Advertisement

Special Considerations for Working with Cubans in Integrated Care: Intergenerational Perspectives on Life-Course Health Promotion

  • Ester R. ShapiroEmail author
Chapter

Abstract

This chapter reviews the existing literature on Cuban Americans in the U.S., their circumstances of migration, demographic status, health and mental health status, and interventions in health and mental health. Recognizing the limited literature focusing specifically on Cuban Americans, the chapter also brings in useful frameworks from broader Latino health/mental health and cultural competence perspectives, highlighting historically and contextually informed intergenerational life-course perspectives that place family at the center. This chapter argues for, and models, cultivation of clinician reflexivity, defined as systematic assessment of personal and professional experiences and assumptions as these impact knowledge. Reflexivity is required for both assessing personal assumptions as they inform patient care specifically with Cuban American patients and their families, and in assessing literatures which may contain biases regarding approaches to health care and what constitutes quality health care in U.S. and global perspectives. The Cuban health care system, considered exemplary in global health and mental health (Cloninger et al. Int J Pers Cent Med, 4(2), 69–89, 2014; Shapiro and Louro Bernal. Global mental health, 2014), has influenced this chapter’s perspective on family-centered integrative care for Cuban American families. Further, the Cuban health care system informs the knowledge of health systems and personal choices of many Cuban families who are increasingly transnational as the ability to visit Cuba and maintain family ties has grown with increased political engagement between the two countries.

Keywords

Cuban American Integrative health Life-course perspective Familismo 

References

  1. Abraído-Lanza, A., Viladrich, A., Flórez, K., Céspedes, A., Aguirre, A., & De La Cruz, A. (2007). Fatalismo reconsidered: A cautionary note for health-related research and practice with Latino populations. Ethnic Disparities, 17(1), 153–158.Google Scholar
  2. Ai, A., Appel, H., Huang B., and Lee, K. (2012). Overall health and healthcare utilization among Latino American women in the United States. J Womens Health, 21(8), 878–85.Google Scholar
  3. Ai, A., Noël, L., Appel, H., Huang B., and Hefley, W. (2013). Overall health and health care utilization among Latino American men in the United States. Am J Mens Health, 7(1), 6–17.Google Scholar
  4. Alegria, M., Mulvaney-Day, N., Torres, M., Polo, A., Cao, Z., & Canino, G. (2007). Prevalence of psychiatric disorders across Latino subgroups in the United States. American Journal of Public Health, 97(1), 68–75.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Bernal, G. (2016). Casas, J., Suzuki, L., Alexander, C., and Jackson, M. (Editors), Handbook of Multicultural Counseling (4th Ed.). Multiculturalism: The Final Frontier—Resistance Is Not Futile. Thousand Oaks, CA: Sage, 60–70.Google Scholar
  6. Bernal, G., & Domenech-Rodriguez, M. (2012). Cultural adaptation of evidence based treatments. Washington, DC: American Psychological Association.Google Scholar
  7. Bernal, G., & Shapiro, E. (2005). Cuban families. In M. McGoldrick, J. Pierce, & P. Giordano (Eds.), Ethnicity and family therapy (3rd ed.). New York, NY: Guilford. 2nd edn. 1996.Google Scholar
  8. Brotherton, S. (2012). Revolutionary Medicine: Health and the Body in Post-Soviet Cuba. Durham, NC: Duke University Press.Google Scholar
  9. Brown, A., & Patten, E. (2013). Hispanics of Cuban origin in the United States, 2011. Retrieved from http://www.pewhispanic.org/2013/06/19/hispanics-of-cuban-origin-in-the-united-states-2011/.
  10. Burroughs Peña, M., Patel, D., Rodríguez Leyva, D., Khan, B., & Sperling, L. (2012). Lifestyle risk factors and cardiovascular disease in Cubans and Cuban Americans. Cardiology Research and Practice, 2012, 1–6.CrossRefGoogle Scholar
  11. Cisio, A., Spence, N., & Gayman, M. (2010). Mental health and psychosocial adjustment of Cuban immigrants in South Florida. Social Science & Medicine, 71(6), 1173–1181.CrossRefGoogle Scholar
  12. Cloninger, R., Salvador-Carulla, L., Kirmayer, L., Schwartz, M. A., Appleyard, J., Goodwin, N., … Rawaf, S. (2014). A time for action on health inequities: Foundations of the Geneva Declaration on person- and people-centered integrated health care for all. The International Journal of Person Centered Medicine, 4(2), 69–89.Google Scholar
  13. Colona, A., & Grenier, G. (2010). Structuring liminality: Theorizing the creation and maintenance of the Cuban exile identity. Ethnic Studies Review, 33(2), 43–51.Google Scholar
  14. Comas-Diaz, L. (2012). Multicultural care: A clinician’s guide to cultural competence. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  15. Darias Alfonso, I. (2012) We are What We Now Eat: Food and Identity in the Cuban Diaspora. Canadian Journal of Latin American and Caribbean Studies, 37(74), 173–206.Google Scholar
  16. Duany, J. (2011). Blurred borders: Transnational migration between the Caribbean and the United States. Chapel Hill, NC: University of North Carolina Press.CrossRefGoogle Scholar
  17. Eckstein, S. (2009). The immigrant divide: How Cuban Americans changed the U.S. and their homeland. New York, NY: Routledge.Google Scholar
  18. Falicov, C. (2007). Working with transnational immigrants: Expanding meanings of family, community, and culture. Family Process, 46, 157–171.CrossRefPubMedGoogle Scholar
  19. Falicov, C. (2014). Latino families in therapy (2nd ed.). New York, NY: Guilford Press.Google Scholar
  20. Garcia-Coll, C., & Marks, A. (2011). The immigrant paradox in children and adolescents: Is becoming American a developmental risk? Washington, DC: APA.Google Scholar
  21. Gomez, M. (2016). Cuban American activists connecting to Cuba: Enduring impacts on U.S. Cuba relations. Presentation at the opening of the University of Massachusetts Boston, Movement in support of Cuba by members of the Cuban diaspora in the US, Puerto Rico & other countries (1960s–1990s), Archive collection, Healey Library. Retrieved March 23, 2016, from http://openarchives.umb.edu/cdm/landingpage/collection/p15774coll35.
  22. Helft, M. (2015). No internet? No problem. Inside Cuba’s tech revolution. Forbes/Tech, July 1. Retrieved March 20, 2016, from http://www.forbes.com/sites/miguelhelft/2015/07/01/no-internet-no-problem-inside-cubas-tech-revolution/#660cb59a76c7.
  23. Holden, K., McGregor, B., Thandi, P., Fresh, E., Sheats, K., Belton, A., … Satcher, D. (2014) Toward culturally centered integrative care for addressing mental health disparities among ethnic minorities. Psychological Services, 11(4), 357–368.Google Scholar
  24. Huffman, F., Vaccaro, J., Nath, S., & Zarini, G. G. (2009). Diabetes self management: Are Cuban Americans receiving quality health care? Journal of Health and Human Services Administration, 32(3), 279–304.Google Scholar
  25. Huffman, F., Vaccaro, J., Zarini, G., & Nath, S. (2011). Coronary heart disease risk in Cuban Americans with and without type 2 diabetes. The Internet Journal of Health, 12.Google Scholar
  26. Jerant, A., Arellanes, R., & Franks, P. (2008). Health status among US Hispanics: Ethnic variation, nativity, and language moderation. Medical Care, 46(7), 709–717.CrossRefPubMedGoogle Scholar
  27. Juckett, G. (2013). Caring for Latino Patients. American Family Physician, 87(1), 48–56.Google Scholar
  28. Juster, R., Bizik, G., Picard, M., LaPierre, G., Sindi, S., Trepanier, L., … Lupien, S. (2011). A transdisciplinary perspective of chronic stress in relation to psychopathology throughout life span development. Devlpmnt & Psychopathol, 23, 725–776.Google Scholar
  29. Kirmeyer, L. (2012). Rethinking cultural competence. Transcultural Psychiatry, 49(2), 149–164.CrossRefGoogle Scholar
  30. Laroche, M. (2013). Cultural psychotherapy: Theory, methods and practice. Los Angeles, CA: Sage Publications.Google Scholar
  31. Lemkin, D., & Stug, J. (2008). Psychological distress of Cuban Americans affected by restrictive U.S. travel policies. Journal of Progressive Human Services, 19(1), 1–18.CrossRefGoogle Scholar
  32. Lopez, G. (2015). Hispanics of Cuban origin in the United States, 2013. Washington, DC: The Pew Research Center.Google Scholar
  33. Lopez, S., Barrio, C., Kopelowicz, A., Vega, W. A. (2012). From documenting to eliminating disparities in mental health care for Latinos. American Psychologist, 67(7), 511–523.Google Scholar
  34. Martin, C., & Petersen, R. (2009). The social construction of chronicity: A key to understanding chronic care transformations. Journal of Evaluation in Clinical Practice, 15, 578–585.CrossRefPubMedGoogle Scholar
  35. Mechanic, D. (2012). Seizing opportunities under the affordable care act for transforming the mental and behavioral health system. Health Affairs, 31(2), 376–382.Google Scholar
  36. Muir, J., Schwartz, S., & Szapocznik, J. (2004). A program of research with Hispanic and African American families: Three decades of intervention development and testing influenced by the changing cultural context of Miami. Journal of Marital & Family Therapy, 30(3), 285–303.CrossRefGoogle Scholar
  37. Nielsen, J., Wall, W., & Tucker, C. (2016). Testing of a model with Latino patients that explains the link among patient-perceived provider cultural sensitivity, language preference and patient treatment adherence. Journal of Racial and Ethnic Health Disparities, 3, 63–73.CrossRefPubMedGoogle Scholar
  38. Perez, L. (2009). Racialization among Cubans and Cuban Americans. In J. Cobas, J. Duany, & J. Feagin (Eds.), How the United States racializes Latinos: White hegemony and its consequences (pp. 134–148). New York, NY: Taylor and Francis.Google Scholar
  39. Perez, R. (2013). Paradise lost: Older Cuban American exiles’ ambiguous loss of leaving the homeland. Journal of Gerontological Social Work, 56(7), 596–622.CrossRefPubMedGoogle Scholar
  40. Perez, R. (2015). Cuba No; Miami Sí: Cuban Americans coping with ambiguous loss. Journal of Human Behavior in the Social Environment, 25(1), 50–66.CrossRefGoogle Scholar
  41. Perez-Stable, E., Ramirez, A., & Villareal, R. (2001). Cigarette smoking behavior among US Latino men and women from different countries of origin. American Journal of Public Health, 91, 1424–1430.CrossRefPubMedPubMedCentralGoogle Scholar
  42. Perrino, T., Brown, S., Mason, L., & Szapocsnik, J. (2009). Depressive symptoms among urban Hispanic older adults in Miami: Prevalence and sociodemographic correlates. Clinical Gerontologist, 32(1), 26–43.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Prilleltensky, I. (2012). Wellness as fairness. American Journal of Community Psychology, 49, 1–21.CrossRefPubMedGoogle Scholar
  44. Rothe, E., Lewis, J., Pumariega, A., & Martinez, O. (2002). Posttraumatic stress disorder among Cuban children and adolescents after release from a refugee camp. Psychiatric Services, 53(8), 970–976.CrossRefPubMedGoogle Scholar
  45. Rothe, E., & Pumariega, A. (2008). The new face of Cubans in the United States: Cultural process and generational change in an exile community. Journal of Immigrant and Refugee Studies, 6(2), 247–266.CrossRefGoogle Scholar
  46. Satterfield, J. M., Spring, B., Brownson, R. C., Mullen, E. J., Newhouse, R. P., Walker, B. B., & Whitlock, E. P. (2009). Toward a transdisciplinary model of evidence‐based practice. Milbank Quarterly, 87(2), 368–390.Google Scholar
  47. Shapiro, E. (1994). Grief as a Family Process: A Developmental Approach to Clinical Practice. NY: Guilford Press.Google Scholar
  48. Shapiro, E. R. (2008). Whose recovery of what? Relationships and environments promoting grief and growth. Death Studies, 32(1), 40–58.CrossRefPubMedGoogle Scholar
  49. Shapiro, E. (2010a). Health and health care: Introduction. In W. Duran (Ed.), Cuba. Detroit, MI: Gale.Google Scholar
  50. Shapiro, E. (2010b). HIV/AIDS in Cuba. In W. Duran (Ed.), Cuba. Detroit, MI: Gale.Google Scholar
  51. Shapiro, E. (2013a). Chronic illness and family resilience. In D. Becvar (Ed.), Handbook of family resilience. New York, NY: Springer.Google Scholar
  52. Shapiro, E. R. (2013b). Culture and socialization in assessment and treatment in thanatology. In D. Balk (Ed.), Handbook of thanatology (2nd ed.). Oakbrook Terrace, IL: Association of Death Education and Counseling.Google Scholar
  53. Shapiro, Ester (2014). Translating Latin American/US Latina Frameworks and Methods in Gender and Health Equity: Linking Women’s Health Education and Participatory Social Change. International Quarterly of Community Health Education.Google Scholar
  54. Shapiro, E., & Atallah-Gutierrez, C. (2012). Latina re-visionings of participatory health promotion practice: Cultural and ecosystemic perspectives linking personal and social change. Women and Therapy, 35(1-2), 120–133.CrossRefGoogle Scholar
  55. Shapiro, E., & Louro Bernal, I. (2014). Integrative health and mental health systems of care: The Cuban experience. In S. Okpaku (Ed.), Global mental health. London: Cambridge.Google Scholar
  56. Silva, S. A., Charon, R., & Wyer, P. C. (2011). The marriage of evidence and narrative: Scientific nurturance within clinical practice. Journal of Evaluation in Clinical Practice, 17, 585–593.CrossRefPubMedGoogle Scholar
  57. Skaine, R. (2004). The Cuban family: Custom and change in an era of hardship. London: McFarland.Google Scholar
  58. Skop, E. (2001). Race and place in the adaptation of Mariel exiles. International Migration Review, 35(2), 449–471.Google Scholar
  59. Smedley, B. D., Stith, A. Y., & Nelson, A. R. (2009). Unequal treatment. Washington, DC: National Academies Press.Google Scholar
  60. Starfield, B. (2009). Primary care and equity in health: The importance to effectiveness and equity of responsiveness to people’s needs. Humanity and Society, 33, 56–73.CrossRefGoogle Scholar
  61. Szapocsnik, J., Muir, J., Duff, J., Schwartz, S., & Brown, C. (2015). Brief strategic family therapy: Implementing evidence-based models in community settings. Psychotherapy Research, 25(1), 121–133.CrossRefGoogle Scholar
  62. Szapocsnik, J., Schwartz, S., Muir, J., & Brown, C. (2012). Brief strategic family therapy: An intervention to reduce adolescent risk behavior. Couple and Family Psychology, 1(2), 134–145.CrossRefGoogle Scholar
  63. Tucker, C., Marsiske, M., Rice, K., Nielson, J., & Herman, K. (2011). Patient centered culturally sensitive health care: Model testing and refinement. Health Psychology, 30(3), 342–350.CrossRefPubMedPubMedCentralGoogle Scholar
  64. Ulmer, C. (2009). Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement. Washington, DC: The National Academies Press.Google Scholar
  65. Vang, Z. M., & Eckstein, S. (2012). Toward an improved understanding of immigrant adaptation and transnational engagement: The case of Cuban Émigrés in the United States. Comparative Migration Studies, 3(6), 2–20.Google Scholar
  66. West Duran, A. (2010). Cuba. Detroit, MI: Gale.Google Scholar
  67. Zambrana, R. (2011). Latino families in the U.S.: Intersectional perspectives on diversity. New York, NY: Routledge.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.University of Massachusetts, BostonBostonUSA

Personalised recommendations