A Culturally Informed Approach to Treatment Through the Use of Dichos with Latinos

October 17, 2022

Information

YCSC Grand Rounds September 20, 2022

Hector Chaidez Ruacho, LCSW, Clinical Instructor, Yale Child Study Center
Anamaria Orozco, LCSW, Clinical Instructor, Yale Child Study Center

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00:14So funny. Always on these zooms.
00:15As soon as someone says we'll
00:16let everyone in, there's just
00:17a silence that falls.
00:21You're going to be having a
00:22great conversation beforehand,
00:23and then it'll just be like,
00:24OK, silence for a moment.
00:28So.
00:47Great.
00:50So we're just at 1:00 o'clock and I'd
00:52like to welcome everyone to our second in
00:55our Grand Rounds series for this semester.
00:57And this will be the first grand
00:59rounds that you can receive CME credit.
01:02And so as you can see Rosemary has
01:05the details on her slide there.
01:07We'll give it just one more moment where
01:10people are still streaming in and and
01:12thank you again for joining us for this
01:15virtual format and being so flexible
01:17going from in person to virtual and then.
01:21Next week, we'll actually be
01:23back in the Cohen Auditorium.
01:25We'll be back in person.
01:26I believe Rosemary is going to arrange some
01:28special treats for us again next week.
01:30Thank you very much, Rosemary.
01:31And we'll be welcoming Dr Nicholas
01:34Allen from the University of Oregon,
01:37who's also the CEO of Kasana Health.
01:39And Doctor Allen will be talking
01:41to us about digital mental health
01:43and particularly its application to
01:46understanding depression in adolescence.
01:48And now to introduce our speakers for today,
01:50I'd like to pass it over to you.
01:52Tara.
01:53Ohh. Thank you so much Kieran.
01:55So although I tend to speak with ohh,
01:57am I muted? No, no, no.
01:59I've got to stop sharing. I'm so sorry.
02:04No worries. Though, OK,
02:05so although I tend to speak with you all
02:08more often wearing my vice chair hat,
02:11my heart first found its home
02:13within our clinical services.
02:15And so I'm really thrilled to firmly
02:17wear that hat as I introduce you
02:19to two of the very many talented
02:21clinicians that I have the honor
02:23and privilege of supporting and
02:25mentoring within my role as the
02:27associate director of Youth Services.
02:29So if given the opportunity,
02:30I could wax poetic about the talents
02:32and unique contributions
02:34of each of our clinicians.
02:35But today I'll contain it to the
02:38two people who will be presenting
02:40so that it will be at those shivis.
02:43Hector and Anna Maria and
02:45you can read their CV's and look
02:47at their profiles to get a sense
02:49of their accomplishments.
02:50But really, in preparation for today,
02:52which will probably be of no
02:53surprise to those of you who know me,
02:55I asked them to answer some questions
02:57for me so that I can introduce
02:59you more to their hearts.
03:00So in this process,
03:01I learned that Hector and Anamaria have
03:03even more in common than I realized.
03:05They both joined our team during the
03:07pandemic and had been working here for
03:09many months before actually getting
03:11to meet many of their colleagues in person.
03:13Despite that challenge,
03:15that challenging beginning they've
03:17anchored into our community.
03:19Both are familiar with the
03:22challenges of immigration.
03:23Hector and his family came to the US
03:26from Tijuana's in the state of Durango,
03:28Mexico, and Anna Maria,
03:29although a New Haven native,
03:32has parents who came from it in Colombia.
03:35Both originate from families who were
03:37in service to their communities.
03:39Hector's family were farmers in Mexico
03:41and migrant farmers in California.
03:44His father was a part of the Cesar
03:46Chavez and Dolores Huerta movement,
03:48fighting for migrant farmers rights.
03:50Anna Maria's maternal grandparents were
03:52both professors in their country in Colombia.
03:55The values of service and advocacy
03:57instilled in them by their families and
04:00their dedications to their community
04:02continues and is modeled daily in their work.
04:05They both committed to providing
04:06quality care to all of the families
04:09that they serve and when I asked why,
04:11they came to the field of social work.
04:13It was clear that their values had
04:15been a North star in their decisions.
04:18They're both driven by the values of equity,
04:20cultural humility and social justice,
04:22and saw social work as a way that
04:24they could use their bilingual,
04:26bicultural experiences to increase
04:28access to behavioral health services
04:31for the Latinx youth and families.
04:34Hector may not be planting seeds
04:36in literal soil,
04:38but he and Anna Maria are
04:39cultivating seeds of change, growth,
04:41and empowerment for those they serve.
04:44As you'll learn from their presentation,
04:46they both seek to meet their families
04:48where they are and to offer adaptations
04:51and entry points to treatment that
04:53are familiar and resonate deeply
04:54with the families they serve.
04:56Each aware of the challenges and
04:58barriers to linguistically and
05:00culturally tailored care
05:01for the Latinx community,
05:02they decided to be a part of the solution.
05:05Not only with their with their
05:07commitment to providing therapy
05:09that is culturally responsive,
05:10but in providing innovative ideas
05:12and teaching others to be able to
05:15serve the Latinx community better.
05:17They are advocates,
05:20educators and clinicians.
05:22With the goal. Oops, I lost my space.
05:27With the goal of providing excellent,
05:29culturally considerate care.
05:30While this would be a spectacular
05:33offering any time of year,
05:35it gives me great pleasure as a Latina
05:37woman myself to highlight the work
05:39of these two Latinx clinicians and
05:41their work to better serve the Latinx
05:43communities during Hispanic Heritage Month.
05:45I invite you to listen deeply to
05:47the sneak peek of the presentation
05:50that they will present at the
05:52Latino social work organization.
05:54I think that's what it's called on the chaos,
05:56which are sayings that hold a
05:58special place in the homes and
06:00hearts of many Latinx families.
06:01And they're using them as ways to
06:03engage and translate concepts.
06:05One that's sticks out for me that I heard
06:08growing up is the macconkey nandas kenyeres.
06:11Literally tell me who you walk with,
06:13and I'll tell you who you are.
06:15Tell me who your friends are,
06:16and I'll tell you who you are.
06:18It's one that my grandmother
06:19and mother always referred to.
06:20And in my life and in my work,
06:22I have no concerns about who I work
06:25with and who I walk with these days and
06:29hope that their talents and values.
06:32Are evident to all of those around me.
06:35So I'm very honored to work with
06:37and support Anna and Hector,
06:39and I hope it says something about
06:41who I am as a person to have
06:43such wonderful people around me.
06:44And so I invite you to be present
06:46and to listen deeply to their
06:48presentation and to keep your eye
06:50out for the places they'll go,
06:52which I believe will include research
06:54and training and compassionate and
06:55culturally informed supervision
06:56that benefits all but most of all
06:59the Latinx community in New Haven
07:00that they feel very passionate.
07:02About and of course,
07:04families beyond New Haven as well,
07:06so please welcome Hector Chavez,
07:08Raucho and Anna Maria Orosco.
07:13You have to do an applause for that.
07:20Thank you so much for for the introduction
07:22Tara that was very, very beautiful.
07:25I actually, you know,
07:27even wanted to take it a little
07:29bit further with just introducing
07:31today's presentation because I,
07:34I I believe we've you know I've done
07:36a version of this presentation to
07:39some of the our Community members.
07:41But I really want to highlight
07:43that today's is a newer and
07:46improved presentation because I
07:47know Maria is forming part of it.
07:50Yeah, I think, you know,
07:51her clinical work and the
07:53insight that she brings into this
07:55presentation will speak for itself.
07:56But I I really do want to be
07:59purposeful and highlighting that
08:01she brings something to this
08:02presentation that I don't bring,
08:04which is that she's part of,
08:06of the Community here.
08:10And and really it's unlike you know
08:12many of us that might have come for
08:15for a fellowship or for a job and
08:17she is a voice from the community
08:19and and I feel strongly that we
08:22should bring more voices like Anna
08:24Marias into into the conversation
08:26so that we can provide a better
08:29work and better services for for
08:31the families that we work with.
08:33So having said that we'll we'll
08:35go ahead and and get started.
08:37So at this quote we wanted to bring
08:40a quote that kind of foreshadowed
08:42a little bit of the themes that
08:44we're going to be speaking to.
08:45This is a quote by a psychiatrist
08:49at Dixon Chibanda from Zimbabwe
08:52who who states we see everything,
08:55everything through the lens of academia,
08:57particularly from the northern hemisphere,
08:59and we don't take the time to look at
09:01the local indigenous knowledge and the
09:03wisdom which is inherent in every culture.
09:06Every culture has their amazing.
09:08Ability to teach you a
09:09piece of profound wisdom.
09:11We must appreciate the local culture
09:12and the role it can play in addressing
09:15not only the mental health issues,
09:17but a wide range of issues.
09:19As I mentioned,
09:20this was just a quote that we
09:21feel that speaks to a lot of the
09:24themes that we're going to be
09:25discussing in our presentation today.
09:29So hi everyone. It's dated before.
09:31I'm Anna Maria, but I also go
09:33by Anna and I just want to say
09:34thank you for having us here.
09:35And I wanna thank Hector for bringing
09:38me into this really important work
09:39that I'm excited to be a part of.
09:42So to get us started,
09:43when we're thinking of improving the
09:45utilization experience of services
09:47specifically among our Latino families,
09:49it's important to understand
09:50that there is an underutilization
09:52of mental health services,
09:53specifically among Latinos.
09:54This has been linked with the feeling
09:57of not being understood to due to not
10:01only value differences but also language.
10:03Between the therapist and the client.
10:05It's important to understand, though,
10:07that this dissatisfaction that's
10:08been reported does not solely revolve
10:11on the therapist ethnicity or race,
10:13but more so on the therapist perceived
10:15understanding and potential openness
10:17to understand the Latino culture.
10:19Something that I think is important
10:21for us as clinicians to keep in mind
10:23when working with Latino clients is
10:24that a lot of our Latino clients come
10:26in and some of them are not documented.
10:28They themselves might not be
10:30documented in their family members
10:31might not be documented.
10:32This really instills an innate fear that
10:35there could potentially be an exposure
10:37to a family member's documentation status.
10:41With that being said,
10:42if you all take a moment to scan the
10:44QR code at the top of the slide,
10:46it'll bring you to a great resource,
10:47which is a report by the American
10:50Psychiatric Association.
10:51In that report,
10:52it is noted that Latino youth
10:53are especially vulnerable to
10:55psychological stress associated
10:57with immigration and culturation.
10:59A lot of the youth we service that
11:00might even be born in this country
11:02have parents who are not documented,
11:04so they do have a risk of potentially
11:07being deported at any time.
11:08That can also mean that that the
11:10youth might have to move out of this.
11:11Country where they were born.
11:14Another thing of note in the report
11:16is that Latinos shared that they are
11:18more likely to have poor communication
11:20with their health provider.
11:22Some of the barriers reported
11:23about this are not only language,
11:26but also lack of culturally tailored
11:28services and culturally sensitive
11:29mental health professionals.
11:36We're gonna I wanted us to to also
11:38move into thinking about maybe one
11:40way in which we can do a better job
11:43in both recognizing and attempting to
11:46understand some of the experiences of
11:48of the Latino families that we serve,
11:50specifically the Latino immigrant
11:52families that that that we serve.
11:56And so this two terms here,
11:58cultural bereavement and migratory
12:00grief are not you know,
12:03solely for Latino immigrant families.
12:05They're an experience that is experienced
12:08by a wide range of immigrants.
12:11But you know speaking specifically
12:13to we're going to make we're going
12:16to be tying it in specifically to
12:18to the Latino immigrant community.
12:20But this first term and cultural
12:23bereavement was was going to to.
12:26Delete attempt to.
12:30Chair or describe the experience
12:32that an immigrant or a group of
12:35immigrants face when they face
12:37losses related to cultural values,
12:40social structures and self identity.
12:42And this second term migratory
12:44grief is very similar in nature.
12:47It speaks to the understanding that,
12:49you know, relocating geographically,
12:51it has a significant it's a
12:54significant change and it's accompanied
12:56by grief like symptoms and.
12:59And in this way,
13:00this kind of can help us view our own
13:03clinical work with with this family
13:05through viewing it in a in a grief,
13:07like through a grief perspective.
13:12So you know, unfortunately,
13:15migratory grief, it has been labeled
13:18a form of disenfranchised grief.
13:20For those of you in the audience who are not
13:23aware of whether disenfranchised grief is,
13:26is it really when people experience a laws
13:29that cannot be either openly acknowledged,
13:33publicly mourned or socially supported?
13:36This can range from the loss
13:38of a pet to the loss of a loved
13:40one through a death by suicide.
13:42Migratory grief was going to a
13:45form of a disenfranchised grief
13:48because actually on on our end on
13:51the mental health provider sent.
13:54We are not acknowledging it as as
13:56maybe we should and we're not having
13:58this conversations in our in our
14:01clinical spaces as as we should Umm
14:03and and really you know we want to
14:06make sure that that we do and we
14:08we have this conversations and we
14:10acknowledge it because as we know.
14:13And disenfranchised grief is not
14:15acknowledged it it only further isolates
14:18a lot of the people experiencing this
14:20losses and and it really harms their
14:23their grieving process in the long term.
14:28So thinking of how we can do
14:30better now that we know what
14:32disenfranchised grief means.
14:34So for those of you that don't
14:36know what cultural humility is,
14:38it's the ongoing process of self
14:39reflection where they're provider not only
14:41learns about another person's culture,
14:43but actively seeks to eliminate
14:45the power imbalance in the
14:47therapist client relationship.
14:49And I think understanding and
14:51implementing cultural humility
14:51can really be helpful in
14:53relating to your Latino families.
14:56Yeah. And so the way that we wanted to.
15:00To tie it in was it really for for
15:05providers and to position themselves
15:08with the Latino families in in in a
15:11way that that puts themselves as the
15:14learners and allows Latino families to to
15:17become the experts of their experience.
15:20So this in a way we're we're speaking to
15:24the use of features and maybe a push to
15:27to attempt to balance the power dynamic.
15:30Between um.
15:31That you know the the clinicians and
15:34the families that we serve and we're
15:37also making the connection and not just
15:40as as this as a tool for for cultural
15:42humility but also making the connection
15:45that by acknowledging by utilizing
15:47tools that are part of their culture,
15:50we're in a way acknowledging a migratory
15:53grief and ensuring that we're going
15:55to preserve some of that Latino
15:57culture in our treatment together.
15:59That this is going to be a space
16:01where they're they're.
16:02Culture is not going to be further
16:05lost in in this new country and
16:07really preserving it in that level.
16:13So we wanted to speak just briefly about
16:17the history of features and and I wanted
16:19to say you know even though teachers
16:22and the teachers that we're using are
16:25in Spanish and often people attribute
16:27it to to Spain as as it being you
16:30know where where they originated from.
16:33And I really really want to make the point
16:36that that this is not the whole truth.
16:39Of course Spain has a lot of
16:41influence in in a lot of this.
16:43Teachers, but it's really a fusion
16:45of cultures that that are coming in
16:48and playing into this wisdom that is
16:51that is being used by the communities
16:54and and by our culture.
16:56I can speak a little bit more to to
16:58Mexican teachers because I know a
17:00little bit more of of that history,
17:02but for example when Spain first
17:05colonized Mexico in the 1500s.
17:08You know it wasn't that that just
17:10everyone took up the the language
17:12and and took up the this the chaos
17:15and and utilized everything that
17:17that's being brought in.
17:18It was a mixture of of both this
17:21European nation that had colonized
17:23and and the indigenous cultures
17:26that that were already present.
17:28So we have to really be mindful of of
17:31when we're speaking about the chaos
17:34that are where they're originating
17:36from but also what influences them.
17:39Even through Spanish writing and and
17:41and the ways that Spanish has evolved
17:44as a language there's still actually
17:46a lot of words that that are that come
17:49from indigenous languages like now
17:51what from Mexico that you know even
17:53works like chocolate that now are even
17:56part of like the English language right.
17:59They're actually part of of Nawat
18:01language 1st and that's what
18:04influenced some of these words to to
18:06come out so very similarly for for.
18:09The the dead shows there,
18:11there's there's a mix there a mix of
18:13both the cultures and all the cultures
18:16that are are coming to play even in
18:19in Spain for example for a long time
18:21in their history they the Muslim
18:23culture was was more present in Spain.
18:26And so even there's even some of
18:28those elements some of that influence
18:30coming in from from that culture
18:32and we want to be mindful of that
18:35when when we're speaking about this
18:37wisdom that has been passed down
18:39from generation to generation.
18:41Even in the Caribbean,
18:42for example, in Puerto Rico,
18:44there's some of the teachers that I've been,
18:46I've been kind of learning and immersing
18:49myself that have the African culture
18:51influencing some of of of them.
18:53And and it's important,
18:54it's really important to give credit
18:57to all the cultures and that we're
18:59not losing some of those cultures in
19:01the process of or in the process of
19:03talking about what influences them and
19:06or what knowledge we're we're sharing.
19:13So for I think you know this is a
19:15quote by by Gary Soto a Mexican
19:17American poet and he speak he's
19:20speaking to the Mexican proverb right.
19:22But but I want to make the point that
19:25this goes beyond the Mexican proverb
19:28this I I feel like this is true for for
19:32any Latino Tito and and it's I think it
19:35really hides like some of the essence of of.
19:39Features and and the way that we're using,
19:42we're utilizing them as a
19:43tool in our clinical setting.
19:44So Gary Soto states the Mexican proverb is
19:48the verbal property of the common people.
19:51It may inform and advise or it may
19:54offer an arguable point to life.
19:57It is amusement and it is wisdom itself.
19:59It is the soothing remedy of to
20:01loss and the loss of hope.
20:03It is the unwritten literature
20:05and philosophy of the poor.
20:07He goes silent to say Mexican proverbs.
20:10Have been passed down from
20:12generation to generation.
20:13They are frequently regional
20:15yet universal and appeal.
20:17They reunite the listener with
20:19his or her ancestors.
20:21I want us to to really think about,
20:23you know, for how long have humanity really,
20:28but if we're more specific,
20:31a lot of Latino countries and Latino
20:33cultures not had access to mental
20:35healthcare and even up to now in
20:38so many places in Latin America.
20:40They're still not access to
20:43mental healthcare,
20:44but are we going to maybe assume that
20:47there was no tools to utilize it in in
20:50responding to some of this distress?
20:52Of course not.
20:53There were there were tools that
20:55were being used throughout the
20:56history and this is where we're,
20:58we're kind of pulling from now.
21:01We're pulling from the tools that
21:03have been historically used and and
21:06in a way that really highlight that
21:08multi generational form of resiliency.
21:11That that we see of a lot of this
21:13cultures that have experienced so
21:15much distress due to their to the
21:17history that is there and histories
21:19of oppression and and in so many
21:22ways histories that that that
21:23have that caused so much harm.
21:25But that yet there's tools and
21:28wisdom that has been passed down
21:31from one generation to another to
21:33ensure that you know there is there
21:36is a push to to that our people
21:38will go on in some way right.
21:40And so even when we I always tie it
21:43into to our evidence based practices
21:46right and a lot of the times maybe we
21:50we view things such as like for example
21:53in CBT there's there's reframing.
21:55That maybe we pull as a tool to use right.
21:58But if we look at some of this
22:01dtos it's in our history Latino
22:03culture has been using reframing
22:05it for hundreds of years.
22:07If simply we just use we look at
22:10this one tool and they chose right.
22:12We've been using reframing for
22:14so long yes maybe in in evidence
22:16based practice we've labeled it
22:18and and kind of researched it
22:19in a different way but but it's
22:22the same tool that people have been
22:23using in some ways in in those local.
22:26Cultures and this is not only true to
22:28to the Latino cultures, it's true for
22:30for many cultures around the world.
22:34Yeah. So when I was speaking
22:36with Hector about EVP's,
22:38I was also reflecting a little bit on
22:40my experience utilizing EVP's with my
22:43Latino families and and thinking of some
22:45of the challenges that presents with.
22:48With implementing it.
22:48So one of the things that I think
22:50is really important to understand
22:52is how impactful language can be.
22:54And while our EVP's that come with
22:56different measures and questionnaires
22:58are translated in the Spanish language,
23:00it's important to note that Spanish
23:02has a lot of different dialects.
23:04So something that might mean one
23:05thing for me and a set of certain way
23:08in Colombia might be said or like
23:10understood a completely different way
23:11for somebody who's from Peru or Mexico.
23:13So while we have all of these
23:16translated in Spanish,
23:17it's just important to understand that.
23:19As clinicians,
23:19we do sometimes have to think of
23:22creative ways to actually make it
23:24understood in the family specific language.
23:26Another kind of reflection I
23:28had in in implementing Evps with
23:31Latino families is that.
23:33Some of the EVPS we utilized have
23:34a certain time frame that we are to
23:37complete treatment in and while there
23:38is some flexibility in that time
23:40frame and the amount of sessions we
23:42are we are to do with our families.
23:44I have found that working with
23:47Latino families it takes a little
23:49bit longer to build rapport and this
23:51is due to there is a clear mental
23:53health stigma among the Latino
23:55community first and foremost.
23:57And secondly,
23:57going back to the points we were
23:59talking about early earlier where
24:00it is difficult for our family
24:02to build trust when they.
24:03Have those innate fears that they
24:06come into our office with so.
24:08Having a family come in and attempting
24:10to kind of collect information
24:12and do these measures when?
24:15Really building trust should be first
24:16and foremost with these families,
24:18at least in in the in my experience
24:20with them.
24:21And lastly,
24:21an example of how impactful
24:23language really can be when we
24:26use these interventions.
24:27So there's an intervention in
24:29one of the EVP's we commonly use
24:32and it's called blue thoughts.
24:34So if I say to you all I'm feeling blue
24:36or if I ask you are you feeling blue,
24:38you understand exactly what I mean.
24:40It means are you feeling sad or
24:41you have do you have a low mood,
24:43however, in Latino culture feeling.
24:45To it's not a concept.
24:46So if I were to ask that to one
24:47of my Latino families,
24:48they would not understand what I'm asking.
24:51So trying to figure out a nice way to.
24:54Almost improved the language
24:55that we're we're putting these
24:57interventions in so that it really
24:58resonates with our family.
25:03So originally we were going to ask for
25:06maybe some volunteers in this slide and
25:10we we really wanted to to get people to
25:12feel maybe a little bit uncomfortable
25:15taking leaps out of their comfort zone.
25:17But we opted to you know maybe keep
25:20the anxiety down and everyone and and
25:22we opted to to read it ourselves.
25:25But I do want to pause this though.
25:27I want to pause this to reflect on on
25:29this right and what I'm speaking to and.
25:32And what it means to to really use a
25:35language that is not your native language,
25:38it's so the vulnerability that it takes,
25:41right? The vulnerability that it takes
25:43even for some of our families that we
25:45work with that may have the language,
25:48they may have learned English as
25:50a second language,
25:51but that might have not have the
25:54all the pronunciation down right.
25:56And that they still feel in some
25:59ways vulnerable to to maybe speak
26:01in front of others.
26:02But it you know they still do it
26:04and they model it in some ways
26:07they model vulnerability for us
26:08and maybe we're missing that.
26:10We're missing that in some of our
26:12work with with Latino families or or
26:15families that speak other languages
26:17that are are speaking English.
26:19It just so that they can they
26:20can communicate with us.
26:21So we want to be very very
26:24mindful about that.
26:25I feel like tying it back
26:27to to migratory grief.
26:28This is one of those huge losses
26:31that are experienced where.
26:33We almost lose our voice from
26:35going from one country to another
26:37where you know in one country
26:40and you feel like you can freely
26:42communicate and and talk to anyone.
26:44Then you get to another country where
26:46that's not maybe the the language that
26:49is used at most commonly and sometimes
26:51even like going to a restaurant becomes
26:54this big vulnerability task and and
26:56pushing yourself to to be vulnerable.
26:59So we want to be mindful of
27:01those losses the vulnerability.
27:03That is that is displayed in
27:05in some of our work together.
27:07But now we can finally get to to
27:09what we've been speaking about,
27:10right.
27:10We've been speaking about teachers
27:12and probably a lot of people in this room.
27:14We're not really sure what what we're
27:16talking about when we're talking about the.
27:19So these are some examples of them.
27:21I'm going to be kind of sharing a little
27:24bit of my own clinical experience with
27:26with some of these features and the
27:28way that I that I've utilized them to
27:31to best fit my my work with my families.
27:34So the first one is a very
27:37common detail that almost,
27:40well,
27:40every Latino family that I've
27:42talked to has the knowledge of this.
27:44The show.
27:45It's very commonly used throughout
27:48Latin America and it's it.
27:50Don't each minus a unique world.
27:52So the way that I often use this
27:57detail this echo actually I've
27:58used it in very different ways
28:00but one of the ways that I've most
28:03commonly used it is in my trauma work
28:06with families that sometimes come in
28:07with like A at least two children that
28:10I'm going to be you know working with.
28:12And sometimes families or parents
28:15will make comments like well
28:18you know this one of their.
28:20Kids, it's improving.
28:21Maybe the trauma symptoms are going down a
28:24little bit faster or the trauma symptoms
28:26were different and they're like, well,
28:28we feel like this kids doing OK now,
28:31but this other kids, well,
28:33no, let's touch on the games.
28:34He's not putting effort into it, right and.
28:36And so we we get the parents
28:38get caught up in like well they
28:40were both in the same thing.
28:43Why are they their reactions so differently.
28:46And so I kind of just you know lay
28:47it out to the families out I I bring
28:50this each or not in a way that I'm
28:52going to teach you but in a way like
28:54well have you heard this djoki like
28:56this on Mundo and I have them kind
28:58of talk to me about what it means
29:00to them and their culture because
29:01I I may have a view of of what the
29:04teacher means but I want to learn
29:06how they view it a lot of the times.
29:08My experience like they tie it into
29:11the same individualized experiences
29:14and so then I'm able to kind of pull
29:16it back to some of the psychoeducation
29:18that we know from trauma that you
29:21know people can have.
29:22While it might be the same event,
29:24they may have very different reactions.
29:26Some of them may go on to have
29:29longer term trauma symptoms and and
29:32others you know and maybe experience
29:35it in a way that it wasn't as.
29:38Uh,
29:38they're able to kind of heal and
29:40cope with it in a in a quicker way.
29:42Or they're just their reactions,
29:44their trauma symptoms were different,
29:45really speaking to this individualized
29:47experience of trauma in some ways.
29:50So, you know,
29:51I think this is one way in which,
29:53you know,
29:54it's not just me bringing in
29:55this psychoeducation from trauma
29:57and kind of putting it on them.
29:58It's really pulling from their
30:00own culture to inform the work
30:02that we're doing together.
30:04And another teacher that I
30:06commonly use is a massive.
30:08Also you have the Angel yoso Ascena Mayo FL,
30:11Hermoso March winds and April
30:13showers bring mayflowers.
30:15I know in English they actually
30:17use this this one a lot and it's
30:20usually the last part,
30:21but I really use this one for even
30:24like for feelings and the importance
30:27of feeling those feelings that
30:29maybe don't feel so good right.
30:32In some sense we just want to get
30:34to to those nice feelings that that
30:36maybe feel like we can process them.
30:39A little bit of a nicer way or or that.
30:42But I I kind of pull it back to the
30:44importance of of kind of staying
30:46with those feelings and
30:47feelings of sadness.
30:49Feelings of anger irritability anything
30:51that comes up not wanting to to just
30:54go to the next one to the one that
30:57feels good and and this one even for
30:59for any of you that work with maybe
31:03circle security or attachment based
31:05that being with the feeling right.
31:08I think it.
31:09This is a feature that kind of
31:11captures that being with each
31:13feeling even when doing parent work.
31:16And so I think that this one's
31:18very nice to to really talk about
31:20feelings and and that's like
31:22education surrounding feelings.
31:24And then this one last one that
31:26I'm going to be speaking to which
31:28this one always cracks me up and
31:31and I actually had like a whole
31:33session one time just just solely
31:35on this feature which is can I
31:37don't Plato it's at Gritton polo.
31:39But they don't know vodka.
31:40To win a dispute is to gain a chicken,
31:43but to lose a cow and lose a cow.
31:45And this one I really use it in my
31:48family work and I I really like
31:51incorporating in my family work because
31:53often and not with every Latino family,
31:56but sometimes the theme of respect
31:59is is very prevalent in some of the
32:02families that that I work with.
32:04And we get caught up on the disputes part,
32:07the little arguments that the parent is like,
32:09whoa,
32:10the the child should just respect
32:13and they should, you know,
32:15that respect kind of turns into
32:17I'm always right as a parent.
32:19Some of my family work, I'm always right.
32:21You respect me,
32:22so I'm always going to be right.
32:24And we get sometimes I pointed towards
32:26like OK, what are we emphasizing?
32:28Are we wanting to win that chicken that
32:31always being right through that chicken?
32:34Or do we want to win the cow,
32:36which the cow I I illustrated as being
32:38a better relationship with our children,
32:41right.
32:41And so where what do we want to win?
32:44Because if we solely focus on this,
32:47on being right in the respect side,
32:49then maybe we're going to lose out on
32:51that bigger price that is out here.
32:53And I think that one,
32:54that one like kind of captures it
32:57and it also brings another coping
32:59skill of of like humor into it,
33:01which I love using humor with my families.
33:04Where you know and and even with the
33:06Latino community they respond so
33:07well to it because sometimes some of
33:09the conversations are so tense and
33:11we bring in bringing like a silly
33:13sounding beach so that it's like OK,
33:16thanks again.
33:16Can feel a little bit lighter in
33:18the room and we can talk about them
33:19in a different way.
33:20So this is just three examples of
33:23the way that clinically I've used
33:25chose that I I really do feel because
33:27I pulled from something that maybe
33:30they knew or that they were familiar with it.
33:33It just works so well.
33:35And in implementing some of the work,
33:37some of the knowledge that that we're
33:39bringing in for mental health to the room.
33:48Sorry, there we go.
33:49So this is also my favorite
33:51part and I'm excited to share
33:53these features with you all.
33:54So I have a few here that I've heard
33:56of myself growing up and I know past
33:59colleagues of mine also using their
34:01work and I'm lucky enough to be able
34:03to implement this in my work too.
34:04So the first one,
34:05I'm not going to go through all of them,
34:07but the first one that I want to
34:09highlight that I I use often is my
34:11whole solar Camilla Campagna and that
34:13means better alone than in bad company.
34:15So.
34:15Specific a few specific ways that I've used.
34:18This one is oftentimes with my
34:20teenagers who are really struggling
34:22to find a friend group that they fit
34:25into or maybe are hanging out with.
34:28Not the best influences,
34:29so implementing this with them.
34:31Can really help them understand that
34:33they are in control about how they
34:35feel in regards to the acclimation
34:37difficulties with peer groups and and
34:39really offer some resiliency to that.
34:42Another one that I think is really
34:43nice to use in treatment is no iMac.
34:45It would be annoying that and this means
34:47that out of the bad something good can come.
34:50So a a good way to put this into
34:53practice is when you're doing TF CBT,
34:55which is a common,
34:57commonly used BP,
34:58and you're doing the trauma narrative
35:00at the end and kind of implementing
35:02this with your client just to help them
35:04look at their story through more of
35:06a survivor lens versus a victim lens.
35:10Another one that's really.
35:12Important to me is cocoa,
35:14cocoa, so alejos and this means
35:16little by little one goes far.
35:17So I've used this in my work and I've
35:20actually also heard a family who was
35:23not Spanish speaking they actually
35:24spoke Swahili used this feature and a
35:27way that I've I've used it in practice
35:30is working specifically with victims
35:33of domestic violence who have had to
35:35move out of their home and and move
35:38to in in that case a woman's shelter.
35:41I've also used it with families.
35:43They were going through documentation
35:45process or potential deportation
35:47threats and there was a lot of layers
35:50to to working through that for them.
35:52The last one that I really enjoy
35:54using is sort of Davi sale,
35:55knowing Guerra,
35:56and that means the four born,
35:58just four armed.
35:59So my favorite way to use this is
36:01specifically with parents and I'm
36:03providing psychoeducation and trying to
36:05bring new tools into their toolkits,
36:06which may be there's interventions
36:08they haven't heard of or
36:10a little reluctant to try.
36:12So bringing this into session
36:14really makes them feel like, OK,
36:16maybe this is something that I
36:18should learn and should try,
36:19and it also could potentially remind
36:21them of things they have heard.
36:22Growing up.
36:23I just want to also note that we
36:25want to be really mindful when
36:27we're using these echos and we
36:29wanna make sure we're not in any way
36:31invalidating the clients experience,
36:32so understanding when the best time
36:34to use that is is also really important.
36:40So these are some of the benefits of details.
36:42I'm not going to go through
36:44all of them for sake of time,
36:45but I do want to highlight a few.
36:47So using leeches can really
36:48help increase the motivation,
36:50engagement of of our clients.
36:53Also do you just can really draw from
36:56the clients cultural perspective,
36:58you're bringing in the clients
37:00language and things that they've
37:01probably heard from their parents and
37:03grandparents right into your session.
37:05Also teachers can address culturally
37:08based reluctancy that might be.
37:10Produced by the fear that getting
37:12treatment and and being present in
37:14treatment might strip our Latino
37:15families of their culture and experience.
37:23Some of the of the implications right
37:25for non Spanish speaking providers.
37:28I think that this, this is really this
37:30is probably the most important slide in
37:33in all of the presentation just because
37:35we're we're making the point that
37:37we're not presenting this simply for
37:40for other Spanish speaking providers.
37:44That's not the point of this presentation.
37:46The point of this presentation is to give
37:49everyone a tool that we can possibly use to.
37:52Improve the quality of services
37:54that we provide for our Spanish
37:57speaking families and this is really,
38:01really important to to.
38:03Can I do?
38:04Because it's like we if we're honest in
38:07this moment in time and probably for a while,
38:10as a field, as a mental health field,
38:13and specifically even speaking to our center,
38:16we're not representative of the
38:18communities that we serve.
38:20And but that doesn't mean that we
38:22cannot do things to improve the
38:24quality of services that we provide
38:26for for the rest of our families.
38:28And this is you know I I know and
38:30I'm really confident because we have
38:33Tara leading us in this direction
38:35and and I'm confident of the moves
38:37that that the center is making to
38:39to make sure that we provide we
38:42become more representative and that
38:44we provide the quality of care that
38:46are all of our families to serve.
38:48But this is something that.
38:50As clinicians,
38:51as individuals we can push ourselves to
38:55to really attempt to to take ourselves
38:58out of maybe our comfort zones and and
39:02to do something for for our families
39:05for the families that we serve.
39:06That yes it might make you
39:09uncomfortable but that might bring
39:11in better results in the long run.
39:14As you know as I was stating teachers
39:16and as you were able to see teachers are
39:18pretty short phrases and we always say.
39:20That,
39:21you know,
39:22English speaking providers can say
39:24this phrases in Spanish and even if
39:27you mispronounce it really badly,
39:28that's actually OK that's perfect
39:31because we're allowing the families
39:33now to take that expert role even in
39:35the pronunciation of their language.
39:37And so we really,
39:39really want to emphasize that,
39:41you know,
39:41taking that push to to be vulnerable
39:43in session with your families and even
39:46like taking the moment to to do your
39:48research on some of the beaches that might.
39:51Apply best for for the clinical
39:54work that you're doing with your
39:56family at the time highlights that
39:58respect for the Latino culture and
40:01in a very cultural humility driven
40:04approach and and also that you know
40:07we're we're acknowledging some of
40:09the of the disenfranchised migratory
40:11grief and really not only saying
40:13it out loud and having those really
40:16important conversations about
40:18migratory grief but also about.
40:20You know,
40:21letting them know that their culture
40:23is going to be respected in this,
40:25in the,
40:26in the therapeutic work that
40:29that we're doing together.
40:32So to wrap up,
40:34actually we wanted to chair and
40:39if you want you can go to the next
40:42slide and we wanted to share like our
40:45best references because I think that
40:47you know we often you know there are
40:50the other references at the end of the
40:52slides but I think this are our main
40:54references for you know at least you
40:56know all the beaches that I know really
40:59and a lot of them come from from my.
41:01Both my grandma and my mom who have
41:04influenced you know that they've
41:06passed down those wisdoms from one
41:08generation to the other to the other.
41:10And they have been the most important part.
41:13And even the reason why I'm even
41:15thinking about utilizing this in
41:17treatment and my push to sometimes even
41:19coming out naturally and me seeing
41:22them because they really are the one,
41:24the teachers that have taught
41:25me some of his teachers.
41:27So, so they they both definitely
41:29get a lot of the credit for.
41:31Or the work that I'm doing even
41:35right now and in this presentation.
41:37So I'm going to highlight them.
41:38And I know Anna Maria has
41:40has a couple of her own.
41:42These are my two best references.
41:44My mom and my etha, my grandmother.
41:46And when Hector and I first
41:49started talking about videos,
41:50I kind of realized I've been
41:52hearing dichos my whole life
41:53and I use it in my work so much.
41:55But I guess I never kind of
41:56really realized it until I hacked
41:58or brought attention to it.
41:59So I'm lucky enough to have grown up hearing.
42:02Pages from both of these women in my
42:05life throughout different life lessons
42:07and different things and implementing
42:09it in my work now with my family
42:11is is really full circle for me.
42:24That's it on our end.
42:25But I just want to point out that I I love,
42:27I love all the details that people put.
42:30And I really want to make sure that I am
42:33able to hopefully take a look at some
42:35of them because I'm always collecting
42:37different details to to use in session,
42:39even with my families, when my families,
42:41when I shared the choke,
42:42like some of my families end up sharing
42:45more with me and I'm like, hold on,
42:47I I need to write them down because I
42:49feel like it's a collection of that,
42:50of that knowledge that I often
42:53don't have even.
42:54But when I was having this
42:55conversation with Anna Maria,
42:56she brought in a couple of maybe
42:59more teachers commonly used in
43:00Colombia that that I had no knowledge
43:02about and and that were, you know,
43:05adjust to to the toolkit because
43:06this is really just the tool, right.
43:08We're not saying that this is
43:10a whole intervention.
43:11We're not saying that this is going
43:13to fix every single engagement or or
43:16any type of like big scale problem.
43:19But this is a tool that we want to use
43:20to kind of improve the quality of care.
43:22And I'm always.
43:24For collecting any detail that I can.
43:28Yeah, I'm enjoying seeing
43:28all of them in the chat.
43:30I couldn't see them before
43:31because my PowerPoint was up,
43:32but these are great.
43:36Anna and Hector, thank you so much for
43:39such a great presentation and for. Just.
43:43I think one of the things that stuck
43:45out aside from the fact that I think
43:47Carolina mentioned it in the chat, that.
43:51What vitros can bring to to the treatment,
43:55I mean just seeing the way that
43:57families kind of can latch on to the
43:59concept you're trying to to convey
44:01because you've given them something
44:02that's very familiar to them,
44:04really is powerful.
44:06So I appreciate that so much.
44:08I also appreciate how you encourage
44:11the non Spanish speaking colleagues
44:13to also try it and to not worry about
44:17the mistakes and to also maybe model
44:20for families who don't feel confident.
44:22Speaking in English that it's OK that
44:24we can all kind of put ourselves in
44:26these positions and and it's OK to
44:28make mistakes and and kind of that's
44:30another way to level that power as well.
44:33So I appreciate that,
44:35but I'm curious,
44:36I know there's many beaches in the chat,
44:39but I wonder if there's any questions
44:42that anybody might have for Diana Maria.
44:48Ohh and Kieran put a note to please keep
44:50the details coming he'll save the chat
44:52and share them so we'll collect we'll
44:55have a repository to ask if there's a
44:56way to save all these because I want
44:58to read them all after
44:59I was like trying to figure out how
45:01to do it and I just figured it out so
45:03we'll we'll save that and ohh great
45:05and you just put one in as well so
45:07they keep coming in fantastic and
45:08I'll I'll share them with them whoever
45:10wants them but I'll share them directly
45:12with you on Marie and Hector thanks
45:13so much for a wonderful presentation.
45:18I just want to say thank you so much.
45:20This was fantastic.
45:22And you know to me it's just so
45:25interesting to to hear kind of the
45:28diversity even within all of our
45:30Latin American cultures, you know,
45:32and you know somebody from Venezuela
45:35and and in Cuba just, you know,
45:38it's not just it's phrases,
45:40you know and even that kind of,
45:42you know, even, you know,
45:43just that slight kind of change
45:45and just a quick story I.
45:47You had walked in to a meeting last
45:50week with one with a colleague
45:52who who is Spanish speaking and
45:54I just went into my process and
45:57I said they Guatemala, Watapur.
46:03You know, which is basically,
46:05you know, we're, you know,
46:06that we've gone to from a not so
46:09great place to maybe a worse place,
46:11you know, and it's something
46:12that I grew up with, you know,
46:14it's probably not even politically correct,
46:16but certainly it's something
46:17that is a part of the culture,
46:19you know, and it just took a minute.
46:22I'm like, wait,
46:22I have to kind of regroup because I
46:24went right to that emotional language,
46:26you know, of of saying that
46:28and and had to catch myself.
46:30But I think you guys should have been.
46:31Passing job.
46:32Thank you so much.
46:34Yeah. Thank you.
46:35Actually, during the conversation
46:37with Hector and I believe Catalina,
46:39we were talking about how the word
46:41straw is said completely different
46:42in all the language, I mean in all
46:44in the countries where we're from.
46:45So for me it's the physical and hector,
46:48I think it was, I can't remember.
46:51Thought that and Carolina.
46:52I believe it was the best sorbetto.
46:55She's on here somewhere,
46:56but it's just so interesting. Yeah.
47:02And have you have you thought about
47:04writing this up is that the plan
47:05are you going to have you going to
47:07disseminate this and in addition
47:09to your upcoming presentation
47:11hopefully yes hopefully that's the
47:14maybe the plan in in the next steps.
47:19I I feel like we're we're wanting and
47:22and to me like it's obviously very very
47:25important to to kind of get out and get
47:29this information along with. Anna Maria.
47:31And to really collect some of this, uh,
47:34how how people feel or even like whether
47:37it be like Spanish speaking clinicians
47:40or or other English speaking clinicians,
47:43how it feels like in the long term.
47:45I would actually love to because
47:47there's like a very, very.
47:49Have minimal research done.
47:52There was research done in the 90s in
47:55the use of Cheetos and it was like one
47:57or two articles and then it never like
48:00kind of went above that and I feel
48:02like this this tends to happen with a
48:05lot of this really amazing tools or
48:07techniques and and yeah we're adding
48:09maybe the piece of like putting the
48:12the details with the migratory grief
48:15that makes it different but I would
48:17love to kind of see and and research
48:19more of of this type of tools not.
48:21This even with the chose buddies even
48:23with Gwen ethos and and other tools that
48:26that would be helpful to incorporate
48:28into some of our of our clinical work.
48:30So that's the the long term or the
48:34long term goals that that are there.
48:38Wonderful. And is this a a shout
48:41out or a call out to all of your non
48:44Spanish speaking Spanish speaking
48:46colleagues to to give teachers a try?
48:50Oh yeah it's definitely it's
48:51a it's a call for action.
48:52We need to you know as a field as
48:54a system and this is including us
48:57the the Spanish speaking clinicians.
48:59We can all do better to improve
49:01the quality of services for our
49:02Spanish speaking families and
49:03this is a call for action for for
49:06everyone and and this is a tool
49:08that I feel like it's doable.
49:10Yes it feels uncomfortable and my
49:13feel uncomfortable but but it's
49:15a tool that we can all use.
49:21You really tapped into some of your
49:24Spanish speaking colleagues emotional
49:26memories and there's so many vitos
49:30flying through the the chat so thank
49:33you for that and it's also lovely
49:35like you know with with this you can
49:37figure out ways feel free to look them
49:40up and find out what they mean and
49:41how you might be able to use them.
49:43You know Hector talked about the April
49:45may I use that to often kind of say that
49:48you kind of you can appreciate the.
49:50The beautiful things,
49:51when you have some hard things before it,
49:54like you need them both to be
49:55able to appreciate them.
49:56So there's lots of different
49:58ways that you can use them,
50:00but you'll see the power of
50:01it in the in the families.
50:03It really drives home a connection.
50:05It helps with that rapport building,
50:08but it also helps with the connection to
50:11the concept that you're trying to teach
50:13in a way that really connects for families.
50:17And it's there's so many coming through.
50:20And and just I wanted to point to
50:22a suggestion that Jessica Mayo had
50:24which I think is is wonderful,
50:25just I don't know if you want to
50:27say anything about your suggestion.
50:34Not sure if Jessica can can can unmute
50:36at the moment, but yeah you can.
50:37You can read it there. I think
50:39there. Sorry it was my computer is almost
50:41dead so I had it docked in my video.
50:45Thanks, Kieran. Umm, yeah.
50:46Just thinking about our waiting room
50:48and the English speaking quotes or the
50:50English quotes that are there that I
50:52think have resonated with some teams
50:53that I see and wondering about the
50:55potential value of having some of these
50:57that we know resonate with Spanish
50:59speaking families and just making
51:00them more prominent in our clinic.
51:03It's a great idea.
51:14There's a comment in the chat that
51:16you're modeling, somebody else went in,
51:18but it says you're modeling such a
51:20way to help increase engagement of
51:22families and also to help ensure
51:24that clinical conversations and
51:25treatment resonate with families.
51:27What a very real,
51:28real way to connect with them.
51:32Thank you, Carrie.
51:34Yeah, it's not and that's
51:36what really it's about, right.
51:37It's about kind of connecting it in
51:40a way that that it brings in some of
51:43their their own cultural knowledge
51:45that that that they bring in.
51:47And and I think that you know,
51:48it's not to say that or we we just have to
51:51throw away all evidence based practices.
51:54Of course not you know there's
51:55a lot of a lot of good substance
51:57there a lot of really really good
52:00techniques that that are there,
52:02but the delivery is definitely not.
52:05Connecting well with with all the
52:07families and maybe the adaptations and
52:10are not maybe where we want them to
52:13be and and in some ways it's really
52:17maybe this push to to make some of
52:20those connections not solely on
52:23like not put all the responsibility
52:25on the Spanish speaking clinician
52:27to to try to get creative or to to
52:29become that but to formulate some
52:31tools that that it's like OK this
52:34is a tool that you can use.
52:35And make it more readily available so
52:38that everyone has like this this type
52:40of tool so to either better engage
52:43or to present the the evidence based
52:45practice and in a way that works and
52:48maybe better for that particular family.
52:53Again as Hector was saying I think
52:55that's like an ongoing process
52:56because I know even for myself when I
52:59sometimes when I read the measures I
53:01realized like oh there's the might be
53:03a little bit of a better way but you
53:04don't know it until you're doing it.
53:06So maybe even having some of the
53:08Spanish speaking clinicians talk about
53:10the creative interventions they use
53:12because I know sometimes we we talk
53:14about it and and different things
53:16that we modify it within the the BP.
53:22Angie, please go ahead.
53:23Ohh I just
53:24wanted to add that.
53:27I've been taking it out of the
53:29context of the Latino population.
53:31I remember having conversations
53:32like with Maria Mutlak.
53:34She's now a fellow in the in the
53:37child psych service and she, she,
53:41you know, she and I would compare,
53:43she's from Iran and I'm from Mexico
53:45and she and I would compare.
53:47And you can see a lot of what the
53:48author was talking about this,
53:50this cross pollination,
53:51this worldwide that they're sayings
53:53that they say in
53:54Iran that are
53:56very similar to things that were said.
53:59In Mexico, and it probably came
54:02through the Muslim incursion, you know,
54:04into Spain where they were 300 years ago,
54:08you know, and just thinking about,
54:09you know, the similarities and how
54:11that can bring us together
54:13not just with Latino populations,
54:15but with our Muslim population, with our,
54:17you know, African American, Caribbean,
54:20Afro, Caribbean population too.
54:27No exactly I think that that's so
54:30true and I even even with I I more
54:34specifically work with with Latino
54:36Spanish speaking families often
54:39however like Dad even I've had you
54:41know colleagues or friends that are
54:44from other cultures and we I see
54:46some some of those similar elements
54:49that you're mentioning where you
54:51know you kind of pull from from
54:53these different cultures and I think
54:55that sharing of cultural wisdom that
54:57sometimes it's it is very similar to.
54:59To maybe some of the values
55:01that that are being.
55:03You know maybe brought from generation
55:05to generation in some ways very
55:08similar and and just learning
55:10from from different cultures.
55:11I think it's the the step and the push
55:14that that we want to make and that's
55:16where I say we're speaking about this
55:18with Latino Spanish speaking families.
55:20But this is true for other immigrant
55:23families other cultures that are
55:25here at the center and kind of
55:28pushing ourselves to to kind of
55:30learn more and to become more more.
55:32Like.
55:32In in a way focused in in providing
55:35better quality care for for
55:38everyone and bringing everyone's
55:40culture into the therapy room.
55:49Cecilia, do you have a
55:50question please on mute?
55:56Thank you, Kieran.
55:57I again I, I just absolutely love
56:00this and I'm curious given the fact
56:03that his Latino heritage and I.
56:06So. So thank you and appreciate
56:09this wonderful presentation.
56:11I'm just curious we have a wealth of.
56:14You know knowledge here and
56:16I'm just wondering, you know,
56:18by I don't know if if this would be it
56:21would be interesting just to see by a
56:22show of hands how many of us actually.
56:26You know here as, as, as, faculty and.
56:29And and fellows and trainees and so forth.
56:34Spanish is their first language.
56:36Start starting with that if
56:38we can show show hands.
56:40I know, just curious because
56:43this is these are some resources.
56:45So if everyone if everyone did
56:47actually put their hand up via zoom
56:48and we would get a total number,
56:50the number comes up directly here and
56:52the number is climbing.
56:56I wish I could put my hand up.
57:03I feel quite fortunate. Thank you.
57:07Only six so far, but there are seven
57:10and the number is climbing, so.
57:13There we go.
57:15I can't put mine up. I don't know how to do
57:16it, but I'm just going to put
57:17my. Actually, I
57:18think that might be the case for a few
57:20people, so I'm sure there's more than 7.
57:27That's a nice *** Cecilia.
57:29Just just shows some some solidarity
57:31and sometimes some of the things
57:33that aren't obvious to us right,
57:35knowing a piece of connection that
57:36we might not see and may not have the
57:39opportunity to connect with others if
57:41we're speaking in English all the time.
57:43So we may not know. Uh, so thanks.
57:45Thanks for that moment.
57:46Does anyone again,
57:48Hector and Anna Maria,
57:50this was so great and so lovely,
57:52and you've got a lot of people
57:55thinking not just about using
57:58features with Latino families,
58:00but also thinking about other proverbs
58:02and saying for other cultures and
58:04other people that we come across,
58:07were there any other questions
58:09that folks have?
58:10You know, this,
58:11we're getting to the end,
58:12but want to make sure that folks
58:14have the opportunity.
58:21Oh, wait, there's one in here.
58:23Thank you. No.
58:24So some statements of gratitude.
58:25So make sure that you have the
58:27chance to take a peek at those,
58:29both of you and everyone else for
58:31the comments and for the lovely
58:33talents that we have in celebrating that.
58:35And also, again, you know,
58:37I, I tell my kids that we,
58:39we live Hispanic heritage life,
58:41don't live Hispanic heritage month.
58:44But during this month,
58:46it's lovely to be able to celebrate
58:48not only some of our Latino clinicians.
58:50And faculty members,
58:51but also the work that are enhancing
58:54the work for some of our Latino family.
58:57So thank you for bringing that
58:58to us today and thank you
59:00for sharing your knowledge,
59:01your experience,
59:02your talent and your culture.
59:07You're having us?
59:15Thank you, everyone. Bye, bye now.