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FALL 2001INSIDE THIS ISSUE Refugee Mental Health 2 The Culture of Death and Dying 3 Calendar of Events 4 Spotlight on Excellence 5 Latino Behavioral Health Week 6 Community-Based Treatment for HIV/ AIDS 7 Page Navigation Panel 8
Volume V, Number 8 Fall 2001 COUNTY OF ORANGE HEALTH CARE AGENCY
Dr. Bernard Rappaport was a man of vision, His brilliant thoughts and quirky ideas baffled many-baffled most. But there was a method to his madness, which allowed him to make significant contributions to the County of Orange. Under his guidance, the children of Orange County received top-notch psychiatric care, clinics were built with the blessing of the local communities, and attention was paid to the importance of culture in treatment. Dr. Rappaport was a man who touched the lives of many. He had the uncanny ability to connect with complete strangers and offer them life-changing advice. It is this type of dedication to his profession that made him the person that he was. He was a man who loved dogs. Dogs had such a profound impact on him that he used his experiences with them to teach others about life. His love and respect for these animals was the foundation for de-fining his relationships. He stated once, "Linda (his wife) and I have learned that when one provides a consistent and organized way of interacting, a supportive, Dr. Bernard Rappaport…. Farewell loving milieu for an animal, that the animal becomes a true, real member of the family." Dr. Rappaport loved his wife Linda more than life itself. His extraordinary dedication and devotion could be seen throughout their forty some years of marriage. Born in New Jersey, Dr. Rappaport received his M. D. from Case-Western Reserve University, Ohio. As a new physician, he served in the Air Force, as a Captain, and was the acting Head of the Psychiatry Department at Sheppard Air Force Base in Texas. He went on to be-come the Superintendent of Wichita Falls State Hospital in Texas, where he single-handedly integrated a traditional medical facility at a time when segregation was the norm. He and his wife Linda came to Southern California, where he became the Director of Children and Youth Services for the County of Orange. He developed many innovative programs that continue to be ahead of their time. Dr. Rappaport passed away on July 14, 2001. He is survived by his wife Linda, and their "daughter," Jocasta, affectionately known as Josie. Cultural 1 PAGE 2 CulturalI n 1999, the United Nations High Commissioner for Refugees estimated the worldwide population of refugees and asylum seekers to be 12.9 million. This number does not include the millions of people displaced within their own countries. The United States government established a ceiling of 80,000 refugees for FY 2001 with the majority of allocations going to African and European regions of the world. Southern California received some 8,000 refu-gees and Orange County received some 1,000. Although the Department of State has developed an orientation pro-gram, which includes a guidebook called "Welcome to the United States," cultural orientation is a far more complex issue. When you add to this the traumatic experiences that led to their refugee status, i. e., war, persecution, re-education camps and other human atrocities, it is no wonder that refugees arriving in Orange County may have difficulty adjusting to life in a new land. As clinicians, a complete assessment can begin to bring to focus any refugee mental health issues. "I al-ways ask ethnicity, primary language, where my patient was born… but I have never asked how my patient came to the U. S." Immigration/ migration assessment is as important an issue for clients as any other. There is an extensive body of research that makes the connection between migration and psycho-pathology (Odegaard, 1932). There are increased rates of psychopathology in voluntary migrants (Malzberg, 1967). Although there are varying characteristics among refugees, the experience of being a refugee itself has unique characteristics that follow a predictable pattern of behavior across all ethnic groups (William, 1985). Murphy was the first to report high rates of serious psychopathology among World War II refugees who had settled in England. The rates for mental illness for various groups studied by Murphy (1955) showed a gradation according to the degree of persecution and trauma experiences during war. Furthermore, if resettlement occurred in a "friendly" locale where "mixing" with the locals occurred, the rates of mental illness were lowest. The converse held true. The highest rates of mental illness occur early after migration— during Refugee Mental Health Latino Social Work Network Orange County Affiliate 12 TH Annual Conference 2001: Social Work Odyssey Preparándonos Para El Futuro Del Trabajo Social (Preparing Ourselves for the Future of Social Work) October 25-27, 2001 Hilton Costa Mesa Orange County, California October 25: Pre-Conference Institute: NASW– Mental Health & HIV/ AIDS: Social Work Practice Issues– full day– 7 CEUs October 26 & 27: Multiple workshops, exciting and thought provoking keynote speakers, entertainment, Board of Directors Luncheon, casino night, dancing, book signing, interesting exhibits, scholarship presentations, Buen Hecho Award, & more Keynote Speakers. Friday, October 26 a. m.: The Most Reverend Jaime Soto-Auxiliary Bishop Diocese of Orange will speak on how we can prepare ourselves to meet the needs of our communities. The first or second year. The older the age of the refugee also correlates with higher levels of symptomot-ology. A number of studies have also demonstrated that difficulty with language has a negative effect on refugee mental health as well. It remains important when working with clients to consider immigration (voluntary or involuntary) factors that can contribute to or de-crease a refugee's ability to adjust. For more information, please attend the upcoming Southern California Refugee Conference, "A Forum for Addressing, Respecting and Under-standing the Mental Health Needs of Refugees (see page 8). (Continued on p. 3) 2 PAGE 3 The old adage goes… "Some things in life are inevitable, like death and taxes …," yet the means to the end of the former can vary greatly by culture. There are definite differences in how various cultures see, react to and experience death. Religion aside, it is an important facet to be aware of when working in the human services field. Many cultures obligate extended family to attend to the sick and dying, to pay their last respects. Many times this obligation does not extend to pregnant women (Mexican culture), who may even be dissuaded from visiting the dying and/ or at-tending funeral services. "I had a client from Mexico who was only a few months pregnant when her father died. At first I thought she was experiencing great difficulties with grief and was really trying to work with her on this issue. It appeared she was resistant to getting closure— to seeing him one last time— to saying her good-byes. She even refused to attend the funeral. Then, another clinician told me that it was probably cultural, so I checked it out and found that to be the case," stated Bernadette, a community mental health worker. Issues very acceptable in the majority culture may be seen as very disrespectful and inappropriate in other cultures. For example, the basic signing of consents for treatment, do not resuscitate (DNR) orders, etc., may re-quire far more sensitivity and time to allow the family and perhaps the "head" of the family (parents, eldest child in many Asian cultures) to make such decisions. Majority culture/ Western values place particular emphasis on issues of confidentiality, and with good reason. When dealing with people from other cultures, especially when ad-dressing death and dying, such is-sues require more flexibility. For ex-ample, for most of us, the patient is usually seen as the keeper of the power to consent, etc. Yet in many The Culture of Death & Dying Cultures, the dying patient may not even be told of the impending death (Chinese, Russian, South Asian). In some cultures, the death of a loved one is disclosed to friends before family, so that the friends can provide emotional support (Ethiopian/ Eritreans). Many people identify the hospital as an appropriate place to die, al-though the move of American culture towards hospice has demonstrated a shift in ideas surrounding death, towards embracing the idea of dying at home. Many Chinese may feel dying at home is bad luck, while other Chinese and Mexicans may feel if their loved one dies in the hospital, that their spirit may get lost. Gypsies (Roma) will keep a window open to allow the spirit to depart. American culture usually marks death with the color black, while Cambodians mourn with the color white. Hmongs must wear their finest clothing when departing this world. The family members may want to dress up the dying person in the hospital as it is shameful to be dressed poorly when entering the next realm. Burial also varies from culture to culture. Some people will want to wash their dead, while others will not care to see the body after death. The best advice clinically is to be aware of the various cultures of your patients, and simply ask questions regarding death and dying, while keeping an open mind. Latino Social Work Network Friday, October 26 p. m.: Dr. James Manseau Sauceda– Director, Multicultural Center– CSULB, Professor, Communication Studies, CSULB– will enlighten us with an interactive approach to face multi-ethnic issues in the future. Saturday, October 27 a. m.: Mr. Victor Villaseñor, renowned author of Lluvia de Oro (Rain of Gold) and other works, spokesperson, and activist will address the conference and will offer a book signing session of his new book Thirteen Senses, Friday at the 7: 00 p. m. casino night reception and immediately following his address Saturday a. m. Visit our web page: www.lswnoc.com To be placed on our mailing list, contact Angela Santos at (714) 704-8378 or by email at santoab@ssa.co.orange.ca.us. For more information, call Alice Apodaca at (714) 704-8829 or by email at apodaca@ssa.co.orange.ca. (Continued from p. 2) 3 PAGE 4
CALENDAR OF EVENTS
Conference: August 10, 2001 Multi Ethnic Behavioral Health Services Task Force Location: Irvine Hyatt Regency Information: (714) 834-0757
Event: August 25, 2001 Seal Beach Clean up! Location: 1 ST Street beach parking lot in Seal Beach Information: (714) 799-0179 Time: 9: 00 am
Conference: September 12 , 2001 Southern California Refugee Forum Location: Newport Beach Marriott Information: (714) 796-0188
Event: September 15-22 , 2001 Latino Behavioral Health Week
Conference: October 4, 2001 Healing the Mind, Body and Spirit Location: Riverside Convention Center Information: (909) 787-7950
Conference: October 1 1, 2001 Spirituality & Mental Health: Beginning a Dialogue Location: Hilton Universal City & Towers Information: (626) 254-5000
Event: October 12-14, 2001 Korean Festival Location: Garden Grove Blvd., Garden Grove Information: (714) 638-1440
Event: October 18-20, 2001 13 TH Annual Conference on Attention Deficit Hyperactivity Disorder "Communicating the science of AD/ HD: From fiction to fact." Location: Anaheim Information: (800) 233-4050
Conference: October 2 5-27, 2001 12 TH Annual Latino Social Work Conference: 2001 Social Work Odyssey Location: Costa Mesa Information: (714) 704-8378
Conference: November 2-3, 2001 Strengthening our Partnership-Families, Schools & Mental Health Services Location: Hyatt Regency Alicante, Anaheim Information: (714) 796-0118 4 PAGE 5 June 2001 Honoree Bill Washburn was born and raised on a cattle ranch in Wyoming. He served as a Corpsman with the Marines in Vietnam, receiving two purple hearts and a Bronze Star. He had always been interested in psychology, and continued his studies when he was discharged from the Marines. Bill began his career with the Health Care Agency in 1980. He currently serves as Service Chief for Alcohol and Drug Abuse Services in South County. Bill enjoys his work with behavioral health consumers, watching people grow and being a part of the experience. According to Bill's colleagues, he always goes out of his way to acknowledge and respect the various cultures of his staff and the clinic consumers. "I value being a part of an organization that offers services to people who otherwise might not have the opportunity to make a positive change in their lives." April 2001 Honoree Spotlight on Excellence a counselor where he worked mostly with Latino youth. "I enjoy working with many different people from different backgrounds," said Paredes, and his colleagues concur. "Benito is always interested in learning about all other cultures. He spends a great deal of time in the Cultural Competency lending library." Born in Nicaragua, Benito was raised in a small town. He attended the University of Central America, and was studying to become a lawyer. Unfortunately, he had to discontinue his studies when the revolution came and his school was shut down. He came to the United States in 1978 and immediately found work. He received his AA degree from Glendale College where he studied Human Services. He currently serves as a Mental Health Specialist for the County's Alcohol and Drug Abuse Services– Drug Court Division. (Continued on p. 7) Behavioral Health Director, Doug Barton; Benito Paredes; Ronnie Kelley (Cultural Competency); Rafael D. Canul (Cultural Competency); Service Chief, ADAS, Brett O'Brien. B enito Paredes began his career with the County in September 2000. Prior to this, he was a volunteer for the California Youth Authority, serving as Ronnie Kelley (Cultural Competency); Bill Washburn; ADAS, Program Manager, John Van Sky; Rafaul D. Canul (Cultural Competency). 5
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Name of Event: Latino Health WeekDate: September 15– 22, 2001
LATINO BEHAVIORAL HEALTH WEEK WHEREAS, the Latino population represents a significant percentage of California's population; and WHEREAS, the Latino population continues to increase at a rapid rate; and WHEREAS, Latinos suffer from mental illness and from alcohol and other drug addictions in the same proportion as the general population; and WHEREAS, Latinos historically underutilized early intervention and preventative public behavioral health services; and WHEREAS, underutilization of behavioral health care results in unnecessary pain and suffering by Latino families; and WHEREAS, the State of California desires to eliminate unnecessary pain and suffering of behavioral health disorders in the Latino community; and WHEREAS, the State of California strives to provide quality behavioral health care to the Latino community: NOW, THEREFORE, BE IT RESOLVED that the Orange County Board of Supervisors does hereby proclaim that the third week of September each year be proclaimed "Latino Behavioral Health Week" and BE IT FURTHER RESOLVED, that Orange County will conduct activities promoting awareness through community education, screening and referral to linguistic and culturally appropriate services, organized and implemented by community health, drug, and mental health agencies. 6
PAGE 7 Approximately 2 million residents live in Orange County. African Americans comprise less than 2% of the population, yet represent almost 7% of AIDS cases. Orange County Epidemiology Data for 2000 reflects the following HIV/ AIDS disparity when the standard calculation of AIDS case rates per 100,000 of a specific ethnic group is applied: Whites – 9.6 per 100,000; Latinos – 16.9 per 100,000; Asians – 1.9 per 100,000 and African Americans – 38.6 per 100,000. Intermediary Health Services is the only community-based, HIV/ AIDS program in Orange County founded and operated by African Americans. The parent organization, The New Millennium Community Coalition (NMCC), provides HIV/ AIDS services through programs and activities
Community-Based Treatment for African Americans with HIV/ AIDS Ernesta Wright, Executive Director, The New Millennium Community Coalition designed and implemented with in-put and participation from African American civic and business leaders, clergy, health care professionals and PWAs (Persons with AIDS) through-out the Orange County service area. The New Millennium Coalition (NMCC) is a community-based organization developed to serve the lower income and disadvantaged community of Orange County through health, education, and economic empowerment. The vision of NMCC is to create strong supportive resources that build upon the many cultural strengths of the African American community, where indi-viduals and families can develop to their full potential. The Intermediary Health Services program evolved from NMCC's initial HIV/ AIDS prevention education and outreach activities and currently pro-vides the following free services to HIV-impacted individuals: pre-and post-test counseling, mental health services, case management, transportation services and support groups. NMCC has proven effective in its unique ability to facilitate networking and collaboration among a broad range of African American civic, business, professional and faith-based organizations, and individuals from a variety of occupations, socioeconomic groups and sexual orientations on addressing the issues of HIV/ AIDS. For further information please contact the corporate office, located at 2215 W. McFadden Avenue, Santa Ana. NMCC's telephone number is 714-835-1032.
Carole Mintzer began her career with the Health Care Agency in 1998. She currently serves as a Staff Analyst in Quality Management. She earned her Masters in Public Administration at the University of Arizona, after which she worked for the Federal Government in the Department of Health and Human Services for six years. "I feel honored to receive the cultural competency award." As Carole's colleagues note, she always attends to the idea of cultural sensitivity in all of her projects, especially in her work with Children's System of Care. According to Carole, "We are so blessed in this County to have such a rich diversity of cultures."
March 2001 Honoree Spotlight on Excellence (Continued from p. 5) Behavioral Health Director, Doug Barton; Ronnie Kelley (Cultural Competency); Carole Mintzer; Rafael Canul (Cultural Competency); Davine Abbott, Manager, Office of Quality Management 7
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County of Orange/ Health Care Agency QM/ Public Information and Communications 405 W. 5th Street, 4th Floor Santa Ana, CA 92701 The Cultural Connection is published quarterly by the Cultural Competency Program of the County of Orange/ Health Care Agency. If you would like to contribute an article, or have comments, ideas, or suggestions for newsletter improvement, please write to us at:
County of Orange/ Health Care Agency 405 W. 5th Street, Suite 400 Santa Ana, CA 92701 Telephone: (714) 796-0188 FAX: (714) 796-0194 Web URL: www.ochealthinfo.com/ behavioral/cultural Editor: Ronnie Kelley, LCSW Ethnic Services Coordinator/ Service Chief I Cultural Competency Contributing Staff: Rafael D. Canul, PhD Production Staff: Antonia Roman
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