Returning Home:
Community Reentry and Mental Health Services
Experiences among Latino Juvenile Offenders
Lisa R. Fortuna, MD, MPH
Norah Mulvaney-Day, PhD
Helena Hansen, MD & PhD candidate
Margarita Alegria, PhD
Center for Multicultural Mental Health Research
Supported by NIMH Latino Research Program Project &
An Excellence in Partnerships for Community Outreach, Research on Health
Disparities and Training (EXPORT) Center Grant
Outline
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Introduction
Motivation
Study Objectives
Methods
Analyses
Results & Narratives
Implications for Mental Health Services
Introduction
• Latino youth are three times more likely to be
incarcerated than whites (Youth Law Center, 1996 )
• Although more than half of detained Latinos received
specialty mental health services, those with psychiatric
disorders are significantly underserved compared with
their white counterparts. (Hough et al, 2002)
• Latino adolescents with psychiatric disorders enter
specialty mental health services at a later age and had
made significantly fewer mental health service visits in
the previous year. (Hough et al, 2002)
Motivation
• Detailed studies of the perspectives of young
Latino ex-offenders on mental health issues and
services has received less attention.
• We need to examine these issues in the context
of community and reentry.
– Services
– Experiences
– Opportunities
Study Objectives
Identify (qualitatively)
potential areas of
service enhancement:
1) Mental health experiences
of Latino young adult exoffenders and attitudes
towards mental health
care
2) How these experiences
may relate to entry and
retention into mental
health services for these
young adults.
Methods
Purposive sample of Latino young adult ex offenders
age 18-24
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Recruitment of 16 young adults ( target 15-20)
Heterogeneity ( gender, language and time in US, ethnicity)
Juvenile justice involvement and community reentry
Able to consent for self ( less barriers related to parental
involvement)
– Examination for recurrent and overlapping themes
In-depth interviews
– Interview 1-1.5 hours
– Open ended question with probes
– Audio taping with permission or notes
Analyses
• Data were analyzed using a grounded theory approach
(Glazer & Strauss, 1996).
• Modifications made to interview guide during the course
of data collection to deepen exploration of recurrent
themes for analysis.
• A preliminary coding system was developed by the first
author independently and then together with a second
coder who blindly coded a subgroup of interviews.
• Thematic categories and an emergent, preliminary
framework for understanding youth reentry were also
reviewed with key informants for conceptual validity.
RESULTS
Treatment History
– Most (75%) of the participants had
experienced some interaction with the mental
health system
– Engagement in any mental health care for all
of the participants was short term (3 or fewer
visits).
– The services they want are not the ones they
are getting
Attitudes and Experiences
1) Coercion
2) and
3) Clinical
Stereotyping
1) Personal Agency
vs.2) Authentic Image
3) Mutual
Recognition
4) Belonging and
Proactivity
Personal Agency vs.
Clinical Stereotyping
Stereotyping
Young people described feeling stereotyped
when they first engage with clinicians
“They also
assume all kinds
of things about
me.”
--Cidro--22 year old
Honduran male
“The therapist just
assumed that I had a bad
family, that my mom was
doing drugs, and that I was
poor.”
--Joey--19 year old PR male
Coercion is at the forefront of initial
experiences of what it means to be involved
in mental health care services.
“They got tired of me
running away [from foster
homes and residential
housing] so they had to
lock me down. All of the
kids in there had to be on
medication. People feel
that medication is going
to help your depression.”
—Emma, 18 year old Puerto Rican
female
Coercion
“But, the day reporting center person—she
made me go to the therapist because I get
angry a lot…Just talk to me about what I
want to do, what I need and then I feel
fine”.
Pablito, 19 year old Salvadorian male
Personal Agency
“I feel the anger management program was
good—they were not strict—they would sit
down and listen to you…Then the staff
could support you in what you have done
well but you were the one that really did it.”
-- Emma, 18 year old Puerto Rican female
Authentic Image
Young people want to feel that a practitioner or
clinician recognizes the experiences that are
relevant to their lives.
“She
never really asked about who I really am
and what I wish for myself.”
--19 year old Puerto Rican female
Mutual Recognition
‘I liked the Puerto Rican counselors…I felt
they could understand where I was coming
from and what I was about. This always
felt like such a rare thing for me—even
from my family.
--Dedra, 18 year old Puerto Rican female
Belonging and Proactivity
Underlying these commentaries is a desire for therapeutic
processes where they feel supported, heard, recognized
and gain more control over their own lives through:
–community contribution
–context
– support
Belonging and Proactivity
“I can’t help myself. My mind is already too
messed up. I have tried the therapy,
medications, but I know my healing is not
going to happen that way. Maybe I can
help others.”
--Ray, 20 year old African American /Latino male
Belonging and Proactivity
“Circle is just the
bomb—people letting
out those tears. There
are hilarious parts
and sad parts—
everything you do out
here in life…”
--Javier--22 year old PR male
Belonging and Proactivity
• “You learn and then you teach circle.
There are hilarious parts and sad parts—
everything you do out here in life. I have
never seen people cry all together like
that…
--Javier--22 year old PR male
Belonging and Proactivity
“I can talk to those in school. I can ask a kid,
what are you doing? I can help them
understand...In that way, I can become
better”.
--Javier--22 year old PR male
Implications
Young people also long to have support from
those who see their potential and abilities
and care about what they can contribute.
Coercion can undermine trust between
clients from this population and clinicians,
an important component of the therapeutic
relationship
Implications
• Relationship building can be essential to prevent
the erosion of trust in the therapeutic
relationship in situations where coercion
determines the client’s participation
• Good clinical practice and sustained open and
caring community based relationships can be
essential components of innovative clientcentered reentry processes
• Community process vs. Individual process
Implications
The young participants gave examples of
interventions, like Talking Circles, which
although not culturally specific to Latinos
may build on an interdependent vs.
individualistic orientation of Latino culture.
Our findings challenge us to examine clinical
norms with our study population.
• Are appropriate clinical boundaries between
provider and patient experienced as distant and
alienating by individuals from certain Latino
cultures or communities?
• Can individual clinicians provide culturally
connected care within the mental health system
structures that are currently in place?
• What policy and system reforms are necessary
in order to make our clinical services truly
accessible to multicultural populations with
needs like our study participants?
Conclusions & Recommendations
For Latino youth offenders in community
reentry we need to focus on:
– Importance of empathetic and engaged
therapeutic alliance
– Supportive Interpersonal Relationships
– Addressing clinical stereotyping ( clinician
training)
– Group, community and relational processes