MENTAL HEALTH CLINICIANS PERSPECTIVES ON THE ROLE OF ACCULTURATION IN THE PROVISION OF SERVICES TO LATINOS: A GROUNDED THEORY EXPLORATION by GABRIELA SEHINKMAN Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Social Welfare Program Jack, Joseph, and Morton Mandel School of Applied Social Sciences CASE WESTERN RESERVE UNIVERSITY May, 2020 i CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the dissertation of Gabriela Sehinkman candidate for the degree of Doctor of Philosophy*. Committee Co-Chair Dr. David Hussey Committee Co-Chair Dr. Anna Maria Santiago Committee Member Dr. Elizabeth Tracy Committee Member Dr. Susan Painter Date of Defense December 9, 2019 *We also certify that written approval has been obtained for any proprietary material contained therein. ii Table of Contents List of Tables .................................................................................................................... vii List of Figures .................................................................................................................. viii Acknowledgments ............................................................................................................. ix Abstract .............................................................................................................................. xi Chapter 1 : Introduction ...................................................................................................... 1 The Role of Acculturation in the Mental Health of Adult Latinos in the United States .... 1 Explanatory Models: The Immigrant Paradox and the Acculturation Hypothesis ............. 7 Incorporation of Knowledge of Acculturation to Mental Health Interventions ................. 9 Social Relevance of Incorporating Knowledge of Acculturation into Mental Health Practice with the Latino Population .................................................................................. 11 Proposed Study ................................................................................................................. 14 Formal Statement of Research Aims ................................................................................ 15 Chapter 2 : Relevant Cultural Competence and Culture Exchange Frameworks and Theories............................................................................................................................. 17 Introduction ....................................................................................................................... 17 Relevant Cultural Competence Frameworks in the Social Work Field ............................ 17 Ethnic-sensitive generalist social work practice ........................................................... 18 Multi-ethnic cultural awareness-based approach .......................................................... 20 Process stage approach ................................................................................................. 24 iii Competing Constructs in Related Fields .......................................................................... 26 Cultural safety ............................................................................................................... 27 Cultural humility ........................................................................................................... 28 Cultural attunement ....................................................................................................... 30 Theory of Acculturation.................................................................................................... 32 Early theories of culture change: Assimilation and cultural pluralism ......................... 32 Contemporary theories of culture change ..................................................................... 34 Berry’s theory of acculturation ..................................................................................... 34 Critique of Berry’s Theory of Acculturation ................................................................ 45 Conclusion ........................................................................................................................ 49 Chapter 3 : Review of the Literatu .................................................................................... 50 Introduction ....................................................................................................................... 50 Culturally Modified Mental Health Interventions for the Latino Population: Current State of the Research.................................................................................................................. 50 What Constitutes a Cultural Adaptation? ......................................................................... 52 Randomized-controlled Trials .......................................................................................... 54 Interventions for depression .......................................................................................... 54 Interventions for schizophrenia spectrum disorders ..................................................... 57 Interventions for posttraumatic stress disorder ............................................................. 58 Quasi-experimental Design............................................................................................... 59 iv Researcher-driven cultural adaptations ......................................................................... 59 Participant-driven adaptations ...................................................................................... 63 Qualitative Studies ............................................................................................................ 66 Summary and Critique ...................................................................................................... 71 Chapter 4: Research Methodology ................................................................................... 77 Introduction ....................................................................................................................... 77 Description of the Present Study ...................................................................................... 77 Rationale for the Use of Qualitative Methodology ........................................................... 81 The Grounded Theory Tradition of Qualitative Inquiry ................................................... 82 Constructivist Grounded Theory Approach ...................................................................... 83 Data Analysis .................................................................................................................... 84 Constructing the Theory ................................................................................................... 89 Reflexivity ........................................................................................................................ 90 Position of the Researcher ................................................................................................ 92 Chapter 5 : Results ............................................................................................................ 94 Introduction ....................................................................................................................... 94 Sample Description and Final Codebook ......................................................................... 94 Research question 1: How do mental health practitioners conceptualize the concept and process of acculturation? .................................................................................................. 95 Substantive-level Theory: Conceptualization of Acculturation and How it Takes Place108 v Research Question 2 ....................................................................................................... 108 Substantive-Level Theory ........................................................................................... 114 Research Question 3 ....................................................................................................... 115 Substantive-Level Theory ........................................................................................... 130 Research Question 4 ....................................................................................................... 131 Substantive-level theory.............................................................................................. 161 Integration of Substantive-level Theory into a Grounded Theory Formulation ............. 161 Postulate 1 ................................................................................................................... 161 Postulate 2 ................................................................................................................... 162 Postulate 3 ................................................................................................................... 163 Chapter 6 : Discussion and Conclusions......................................................................... 167 Introduction ..................................................................................................................... 167 Conceptualization of Acculturation and Sources of Knowledge .................................... 167 Ways in Which Acculturation Knowledge Informs Clinical Practice and Variation Based on Clinician Level of Acculturation ..............................................................................