Ethnocentric perception of childrearing practices in protective services

Child AbUrp & Negkcr, Vol. 9. pp. 389-396. Printed in the U.S.A. All nghls reserved.

1985

ETHNOCENTRIC PRACTICES

Copynghl

PERCEPTION

0145-2134/85 $3.00 + .oO G 1985 Pergamon Press Ltd.

OF CHILDREARING

IN PROTECTIVE

SERVICES

ELLEN GRAY,PH.D. AND JOHN COSGROVE,D.S.W. National Committee for Prevention of Child Abuse, 332 South Michigan Ave., Chicago, IL 60604 Abstract-The

protective services system in the United States may be committing a form of institutional abuse of minority families if the professionals who work in that system are not sufficiently well versed in the unique childrearing practices of each culture in the communities the system represents. It is easy for misunderstandings to occur from an ethnocentric perspective, and these misunderstandings are unlikely to be in the minority group’s favor. Although there is wide agreement that this represents a problem, there is not enough information readily available to allow protective service professionals to adopt a cross-cultural perspective in conducting their work. To discover some of the possible misunderstandings by the dominant American culture of subculture childrearing practices, this study was conducted through m-person interviews with members of six minority groups, Mexican-, Japanese-, Vietnamese-, Filipino- and Samoan-Americans and Blackfeet Indians, in three communities in conjunction with an evaluation of child abuse prevention demonstration projects. The themes of delegating responsibility to children and issues of dominance and submission emerged as areas for awareness and sensitivity on the part of child protective services. R&sum&-Aux Etats-Unis les services de protection de l’enfance pourraient bien per&cuter les familles appartenant aux groupes ethniques minoritaires chaque fois que les membres de ces services de protection ignorent les aspects uniques culturels de la communautt dont ils s’occupent en ce qui conceme l’education des enfants. Un point de vue ethnocentrique favorise les malentendus et il est peu probable que ces malentendus favorisent le groupe minoritaire. Chacune convient aisbment que cela represente un probltme mais l’information a disposition des services de protection de l’enfance est insuffisante pour que les dits services menent leur action dans une perspective r+.ellement transculturelle. L’ttude rapportte ici represente une tentative de decouvrir ce qui dans les habitudes tducatives minoritaires constitue le fondement du malentendu en questionnant les membres des sous-cultures eux-memes. 6 groupes minoritaires dam 3 communautts differentes ont ttt soumis a uin examen par interview de personne ti personne, cela en parallele avec une evaluation de projects censts demontrer la prevention de la maltraitance d’enfants. Ces projets s’adressent a des groupes Mexicains, Japonais, Vietnamiens, Philipins, Amtricains de Samoa et Americains “pie& no&.” Les auteurs pensent avoir projeter une certaine lumiere sur les coutumes de putriculture et d’education des enfants dans ces sous-cultures et font des suggestions pour qu’une telle recherche continue.

Key Words-Child Abuse and neglect; Culture; Ethnicity; American Indians; Mexican-Americans; cans; Samoan-Americans; Filipino-Americans; Vietnamese-Americans.

Japanese-Ameri-

INTRODUCTION THE ISSUE OF CULTURE in examining child abuse and neglect ing one in that it is frequently raised but almost never dealt with. statements on the subject are that cultural issues must be considered and neglect; child abuse investigators, adjudicators and treatment

in America is an interestThe only accepted public in examining child abuse professionals must take

This study was conducted as a part of the Collaborative Research of Community-and Minority Group Action to Prevent Child Abuse and Neglect, Grant No. 90-C-2048, from the National Center on Child Abuse and Neglect, U.S. Department of Health and Human Services. Its contents should not be construed as official policy of the National Center on Child Abuse and Neglect or any agency of the federal government. Much more material was gathered than can be presented here, and interested readers are encouraged to contact the authors for the longer presentation of study findings. 389

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Ellen Gray and John

c‘
culture into dccount in performin g their role. dnd policies should not br: m,& ttricri> t’r~~m the perspective of dominant cultural values and practiceh. We do not hno\\ ho\\ to put thc’\c sentiments into practice. however. ,4 cross-cultural perspective on child abuse and neglect ha5 been called for c)ften cntlugh [l-6] to make it essential to pursue. Great strides toward ans\vering the yuebtion c)t’culturelinked definitions and perceptions of thresholds of maltreatment were made b! Gio\annnni iiand Becerra in their book. Defining Ch/ld Ahuse [6]. Presentin, 0 a range c)f child abuse gnettes for rating to a sample population of varied ethnicitv. the\ found persl\tent ethnic differences, even within socioeconomic groupings. There was agreement among blach wpondents, despite differences in education. income or gender. but black> II> a Mhole diKered from other groups in rating child abuse. Blacks in general rated failure to provide and supervisicjnrelated abuse as more serious than other ethnic groups. Ethnicity appears to he the influential factor in their responses. Among whites. however. education made a significant dltTcrenc< 111 ratings. Higher educated whites gave less serious ratings to each categor\ of incidents. Hi+ panics rated physical and sexual abuse, and sexual abuse related to d&is. a> more serious than other groups did. but Spanish-speaking and English-speakin g Hispanics diKered significantly (Spanish-speaking groups rated them higher than English-speaking Hispanics). Hispanics did not consider lack of supervision or failure to provide for children as seriousi! as did the black sample, but they did rate these categories as significantly more serious than did the whites. Clearly ethnic or cultural differences add substantially to the ahead? complex task of defining maltreatment. When different cultures come into contact rvith one another. the potential for confusion and conflict multiplies [l. 21. Under such condition5 perceptions of the relative value and harm of different childrearing practices will unavoidabl! depend on the background of the observer. The official view of those practices that are harmful to children and that require intervention will probably be biased in favor of the dominant culture [7]. This, in turn. sets up the possibility that these official judgments may be in error resulting in the violation of the cultural integrity of a family and community when there ih no real harm or threat of harm to a child.

METHOD

Assuming that this may be happening, this study was initiated in the hope that it could uncover areas of child rearing in minority cultures that are likely to be misunderxtovd bl the dominant culture. and that some patterns would be suggested that would aid our understanding of these areas. The opportunity presented itself In the course of a cooperative research efi)rt in which the National Committee for Prevention of Child Ahu~ wab engaged with a group of projects established to demonstrate approaches to the prevention of child abusz and neglect [Xl. The projects included the Pan-Asian Parent Education Project. whose clientele were Filipino-, Japanese-, Samoan-, and Vietnamese-Americans in San Diego. California: the Blackfeet (Indian) Child Abuse Prevention Center, in Browning Montana: and the .Avance Parent Child Education Program, a Mexican-American project in San Antonio. Texas. Each of the projects employed statf who were members of the ethnic group the! served. Their intimate knowledge of the childrearing practices of their respective groups by virtue of their membership in them as well as their sensitivity to the subject of maltreatment engendered by the nature of their work. made them uniquely qualified to relate to this study. although it would be incorrect to generalize their attitudes to other mrmhcrs of their subcultures. Many of the staff interviewed were non-professional or parprofe+ional \\,arhttrs. occupying \uch jobs as child-care worker. community liaison and hub dri\cr.

Ethnocentric perception of childrearing practtces

391

Categories qfHarm The intent of the study was to conduct with the available staff of the various projects an exploration of c~ldr~a~n~ practices by means of interviews containing questions and prompts on two dimensions: type of harm to which children may be subjected in these families: and cultural factors that could help explain the context of a given practice. The categories of harm and definition of abuse employed in the study were taken from standards for coercive intervention developed with social and behavior scientists, including minority representatives. The categories are: ( 1) non-accidental physical harm, which causes or creates a substantial risk of causing disfigurement, impairment of bodily function or other serious injury; (2) negligence, not necessarily willful, which could result in physical harm as described above; (3) emotional harm in which a child shows evidence of severe anxiety, depression or withdrawal or untoward aggressive behavior toward self or others and the failure of parents to provide treatment; (4) sexual abuse which results in serious physical or emotional harm as described: {S) medical neglect where that neglect would result in physical harm, as described;, and (6) contributing to the delinquency of a child by encouragement, guidance or approval f9, pp. 10-121. The cultural elements that indicate whether a practice is harmful within an ethnic group were derived from Korbin’s cultural “contextual factors.” If the following conditions are satisfied in Korbin’s scheme, the behavior should not be considered abusive: (I) the behavior in question actually reflects’ a sanctioned practice of that culture; (2) it falls within the limits of (behavior and) deviation acceptable in that culture; (3) the intent of the responsible caretaker is consistent with cultural “rules” governing the practice; (4) it is the perception of the child that this is an appropriate practice in the situation; (5) the practice is important in the development of the child as a member of the culture [IO, pp. 1I-131. These factors provided a structure for the interview schedule and a frame of reference for the interviewers.

Every staff member who was available on the days the interviewers visited a project was interviewed. One- to two-hour interviews (34) were conducted among Mexican-Americans (14); Asian-Ame~cans f 13), which included Filipino-Ame~~ans (3), Jap~es~-Ame~cans (3), Samoan-Americans (3) Vietnamese-Americans (4); and Blaclcfeet Indians (7). The authors and one consultant associated with the child abuse prevention evaluation project were the interviewers. The tape-recorded interviews were audited by the non-inte~ie~ng researchers early in the study in an effort to reduce the differences in interviewing style and strategies for solving interviewing problems. Respondents were requested to report on practices accepted in their culture which outsiders might consider harmful. The fact that a respondent mentioned a practice in response to this request, or the fact that it is reported in this paper, does not mean that the practice is abusive by the definitions presented earlier. Many practices reported as potential1~ misperceived fall far short of the guidelines for coercive inte~ention.

RESULTS

Fourteen people were interviewed about c~ldrea~ng practices in the ~e~can-Arne~c~~ communitv. The population served by the project in which these respondents worked is made up of low&come residents of a public housing project in San Antonio, Texas. The respon-

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EllenGray and John Cosgrove

dents were all born in that same community and occupied professional. paraprofessional. and support positions in the program. Two-thirds had completed college. Two of the 14 respondents reported no childrearing practices that might be misunderstood by outsiders to their culture. Reported childrearing practices that could be misconstrued (66) included: physically harmful practices (14); emotionally harmful (20): sexually harmful (3): medical neglect (5); and cont~buting to de~nquency (7). Many times the respondents themselves saw the practices they reported as potentially harmful to children: however. these practices were often considered to be, at worst, cultural adaptations to conditions of poverty. Neglect was reported more than any other type of harm. The type of neglect most often cited in these interviews involved the lack of adequate supervision of children which, according to the respondents, usually represented the breakdown of traditional practices involving the care of infants and small children by older siblings. This practice may be in transition in the particular Mexican-American community studied. for while the respondents may have undertaken, accepted, and valued this responsibility when they were children and felt this was the case with many of the families they serviced, they said they themselves would no longer place their younger children in the care of an 8-year-old or younger child. The category mentioned most frequently after neglect was physical harm. This always took the form of physical discipline, most often for disobedience which followed after several verbal warnings. Examples of misconstrued practices in the category of emotional abuse came from respondents’ feeling that outsiders might be bothered by the lack of warmth shown to children. as shown in the practice of parents calling their children names based on physical attributes such as size or color (e.g., “gordito” which is Spanish for fat); however, nicknames were said to be given and received in the spirit of affection Furthermore. respondents generally felt that parents conveyed their love in other ways that the children understood, such as going without some things themselves in order to meet their children’s needs. Of the groups interviewed, the Blackfeet and Mexican-Americans have had the longest history of contact with the dominant or Anglo culture. Of the two, the Mexican Americans have interacted-with that culture on a more extensive scale. The relatively high number and the diversity of the examples given by the respondents strongly suggest that this group still maintains a separate identity despite its extensive exchange with American society as a whole and that this is perceived as the basis for substantial misunderstanding of the MexicanAmericans’ care and concern for their children. This misunderstanding is compounded by the generally low socioeconomic status of most Mexican-Americans. The .Sumoan-Americans Another group with a very broad response pattern was the Samoan-Americans. Samoan childrearing practices present perhaps the most marked contrast to American norms of all the groups studied and thus make it particularly likely that Samoan-Americans come to the attention of the guardians of these norms, the protective service agencies. in fact, recent records of reports of maltreatment in Hawaii show that Samoans there are represented in the area of physical abuse more than eight times as frequently as would be expected from their proportion in the population [ 111. The responses of the Samoan-Americans interviewed in San Diego regarding practices which outsiders might consider harmful supports this over-representation with 5 of the 14 samples being in the category of physical harm. Reflecting the breadth of the cultural gap was the fact that other examples given included all of the other five types of harm. A major difference with the Samoan-Americans was that. unlike other groups, the respondents consistently identified with and approved of almost all of the practices they reported. They, more than in any other group studied, seemed to feel less need to alter their ways to

Ethnocentric perception of childreanng practices

393

accommodate to the different environment and the expectations of American society. The respondents were fairly representative of their sample. except for their being immersed in the issue of child abuse. Two held paraprofessional positions with the project and one an administrative position. All had finished high school, but none had attended college. It was reported that in the Samoan-American subculture, physical discipline was used quite readily with children of all ages both to train and to punish. A preschooler may have a hand slapped for touching a valued object, or for disobedience a teenager may he spanked until the buttocks are bruised. Beatings that fall just short of requiring medical attention are acceptable and appropriate behaviors within the Samoan lifestyle. Almost two-thirds of the examples given by the Samoan-American respondents fall into the categories of physical and emotional harm (mostly verbal abuse or lack of an open display of affection). Again the respondents generally approved of these practices. Americans of the majority culture would not be comfortable with many of these behaviors, particularly the preferred use of physical discipline, but none of the approved practices described was of a level that would call for coercive intervention as defined earlier. In an open and non-defensive manner, all respondents described children’s acceptance of these behaviors. So too did each respondent characterize the parents’ motivation as one of caring enough to guide their children’s development. The respondents report that an indulged infancy followed in childhood by rewards of gifts for good behavior and corporal punishment for bad, communicate the parents’ love and appreciation of the child. From the respondents’ discussions of their own children, however, a trend toward moderation in regard to traditional practices of physical discipline is detected as the Samoan-Americans become more acculturated. The Vietnamese-Americans The Pan-Asian Parent Education Project also served the Vietnamese community in San Diego. Of all the groups under study, the latest to arrive in the United States were the Vietnamese. Of the examples of practices brought by the Vietnamese that were reported as Iikely to be seen as harmful, 50% involved physical punishment (11 out of 22 practices). Vietnamese physical discipline as described was less severe and more deliberate than that of the Samoans. The respondents emphasized that the punishment should not be conducted in anger and the child should understand why he was being punished. The respondents repeatedly described this physical punishment as a way for the parents to show that they care for the child. One respondent explained it with a Vietn~ese saying, “When you hate them, give them sweetness; and when you love them, give them punishment.” Among misunderstood practices of the Vietnamese are their folk remedies. For example, cao gio, a folk remedy in which a warmed coin is rubbed briskly over a child’s body, is reportedly still being used to cure colds and other minor ills. Bruises that result from this practice, first thought to be indications of physical abuse by the medical community, are now being recognized and accepted as not intentionally harmful [ 121. Other less extreme forms of folk remedies have also survived, sometimes being used simultaneously with modem medicine. Possible emotional harm that was reported (5 practices) related to the manner of showing affection. As with the Mexican-Americans, the use of nicknames related to some physical characteristic was reported by this group as a sign of affection. This is one of the few ways caring is openly displayed to Vietnamese children beyond preschool age. The next most frequent category reported after physical harm (with less than half as many practices) was that of potential neglect. While some sibling caretaking was reported, there were also examples of young school-aged children being left completely without supervision. All respondents disapproved of the lack of supervision. and attributed these practices not to

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Ellen Gray and John Cospro~e

the lack of concern of parents but to incomplete adjustment of ,ome film~lir> tl> &;NIC changes in their environment. Here the background of the rzhpondrnt> intltlen- ie\,ei educ;ltic)n in m~~\tl\ urban .lrc’;l\ ~\~rh more Western influence.

Only 13 expressions of practices that might possibly cause misunderstanding emerged from discussions with Filipino staff members of the Pan-Asian project. and these came from onI> two of three respondents. The two who responded were members of the prnftzssional st;tfl’ ot the project and had at least a coiiege education. The themes that emerged (if themes can be said to exist in responses of only two individuals) were a n~~chaiant view of the sexuality of children, taking forms that might be construed as neglectful (3 practices). and behaviors tht would certainly be called overprotective in the dominant American culture. From the Filipino respondents’ view, the sexuality of children is overdrasfn b>, rn;lJclrir! culture American parents. Filipino-American parents let their i- and 2-vear-old children pc~ naked in their homes, weather permitting. It was as if seeing children as sexual beings R hose behavior was to be judged by adult sexual standards was a new and very odd notion to the Filipino respondents and one which was quite inappropriate in their way of thinking although they were cognizant of how their laxness about covering the child could be seen by Western Americans. Six out of seven of the practices mentioned by the Filipino respondents that could roughI> be categorized as vulnerable to charges of emotional abuse fell under thr rubric of oi’erprotectiveness. Examples given included not letting children get frustrated, perspire. climb trees. \it on the floor, or climb stairs without assistance. Even though the respondent3 had learned to call their actions overprotectiveness, this appeared to be only a semantic concession to the dominant culture. They still believed in the tightness of their way\.

Although there is quite a bit of information available on the cultural patterns of Japanese people [I 1, 13-151, not a great deal of this material as it bears on childrearing (particularI\ misunderstood practices) came out in the interviews with Japanese staff member5 c,Cthe PanAsian Parent Education Project. Two of the respondents were paraprofe~~i~~nai~ with the project; one held a professional position. Ail had a college educati(~l~ or more. The majority of the practices mentioned (4 of 7) could be misconstrued a.~emotional harm. For example, Japanese-American children are expected to take up all or nearly all ot’ their free time with studying. Humility of the child was an issue in two practices that Kerr related. One woman mentioned that children have little say in decisions regarding their lives until they become adults and leave home. Another said that children intent~~~nall~ are not praised in the Japanese-Ame~can families. The Blackfeet The seven Blackfeet respondents lived on the Blackfeet reservation in Browning. Montana where they were born. They were unusual residents. however. in that the irast educated among them had finished eleventh grade and one had a master’s degree. Twenty-three potentially misunderstood practices emerged from interviews with this group. Almost half of thebe practices were in in the category of emotional harm (1 I practices). The.second mo\t prevalent category was neglect (7 practices), followed by lack of medical treatment and contributing I!> delinquency categories (2 each) and one practice fell into the catcgorh ol’ phyhlcal ahu.sc.

Erhnocentric perception of childrearing practices

39.5

In the category of emotional abuse, Blackfeet respondents, with wide agreement, gave examples in several areas that children after the age of 6 or 7 are not shown affection physically in this community. One of the most interesting practices, because it appears to differ so greatly from non-Indian childrearing practices. is the belief in offering little or no overt guidance to children. One woman pointed out that the children are watched but that their parents do not tell them to behave or spank them to exact compIiance. Even truancy is permitted by parents. One respondent gave the example of a child at a pow-wow sticking his finger in the fire as several adults. including his mother, watched but did not warn the child or otherwise prevent him from burning himself. Once burned, the respondent said, he stayed away from fire. According to several Blackfeet respondents. the belief in allowing children to learn from experience rather than “doing as the parent says” has been part of the Indian childrearing philosophy for generations. As a respondent explained, “Indians traditionally have relied on setting an example for their children. rather then punishing them. Unfortunately, with the breakdovv:n in families, increasing divorce, increasing drug and alcohol use, the parents are often not good examples.” Non-interference in childrearing is well-grounded in lndian tradition. but the necessary assumptions upon which it is based can no longer all be made, at least in the respondents’ community. This statement holds true for another frequently mentioned aspect of childrearing, that of intergenerational responsibility for children. Grandparents are often expected to raise their children’s children. or at least care for them part of the time, A respondent reported however, “Kow there are very few elders left (in the 55-75 age group) and the middle-aged (45-55) are running the tribe and have little time to look out for their grandc~ldren. However, the younger generation often leave their babies and assume their parents will check in.”

SUMMARY From the perspective of the respondents in this study, there are a number of areas of potential misunderstanding of subcultural childrearing practices by dominant culture Americans in the protective services system. The respondents of Japanese heritage reported the fewest practices (per respondent) that might occasion this misunderstanding,.and the Vietnamese the most. If these averages are meaningful (and they may not be due to the small numbers of respondents in each group), several plausible explanations are offered: The Japanese have been in this country longer than many of the non-native ethnic groups represented in this study and the Vietnamese the shortest time, accounting for widely different acculturation levels: the Japanese-Americans may be more dispersed yithin the majority culture than the other groups. also accounting for increased acculturation: and/or the Japanese culture may have a great deal more in common with the dominant American culture than does the Vietnamese culture. with the other groups falling along the continuum between the two. The largest number of responses from all the groups cluster in the areas of delegating responsibility to children and issues of dominance and submission between parents and children. Regarding the theme of giving responsibility to children, several of the subcultures reported a different approach than that of majority-culture Americans. The crux of the concern for protective services is whether the children are emotionally and intellectually equipped to handle the responsibility. Although this is largely a matter of judgment, a determination must be made regarding the child’s readiness. All evidence that can be brought to hear on the state of preparedness of the child for the task or responsibility and the availability of alternative resources such as affordable child care should be gathered and applied. In addition to the issue of responsibility. the concepts of dominance and submission were prevalent. According to this stud!. the protectiveness of Japanese and Filipino mothers who

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and John Cosgrove

are not intent on raising “rugged individualists” can be misperceived by Westerners as stilling to a child’s emotional health. So. too. the severe physical discipline mentioned by the Samoan respondents may be perceived as physically harmful. Although the Samoan-. Japanese-. Filipino-American and Blackfeet Indian approaches to dominance and submission issues are different. the prevalence of this theme suggests that it is an area of wide variation from majority norms and values and one to which majority culture members and other outsiders should be sensitive. Protective services would do well to learn about the attitudes surrounding dominance and submission in any subcultures they will be working in as well as to examine their own values and attitudes. Responsibility of children and dominance and submission are not the only issues representing differences between subcultures and the dominant culture or among subcultures. but may be blind spots for majority culture members and therefore for the protective service system as a whole. They are areas that warrant further examination. Acknowledgement-The authors wish to thank the respondents for their cooperation and then patience in answering some very difficult questions; Linda Barrett for her interviewing help: and in particular. project directors. Kyung (Kay) Sook Song, Gloria Rodriguez and Violet Butterfly for making arrangements for the interviews and helpmg us understand their cultures.

NOTES

AND

REFERENCES

1. KORBIN. J. E. A cross-cultural perspective on the role of the community in child abuse and neglect. Chdd Abuse & Neglect 3:9-18 (1979). 2. KORBIN, J. E. The cultural context of child abuse and neglect. In: The Barrered Chrld, C. H. Kempe and R. E. Heifer (Eds.). University of Chicago Press. Chicago (1980). 3. KORBIN, J. E. (Ed.). Chiid Abuse and Neglect: Cross-cultural Perspecrwes. University of California Press. Berkeley and Los Angeles (198 1). 4. ROHNER. R. They Love Me, The,v Love Me Nor. Human Relations Area Files. New Haven ( 1975). 5. ROHNER. R. and NIELSEN, C. Parental Acceptance and ReJectron: A Review of Research and Theon,. Human Relations Area Files. New Haven (1978). 6. GIOVANNONI, J. M. and BECERRA. R. M. Definmg Chrld Abuse. The Free Press. New York (1979). 7. LAUDERDALE, M.. VALIUNAS, A. and ANDERSON, M. Race. ethnicity and child maltreatment: An empirical analysis. Child Abuse & Neglect 4: 163-169 (1980). 8. The group of projects established to demonstrate approaches to the prevention of child abuse and neglect were funded by Department of Health and Human Services Grants Numbers 90-CA-2144-02. 90-CA-2145. and 90CA-2143. 9. INSTITUTE OF JUDICIAL ADMINISTRATION. AMERICAN BAR ASSOCIATION JUVENILE JUSTICE STANDARDS PROJECT. Standards Relafing ro Abuse and Neglect Ballinger. Cambridge (1977). IO. KORBIN. J. E. Anthropological contributions to the study of child abuse and neglect. Child Abuse & lveglecr 1:7-24 (1977). Il. DUBANOSKI. R. A. and SNYDER. K. Patterns of child abuse and neglect m Japanese- and Samoan-Amencans. Chrld Abuse & Neglect 4:217-225 ( 1980). 12. YEATMAN. G. W. et al. Pseudo-battering in Vietnamese children. Pedlatrrcs 58:616-617 (1976). 13. Pan-AsIan Childrearrng Practrces: Filrpino, Japanese. Korean, Samoan, Vretnamese. Pan-Astan Parent Education ProJect, San Diego (1982). 14. SUE. D. W. Counseling the Cultural(v Drfferenr: Theorv and Pracrrce. John Wiley & Sons. New York (1981). 15. SUE, D. W. and MCKINNEY, H. Astan Americans in the community mental health care system. Amencan Journal of Orrhops_vchrofr?,45: I I I I IX ( 1975).