7 minute read

If you provide services at a Federally Qualified Health Center (FQHC), or similar health care center, it would be unusual if you did not meet with patients who are Spanish-speaking. I was thrilled to meet-up with an enthusiastic group of professionals at the recent CFHA conference with the goal of establishing a Special Interest Group (SIG) focused on providing behavioral health services to Spanish-speaking patients.

Now that the Serving Latinx Populations in Primary Care Behavioral Health (SLP-PCBH) working group is formed and generating information (such as this blog!), we are excited to share our knowledge, offer support to each other, and continue to provide excellent services to Spanish-speaking individuals and families. It was unanimous among those who met at CFHA Denver that this group meets an important and specific need.

The formation of this working group was personally significant in many ways. I was born and raised in Lima, Peru, learning and speaking Spanish and English simultaneously, and it’s been very fulfilling to provide services to other Spanish-speaking individuals for over 10 years now. An ongoing part of strengthening my practice has been refining the way I express and provide services in the Spanish language.

Culturally and linguistically, some aspects of the clinical training I’ve received don’t “translate” as smoothly I’d like. Moreover, given the great diversity within our local Latinx and Spanish-speaking community, there is much complexity to consider. Despite this complexity, there are several considerations and valuable “nuggets” I’ve discovered from working with the Spanish-speaking individuals. I want to offer a few of them to you in this article.

Consider if your open-ended questions are too open-ended

As a student of Motivational Interviewing (MI), I think a lot about how to appropriately adapt and apply MI principles to the Spanish language and Latinx culture. There is much beauty in the MI directive to ask open-ended questions that elicit change. However, many individuals from Central and South American countries are accustomed to an authoritarian professional style, where the visit is about them being told what to do. It may feel uncomfortable to the individual you’re serving to be asked what they would like to do about their problem.

Is it also possible that asking questions that are too open-ended may come off as you being unsure on how to advise the patient? Consider instead narrowing down choices by using the MI technique of offering a menu of options, or suggesting a spectrum of possibilities, and then asking them what they are most inclined towards. Often an individual may still remain interested in your advice on “what they should do,” despite how much MI you use. In these cases, using examples of what other patients have done can work nicely as a conduit to empowering them to make their own decision.

Consider your assumptions about the learning style of others

Often BHCs are cautious to come across as too didactic or patronizing if we offer to teach patients a new skill during a visit (and understandably so!). However, for many individuals who were raised in educational systems outside of the US, the didactic approach is very normal and expected. (Personally, my early education in South America focused much more on a “listen-learn-repeat” style, than on critical thinking and analysis.)

Indeed, health and psychoeducation are important BHC tools and should be utilized. Therefore, when you use them, use the MI approach of asking permission to share information, and your knowledge will most likely be happily received. It can also work well to kindly ask the individual to talk about what they themselves know already, and if there are any additional things they would like to learn. Asking for permission and assessing patients’ current level of knowledge may help them appreciate more teaching.

Consider that “Goal setting” is often a culturally bound value

Many Latinx and Spanish-speaking individuals may feel apprehensive about voicing commitment to a goal right there and then during their BHC visit. I commonly hear the response, “Si Dios quiere” (“If God wills it”), when prompting commitment or intent towards an action plan. While we are taught the importance of choosing SMART goals in order to support outcome success, we should also challenge our own cultural assumptions and professional predispositions regarding change.

Many individuals may be in the action stage of change even if they are giving you an ambivalent answer. Culturally, it may be more important to say “maybe” with an intention to follow through, rather than run the risk of committing but not being able to follow through and feeling perceived as lacking integrity. If your insurance payer requires that you write SMART goals, or something similar, for your Plan then the Plan can be written as something such as, “Pt will do [action] at least one or more times by next visit.” Thereby also explaining that the patient has the intention to do more.

Put your doubts aside and try speaking Spanish more often

If you aren’t already bilingual, be willing to be vulnerable and demonstrate cultural humility by learning more Spanish. Many of the professionals I speak with get caught in “all or nothing” thinking when it comes to their goal of “wanting to learn Spanish someday.” I recommend putting those BHC goal setting skills to use and start by a) learning greetings; b) then moving on to basic things such as weather and days of the week; and then c) eventually learning to introduce yourself and your services, followed by an explanation that you need to use an interpreter after this, thanking your patient  for their understanding. Indeed, several of the professionals I’ve spoken with have found that taking these steps resulted in a strengthened relationship with their patient.

While there is definitely more to discuss concerning this topic, these are some useful starter tips that can go a long way for BHCs who are trying to integrate themselves into the world of someone who is Spanish-speaking.

Do you have extra thoughts on this topic? We’d love to hear more in the comments section, or perhaps you’d consider joining our working group through your CFHA account today!