Crossroads: The Psychology of Immigration in the New Century

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and traditional mental health settings. However, given the increasing number of contacts that a significant number of immigrants are likely to have with such institutions as law enforcement, the judiciary system, and immigration services (i.e., Immigration and Customs Enforcement), it behooves us to address assessment issues and challenges that exist in these settings. Intervention The present state of knowledge concerning clinical practice suggests that to provide the most effective mental health services to immigrants, clinicians should apply the following guiding principles: • Use an ecological perspective (Bronfenbrenner & Morris, 2006) to develop and guide interventions. • Integrate evidence-based practice with practice-based evidence. • Provide culturally competent treatment. • Use comprehensive community-based services. • Use a social justice perspective as a driving force for all services. While these principles are referenced throughout the report, they are presented here in more detail to underscore their importance in guiding clinical interventions. Ecological Framework In line with one of the underlying perspectives inherent in this report and with recommendations put forth by various multicultural psychologists (e.g., Casas et al., 2008), it is recommended that clinicians give serious consideration to the use of an ecological framework (Bronfenbrenner & Morris, 2006). As previously noted in this report (see the Introduction), such a framework is based on the belief that the human experience is a result of reciprocal interactions between individuals and their environments, varying as a function of the individual, his or her contexts and culture, and time. Each context offers particular risks as well as protective factors that either detract from or enhance healthy adaptation. They need to be understood in framing the immigrant experience and considered in the development and implementation of mental health treatments. Using this framework, a clinician should gather relevant information from the five systems that subsume the client’s contexts and culture (i.e., the micro-, meso-, exo-, macro- and chronosystems) (see the Introduction). As noted in Resilience and Recovery After War: Refugee Children and Families in the United States (APA, 2010c, p. 4), the information that should be gathered to inform interventions includes effects of migration (before, during, and after), legal/documentation status, acculturation, risk and resilience, cultural and religious beliefs, age of migration/developmental stage, race, ethnicity, gender, social class, sexual orientation, disability/ability, experiences of racism and discrimination, language and educational barriers, and access to services and resources. This information is often critical to developing a complex understanding of the individual’s experiences of distress. Evidence-Based Practice and Practice-Based Evidence An important dialectic in mental health intervention research involves evidence-based practice and practice-based evidence. Evidence-based practice in psychology (EBPP) is the integration of the best available research with clinical expertise. The purpose of EBPP is to promote effective psychological practice and enhance public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention (Kazdin, 2008). Evidence-based practice approaches psychological treatment with the assumption that individual characteristics and sociocultural context both play important roles in assessment and intervention (La Roche & Christopher, 2009; Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). There has been growing discussion in the field about prioritizing evidence-based treatments (EBTs) over practice-based adaptations of these treatments or practice approaches judged appropriate by clinicians but not empirically tested in randomized clinical trials. Efficacy research that identifies EBTs incorporates randomized controlled trials and focuses specifically on outcomes that result from care provided by well-trained mental health professionals. To make causal inferences about intervention effectiveness, randomized clinical trials use tightly controlled designs, carefully select their client populations, maintain strict fidelity to the intervention model, and use well-trained mental health professionals proficient in the service model being tested (La Roche & Christopher, 2009). But many such studies have been 68 Report of the APA Presidential Task Force on Immigration
criticized for limited generalizability outside the university clinic settings where they are developed and particularly to ethnic minority and immigrant populations. A few studies have examined the effectiveness of evidencebased practice with immigrant clients in treatment. For example, Duarté-Veléz, Bernal, and Bonilla (2010) described a culturally adapted cognitive–behavioral therapy (CBT) for a Latino adolescent coping with depression. This adaptation of CBT involved the consideration of specific cultural values concerning sexual orientation, masculine identity, spirituality, and family. Two other examples of treatments that have demonstrated effectiveness with immigrant populations include the Culturally Informed and Flexible Family-Based Treatment for Adolescents (Santisteban & Mena, 2009), which combines family and individual CBT with educational interventions to treat intrafamily stress and conflict, and Cuento Therapy (TEMAS; G. Constantino et al., 1988), a culturally sensitive cognitive therapybased intervention aimed to reduce anxiety and improve academic self-esteem and performance with Latino/a students. Despite these studies, research documenting the effectiveness of EBTs with diverse communities is still in its infancy. In fact, much of what is known about the use of EBTs with immigrants has been drawn from research on the impact of evidence-based mental health treatments on ethnic minorities, particularly African American and Latino/a American clients. Miranda et al. (2005) found substantial evidence demonstrating that evidence-based treatments for depression (e.g., CBT) improve outcomes for African Americans and Latinos and that these results are equal to or greater than those for White Americans. Research on the EBTs with Asian Americans has been very limited, and the evidence that does exist seems to suggest that cognitive therapy is effective for the treatment of anxiety and depression (C. G. Hall & Eap, 2007; Miranda et al., 2005). C. G. Hall and Eap (2007) cautioned, however, that “this evidence is based on relatively few patients” (p. 455) and that these studies have been criticized for their methodology. Implementation of EBTs in real-world settings, such as Immigrant Populations in Clinical Contexts Research on culturally adapted interventions indicates that interventions in clients’ native languages are more effective than those conducted in English, culturally adapted interventions are more effective than those not targeted to specific cultural groups, and ethnic matching in the therapeutic dyad is likely to improve client retention and therapeutic outcome. community clinics and schools, involve numerous challenges. In particular, extensive adaptations to the intervention are often required, though researchers reporting on intervention effectiveness rarely report on the various adaptations made in the implementation process. In recent years, another approach has been evolving in the field among those advocating for learning from practicebased evidence (Birman et al., 2008). While empirically based researchers generally treat existing community practices, or “treatment as usual,” as substandard practices, many clinical programs have developed creative ways of working with immigrant populations that have not yet been documented in the literature. For example, the Latino Mental Health Clinic, the Haitian Mental Health Clinic, the Portuguese Mental Health Clinic, and the Asian Mental Health Clinic at the Cambridge Health Alliance are outpatient clinics staffed by immigrant and multilingual mental health practitioners who have provided direct clinical services (assessment, psychotherapy, and psychopharmacology) to immigrant communities for over a decade. Rural areas also have needs for these types of services, though access can be difficult. In Maine, for example, the Maine Migrant Health Program provides integrated primary care from a mobile van to address this barrier. Although several clinicians have written about their experiences with clients in these clinics (Desrosiers & St. Fleurose, 2002; Halperin, 2004; Tummala- Narra, 2009), a lack of resources for systematic research has precluded documentation of the lessons learned in clinical practice with these different immigrant communities. Nonetheless, it is important to learn from the wisdom of these clinicians and how they have modified traditional approaches to treatment in their work with immigrant clients. Thus, the practice-based evidence approach seeks to understand “practice as usual” and gather evidence on its effectiveness (Beehler, Birman, & Campbell, 2011; Birman et al., 2008). Research on culturally adapted interventions indicates that interventions in clients’ native languages are more 69
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Report of the APA Presidential Task
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Crossroads The Psychology of ImmIgr
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Preface One of the benefits of serv
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Diane Elmore, PhD (APA Public Inter
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2011; C. Suárez-Orozco & Suárez-O
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2010; M. H. Lopez & Taylor, 2010).
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designed with their educational obs
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al., 2006), communication problems
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Sloan, & Sperling, 2011) and toward
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• The mesosystem is made up of in
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lesbian, gay, bisexual, disabilitie
Page 26 and 27:
contributed to the growth of undocu
Page 28 and 29: All other countries 42% FIGURE 3. T
Page 30 and 31: to learn English (Bayley & Regan, 2
Page 32 and 33: Exclusion Act of 1882) specifically
Page 34 and 35: and mental health outcomes. Discrim
Page 36 and 37: adaptation: acculturation, Cultural
Page 38 and 39: In a number of studies, strong iden
Page 40 and 41: documented the problems caused by a
Page 42 and 43: Populations Facing Unique Challenge
Page 44 and 45: American region (Mexico, Canada, Ce
Page 46 and 47: the government or a group the gover
Page 48 and 49: Notably, in 2000, approximately 650
Page 50 and 51: often rely on their ethnic immigran
Page 52 and 53: Life span Considerations Looking at
Page 54 and 55: Transition to adulthood in the Unit
Page 56 and 57: In a study of Korean elders, there
Page 58 and 59: those of native English speakers an
Page 60 and 61: linguistic group in the United Stat
Page 62 and 63: or deported, immigration officials
Page 64 and 65: Immigrant students whose education
Page 66 and 67: to read in the home language promot
Page 68 and 69: & Mapp, 2002). Teachers, in turn, v
Page 70 and 71: In a knowledge-intensive economy, h
Page 72 and 73: separation from country of origin,
Page 74 and 75: As individuals negotiate their iden
Page 76 and 77: Barriers to Treatment While an incr
Page 80 and 81: effective than those conducted in E
Page 82 and 83: development, to remediation). Thera
Page 84 and 85: Considerations for the Field The Un
Page 86 and 87: time. For example, under what condi
Page 88 and 89: summary of recommendations Recommen
Page 90 and 91: • Support opportunities for dialo
Page 92 and 93: Culture brokering: When children of
Page 94 and 95: Protective factors: Conditions in f
Page 96 and 97: eferences Abraham, M. (2000). Isola
Page 98 and 99: Bedolla, L. G. (2000). They and we:
Page 100 and 101: Carhill, A., Suárez-Orozco, C., &
Page 102 and 103: Delgado-Gaitan, C. (1994, April). M
Page 104 and 105: Gee, G. C., Spencer, M., Chen, J.,
Page 106 and 107: www.splcenter.org/get-informed/inte
Page 108 and 109: LaFromboise, T., Coleman, H. L., &
Page 110 and 111: McKitrick, D. S., Edwards, T. A., &
Page 112 and 113: psychological, and educational appl
Page 114 and 115: Robjant, K., Hassan, R., & Katona,
Page 116 and 117: Stepick, A., Stepick, C. D., & Labi
Page 118 and 119: the job that’s tough”: The ELL
Page 120 and 121: Waters, M. C., & Jiménez, T. R. (2
Page 124: AMERICAN PSYCHOLOGICAL ASSOCIATION
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Crossroads: The Psychology of Immigration in the New Century

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