ABSTRACT
BACKGROUND: Although unhealthy alcohol use is associated with increased morbidity and mortality among people with HIV (PWH), many are ambivalent about engaging in treatment and experience variable responses to treatment. We describe the rationale, aims, and study design for the Financial Incentives, Randomization, with Stepped Treatment (FIRST) Trial, a multi-site randomized controlled efficacy trial. METHODS: PWH in care recruited from clinics across the United States who reported unhealthy alcohol use, had a phosphatidylethanol (PEth) >20 ng/mL, and were not engaged in formal alcohol treatment were randomized to integrated contingency management with stepped care versus treatment as usual. The intervention involved two steps; Step 1: Contingency management (n = 5 sessions) with potential rewards based on 1) short-term abstinence; 2) longer-term abstinence; and 3) completion of healthy activities to promote progress in addressing alcohol consumption or conditions potentially impacted by alcohol; Step 2: Addiction physician management (n = 6 sessions) plus motivational enhancement therapy (n = 4 sessions). Participants' treatment was stepped up at week 12 if they lacked evidence of longer-term abstinence. Primary outcome was abstinence at week 24. Secondary outcomes included alcohol consumption (assessed by TLFB and PEth) and the Veterans Aging Cohort Study (VACS) Index 2.0 scores; exploratory outcomes included progress in addressing medical conditions potentially impacted by alcohol. Protocol adaptations due to the COVID-19 pandemic are described. CONCLUSIONS: The FIRST Trial is anticipated to yield insights on the feasibility and preliminary efficacy of integrated contingency management with stepped care to address unhealthy alcohol use among PWH. CLINICALTRIALS: gov identifier: NCT03089320.
Subject(s)
COVID-19 , HIV Infections , Humans , Cohort Studies , Pandemics , COVID-19/complications , Alcohol Drinking/epidemiology , Alcohol Drinking/therapy , HIV Infections/therapy , HIV Infections/complications , Randomized Controlled Trials as TopicABSTRACT
INTRODUCTION: Cow epithelium allergy (CEA) has been described in workers highly exposed to cattle, such as farmers and veterinarians, being a health problem in this population since it is their main livelihood. This study aimed to characterize the main clinical manifestations and define the sensitization profile of the cow epithelium-allergic population treated in our health area. METHODS: This is a retrospective study including a total of 34 patients with a clinical diagnosis of CEA, confirmed by skin tests, bovine epithelium-specific IgE levels and allergen-specific conjunctival challenge test in some cases. They were distributed by age, sex, profession, clinical symptoms, specific IgE levels to other mammalian epithelia, pollens, mites, and foods. Immunoblotting was performed with extracts from cow dander, cow body fluids (urine and saliva), bull urine, and 17 sera from immunotherapy-untreated CEA patients. RESULTS: The mean age of the patients was 44 years, with a higher incidence in cattle farmers. Rhinoconjunctivitis occurred in 100% of cases, with 35% having monosensitization to cow epithelium. Sera from most patients detected a 20-kDa IgE-binding band in cow dander, cow saliva, cow urine, and bull urine, corresponding to the major allergen Bos d 2 (bovine lipocalin). In 70% of the patients, a 25-kDa band was detected in cow and bull urine extracts, whose identification by mass spectrometry and investigation with protein databases led to the identification of a Bos taurus lipocalin (UniProt protein ID: A0A3Q1LGU7_BOVIN). CONCLUSION: CEA should be considered in patients exposed to cattle and as a cause of occupational disease. The IgE immunodetection revealed sensitization to a protein present in cow and bull urine (odorant-binding protein) not previously described.
Subject(s)
Allergens , Hypersensitivity , Female , Cattle , Animals , Male , Allergens/adverse effects , Retrospective Studies , Skin Tests , Epithelium/chemistry , Immunoglobulin E , Lipocalins , MammalsABSTRACT
BACKGROUND: HIV disproportionally affects persons who inject drugs (PWID), but engagement with HIV pre-exposure prophylaxis (PrEP) is low. We describe the rationale and study design for a new study, "Contingency Management and Pre-Exposure Prophylaxis (PrEP) Adherence Support Services (CoMPASS)," a hybrid type 1 effectiveness-implementation trial to promote HIV risk reduction among PWID. METHODS: In four community-based programs in the northeastern United States, PrEP-eligible PWID (target n = 526) are randomized to treatment as usual or Contingency Management (CM) and, as indicated, stepped up to PrEP Adherence Support Services (CoMPASS) over 24 weeks. During CM sessions, participants receive timely tangible rewards for verifiable activities demonstrating 1) PrEP initiation and adherence, and 2) engagement with medications for opioid use disorder (MOUD) and other OUD-related care. Participants who do not have high levels of biomarker-confirmed PrEP adherence at week 12 will be stepped up to receive PrEP Adherence Support Services (PASS) consisting of strengths-based case management over 12 weeks. Interventions are delivered by trained PrEP navigators, staff embedded within the respective sites. The primary outcome is sustained PrEP adherence by dried blood spot testing at 24 weeks. To inform future implementation, we are conducting implementation-focused process evaluations throughout the clinical trial. CONCLUSIONS: Results from this protocol are anticipated to yield novel findings regarding the impact and scalability of CoMPASS to promote HIV prevention among PWID in partnership with community-based organizations. http://ClinicalTrials.gov identifier: NCT04738825.
Subject(s)
Anti-HIV Agents , Drug Users , HIV Infections , Pre-Exposure Prophylaxis , Substance Abuse, Intravenous , Humans , HIV Infections/prevention & control , HIV Infections/drug therapy , Anti-HIV Agents/therapeutic use , Pre-Exposure Prophylaxis/methods , Substance Abuse, Intravenous/complications , Risk Reduction BehaviorABSTRACT
Learning collaboratives are increasingly used in behavioral health. They generally involve bringing together teams from different organizations and using experts to educate and coach the teams in quality improvement, implementing evidence-based practices, and measuring the effects. Although learning collaboratives have demonstrated some effectiveness in general health care, the evidence is less clear in behavioral health and more rigorous studies are needed. Learning collaboratives may contain a range of elements, and which elements are included in any one learning collaborative varies widely; the unique contribution of each element has not been established. This commentary seeks to clarify the concept of a learning collaborative, highlight its common elements, review evidence of its effectiveness, identify its application in behavioral health, and highlight recommendations to guide technical assistance purveyors and behavioral health providers as they employ learning collaboratives to improve behavioral health access and quality.
Subject(s)
Cooperative Behavior , Psychiatry , Humans , Quality Improvement , Evidence-Based Practice , Surveys and QuestionnairesABSTRACT
OBJECTIVE: This study examined the association between immigration legal status and distress from the announcement of the termination of the Deferred Action for Childhood Arrivals (DACA) program among individuals affected by this potentially traumatic event (PTE), along with identifying relevant risk factors. METHOD: Participants (N = 233) affected by the termination announcement provided cross-sectional self-reports on distress from the announcement that was measured using the Impact of Events Scale-Revised. RESULTS: Of the participants, 40.7% met the clinical cutoff for distress from the PTE indicative of posttraumatic stress disorder. DACA recipients had significantly higher levels of distress from the PTE compared with non-DACA undocumented immigrants and documented counterparts, χ²(2, N = 233) = 23.25, p < .001. After controlling for covariates, being a DACA recipient (OR = 4.11, 95% confidence interval [1.99, 8.50], p < .001), being male (OR = 2.06, [1.05, 4.03], p = .035), and having lower financial security (OR = .54, [.38, .75], p < .001) were significantly associated with distress. CONCLUSION: The future of DACA recipients is uncertain, which can be trauma inducing. The field of psychology needs to make space for this kind of experience as potentially traumatic. Advocacy efforts to shift immigration policies can be strengthened to alter the negative effects of the potential termination of DACA on those affected by it. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Subject(s)
Mental Health , Undocumented Immigrants , Humans , Male , Child , United States , Female , Cross-Sectional Studies , Emigration and Immigration , PolicyABSTRACT
Unaccompanied youth from the Northern Triangle countries of El Salvador, Guatemala, and Honduras represent a growing demographic in communities nationwide. This vulnerable group often presents with early childhood adversity and repeated traumas that heighten their risk for poor mental health outcomes such as depression, anxiety, and posttraumatic stress. Harsh and exclusionary policies that result in family separations, extended detention stays, and unequal access to healthcare further exacerbate suffering. For mental health providers, attention to premigration, migration, and post-migration experiences is essential to understanding the youth's mental health trajectory and applying trauma-informed interventions that maximize potential for a successful resettlement. Post-migration environments that offer opportunities for educational attainment and social engagement, promote a sense of belonging, and can enhance recovery and healing.
Subject(s)
Transients and Migrants , Adolescent , Central America , Child, Preschool , El Salvador , Humans , Mental HealthABSTRACT
There are few available culturally and linguistically adapted behavioral health interventions for substance use among Spanish-speaking adults. The authors describe the cultural adaptation of an innovative computer-based training for cognitive behavioral therapy program (CBT4CBT). Based in cognitive-behavioral skills training, CBT4CBT utilizes a telenovela to teach monolingual Spanish-speaking adults who have migrated to the United States to recognize triggers; avoid these situations; and cope more effectively with the consequences of substance use. Participants endorsed high levels of satisfaction with the program content and found the material to be easy to understand and relevant to their life experiences.
ABSTRACT
Although many studies have examined religiosity as a protective factor for substance use, few have considered its relationship to treatment outcomes among Latinx adults. Using data from 89 individuals participating in a randomized clinical trial evaluating a culturally adapted Spanish-language version of web-based cognitive behavioral therapy (CBT4CBT-Spanish) for substance use, we evaluated the relationship between religiosity, as measured by the Religious Background and Behavior questionnaire, and treatment outcomes. Overall, there were few significant correlations between religiosity scores and treatment outcomes. Past-year religiosity was positively correlated with one measure of abstinence for those randomized to CBT4CBT-Spanish, but this did not persist during a six-month follow-up period. Findings suggest that religiosity may be associated with short-term abstinence outcomes among Latinx adults receiving a culturally adapted cognitive behavioral therapy treatment. However, additional research is needed with larger and more heterogenous Latinx populations.
Subject(s)
Spiritual Therapies , Substance-Related Disorders , Adult , Humans , Religion , Spirituality , Substance-Related Disorders/psychology , Substance-Related Disorders/therapy , Treatment OutcomeABSTRACT
There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use. The authors' interpretation of the literature is that it offers compelling evidence that children and youth in the U.S. are being sent to EDs for mental health conditions at increasing rates for reasons frequently judged as clinically inappropriate. As a major health inequity, it is infrequent that such children and youth are seen in EDs by a behavioral health professional or receive evidence-based assessment or treatment, even though they are kept in EDs far longer than those seen for reasons unrelated to mental health. The rate of increase in these referrals to EDs appears much greater for African American and Latinx children and youth than White children and is increasing for the publicly insured and uninsured while decreasing for the privately insured. A comprehensive set of strategies are recommended for improving healthcare quality and health equity. A fact sheet is provided for use by advocates in pressing this agenda.
Subject(s)
Health Equity , Adolescent , Child , Emergency Service, Hospital , Humans , Medically Uninsured , Mental Health , Referral and ConsultationABSTRACT
Deferred Action for Childhood Arrivals (DACA) offers temporary administrative relief from deportation for undocumented immigrant adolescents and young adults who were brought as children to the United States. Accordingly, DACA has contributed to creating a different landscape of opportunities for this group. However, DACA has been and continues to be highly contested in the national political climate. Threats to DACA give rise to considerable anxiety, fear, and distress among its recipients, who face significant barriers to accessing mental health care services. Thus, a group of psychologists partnered with a leading immigrant rights advocacy organization and formed a reciprocal collaboration to understand and meet the mental health needs of undocumented communities. A major focus of the collaboration is to foster learning and support members of the immigrant community in contributing to their own well-being. The collaborative developed and delivered a stand-alone web-based mental health education session to DACA recipients and their families and practitioners serving this population. The session presented the use of dialectical behavioral therapy skills, three emotion regulation and four distress tolerance skills, as a strength-based approach to managing painful emotions and distress. Session content was adapted to include culturally informed examples for each skill. Quantitative and qualitative findings show that those who participated in the web-based program benefited from the education received. Findings also underscored participants' need for learning culturally sensitive coping strategies for managing stress. We provide recommendations on the delivery of culturally congruent healing interventions for immigrants with a focus on enhancing access among immigrant communities.
ABSTRACT
The topic of immigration is timely yet polarizing. By definition, to be an immigrant implies being in a state of transition and transformation. The eventual outcome is likely to be influenced by a series of contextual factors starting in the country of origin, continuing during the migration journey, and culminating in receiving communities. The authors use a fictional case example of a Central American immigrant woman to illustrate VALOR, the Spanish word for courage, as an acronym that identifies five key areas for clinical consideration in behavioral health settings: Values, Arrival in the United States, Losses, Obstacles to care, and Resources. VALOR offers guidance for a culturally informed assessment critical for mental health clinicians. Implications for culturally affirming treatment directions including advocacy, community linkage, and attention to trauma and unresolved grief are woven into the discussion.
ABSTRACT
Living under chronic uncertainty, fear, and isolation is the experience of many undocumented immigrants particularly under the recent sociopolitical climate. Yet, despite facing chronic adversity and an uncertain future, undocumented immigrants are highly resilient. This paper draws upon the clinical and research expertise of leading Latinx psychologists working with diverse undocumented communities across the United States. Qualitative data from seven focus groups with undocumented Latinxs and 15 in-depth interviews with key informants were used to complement clinical insights to identify and highlight strategies of undocumented Latinxs that promote their resilience. Overall, six primary strategies emerged including cognitive reframing, behavioral adaptability, acceptance, sociability, courage, and ancestral or cultural pride. Within each of these primary strategies, two-to-five additional facets emerged. We also identified the positive effects of the aforementioned strategies, including the fostering of meaning, purpose, and hope. Our findings are essential to address biases and stigmatization against undocumented immigrants, as well as to inform strength-based interventions and services, as well as culturally and contextually sensitive resources. Health services providers working with undocumented Latinxs can identify and build on strengths in their patients to demonstrate accurate cultural understanding and also to support resilience. (PsycInfo Database Record (c) 2022 APA, all rights reserved).