Growing Cultural Competence

Interviewer: I’m here with Vanina Hochman. Thank you so much for being with us today.

Hochman: Thanks for having me.

Interviewer: Absolutely. Let’s start by having you just tell us a bit about your own personal journey, and what led you to the world of mental health.

Hochman: Absolutely. I’ve been part of the clinical world. I’ve been a clinician for almost 15 years. I started off as a psychologist, I am a licensed Marriage and Family Therapist. I knew from a very young age that this is just where I wanted to go. My mom is actually a psychologist. It kind of runs in the family.

Interviewer: Wow.

Hochman: I never really built any other type of profession. I just knew where I wanted to go. I wanted to help. I wanted to understand behaviors and make sense of people’s behavior by looking at context, and understand people. People always came to me for help and advice. It was just a calling.

Interviewer: Just a natural thing.

Hochman: Yes, that’s just how it worked out. I worked in nonprofit for a very long time and private practice. I’m still in private practice actually. For a little bit over a year, I’ve been with Retreat as a community relations representative. It’s been great.

Interviewer: Cool. Just to give a quick overview of that, how do you describe your role with Retreat, and what the patient-centered philosophy is there?

Hochman: I was hired by Retreat to focus on the Miami territory. As we all know, Miami has a high population of Hispanic. Actually, it’s like a melting pot of cultures. We’ve brought in a lot of different cultures into Retreat, and we have a very individualized treatment philosophy at Retreat. It’s not cookie cutter, we don’t provide the same care to every single person. We take into consideration cultural factors. We take into consideration what the patient’s needs are, where they’re coming from, things like dietary needs sometimes, cultural, ethnic backgrounds. We specialize in giving each client, each patient what they need to recover. That’s really what patient-centered care is.

Interviewer: Here at the conference, you just gave your presentation about cultural competency in mental healthcare, so could you begin by giving us just a quick intro of what that concept, cultural competence, what that means to you?

Hochman: Really, what I wanted people to get out of it was to be a little bit more open-minded. You really can’t be an expert in every culture. You can’t expect every clinician or every person that deals with patient to understand absolutely everything about every culture. I am Hispanic myself, so maybe I would understand a little bit about more the Hispanic culture, but it doesn’t mean that I’m only going to be dealing with Hispanics. I’m going to be dealing with a lot of different cultures.

I’m not going to become an expert with every culture, but I want to be very curious, open-minded, and find out about other cultures. Just have an informed curiosity about what other cultures are about, and make the other person feel comfortable, make the patient feel comfortable, and understand what their needs are. To break the barriers that people have coming into treatment. Take that out of treatment, take that barrier out of treatment.

Interviewer: Because there’s enough barriers already.

Hochman: There is so many barriers already. That’s one thing that we’re going to try to remove, so it’s really more of a team approach.

Interviewer: Like you mentioned a little bit earlier, specifically working in South Florida and Miami, like you said, Hispanic population, Latina population there, what are some of the common challenges that you see with that culture, with that population that might keep patients and treatment providers from really connecting and getting them the help they need?

Hochman: There’s a lot actually. It’s very common for Hispanics and the Latin community to keep things in the home, to want privacy. They think that if they take it outside of the home, if they seek mental healthcare that their privacy is going to be compromised. We don’t like to air our dirty laundry. In Spanish it says, lavar la ropa sucia en la casa, it means, wash your dirty clothes in the house. The translation is don’t air your dirty laundry, so they like to keep things in the house. It’s really about being informed and educating the population that everything is confidential, that they can seek treatment and still have a confidentiality. That’s part of it, it’s education.

There’s also a lot of lack of insurance, really. There is a big huge indigent population, lack of funds. They don’t have access to the right type of care. A lot of them really, they’re immigrants, and they’re afraid that they’re going to be deported. They’re afraid to seek treatment because they think that we’re going to call immigration on them. They rather sit home and deal with the problems at home, once again, with fear of being exposed.

Interviewer: That’s not going to be good for your mental health, if you fear.

Hochman: Exactly. That adds fear to it, so that’s a huge thing as well. Language is a barrier. Not every facility has Spanish speaking staff. We do at Retreat in every department. We have nurses that speak Spanish, therapists that speak Spanish; our medical director in Palm Beach, Dr. Morales, speaks Spanish. We have someone in admissions, in intake. In every department, we have someone that speaks Spanish.

It’s important that language is not a barrier.

There are many, many barriers. A lot of it too, is that Hispanics rely a lot on natural and home remedies, so they like to keep it in the house. Another reason why, and then they rely a lot on God and spiritual faith. They think that God will heal, especially when it comes to mental health, and that’s good too that they have faith.

Interviewer: Right, yes. That’s the thing is, you don’t want to say like, “Well, you need to lose that if you’re going to move on.”

Hochman: No, absolutely not. It’s reaching a point where you’re in the same place with the patient, but letting them know that they can come to a facility where we will nurture those things that they believe in, but still offer really good clinical treatments.

Interviewer: Ye, even to back how you were saying about keeping the dirty laundry in the home, and having that close-knit family, that can be a real asset. If you can educate the family and give them the support they need, because addiction is a disease of isolation. A lot of people, they don’t even have that family support. If you can turn that into a positive, that seems like a real win.

Hochman: You’re so right when you said that, that just sparked something in my head, and especially in Hispanic community. The family is so important. That family program, that family support, and we know addiction is a family disease, so the family has to be treated, and they have to know that a family can come and stay together. We have a family program at Retreat as well, so it’s important to treat the family not just the individual as well.

Interviewer: When there are some of these cultural differences and they’re not understood between the therapist, the treatment provider and the patient, if those aren’t addressed, if those aren’t dealt with, how can they negatively influence the way they connect some of those interactions and the emotions that are generated?

Hochman: Unfortunately, first of all, there’s misdiagnosis. The person could be misdiagnosed and that is not good healthcare. Then, obviously, it’s not going to be successful treatment. By successful treatment, I don’t mean that the person won’t recover or that the person won’t reach a certain goal, but you’re not going to have the best level of treatment if you can’t have the right communication. It’s all about connection. At the end of the day, no matter what type of treatment you’re seeking, whether it is addiction, whether you’re in private practice, whether you’re going to a doctor for knee pain or diabetes, or whatever it is, it’s all about connection. Connection is really what heals. Love heals. I really, truly believe that, and if you don’t have that connection with your provider, with your therapists, with your treatment specialist whoever it is, it’s very hard to gain that trust to open yourself up to absorb what that person is giving you.

Interviewer: Yes, because opening up and saying, I have this problem that I don’t understand, is hard enough already, but if you feel like you’re not being understood, hanging on that level that just adds another barrier like you’re saying.

Hochman: Yes, and how can you trust someone if you don’t feel understood? That’s how you build trust.

Interviewer: You alluded to a little bit of this earlier, but another factor in this whole discussion is that each community, each ethnic group has their own cultural ideas about mental health. Some, like you said earlier, they don’t want to get it outside the families. A lot of people see it as a sign of weakness, or maybe they don’t even know that there are options for them, or they have something that they need help with. I imagine that’s part of what you’re doing. Are you doing some outreach in the community, or what are some ways that you overcome those types of barriers?

Hochman: Education is huge. It’s almost like psychoeducational type of community events. A lot of outreach into different populations, where we wouldn’t usually go out to, family support programs–

Interviewer: What does that outreach look like? Do you go and you have a man and you’re doing screenings? What does that look like?

Hochman: Not so much. It’s more like community events, or family support groups, or going to different conferences and speaking, such as I came and spoke today, but letting people know that we’re there. Going to different types of events, not necessarily always addiction type of conferences, but maybe more health and wellness fairs for indigent population in the overtown parts of Miami where a lot of outreach doesn’t happen.

Interviewer: Yes, or even just community fairs, community events.

Hochman: A lot of community fairs, a lot of community events. Absolutely. A lot of schools. I’ve been going to universities, I’ve been going to schools meeting with PTAs, Parent Teacher Associations.

Interviewer: Like for high schools?

Hochman: For high schools, yes. Meeting with parents, that’s huge. That’s had a huge impact.

Interviewer: Meeting with them about their kids and how to interact with them, or what are you doing specifically?

Hochman: Just educating about what to look for, because kids are experimenting a lot with drugs, and drugs nowadays are very potent and dangerous. It’s a very fast spiral type of–

Interviewer: Spiral, a downward spiral.

Hochman: Downward spiral.

Interviewer: A lot of is like preventative, staying a step ahead of that, I guess.

Hochman: Yes. It’s really educational, a lot of education.

Interviewer: That’s great, going to where they already are; at PTA, at the community fairs, so they don’t have to maybe take that first step to find you.

Interviewee: Yes.

Interviewer: At Retreat, looking at the work you’re doing there, what are some of the practical ways that you’ve created a safe environment sensitive to meeting those needs of people who are culturally and linguistically diverse backgrounds? That’s the term, right? Cult.

Hochman: Yes, cult. Exactly. Diverse population that speak different languages, being able, like I said, once again, to individualize a treatment plan, not everyone is going to have the same group, the same therapist, the same treatment plan, not even the same menu for lunch. If someone is kosher, for example, with we can provide a kosher meal. If someone is a vegetarian, because of religious purposes, we can provide vegetarian meals.

Even those things will make a person feel more comfortable, understood and safe, because that’s the way that they grew up. We have tracks at Retreat. The tracks are based on your age, your drug of choice, and your background, your history.

Interviewer: I’m going to move your mic, because it’s picking up that lady over there. All right, sorry.

Hochman: Not everybody can sit in a group together and find common ground at the beginning of recovery. Once again, we take the excuses out of the beginning of the recovery process. When they come to Retreat, which is a true detox residential, and they’re coming really from a crisis, most of the time it’s a pretty low point, and they’re coming from a crisis type of situation, and it’s the beginning of the recovery process or a relapse. They’re trying to look for excuses. Sometimes the excuse is, “I’m not sitting in a group with someone that I don’t have anything in common with,” or, “I strongly believe in my religion, and I have nothing in common with this,” or, “I speak another language and I don’t understand this.” These are all barriers to treatment.

Interviewer: Because everyone is looking for a way to say, I don’t want this, I need to leave.

Hochman: Exactly. We are removing those things. We have tracks and the tracks have nice names like Explorer and Odyssey. They are divided based on, like I said, age, drug of choice, and background history. You sit in groups with people that have similar backgrounds to you.

Interviewer: You’d start off maybe in a group with others, like Spanish speakers?

Hochman: Yes, absolutely, with a Spanish speaking therapist. You feel more comfortable, and you have something in common towards later on in the recovery I think everyone finds a common ground, but we’re talking about more the beginning.

Interviewer: Starting there.

Hochman: Starting, yes. We have a trauma track, where the men and the women are separate. It’s gender specific. It’s very specific care, it’s very individualized. I think that’s what sets Retreat apart, that’s how we make people feel more comfortable, and that’s how we individualize the treatment.

Interviewer: All right. I’m just going to have one more question. Is there anything else that you did in your presentation that you’d want to cover, or anything that we haven’t covered yet? If not, that’s okay. I just always like to pause and make sure.

Hochman: No, nothing.

Interviewer: Okay, it’s been great so far. I just wanted to give you that chance. I will just have one last question for you. Everyone who chooses to serve in this field has their own personal reasons for dedicating so much of their life to the cause of recovery. Could we end by having you sum up why making sure people from all backgrounds can receive the care that they need?

Hochman: Yes, absolutely. Substance abuse disorder, and any type of mental health disorder does not discriminate. Everyone can be affected, anyone can be affected, and everyone should have the access to good care. It’s really important to me from my own experiences. I immigrated to this country 30 years ago, and it’s been my passion to always be able to help. I think that it’s important that we are very aware.

Interviewer: You had that experience of coming into a new environment and feeling what a lot of these people are feeling.

Hochman: Yes, absolutely. I think that people’s behavior makes sense in context, and it gives me great satisfaction to have a person feel understood and welcomed and loved. Once again, connection with someone and love does heal, I believe, along with really good mental healthcare, of course, and that’s really been the purpose.

Interviewer: Yes, I bet it needs the love too.

Hochman: Yes.

Interviewer: It can’t just be the clinical stuff, it has to be love too.

Hochman: It does. If anything that I speak passionately about, if I can just have someone leave with a little bit more open mindedness and have them understand, or just be more aware of what their own unconscious biases are, and maybe think, “I have to sometimes be more understanding, more accepting, more curious about other cultures.” Just by asking questions, just by being more open, and making someone feel comfortable, if I can spark that in someone, then I’ve done something good.

Interviewer: Yes, and you never know where that all will spread, from helping that one person help other people.

Hochman: Yes, play it forward.

Interviewer: Cool. All right. Well, Venina, thank you so much for your time. It’s been a pleasure.

Hochman: Thank you so much for having me.