Social Isolation in Latina Immigrant Women: A Look at Durham, NC

1 Becky Kyle December 10, 2012 SOWO 709 Social Isolation in Latina Immigrant Women: A Look at Durham, NC INTRODUCTION Social isolation and a lack of social support can have a tremendously detrimental impact on an individual and their family system. Cassioppo and Hawkley (2003) note that poor, elderly, and minority populations are most likely to experience negative physiological consequences associated with high levels of perceived social isolation. This paper seeks to examine the role of social isolation in the lives of Latina immigrant women in the United States with a particular look at the issue in Durham, North Carolina. In a treatise on addressing gaps in services to meet the mental health needs of Latina women, one provider notes: Social isolation can go beyond the family and occur within one s community, culture, and society. For example, a Latina can be isolated by being in a community with only one or no other Latinas in the area. A Latina who is undocumented may be forced into isolation by her fear of being in public and possibly being deported or by agencies not serving undocumented women (D Arlach, Gracia, Grumbach & Hudson, et. al., 2006). BACKGROUND INFORMATION Social Isolation Social Isolation is a problem that is growing in the United States. In an examination of core discussion networks (the people with whom we discuss important issues) using data from 2004, it was found that people s core discussion network had decreased significantly compared to 1985. The average network size shrunk from 2.94 in 1985 to 2.08 in 2004, meaning the loss of about one confidant (McPherson, Smith-Lovin & Brashears, 2006). Perhaps more alarming, the number of people who reported that they had no one with whom they discussed important matters almost tripled. One reason this is so important is that we know that social contact with other people is so important for both our physical (Cassioppo & Hawkley, 2003) and social/emotional health (McPherson, et. al., 2006). While losses were seen in both the number of kin and non-kin confidants, the largest losses were seen among non-kin, meaning the worst erosion of social ties has occurred in an individual s connectedness to community and neighborhood. While the study mentioned above did not collect data on ethnicity, the Black and Other racial categories did report having smaller

2 discussion networks than their White counterparts in both 1985 and 2004 (McPherson, Smith- Lovin & Brashears, 2006). Latinos in NC The Southeast of the US and North Carolina in particular have seen a rapid increase over the last few decades in the Hispanic/Latino population. North Carolina saw a 393.9% increase in the Hispanic population from 1990 to 2000. While North Carolina has been on the path of migrant farmworkers for decades, recent trends have been to see more permanent settlement to the region. Durham County saw a shift from 7.6% to 13.5% in the percent of the population that identified as Hispanic (U.S. Census Bureau, 2000 & 2010). Agencies serving immigrant and other vulnerable populations have had to scramble to try and meet the needs of this growing population and some have had more success than others. Policy Impact The adoption of 28(7g) has created a climate of fear among many immigrant communities around the country, both documented and undocumented. This policy allows local law enforcement to act as extensions of ICE and enforce civil immigration violations. North Carolina has the highest number of local jurisdictions participating in the program (Nguyen & Gill, 2010). Recently, 287(g) has gotten a lot of negative attention due to allegations of racial profiling and the case of the suit against the Sheriff in Alamance County. While recognizing that profiling did occur and that it was unconstitutional, the ruling in the Alamance case did little to concretely limit the application of 287(g) or the Secure Communities initiative put out by ICE (Kim, 2012). Secure communities works similarly to 287(g) in that individuals can be put into a database for minor offenses and subsequently deported if they are found to be undocumented (Nguyen & Gill, 2010). In an analysis of the impact of 287(g) (and the same could likely be said for Secure Communities) Nguyen and Gill (2010) found that the policy did not reduce crime rates and actually led to an increase in the underreporting of crime in the Hispanic community. Trust in law enforcement was also negatively impacted. Fear of reporting crime and lack of trust of officials can serve to isolate Hispanic women that are victims of criminal activity (domestic violence, assault, etc.). It may also serve to undermine the trust these women might have in individuals, like social workers, that might be seen as extensions of the government. One piece of legislation that is also likely to contribute to Latina immigrant women s social isolation is welfare reform. Among many changes to the welfare system, the welfare reform of 1996 wrote into law that undocumented persons were not allowed to benefit from public services such as food stamps and TANF. Documented immigrants were also barred from these services until they had been here for 5 years or more. Some states extend benefits to immigrant groups (both documented and undocumented) that are prohibited from using federal dollars by using state funds, but this varies greatly state by state and can cause confusion in both the immigrant community and for intake workers (Chang-Muy & Congress, 2009). The explicit bar from using

3 federal funds speaks to the obvious mistrust of immigrant communities that pervades much legislation. There are currently about 12 million undocumented immigrants in the US and welfare reform prevents many of these individuals from accessing services they might need (Chang-Muy & Congress, 2009). It also impacts their family members, specifically citizen children, because the perceived anti-immigrant bias of social services discourages families from applying for services that children might qualify for. A state policy that has a direct impact on the mobility of the Latino community and thus their physical isolation is the requirement of a social security number to obtain a North Carolina driver s license (N.C. D.M.V., 2012). This is compounded by the fear of checkpoints that have become a part of the Durham landscape since the city s participation in the Secure Communities initiative. Depending on how careful a family is regarding driving without a license, they may have to wait until someone with a driver s license is available to take anyone to any appointments. This can be very frustrating for service providers trying to get families connected to appointments/services they may need; some families may be highly motivated but totally unable to access various programs/services due to significant transportation barriers. These barriers are compounded by heightened surveillance and lack of public transit. SERVICE NEEDS One of the biggest needs that I have encountered in working with Hispanic families is building trust and relationships between non-kin Latina women. Some women may perceive that they have enough kin to meet their social/emotional needs, but this is not true of everyone. Because of the economic climate, some families have had to move where they knew someone could get them work, which may not be where there is a family network to receive them. Mental health needs of Latinas Mujeres Latinas en Accion is a non-profit out of Chicago aiming to empower and advocate for Latina women. Part of their mission is to inform the community on the needs of this community. In a treatise looking at the mental health needs of Latinas and the gaps in services, groups were identified as an area that needed more investment. In their recommendations to service providers, they note that groups provide a way for the community to come together and to provide a safe space for Latinas (D Arlach, Gracia, Grumbach & Hudson, et. al., 2006). Because the group is marginalized, being minority women, providing safe spaces to express feelings openly among supportive peers should be an important part of any comprehensive service package for this community. Community mental health providers In discussing the needs of patients with community mental health providers (Lincoln Community Health Center) in Durham, one of the biggest needs they identified as being unmet was more groups. Many patients at Lincoln have unmet mental health needs and many of these mental

4 health needs are tied to a particular illness or obstacle they have encountered. In searching for support groups in the Durham area, it became clear there is a scarcity of groups being offered. Duke offers some groups, but many are limited to active patients in their system. Another reason the providers thought the community needed more groups is that many patients cannot afford individual psychotherapy; groups provide a cost-effective way of reaching many patients with psycho-educational material and peer support. Of the groups that are offered in the Durham area, very few are offered in Spanish. One of the longest-running support groups that offered services in Spanish was a post-partum depression support group offered through Duke. That group has since disbanded and practitioners at Lincoln expressed frustration at having nowhere to send women who needed peer support, especially women who are uninsured. Key informant- Sarah Herndon Sarah Herndon is a Family Support Worker (LCSW, MSW) that works with the Healthy Families Durham Program. Her caseload is all Hispanic families. Sarah has seen first-hand the detrimental impact social isolation can have on families and the many barriers to moms having a well-developed social network. Sarah co-taught a group several years ago that focused on maternal outcomes and building support, and she noted how successful the group was in building relationships between families; some moms exchanged phone numbers and continued their relationship after the group ended. Sarah noted that groups are an important way of moms having peer interaction and that sometimes the learning that occurs in groups can have a more lasting impact than a one on one home visit. Hearing another parent share strategies or talk about how they faced an issue can resonate more for some parents than going over a worksheet with a Family Support Worker. Sarah is this author s current field instructor and is very supportive of the idea of incorporating groups more systematically into the Healthy Families program as it fits very well with the overall mission of Healthy Families. NEW INTERVENTION Having access to close networks of people from the same cultural origin as well as to programs that support these networks is associated with the social and economic integration of immigrants in the host county and with their well being (Zhao, Xue, & Gilkinson, 2010). Instead of doing two loosely structured groups with both English and Spanish speakers over any 6 month term, which is the current requirement at Healthy Families, I am proposing doing a bimonthly all-spanish group for Latina moms and their children. This group will meet in a participant s home or a communal room at an apartment complex, pending confirmation. Transportation will be provided (through taxis and bus passes), and participants are welcome to bring their children. There will be concurrent activities for older children (2-4) for part of the session. The typical schedule for group will be:

5 11:00-11:15 Check-in 11:15-11:30 Activity with moms and children together 11:30-12:00 Moms meet separately from children and discuss topic of the day (psycho-education and discussion) 12:00-12:20 Communal meal 12:20-12:30 Closing activity The group will involve psycho-education, peer support, and discussion. There will also be time to work on parent-child interaction during joint activities. During the first session, participants will get the chance to express which psycho-education topics would be most relevant and helpful for their families. Potential psycho-educational topics include: maternal depression and anxiety, managing difficult behavior in children, taking time to take care of oneself (self-care), nutritious diet on a budget, assimilation vs. biculturalism, raising children away from culture of origin and extended family, effective discipline, and domestic violence and machismo. Participants will be asked in the final group to reflect on the effectiveness of the group process and the relevancy of topics presented. EVIDENCE A review of the literature supports the use of peer support to improve outcomes for immigrant women. In an examination of recent immigrants to Canada it was found that immigrant women who say they had at least one reciprocal support relationship within their social networks were more likely to say they are in good health than their peers without such a relationship (Zhao, Xue, & Gilkinson, 2010). Thus building peer relationships is important for health outcomes. Building Social Capital One way of thinking about peer support and groups is to think of them as strategies for building social capital. Social capital can be defined as the sum of the resources, actual or virtual, that accrue to an individual or a group by virtue of possessing a durable network of more or less institutionalized relationships of mutual acquaintance and recognition or the ability of actors to secure benefits by virtue of membership in social networks or other social structures (Zhao, Xue, & Gilkinson, 2010), essentially social relationships that confer some advantage. Social capital has been positively linked to many positive health, employment and other outcomes and has been found to be especially important to the well-being of immigrant communities (Zhao, Xue, & Gilkinson, 2010). In the literature on social capital, there are many ways of categorizing different kinds of capital; one distinction that is often made is that between social capital that lends social support and that which lends social leverage. Networks composed of ties that offer social leverage help

6 individuals to get ahead or change their opportunity structure. Ties that offer leverage can promote upward mobility by providing access to education, training, and employment. Large, dispersed, and heterogeneous (interclass) social networks increase the opportunity for advancement. Connections with organizations outside one s own community can also decrease one s potential for exploitation or victimization (Dominguez & Watkins, 2003). By hosting groups through Healthy Families, we are actually building both social support, by connecting moms to their peers, and social leverage, by strengthening the ties to Healthy Families, a community organization. Groups There is evidence that suggests that using targeted groups with minority populations can eliminate many service barriers faced by this population. There are many adults that have unmet mental health needs, especially among minority populations (U.S. Department of Health and Human Services, 1999). In many minority communities there is also much stigma against seeking mental health services. Seeking unofficial, informal support through groups may be one way for some mental health needs to be addressed, perhaps for the first time. Participants do not have to have clinically significant mental health needs to benefit from group participation because building the support and eroding social isolation can serve to prevent future mental health concerns given that social isolation can detrimentally impact one s mental health (U.S. Department of Health and Human Services, 1999). By tailoring services specifically to a population, in this case running a group in Spanish with Latina immigrant moms, you can increase trust and build the sense of peer support. When programs and services are specialized to meet the needs of identified minority communities, they tend to have greater success in recruiting and retaining participants (U.S. Department of Health and Human Services, 1999). There is also precedent for using peer support groups with moms. In an examination of a group for single mothers it was found that even though the group focused on psycho-education and skill-building, moms felt more connected and supported after participating in the group. After the group, mothers identified improved self-esteem, support from other mothers, improved parenting skills and improved communication with their children as outcomes of group participation. All of the women commented on the decreased sense of isolation that they experienced as a result of connecting with other lone mothers (Lipman, Kenny, Jack, Cameron, Secord, & Byrne, 2010). Thus a group does not necessarily have to focus exclusively on building connections for those connections to happen. Parent support groups have also been demonstrated to effectively strengthen and forge social relationship as well as improve child outcomes. A decrease in child maltreatment and an increase in adequate parenting skills have been found to be consistently associated with the presence of supportive social relationships for the parent (Parent Trust for Washington Children, 2009).

7 Circle of Parents is a parent support group hosted in many sites around the country. The state of Washington looked at all of the Circle of Parents groups held in the state and found that participants showed improvement in family management skills, building healthy relationships in the family, and their reported level of social support (Parent Trust for Washington Children, 2009). CASE STUDY- ORGANIZATIONAL HOME I am proposing running a peer support group for Latina moms through the Healthy Families Durham program. Healthy Families Durham is a home visiting program that currently serves first-time parents in Durham County. The program is housed in the Center for Child and Family Health, which seeks to improve the prevention and treatment of childhood trauma. Healthy Families serves the prevention directive of the Center by working to prevent child abuse, identify special needs, and promote child health and development (Healthy Families Manual, 2012). Families served by Healthy Families typically fall into a high-risk category to receive services; high-risk is defined as having one or more of the following risk factors: history of substance abuse, history of mental health problems, marital/family problems/ violence, history of/or current depression, history of childhood abuse/neglect, lack of social support, or teenage parent. The goal of Healthy Families is to strengthen families by increasing their capacity to nurture their children in the following ways: Promoting positive parenting skills and parent-child interaction Ensuring optimal prenatal care and encouraging optimal child health and development Improving family coping skills and responsibility Providing parents with support so that they can be more nurturing with their children (Healthy Families Manual, 2012). A large proportion of the families served through Healthy Families are Latino immigrants. The program also has a very flexible curriculum. While group attendance is not a mandatory part of Healthy Families, some workers have run groups for moms in the past and attendance at community groups (reading circles and playgroups) is encouraged. Thus Healthy Families seems well poised to integrate groups to increase Latina social support into their program model since supporting families is the overall goal of the program. Another reason Healthy Families seems in a good position to incorporate more groups is that the Early Head Start program, just a little ways down the hallway at the Center for Child and Family Health, already has a group curriculum. Early Head Start uses the same base curriculum (Parents as Teachers) as Healthy Families but their programmatic goals are slightly different. Early Head Start is a federally-outlined program that mandates a certain number of annual groups and is focused on school-readiness. Healthy Families is more flexible but could borrow the group

8 process and content used at Early Head Start and adapt it to focus on family outcomes and increasing connections between the parents. Due to the parameters of a grant that Healthy Families received, they are currently required to provide two groups every six months. Sarah Herndon, my field instructor at Healthy Families, is responsible for providing groups for the next term. In discussing groups with her, she mentioned that she and a coworker co-taught a series of groups a couple years ago that brought moms together in a client s home. Sarah mentioned that the home environment made the group seem a lot more personal and friendly and was probably responsible for the overall success of the group. Sarah was also able to secure grant funding for the group, which allowed them to offer transportation services. She notes that this made a tremendous difference for a few families that would have had no other way of participating. After meeting with Sarah, it seems clear that providing adequate transportation and aiming to host the groups in a home or apartment should be important aspects of the group planning and will lead to a more successful and accessible group. Timeline December- Apply for Durham Communities grant. Healthy Families has received this grant before to fund specific group series. Having the grant provides flexibility in paying for transportation and providing meals as an option instead of an inexpensive snack. January- Start exploring level of interest in the group with moms. Discuss with moms whether they might feel comfortable hosting the group in their home. Conduct first group at the end of the month. February, March, & April- Continue with groups. May- Conduct closing group. Meet with director of Healthy Families to evaluate the successes and obstacles encountered with the group and whether Healthy Families might be interested in standardizing the curriculum and group process.

9 REFERENCES Cacioppo, J. T. & Hawkley, L. C. (2003). Social isolation and health, with an emphasis on underlying mechanisms. Perspectives in Biology and Medicine, 46(3), S39-S52. Chang-Muy, F. & Congress, E. (Eds.). (2009). Social Work with Immigrants and Refugees: Legal Issues, Clinical Skills, and Advocacy. New York, NY: Springer Publishing Company. D Arlach, L., Gracia, A., Grumbach, G. & Hudson, J. (2006). Latina portrait: Latinas mental health needs. Retrieved from: http://www.mujereslatinasenaccion.org/resources/latinasmentalhealthneeds.pdf Dennis, C. L., Hodnett, E. D. (2009). Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database of Systematic Reviews 4. doi: 10.1002/14651858.CD006116.pub2. Dominguez, S. & Watkins, C. (2003). Creating networks for survival and mobility: social capital among African-American and Latin-American low-income mothers. Social Problems, 50(1), 111-135. Healthy Families Manual (2012). Kim, C. (2012). Class lecture. Lipman, E. L., Kenny, M., Jack, S., Cameron, R., Secord, M., & Byrne, C. (2010). Understanding how education/support groups help lone mothers. BMC Public Health, 10(4), 1-9. McPherson, M., Smith-Lovin, L. & Brashears, M. E. (2006). Social isolation in America: changes in core discussion networks over two decades. American Sociological Review, 71(3), 353-375. N.C. D.M.V. (2012). Retrieved from: http://www.ncdot.gov/dmv/ Nguyen, M. T. & Gill, H. (2010). The 287(g) program: the costs and consequences of local immigration enforcement in North Carolina communities. Retrieved from: http://isa.unc.edu/migration/resources.asp Parent Trust for Washington Children (2009). Outcome evaluation and program effectiveness: Circle of Parents Support Group Network 2003-2009. Retrieved from: http://www.parenttrust.org/uploads/pdf/programoutcomes/cop2009.pdf U.S. Census (2000). Profile of general demographic characteristics: 2000. Retrieved from: http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk U.S. Census (2010). Profile of general population and housing characteristics: 2010. Retrieved from: http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk

10 U.S. Department of Health and Human Services (1999). Mental health: A report of the Surgeon General. Retrieved from: http://profiles.nlm.nih.gov/ps/access/nnbbhs.pdf ANNOTATED BIBLIOGRAPHY 1. Dominguez-Fuentes, J. M. & Hombrados-Mendieta, M. I. (2012). Social support and happiness in immigrant women in Spain. Psychological Reports, 110(3), 977-990. This article examines the role social support and perceived social support have on the happiness of immigrant women. The authors found that the biggest predictors of happiness were emotional support from family and instrumental support from ethnic community. They also found that perceived adequacy of support also predicted happiness. While this article looks at immigrant communities in Spain, the link between social support and happiness can be extended to immigrant communities here in the U.S. This article also points out the important role organizations can have in providing informational support to immigrant women as well as supporting women in their use of informal social networks. 2. Fox, J. A. & Kim-Godwin, Y. (2011). Stress and depression among Latina women in rural southeastern North Carolina. Journal of Community Health Nursing, 28, 223-232. This article looks at the level of depression and the types of stressors that contribute to depression to Latina women in North Carolina. Nearly half of the women surveyed screened positive for possible depression, indicating a higher prevalence rate for this population when compared with the general adult population. Three of the most consistent stressors identified by respondents included separation from family members, religion, and immigration status. This article is interesting to our examination of social isolation because the first stressor refers to possible low levels of support. The last stressor, immigration status, is important because it shapes the experience of undocumented persons. Unfortunately in Healthy Families we don t explore immigration status too much because we do not want to document the problem and possibly lead to someone being found out, but I think it is an incredibly important part of an immigrant s experience and cannot be disregarded in any look at an immigrant s mental health. 3. House, J. S. (2001). Social isolation kills, but how and why? Psychosomatic Medicine, 63(2), 273-274. This article examines the link between social isolation and negative health outcomes and explores some of the physiological processes at work. Social isolation is linked to higher mortality and a host of other poor health outcomes. It is important to understand the possible consequences of social isolation if we want to target the issue; it is also important in providing psycho-education to help patients/clients understand the connections between behavior and health.

11 4. Records, K., Welborn, D., Casillas-Young, R., & Coonrod, D. (2011). Mamas saludables, familias saludables (Healthy moms, healthy families): Support group designed for Latinas with postpartum depression symptoms. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 40(1), S17. This article briefly describes the above initiative. This group was specifically designed to meet the needs of Latina moms. The program creators recognized that other standardized programs were not providing culturally sensitive services and that Latinas come from a community that underutilizes mental health services. Thus, they set out to create a program that tackled those two issues. 5. Shattell, M., Hamilton, D., Starr, S., Jenkins, C., & Hinderliter, N. (2008). Mental health service needs of a Latino population: A community-based participatory research project. Issues in Mental Health Nursing, 29, 349 368. This article looks at ways to bridge the gap between research and the Latino population. Many times we rationalize doing a research study and then pulling out of the community by saying it will shape future programs that will have a more lasting impact. Engaging the target population in research and making the process and result meaningful for the community is a much more service oriented approach and more in line with the Social Work Code of Ethics. In conducting groups with Latina women, I hope to actively engage participants in shaping the group and determining what parts of the group are important to continue to offer in the future and what is not as essential.