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    Martin Luther King: May His Legacy Live On

    Roy Aranda, Psy.D., J.D.

    January 15, 2018

    It hurts as the realization sets in – more deeply every day – that we are taking steps backwards, regressing as it were, when it comes to maintaining bragging rights about our civil rights. There is a regression, an erosion, increasingly apparent since 2017.

    Civil rights pertain to basic rights to be free from unequal treatment based on certain characteristics such as race, gender, disability, etc., as distinct from civil liberties that are identified in the Bill of Rights and protect against discrimination in a number of settings based on legally protected characteristics.


    The APA has listed the following in its Ethical Principles of Psychologists and Code of Conduct:

    · Age

    · Gender

    · Gender identity

    · Race

    · Ethnicity

    · Culture

    · National origin

    · Religion

    · Sexual orientation

    · Disability

    · Language

    · Socioeconomic status

    We certainly can use a booster dose of Martin Luther King’s legacy and what he championed so fervently and gave his life for. Sort of like a “flu shot” to inoculate against the particularly virulent “bug” infecting our great nation.

    I leave you with some snippets from King’s astonishing speech: I Have a Dream, 08/28/63:

    · I am happy to join with you today in what will go down in history as the greatest demonstration for freedom in the history of our nation.

    · Five score years ago, a great American, in whose symbolic shadow we stand today, signed the Emancipation Proclamation. This momentous decree came as a great beacon light of hope to millions of Negro slaves [Audience:] (Yeah) who had been seared in the flames of withering injustice. It came as a joyous daybreak to end the long night of their captivity. (Hmm)

    · In a sense we’ve come to our nation’s capital to cash a check. When the architects of our republic wrote the magnificent words of the Constitution and the Declaration of Independence (Yeah), they were signing a promissory note to which every American was to fall heir. This note was a promise that all men, yes, black men as well as white men (My Lord), would be guaranteed the unalienable rights of life, liberty, and the pursuit of happiness. It is obvious today that America has defaulted on this promissory note insofar as her citizens of color are concerned.

    · Now is the time (Yes it is) to make real the promises of democracy. (My Lord) Now is the time to rise from the dark and desolate valley of segregation to the sunlit path of racial justice. Now is the time [applause] to lift our nation from the quicksands of racial injustice to the solid rock of brotherhood. Now is the time (Yes) [applause] (Now) to make justice a reality for all of God’s children.

    · …in the process of gaining our rightful place, we must not be guilty of wrongful deeds. Let us not seek to satisfy our thirst for freedom by drinking from the cup of bitterness and hatred. (My Lord, No, no, no, no) [applause] We must forever conduct our struggle on the high plane of dignity and discipline. We must not allow our creative protest to degenerate into physical violence.

    · …so even though we face the difficulties of today and tomorrow (Uh-huh), I still have a dream. (Yes) It is a dream deeply rooted in the American dream. (Yes)

    · I have a dream (Mhm) that one day (Yes) this nation will rise up and live out the true meaning of its creed (Hah): “We hold these truths to be self-evident, that all men are created equal.” (Yeah, Uh-huh, Hear hear) [applause]

    · I have a dream (Yeah) [applause] that my four little children (Well) will one day live in a nation where they will not be judged by the color of their skin but by the content of their character. (My Lord) I have a dream today. [enthusiastic applause]

    · This will be the day, this will be the day when all of God’s children (Yes, Yeah) will be able to sing with new meaning: “My country, ‘tis of thee (Yeah, Yes), sweet land of liberty, of thee I sing. (Oh yes) Land where my fathers died, land of the pilgrim’s pride (Yeah), from every mountainside, let freedom ring!” (Yeah)

    · And if America is to be a great nation (Yes), this must become true. So let freedom ring (Yes, Amen) from the prodigious hilltops of New Hampshire. (Uh-huh) Let freedom ring from the mighty mountains of New York. Let freedom ring from the heightening Alleghenies of Pennsylvania. (Yes, all right) Let freedom ring (Yes) from the snow-capped Rockies of Colorado. (Well) Let freedom ring from the curvaceous slopes of California. (Yes) But not only that: (No) Let freedom ring from Stone Mountain of Georgia. [cheering] (Yeah, Oh yes, Lord) Let freedom ring from Lookout Mountain of Tennessee. (Yes) Let freedom ring from every hill and molehill of Mississippi. (Yes) From every mountainside (Yeah) [sustained applause], let freedom ring.

    · …and when we allow freedom ring (Let it ring), when we let it ring from every village and every hamlet, from every state and every city (Yes Lord), we will be able to speed up that day when all of God’s children (Yeah), black men (Yeah) and white men (Yeah), Jews and Gentiles, Protestants and Catholics (Yes), will be able to join hands and sing in the words of the old Negro spiritual: “Free at last! (Yes) Free at last! Thank God Almighty, we are free at last!”

    Add to this modernly, the many unfortunate “S…” places that have emerged on the radar.


    Roy Aranda, Psy.D., J.D.

    semper ad lucem

    ~Life's most persistent and urgent question is, 'What are you doing for others?'~
    ~The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy~
    Martin Luther King




    Joint Doctoral Program Ph.D. in Interdisciplinary Research on Substance Use

    The School of Social Work at San Diego State University and the Division of Global Public Health at the University of California

    The School of Social Work at San Diego State University and the Division of Global Public Health at the University of California, San Diego are now offering a Joint Doctoral Program Ph.D. in Interdisciplinary Research on Substance Use. This program is designed to prepare the next generation of leaders in substance use research with the knowledge and skills to advance evidence-based and applied substance use research, interventions, programs, and policies.


    Our joint doctoral program opens up a world-wide, Ph.D opportunity for prospective students in the field of Substance Use. Prospective students must have a foundational background in research (e.g., prior courses in statistics and research methods and participation in research (e.g., co-author on peer-reviewed paper).


    The focus of the Ph.D is on research and its application to substance use prevention, broadly defined as primary prevention and harm reduction; therefore, its curriculum stands out as unique within the field. Students will also be equipped to conduct research to include co-occurring disorders that often accompany substance use (e.g., Mental Health, HIV, Tuberculosis)


    Generous program support for Students: On a competitive basis, the program includes tuition and four training scholarships (Teaching Associateship positions) per year ($20,000/year for up to 4 years).


    This non-clinical research degree is the first of its kind in the nation. Graduates of this program will be well-equipped to take leadership positions in substance use and related fields and contribute to the advancement of policies aimed at reducing the burden of substance use among impacted communities.


    We are now accepting applications.


    Please contact us if you would like additional information about the program.






    http://socialwork.sdsu.edu/irs u/


    POSTED 12/21/16

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    Congratulation to Dr. Dilica Granville


    The New York Academy of Medicine welcomes Dr. Granville as a Fellow Member

    Dear Dr. Granville,

    Congratulations, I would like to welcome you as a new Fellow Member to The New York Academy of Medicine, induction ceremony on November 3rd.

    We hope that you will share this exciting news with all your colleagues. The Academy’s prestigious Fellows program, the foundation on which the Academy was established in 1847, includes more than 2,000 individuals, elected by their peers, from across the medical and health professions, and other disciplines affecting health.

    Academy Fellows and Members are distinguished professionals in medical and health professions and other disciplines affecting health, who embody the highest levels of achievement and leadership in urban health, elected by their peers. Fellows span a wide range of disciplines including medicine, nursing, public health, administration, health policy, pharmacy, dentistry, law, and government, and are academics, practitioners, and policy makers in their fields.

    In a tradition of honor and service, the Fellows are organized into diverse Sections and workgroups that address clinical and population health issues facing individuals and communities in New York City and cities around the world. Working collaboratively across disciplines, specialties, and institutional boundaries, Fellows participate in cutting edge research, educational, and health policy programs; organize events addressing critical health issues; and enjoy unprecedented networking opportunities as well as active engagement with staff of the Academy in the work conducted by the Institute for Urban Health and the Library.

    Wishing you a very Happy Thanksgiving.

    Best regards,





    Office of Trustee and Fellowship Affairs

    212.419.3645 | Office


    The New York Academy of Medicine


    1216 Fifth Avenue | New York, NY 10029




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    Star Named Ruth

    In Loving Memory of Ruth Negron Gaines, MSW

    President of NAPRHSW (2014 TO 2016)

    Stars on earths

    Are few and rare.

    They're sent to earth

    For only a short while

    To brighten the world

    And make it a much better place.

    But they are only on loan

    Because this treasured gift

    Is missed so much by God

    That He can't wait

    To have them again

    By His side where they belong.

    Star Ruth was such a star

    Whose big bright eyes

    And treasured smile

    Touched everyone in her path.

    She leaves behind a legacy of love,

    Of cheer, and good will.

    She opened doors of opportunity

    And healed hearts in pain

    And offered messages of hope,

    Of endurance, resilience, and prosperity.

    We, on earth must understand

    That such a gift must leave our side.

    But when that time comes,

    And as we view the shiny lit path

    On the way to Heaven above,

    As wide and gorgeous as

    The most beautiful rainbow,

    It is through the tears that flow

    Of sadness and joy for the

    Love she leaves behind,

    That we must reconcile that

    That love lasts forever

    And it is Star Ruth's time

    To make the Heavens shine.


    In loving memory of Ruth Negron Gaines,


    Roy & Irma Aranda

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    Cross Cultural Work

    Establishing a Helping Relationship – Helpful Questions to Ask

    Basic History to Know

    by María Elisa Cuadra-Fernández, LCSW-R, ACSW, CASAC, CPP, ICPS, ICADC



    The Social Work, as well as other human services fields, are increasingly being challenged to effectively communicate with clients/patients who are linguistically, culturally, and historically different from ourselves. In working with Latinos, these differences have at times, been intensified by practitioners themselves, because they have been taught to view Latinos like one group, rather than multiple groups of people or different ethnic/racial backgrounds and with different and unique histories.


    Latinos come from 21 countries of origin. Each country is unique. Traditions, cultures, foods, collective ways of viewing the world, and language have evolved over a period of 700 years since the Spanish colonizers arrived in the Americas. Additionally, indigenous traditions and organized societies have existed in the Americas for more than 10,000 years. Many of these nations were severely traumatized and continue to assert their existence and their traditions throughout Latin America.


    Some Latino countries that were further traumatized by slavery; particularly Caribbean nations and nations in eastern Central and South America. This blending of cultures, races, ethnicities and ways of living have made every nation different and unique.


    Additionally, after the US industrial revolution, many Latin American countries were economically colonized by US corporations, who sought to produce products at lower costs by locating factories in Latin America. The effects of this economic colonization included the destabilization of the economies of many Latin American countries who relied on farming as their livelihood. There is a direct connection with the massive migration from Latin America north as thousands seek jobs and to re-establish themselves in North America as they attempt to survive. The current “wave” of immigration is a migration of family survival.


    The following open ended questions are intended to assist practitioners, educators, and other human services professionals in establishing a rapport with a client who is “different” than oneself. They serve as an effective tool in that they are void of assumptions and allow the person to tell the professional who he or she is and what has happened in the lives of their family to prompt migration.


    Remember, migration is an act of extreme courage. It requires a person to leave behind all that is near and dear and to venture out into the unknown in the hopes that in doing so his or her family will survive.


    Questions to Assist with Cross Cultural Learning and Exchange/ Building Rapport:


    What is your country of origin and would you tell me about it?

    What were the circumstances that brought you to the US?

    How do you feel about being here?

    Is it as you imagined it would be? How is it similar and how is it different?

    Who did you have to leave behind? How does this feel to you and to your child?

    What do you worry about?

    Have you and your children experienced discrimination? Tell me about it and how I could help you.

    What are the unexpected problems that you have faced since you arrived?

    Are there problems in your family or with your children? What do you think caused these problems? How can they be solved? How can I help?

    Why do you think the problems started when they did?

    What do these problems do to you and your family? How do they work?

    How severe or serious is this situation?

    How are you treated by your employers?

    How is your work situation?

    What would help your family so that your children could do very well and succeed in school?

    What are your dreams for your child?

    How can I/we help make this happen?

    What would have to be different so that your child and family could meet what you believe is its’ full potential?

    How do you feel emotionally?

    Do you miss anyone?

    How is this for you?

    Are there any concerns occurring in your marital/partner relationship that you would like support with?

    How do you cope with stress?

    How do you have fun?

    How do you spend time with family and friends?


    COPYRIGHT, Great Neck, NY, 2016


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    Contaminated Heroin: a Serious Danger

    How Parents Can Protect and Help Their Teens

    by María Elisa Cuadra-Fernández, LCSW-R, ACSW, CASAC, CPP, ICPS, ICADC



    The death of actor Philip Seymour Hoffman and the unexpected deaths of several Long Island teens as a result of heroin have been met with deep grief and sadness by many. Heroin, is available and successful, talented individuals and teens in affluent suburban communities, on Long Island, can be at risk. This frightening reality poses challenges for parents. This article will help you learn about heroin, contaminated heroin, and how to better protect your teens from these dangers. Educating teens and knowing when treatment is needed, is crucial to their development and their safety.

    In 2010, the new influx of heroin was believed to be connected to the availability of higher “purity” heroin (which was more suitable to inhale) and to decreases in prices, making it more obtainable by teens. Many teens don’t understand that all routes of administration (inhaling, smoking, and sniffing/snorting) were highly addictive. Purchasing of substances on the streets is dangerous. Accidental over doses and even fatalities have occurred. Young people have no idea what and how much they are administering. Contaminated heroin is available and is being sold as pure heroin making the risk of over dose higher.

    Contaminated Heroin: Fentanyl

    Mixing heroine with fentanyl is nothing new. Its’ history can easily be traced back to the late sixties and seventies, a time of many overdoses by many young people, including famous musicians and celebrities (i.e. Janis Joplin, Jimi Hendrix, Jim Morrison, etc.). In 2005 and 2006 there was an outbreak of contaminated heroin and over 1000 people lost their lives nationwide.

    The Nassau County Medical Examiner’s office recently reported that several deaths that were initially thought to be heroin over doses, were in fact caused by a combination of heroin contaminated with the potent narcotic fentanyl. This does not mean that we have an “outbreak”; however, it does mean we need to educate our children, before there is an outbreak.

    In Nassau County and New York City, heroin contaminated with fentanyl has been sold in small clear cellophane packets labeled “24K”, “Bud Ice”, and “Thera-Flu”. It’s very important to note, however, that all heroine packets, whether labeled or not, can contain fentanyl. All packets can, in fact, contain anything and therefore can be highly dangerous.

    What is Fentanyl and Why is it so Dangerous?

    Fentanyl is believed to be 50 to100xs more potent than morphine (the active ingredient in heroin). It is a potent, synthetic, opioid analgesic with rapid onset and short duration of action. Clinically, it’s been used as an anesthetic and to treat and control pain. Due to its high potency, it’s very easy to ingest too much, leading to accidental over dose.

    Fentanyl has also been abused with minor tranquilizers like benzodiazepine (Xanax) and with oxycodone. This is also a highly dangerous combination.

    As an aside, the abuse of benzodiazepine in combination with oxycodone has been linked to increased incidence of accidental drug overdose. These drugs, which are often prescribed together to manage pain and anxiety; have also led to fatalities, particularly in young women.

    What is Metamizole?

    Metamizole has also been found in street heroine. It’s an analgesic pain reliever and fever reducer that was widely used from the late 1920s until the 1970s when it was banned in the United States. It causes suppression of the immune system in small numbers of people. In some, this can be fatal due to infection.

    What is Heroin?

    Heroin is extracted from the seed pod of certain poppy plants. It is a processed form of morphine and is sold as a white powder, a brown powder, or a black sticky substance often called “black tar”. One of the many dangers of “street heroin” (heroin sold on the street) is that it is often “cut” (mixed) with other substances. Heroin confiscated by authorities has been found to contain starch, sugar, powdered milk, and quinine. Sometimes, confiscated heroin has also contained strychnine and other poisons. Heroine can also contain fentanyl making the risk of over dose very high. Educating teenagers to the seriousness of these dangers is enormously important and necessary, particularly at this time.

    Other Related Health Concerns

    Heroin abuse, like other substance abuse, is a progressive disease process. In teenagers it often begins as “recreational” use, increases slowly, and eventually leads to daily use and loss of control. Loss of control signals that a psychological and physical disease process is active. Loss of control also signals that the disease has moved from one of substance abuse to addiction. It’s important to remember that it’s a disease and like all other diseases, it needs professional treatment.

    Addiction to heroin puts teenagers at much higher risk for infection to HIV, Hepatitis C (HCV), and Hepatitis B. It interferes with judgment, particularly when they are under the influence of the drug. This can lead to unprotected sex and the greater likelihood that the substance abusing partner is HIV positive or HCV positive. It can also result in unplanned pregnancy and/or an increased risk of sexual assault.

    Other possible consequences from pro-longed use include bacterial infections of the blood vessels and heart valves, abscesses, infections of soft tissue, liver or kidney disease, scarred/collapsed veins, and pneumonia and/or tuberculosis. Educating teenagers to these consequences is most important.

    Addiction to Heroin

    Adolescence is a time of exploration and experimentation making many teens particularly susceptible to experimentation with heroin if available in their social circles. Unlike adults who begin their addictions to avoid and/or cope with problems, adolescents frequently begin theirs with innocent experimentation thereby making education all the more important. Because heroin is so highly addictive its’ use can easily “derail” teens from a healthy life course and interrupt their emotional and psychological growth and progress and their academic success. One of the most detrimental consequences is the addiction itself. Additionally, heroin that’s contaminated can lead to brain damage, other physical damage and death, as we saw with the tragic loss of Philip Seymour Hoffman. It can lead to accidental overdose.

    Addiction to heroin causes drug seeking which is compulsive behavior. Molecular changes and neurochemical changes in the brain and physical dependence (as evidenced by increased tolerance to the drug) also happen. Behavior changes become obvious to parents but also confusing. Often, parents never suspect that the changes are a result of a growing dependence on this lethal drug. As the teenagers’ body steadily adjusts to the presence of the drug, withdrawal symptoms begin to occur if use is reduced.

                Symptoms of withdrawal that parents can notice are restlessness, complaints of muscle and joint pain, insomnia, bouts of stomach upset that include vomiting and diarrhea, goose bumps on the skin and complaining of feeling cold, and involuntary leg movements.

    What Parents Can Do

    • Read and share this article with your teenager.
    • Be alert to the above mentioned symptoms of withdrawal.
    • If your child appears impaired do not assume s/he has consumed alcohol alone.
    • Notice changes in your child’s patterns of behavior.
    • Notice if s/he is associating with a different crowd.
    • Secretiveness is often present.
    • Refusing to bring new friends home to meet you is common.
    • Notice unexplained periods away from home without legitimate explanation regarding their where-abouts.
    • Drop is school performance.
    • Cutting school.
    • School or other officials reporting to you that your child has publicly misbehaved.
    • Arrest or official reprimand for unruly behavior and/or public intoxication. 

    Recognizing Symptoms of an Over Dose

    Parents must be realistic recognizing that heroin (including contaminated heroin) is available to many kids. If you notice symptoms, don’t assume that it’s alcohol intoxication. Parents whose children have suffered over doses, have often expressed that they thought their teenager was drunk and that it never occurred to them that they were using heroin.

    Parents should immediately call 911 and get medical attention for their teen if they notice any of the following:

    • Intoxication – regardless of what the child says is causing it.
    • Slowed or labored breathing.
    • Falling asleep or “nodding out”.
    • Being difficult to wake up or not waking up if you attempt to awaken them.
    • Muscle spasm of any kind.
    • Pupils that look small or like “pin points”.
    • Discolored nails or lips that appear blue or different.

    Teach your children to recognize the above symptoms in other teens and let them know it’s OK to immediately call for help. Many teenagers hesitate to call immediately for fear that they will be in trouble either with parents or with the police. Saving a life, is most important in these circumstances. Teach your teenager to call for help if any of their friends has any of the above symptoms.

    Many teenagers and parents have saved lives. NY State passed the “911 Good Samaritan Law” to protect those who intervene and seek emergency care for a friend, family member, or loved one who is suffering an overdose. This law protects the person who calls and who seeks help.


    Treatment is Available and Crucial

    If your child is experimenting with heroin or any other substance, it’s vital that you know as soon as possible and that you seek professional help for your child and for your entire family. Family education and family involvement are pivotal for successful treatment.

    All addictions exist in a context. A professional can quickly guide parents in re-evaluating and changing family dynamics making the presence of substance abuse harder for the teen to maintain. Treatment is available out-patient and/or inpatient depending on the needs of your teen and family and the level of care that’s appropriate. Therapy, detoxification, and psycho-tropic medications are available to effectively assist in a full recovery from heroin or other substances. Always remember that addiction is a disease and needs treatment like all other diseases. It is not a moral failing and it is not simple poor judgment. The person is ill and needs help.

    Getting Help - Call COPAY today at 516.466.2509

    COPAY has successfully provided substance abuse treatment and education to adolescents, adults, and families for more than 30 years. If you suspect drug abuse or alcohol abuse in your teen, call COPAY today at 516-466-2509. Schedule an appointment with one of our experienced professionals and discuss your concerns.

    COPAY offers a Parent/Teen Screening Service whereby you contract for two sessions with a professional to explore your concerns with your child. A urine toxicology test is completed that will provide clear answers. You will know if your teen and family would benefit from treatment. This simple professional service saves lives.

    COPAY also provides a 12 week Educational Series for Families and Teenagers. Here, you and your child will learn about substance abuse and the family. You will also learn about addiction in the context of the family and how families can change making it harder for the addiction to continue. This promotes positive change. COPAY offers a Support Group for Parents of Teens Abusing Drugs and Alcohol. This is a wonderful therapeutic tool that enhances full recovery.

    Treatment for co-existing mental health issues (i.e. anxiety, depression, relationship concerns, etc.) is available. All calls to COPAY are strictly confidential.

                 Call COPAY today at 516-466-2509. We are here to assist you and your teen.

    COPYRIGHT, Great Neck, NY 2016

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    Living in the Shadows: Plight of the Undocumented

    By Roy Aranda, Psy.D., J.D.

    Journal of Clinical Psychology

    Published online on August 23, 2016


    The word “immigration” has become a household buzzword. The welcome sign on the Statue of Liberty that reads, “Give me your tired, your poor, your huddled masses yearning to breathe free,” however, is fading and has been replaced by many complicated conditions. What to do with the very large number of undocumented immigrants living in the United States and arriving at the United States every day commands considerable attention and has been the subject of breaking stories in the news. Working in the field of immigration demands an awareness of and sensitivity to diversity and cultural competence. Despite a “hot” sociopolitical climate when it comes to undocumented aliens and what to do with them, there are many ethical tenets that psychologists must be familiar with, among them rendering competent multicultural services. This article offers an overview of immigration law, the challenges of performing culturally competent assessments and consequences of failing to do so, and the plight of a particularly vulnerable group: unaccompanied children. Vignettes offer a personal look into the proceedings of 7 undocumented individuals in 4 major areas: asylum, hardship, U‐Visa, and VAWA.

    doi: 10.1002/jclp.22361
    Open full text

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    Anxiety and PTSD in Latino Children of Immigrants: The INS Raid TV Images Connection to the Development of These Disorders

    by María Elisa Cuadra-Fernández, LCSW-R, ACSW, CASAC, CPP, ICPS, ICADC

    January 2016, Great Neck, NY – Please read the following quotes from COPAY Kids shared with

    COPAY Kids as they express their feelings and concerns regarding the ICE

    raids that they observe on TV. Comprehensive immigration reform and

    humane policies and actions are needed. that do not terrify

    and marginalize innocent children and result in families being separated.


    For many years, social workers have been acutely aware of the impact of poverty and marginalization on the emotional, psychological, and physical health of children and adolescents. Among our country’s newest citizens, are thousands of Latino children and adolescents, born in the United States, whose parents are foreign born. Their families live in constant hiding and fear of discovery, prolonged incarceration, and eventual deportation. Our newest citizens, the Latino children, live in constant fear and terror that their mother or father will be taken, will disappear, and will never be seen again. They carry and express this terror daily both verbally and with their actions. They take it to school with them daily, to bed with them every night, and it is constantly present in every interaction they have with others. The level of chronic stress and fear experienced is what anxiety disorders and Post Traumatic Stress Disorder (PTSD) are made of. In fact, their normal reactions to the very real threat of separation/abandonment are, by definition, the same as the definition of a diagnosable anxiety disorder. INS raids are bad for the developing children who need the love and safety of their parents and family to be present and assured so they are free to be children and to grow.

    The authorities and our elected officials, often focus on the undocumented immigrant but seldom on the daily plight of the innocent child or teenager. Latino children have become victims of government policies that threaten the integrity of their families and that deny their existence and their human need for their parents.

    Latino children are citizens of the United States and will grow up in this country and be this nation’s next generation. The INS raids are forcing them to grow up in fear and with extreme chronic stress. They are frequently referred to community based treatment facilities with symptoms of Anxiety Disorders including Generalized Anxiety and Post Traumatic Stress, Obsessive Compulsive Disorder, Selective Mutism, and Regressed Behavior.

    Latino children need your advocacy and need you to be a voice for them and for their families. The ethics of our profession dictate that we say no to government policies that terrorize innocent children and teenagers and that threaten them with parental abandonment and rejection on a daily basis. As social workers it is time to proactively educate elected officials and to assist them and demand from them that policies have vision and compassion. Your voice must say no to the psychological abuse and neglect of these children.

    As social workers and mental health experts, we are in a position to demand that our nation respond to the plight of the undocumented parent with compassion and understanding and with pro-active policies that create an environment where Latino children can feel safe, supported and can grow and prosper. In doing this we will be creating a sound and stable future generation.

    This article will define Anxiety Disorders and PTSD as seen in children, and will provide a framework for understanding that the mental health of Latino children is being jeopardized by INS raids of Latino families. It will connect the symptoms experienced by children and teens to the chronic stress, fear, and anticipatory anxiety they live with daily…a fear that is real. It will support the notion and only pro-active and compassionate policies make sense and are needed in building our next generation.

    Anxiety Disorders

    As previously mentioned, the current problems faced by many Latino children relative to real fear and stress over potential family loss are, by definition, the same as what the American Academy of Child and Adolescent Psychiatry, define as diagnosable symptoms of an Anxiety Disorder in Children. We can clearly argue that our current social policies and how they are impacting on Latino children through INS raids are, in fact, creating anxiety disorders in our children. The criteria for diagnoses, is presented below next to the “bullets”. Following each criterion, in italics, is a reflection of current circumstance in the daily life of Latino children.

    They are as follows:

    • Constant thoughts and intense fears about the safety of parents and caregivers — Latino children worry that their mother or father will be taken away or will fall victim to violence.  
    • Refusing to go to school — Due to marginalization and also due to learned hyper vigilance. This is more common in teens who experience hopelessness and also who feel they must be responsible for younger siblings if parents are taken or hurt.  
    • Stomach aches and other physical complaints — Latino children describe these symptoms as well as headaches and muscle aches and pains.  
    • Being overly clingy — Fear of separation due to anticipated possible loss or violence. Regressed behavior.  
    • Panic or tantrums related to having to separate from parents — Often described in referrals of school personnel to community treatment facilities.  
    • Trouble sleeping or nightmares — Hyper vigilance is frequently present in Latino children and teenagers. If left untreated it results in more serious mental health and physical problems.  
    • Fear about a specific thing — Afraid of losing their parents and families. Afraid of foster care placement. Afraid of the “unknown”. Afraid of violence directed at their parents and/or themselves and their siblings.  
    • Fear that causes significant distress — Frequently a presenting problem in treatment.  
    • Fear of meeting or having to talk to particular people — Afraid of anyone who comes to their door. Afraid of school personnel. Afraid of treatment professionals. Afraid of all or most authority figures. Families frequently seek refuge in the Church as it is the institution that historically has protected the family in their countries of origin.  
    • Avoidance — Avoid contact with adults, particularly non-Latino adults and most authority figures.  
    • Having few friends — Related to issues of poverty and marginalization.  
    • Worries over things before they actually happen — Chronic worry over parents being taken or harmed. This fear heightens when news media show clips of INS raids or violence targeting Latinos.  
    • Constant worries or concerns about family — Fear of losing their families and being victims of violence. 
    • Repetitive or unwanted thoughts (obsessions) or actions (compulsions) — Over time, and given genetic pre-disposition, children can also develop Obsessive Compulsive Disorder an anxiety disorder that requires on-going treatment.  
    • Fears of embarrassment — Caused by marginalization and poverty.  
    • Low self esteem or lack of self confidence — Also caused by marginalization and poverty coupled with their families being the target of possible INS raids and also community violence and rejection. The National Center for Post Traumatic Stress Disorder (PTSD) further defines criteria for the development of this disorder in children. It states that children and teenagers can develop PTSD when exposed to “a threat involving one’s or another’s life or physical integrity and that this exposure caused great fear, helplessness, or horror”. As is clear, this is the plight of the Latino child and teenager and it is therefore no wonder that more and more children are exhibiting such symptoms.

    Latino children, like all children, need the freedom and safety to just be children and to grow. The energy the child must invest in managing and coping with their fear and stress is energy that is lost to them relative to their cognitive, emotional, psychological, and academic development. Chronic anxiety impedes children from moving effectively through the many stages of human development (per Erickson) and can hinder a child or adolescent from eventually attaining mature relationships and mature functioning in their adult life. This causes problems for them, their families, their future children, and for all of society.


    The relationship between chronic fear and stress and the development of anxiety disorders and PTSD, as well as resultant delayed human development (difficulty meeting developmental milestones), is clear. Current social policy in the form of INS raids is seriously impacting on the mental health of Latino children and adolescents and is something that requires immediate advocacy and education. Social workers can and should take the lead in informing elected officials and in holding government accountable for humane treatment of citizens. If the Latino child, our newest citizen, is to have a chance to fully contribute to this nation as a future adult, the emotional needs and feeling of safety and belonging of Latino children must be protected. Policies that show compassion, that strive to keep families united, and that support diversity are needed immediately so that the Latino child and all children have an opportunity to grow and develop to their full potential.

    María Elisa Cuadra-Fernández, PhD/ABD, LCSW-R, ACSW, CASAC, CPP, CPS, ICADC, ICPS, is the Executive Director/CEO of COPAY Inc. a bilingual professional out-patient treatment, youth prevention, and leadership development agency. She is on the faculty of Adelphi University, School of Social Work , Graduate Division, and currently serves as the Chairperson of the Long Island Hispanic Coalition and the Nassau County Heroin Prevention Task Force. The author can be reached at MECFCOPAY@aol.com or 516-466-2509.

    Copyright 2014, 2015, 2016 – Great Neck, NY


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    BY Vilma E. Matos, LCSW-R

    Second Vice President of NAPRHSW


    During the past few weeks there has been an increased threat on Long Island, whether real or perceived, that Immigration and Customs Enforcement (ICE) agents are here to raid homes to arrest and deport undocumented Central America immigrants. With Long Island having a large concentration of immigrants, these numerous communities are on high alert to keep them and their children secure from deportation. Homes are full of adult chatter discussing possible home raids, how to hide and keep a low community profile by staying inside, the fear of arrest and deportation, but the most insidious topic for children, the fear of family separation (parents being deported while their children are left behind). As these open discussions take center stage in their homes, parents are not aware of the unintentional emotional repercussion for their children’s emotional stability. Such unexpected discussions are being conducted in the presence of their vulnerable children who are absorbing their parents’ anxiety and thus transforming them into their own.

    In their young minds, children and teens are interpreting that their parents “are going” to be deported and are left pondering the questions, “What will happen to me if my parents are deported?” and “Who will take care of me?” Immigrant children are then arriving in schools with heightened anxiety about whether their parents will be home when they arrive from school; will ICE agents be waiting at the bus stop to arrest them and/or their parents are concerns they have been sharing with school staff. They are experiencing restless sleep and poor concentration in completing school work. It has become quite apparent that these recent events have most likely initiated or compounded existing emotional stress for our young immigrants many who have already experienced trauma before and/or during their migration to the United States.

    As mental health professional we must take heed to address the increasing psychological impact this is having on our immigrant parents and their children. We must educate the parents while simultaneously supporting the children. By tweaking relevant information from both the Red Cross, “Helping Children Cope with Disaster” and the National Association of School Psychologists, “Identifying Seriously Traumatized Children: Tips for Parents and Educators” the following is being recommended to address this current crisis:


    Parent Tips to Help Your Children Cope With Deportation Raid

    1. Calmly discussed factual information about the crisis directly to your children in a way they can understand taking into consideration their age and level of maturity. Be cognizant of eliminating or reducing adult hysteria in front of the children so as not to cause unnecessary heightened fears/anxiety.
    2. Calmly discuss preparedness plans so children can strengthen their sense of safety and security. Reassure them as needed. A plan such as who they would live with in the event that either or both parents are deported should be discussed.
    3. Have a list of phone numbers of nearby relatives/friends, religious leaders, community agencies the children can call for assistance. Phone numbers of current attorneys involved with the family should also be listed.
    4. Try to elicit your children’s thoughts, feelings and concerns so you can address them simply without elaboration which is needed for an older child or adult.
    5. Try to maintain normal family routines of work, school, play, meals, rest and religious practices during this period of uncertainty to give the children a sense of normalcy and security.
    6. Spend extra time with your children.
    7. Monitor and limit your family’s exposure to the media. Keep the news to a minimum. The more the children and family hear, the more anxious they become. This will also help the parents reduce their own anxiety about the uncertainty of the situation.

    Should you find that your children’s past normal routine of eating, sleeping, socializing or studying, etc. has changed during or after the crisis you may consider having them seen by a community or school mental helath professional who can help assess them for “Severe Stress Disorder” or “Post Traumatic Stress Disorder.”

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    ��Additional Resources include:

    Hotlines to Call:

    • In New York, if you have questions or concerns about potential ICE raids, call the The New York State Office of New Americans “New Americans” Hotline: 1-800-566-7636
    • Report When a Raid is happening. If you or someone you know experiences a raid, you can call theUnited We Dream hotline immediately and report it: 1-844-363-1423.To receive text alerts, text: WATCH ICE to 877877.

    Vilma E. Matos. LCSW-R is a recently retired clinical bilingual school social worker who has 18 years of experience working with immigrant students. She developed and provided “New Comer” support groups and designed a board game, My Journey to the United States – Mis Pasos a los Estados Unidos Board Game© to help immigrant youth open up an discussed their experiences in a non-threatening and fun way. She is currently conducting presentations to schools and clinics and how to help immigrant youth and their families.

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    A Patient’s Healthcare Experience

    By Roy Aranda, Psy.D., J.D.

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    It’s that time again, another birthday. No train rides for me today given my adventure a few years ago. How quickly it seems that these birthdays come and go. Because healthcare concerns all of us, and is something we encourage our patients to be mindful of and monitor, I thought I’d reflect on a patient’s healthcare experience today.


    As I try to understand more the complexities of healthcare, impending changes and transformations in delivery systems, and evolving requirements that are thrust upon us almost daily and pose numerous hurdles and obstacles, I can appreciate the challenges many health care providers have in just making a living. Much of the work I do is in the area of behavioral medicine. I am used to communicating with many specialists (e.g. PM&R; neuro; ortho; PT; chiro; radiology), reading their reports, looking at all kinds of medical records, reports by insurance company IME doctors and consultants, hospital records, and legal documents pertaining to proceedings that impact the health care patients receive and determinations of permanence and degree of disability.


    Many of my patients lack the ability or savvy to provide detailed aspects of the treatment they receive. Below I explain more fully health literacy and mental health literacy. Many patients are overwhelmed by frequent visits and various kinds of medical tests and procedures. They don’t understand terms, findings, or the pros and cons of recommended treatment procedures such as different kinds of injections and surgical procedures, and are not sure what to report or to whom to report how they feel. Many entertain erroneous beliefs, misinformation, and uncertainties as to outcome (let alone best and worst case scenarios), likelihood of recovery, how much recovery, time frame of recovery, and functional limitations impacting ability to return to work and tend to ordinary ADLs, or possibility of having to seek vocational training or education to work at something else, and perhaps even never to be able to work again. Many state that they want to be how they were before. Many insist upon having assurances that an intervention (especially surgery) will be successful. Many want to be given a percentage as to likelihood of recovery or extent of recovery.


    I’d like to share the experience of a highly verbal, well-educated and detail-oriented patient who had to seek medical attention after some bouts of shortness of breath. He described a disjointed course of care and treatment after a few visits to a health care facility that left him feeling anxious and insecure and worried about his well-being. He also had begun to experience a sense of a foreshortened future. With sarcasm and holding up his hands the patient stated that one day they look at your right pinky and another day your left pinky. This patient meticulously had written down his symptoms to go over with the doctor. I usually tell patients to do this so as to not forget, and encourage them to self-monitor and jot things down after an appointment. He stated that the first appointment with the PCP was brief, preceded by seeing the medical assistant who only took cursory notes. He was puzzled by the brief questionnaire that routinely is administered to assess depression and possible suicide risk in that he was not given an opportunity explain answers and had to answer yes or no so the assistant could enter the responses in the computer. The medical assistant was unable to take an EKG despite several attempts, and the PCP told him he’d have to return another day as it was near closing time. If unfamiliar, this is (Continued on the next page) PAGE 13 a 12-lead EKG. Proper protocol calls for prepping the patient and explaining the procedure. Placement of the leads is crucial; improper placement may result in erroneous readings, which of course, in the area of cardiac health can have grave consequences. It struck the patient that the doctor visits lasted 15 minutes. Have others experienced this? A modern, cost-saving medical care approach reduced to 15 minutes? Empirically validated? Perhaps the most important appointment, a cardiac workup, was scheduled about a month and a half down the road. The cardiologist’s schedule was very limited and he was super booked (overbooked?).


    The patient reported that he decided to go to the ER during the holiday season because of continued symptoms and feeling increasingly anxious. He stated that the ER experience was very different than the health care center experience. He felt well-treated and listened to. And knock on wood, the tests were negative. He said that the ER physician told him that his experience at the health care center was not unique and that cost saving measures called for quick treatment and minimal use of tests that were expensive. Armed with an ER visit, the patient was able to have his cardiac appointment moved up significantly. He also obtained a full copy of all medical records. I always encourage my patients to obtain records. Some have them scattered, folded all over, in random order, creased, stained, and ripped. Some don’t have the vaguest idea what they did with them. Some tell me that they gave the records to other doctors or to their lawyers and did not ask for or make a copy.


    At the beginning of this brief essay I stated, “Many of my patients lack the ability or savvy to explain in detail aspects of the treatment they receive.” If an articulate, well-educated patient can go through this, what must it be like for less educated patients and far less medically knowledgeable, and the less assertive and less vocal about expressing their discontent when treated patronizingly or like third-class citizens? And even worse for unempowered and disenfranchised patients where language, cultural, and financial barriers are prevalent, and access to providers limited because of geographic and insurance restrictions.


    There is a wealth of material in the area health literacy. According to http://health.gov/communication/literacy/quickguide/factsbasic.htm, “health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions… Health literacy is dependent on individual and systemic factors: • Communication skills of lay persons and professionals • Lay and professional knowledge of health topics • Culture • Demands of the healthcare and public health systems • Demands of the situation/context Health literacy affects people's ability to: • Navigate the healthcare system, including filling out complex forms and locating providers and services • Share personal information, such as health history, with providers • Engage( in self-care and chronic-disease management • Understand mathematical concepts such as probability and risk. A Patient’s Healthcare Experience People with limited health literacy often lack knowledge or have misinformation about the body as well as the nature and causes of disease. Without this knowledge, they may not understand the relationship between lifestyle factors such as diet and exercise and various health outcomes.


    Culture affects how people communicate, understand, and respond to health information. Cultural and linguistic competency of health professionals can contribute to health literacy. Cultural competence is the ability of health organizations and practitioners to recognize the cultural beliefs, values, attitudes, traditions, language preferences, and health practices of diverse populations, and to apply that knowledge to produce a positive health outcome. Competency includes communicating in a manner that is linguistically and culturally appropriate. For many individuals with limited English proficiency (LEP), the inability to communicate in English is the pri barrier to accessing health information and services. Health information for people with LEP needs to be communicated plainly in their pri language, using words and examples that make the information understandable. Only 12 percent of adults have Proficient health literacy, according to the National Assessment of Adult Literacy (emphasis added). In other words, nearly nine out of ten adults may lack the skills needed to manage their health and prevent disease. Fourteen percent of adults (30 million people) have Below Basic health literacy. These adults were more likely to report their health as poor (42 percent) and are more likely to lack health insurance (28 percent) than adults with Proficient health literacy. Populations most likely to experience low health literacy are older adults, racial and ethnic minorities, people with less than a high school degree or GED certificate, people with low income levels, non-native speakers of English, and people with compromised health status. Education, language, culture, access to resources, and age are all factors that affect a person's health literacy skills.”


    What can we do, as health professionals, to increase the chance that our patients understand what we are telling them? There is something known as the Teach-Back Method: • A way to make sure you—the health care provider—explained information clearly; it is not a test or quiz of patients. • Asking a patient (or family member) to explain—in their own words— what they need to know or do, in a caring way. • A way to check for understanding and, if needed, re-explain and check again. • A research-based health literacy intervention that promotes adherence, quality, and patient safety. (http://www.teachbacktraining.org/using-the-teach-back-toolkit) Mental health literacy is highly relevant to our profession. Briefly, mental health literacy: …has been defined as “knowledge and beliefs about mental disorders which aid their recognition, management or prevention. Mental health literacy includes the ability to recognize specific disorders; knowing how to seek mental health information; knowledge of risk factors and causes, of self-treatments, and of professional help available; and attitudes that promote recognition and appropriate help-seeking.” (https://en.m.wikipedia.org/wiki/Mental_health_literacy)


    A most interesting study on mental health literacy was published by The British Journal of Psychiatry in 2000. The authors concluded that: If the public's mental health literacy is not improved, this may hinder public acceptance of evidence-based mental health care. Also, many people with common (Continued on the next page) PAGE 14 A Patient’s Healthcare Experience (Continued from previous page) PAGE 15 mental disorders may be denied effective self-help and may not receive appropriate support from others in the community. (http://bjp.rcpsych.org/content/177/5/396) Recent research on cross-cultural aspects of mental health literacy …validated measures of MHL in European American and Indian samples. The results lend strong quantitative support to the MHL model. Recognition of symptoms of mental illness was a central variable: greater recognition predicted greater endorsement of social causes of mental illness and endorsement of professional help-seeking as well as lesser endorsement of lay help-seeking. The MHL model also showed an overwhelming cultural difference; namely, lay help-seeking beliefs played a central role in the Indian sample, and a negligible role in the European American sample. Further, collectivism was positively associated with causal beliefs of mental illness in the European American sample, and with lay help-seeking beliefs in the Indian sample. These findings demonstrate the importance of understanding cultural differences in beliefs about mental illness, particularly in relation to help-seeking beliefs. (http://journal.frontiersin.org/article/10.3389/fpsyg.2015.01272/full) Additional References and Resources Mental health literacy. Public knowledge and beliefs about mental disorders A. F. JORM The British Journal of Psychiatry Nov 2000, 177 (5) 396-401; DOI: 10.1192/bjp.177.5.396 A Mental Health Literacy Database: http://www.scattergoodfoundation.org/literacydatabase#.VoCADIAo7rd A comprehensive Journal of Mental Health article published in April of 2014 pertains to measuring mental health literacy: Measuring mental health literacy – a review of scaledbased measures (http://tinyurl.com/jqpnsxc) The Mental Health Literacy Scale (MHLS): A new scale-based measure of mental health literacy. (http://www.ncbi.nlm.nih.gov/m/pubmed/26228163/) Roy Aranda, Psy.D., J.D. is President of Long Island Psychological Consulting, P.C. where he specializes in behavioral health, personal injury, and PTSD and performs evaluations in several forensic settings. He is President of New York State Psychological Association and member-at-large on the SCPA Board. He can be reached at braindocr@aol.com.