Facing the Obstacles

Parents of Hispanic children in the United States have historicallyencountered numerous challenges innegotiating mental health care services.These include, among others,insufficient command of the Englishlanguage, cultural value differences,and a lack of community-basedservices. As the Hispanic populationacross the country continues toincrease, social workers will need to remain steadfast in their efforts to integrate cultural considerationswhen engaging Hispanic parents in the mental health treatment of theirchildren. While not comprehensivelyaddressing all the cultural factors andbarriers that influence how Hispanicparents perceive child mental healthservices, this article is intended as anoverview of these issues in the hope of raising awareness among socialworkers who provide services to thispopulation.

A Rapidly GrowingPopulation that FacesChallenges

The U.S. Hispanic population has grown to significant levels. Census data indicates the presence of 41,322,100 Hispanics accountingfor 14.2 percent of the nation’spopulation. In some states, the increaseis markedly noticeable. In 2005,Hispanics comprised 3,250,768persons or 19.1 percent of Florida’spopulation. Florida ranks seventhamong the highest Hispanic populatedstates, surpassed by New Mexico,California, Texas, Arizona, Nevada,and Colorado (U.S. DemographicEstimating Conference Database,2005).

These growth trends reflect changes in the growing number of Hispanicchildren. In 2006, the U.S. CensusBureau reported a total of 16,361,000Hispanic children aged 0 to 19 yearsof age (www.census.gov/popest/national/=asrh/NC-EST2006-asrh.html). Research studies andpractice wisdom indicate that Hispanicyouth, regardless of acculturation

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©2008 National Association of Social Workers. All Rights Reserved.

ISSUE TWO – 2008

SectionConnection…Children, Adolescents & Young Adults

IN THIS ISSUE

Child Mental Heatlh Services:Integreting CulturalConsiderations When Engaging Hispanic Parents ......1

Letter From the Chair ................2

Impulse Control: Teaching Children How to Slow Down and Think ....................6

Treatment of Substance Abuse in Old Order Amish Youth..........................8

Publication of articles does notconstitute endorsement by NASWof the opinions expressed in thearticles. The views expressed arethose of the author(s). (Child Mental Health Services, continued on page 3)

CHILD MENTAL HEALTH SERVICES:INTEGRATING CULTURAL CONSIDERATIONSWHEN ENGAGING HISPANIC PARENTS

Ana M. Leon, PhD, ACSW, LCSW

Issue Two – 2008 • Children, Adolescents, and Young Adults 2

Children,Adolescents, &Young Adults

SectionConnection

A NEWSLETTER OF THE NASWSPECIALTY PRACTICE SECTIONS

SECTION COMMITTEEChair

Tonia Caselman, PhD, MSW, LCSWTulsa, OK

EditorSandra Altshuler, PhD, ACSW, LICSW

Columbia, SC

Elizabeth Fung, PhD, ACSW, DCSWChicago, IL

Rose Marie Pryor, LCSWWyoming, OH

Scott Ryan, PhD, MSW, MBATallahassee, FL

NASW PresidentJames J. Kelly, PhD, ACSW

Executive DirectorElizabeth J. Clark, PhD, ACSW, MPH

NASW STAFFManager

Susan Rubin, MA, MBA

Specialty Practice ManagerYvette Mulkey

Program CoordinatorRochelle Wilder

Letter From the ChairNASW Children, Adolescent and Young Adult Section, (CAYA)recognizes that many young people have mental health problems that are painful and limiting. In fact, one in ten children has a mentaldisorder severe enough to cause some kind of impairment infunctioning. CAYA also recognizes that mental health problems can be recognized and treated successfully, particularly when they areaddressed with systemic approaches.

As the largest group of mental health service providers, social workersare on the forefront of delivering services to youth with mental healthissues. CAYA is committed to bringing you relevant and practicalpractice perspectives that will help you in your work with children,youth, and young adults. This newsletter issue of CAYA includesarticles with excellent suggestions and resources for those workingwith children and youth who have grief, substance abuse, andimpulsivity issues.

Ronald Chupp’s article, “Treatment of Substance Abuse in Old OrderAmish Youth,” reminds us how to apply evidenced-based practices in a culturally competent fashion. While not all of us will have anopportunity to work directly with Amish young people, there areimportant lessons to be learned in this article, such as treatmentdecisions that the author reminds us to consider when working with unique populations.

Ana Leon’s article, “Integrating Cultural Considerations whenEngaging Hispanic Parents,” provides specific tips on culturallysensitive practice with Hispanic families (the fastest growing minoritygroup in the U.S.). She tells us how to use “personalismo,” a friendly,warm approach that is highly valued among Hispanics, but may bechallenging to some non-Hispanic social workers who are concernedabout appropriate worker-client boundaries.

My article,“Impulse Control: Teaching Children How to Slow Downand Think,” describes the multitude of problems that impulsivechildren face academically, behaviorally, and socially. However,despite these problems, research has shown promising results forcognitive/behavioral interventions. Some of these evidenced-basedpractices include verbalized self-talk, problem-solving, and lookingahead.

Our future depends on the mental health and strength of our youngpeople. As frontline workers, social workers have an important role to play in providing the highest quality treatment and prevention tochildren and youth. CAYA commends you for your commitment tolifelong learning and dedication to building your skills and knowledgeby subscribing to this specialty practice newsletter.

Tonia Caselman, LCSW, PhD

3 Children, Adolescents, and Young Adults • Issue Two – 2008

levels, are at risk for mental health challengesthat include substance use and abuse, teenpregnancy, domestic violence, and depression(Lopez, Bergren & Painter, 2008). Others(DeGarmo & Martinez, 2006) report that Latinoyouth have the highest school dropout rate in the United States, often because they lack Englishproficiency and, for reasons already noted, aremore at risk for not completing high school.Latina adolescents are more likely than white andblack adolescent girls to have attempted suicide.Recent literature (Lara, Akinbami, Flores, &Morgenstern, 2006) identifies health carechallenges among Hispanic children such asdiabetes, lifetime asthma, and obesity. Theseconditions often co-exist with mental healthproblems.

Differences among Hispanics

While there are cultural differences withinHispanic subgroups, there are similarities in thevalues by most Hispanics. Our profession alreadyunderstands that all Hispanics are not the same,and thereby, cannot be treated with a “cookiecutter” or other broad brush approach. Inproviding services to Hispanic children and theirfamilies, it is therefore important to understandthe cultural differences and commonalities amongthe various Hispanic cultural groups, such asPuerto Ricans, Cubans, and Mexicans. Equallyimportant is the recognition of factors that affecthow closely Hispanic families and childrenadhere to traditional cultural values. Theseinclude socio-economic status, level of education,generational differences, level of acculturation,and where individuals are raised (urban versus rural).

Traditional Hispanic View of Mental HealthHispanic families often view addressing a child’semotional, behavioral, or mental health needs asa private matter better addressed by the familyand other informal support systems, such as the

extended family or godparents. Hispanics tend to have a dual belief system regarding the causesof mental and physical illness that combines arespect for contemporary medical knowledgewith traditional folk beliefs (Silva, 2005). Theytend to view the mind, body, and spirit asinterconnected and requiring balance. They mayview illness as an indication of an imbalanceamong the three. Within the literature, certainterminologies have been identified that refer toHispanic traditional beliefs about emotional andphysical illness. Counselors should be aware oftheir mention by Hispanic clients duringassessment. These culture-bound syndromesinclude susto (fright), ataque de nervios (similarto a nervous or panic attack), and mal de ojo(evil eye) (Comas-Díaz, 2006). Once services aresought from a mental health delivery system, thechild and parent are engaged more easily if thesocial worker identifies and integrates into thetreatment not only the informal supports that the family typically utilizes, but the family’sperspectives on mental health.

Hispanic parents may be more likely to blametheir child’s mental health or behavioral issues on either external sources such as friends,negative thoughts from envious relatives orneighbors (mal de ojo) or on personality flaws setat birth. It is not uncommon for some Hispanicparents to reference a cliché that states that “atwisted tree cannot be straightened since naturemade it that way” as a way of explaining thattheir child was “born that way” and their beliefs

(Child Mental Health Services, continued from page 1)

WE WANT TO HEAR FROM YOU If there are general themes or specific content that you’d like to see in the SectionConnection, or if you have comments orquestions regarding anything you’ve read in current or past issues, let us know bysending an email to sections@naswdc.org.

Issue Two – 2008 • Children, Adolescents, and Young Adults 4

that no amount of mental health treatment willchange the behavior. This perspective maydecrease the parent’s commitment and motivationto fully engage in the child’s treatment. It maysometimes result in the parent withdrawing thechild prematurely from treatment since positivechanges in behavior are not immediately evident.

It is not uncommon for Hispanic parents whohave not mastered the English language torequest that a bilingual Hispanic social worker be assigned to work with their child. Emotionallyladen content for anyone who speaks more thanone language is sometimes better expressed in thenative language. If the agency can accommodatethis request, it will help the Hispanic parent andchild to more effectively develop a therapeuticrelationship. However, there are some agenciesthat do not have sufficient numbers of bicultural,bilingual social workers who can work with thispopulation. In some instances, agencies try to“make do” with a non-Spanish-speaking socialworker. These non-Spanish speaking socialworkers, despite good efforts, may not effectivelycommunicate with the parent on the child’streatment progress. In other cases, agencies will attempt to use the child to communicate as a translator if the child speaks some English.Putting the child in the translator role mayundermine the parent’s position and authorityand also put the child in a biased position toreport to the parent information on the child’sown treatment.

Cultural Values Help Build Rapport in Mental Health Treatment

There are several cultural values that can helpsocial workers develop good rapport withHispanic children and their parents. For examplepersonalismo, which is a friendly and

interpersonally warm approach, is highly valuedamong Hispanics and often expected fromhelping professionals. Developing this warminterpersonal style can be challenging to somenon-Hispanic social workers who may befocusing more so on maintaining appropriateworker-client boundaries. These boundaries areimportant in therapeutic work; however, theHispanic parent may respond more effectively if the social worker can balance maintainingboundaries with a degree of warmth and isperceived as interpersonally approachable.

Respecting a Hispanic family’s hierarchy andboundaries can help the social worker engage the parent and subsequently engage the child. As in other families, the Hispanic parent has theultimate say in whether a child’s mental healthtreatment will continue or not. Thereforerespecting the family structure, roles, andassigned responsibilities can assist in ensuringthat the child’s treatment is not prematurelyterminated. An example of respecting theHispanic hierarchy is recognizing that while themother is responsible for coordinating manyaspects of the family’s life, in the home, as well as in public, the father is always respected as thehead of the household. Additionally, Hispanichierarchical boundaries are designed to payrespect to grandparents. They may be an integralpart of the family system and be perceived as“advisors” to the child’s parents on matters ofparenting. They frequently hold powerful roles in the family as respected elders. In traditionalHispanic families, children do not have the samerights in voicing their opinion or in challengingparental decisions, actions, or ideas as mightoccur with their American counterparts. In somevery traditional Hispanic families, children are tobe “seen, but not heard,” since their interactioncan be seen as inappropriate among thediscussion of their elders.

INTERSECTIONS IN PRACTICEEtiology and Treatment of Trauma for Social Workers to earn 3 Free CE Units, visitwww.socialworkers.org/sections and click on the InterSections in Practice link.

5 Children, Adolescents, and Young Adults • Issue Two – 2008

Recommendations

Social workers and agencies providing services toHispanic children and their families can benefitfrom the following considerations:

• Hispanic cultural values should be integratedin the mental health treatment of Hispanicchildren.

• Availability of Spanish-speaking personnel isvery important. Many Hispanic parents stillhave limited proficiency in English.

• Culturally, it is important for social workers to adopt a warm and friendly (personalismo)approach that will engage both the parent and the child.

• Hispanic parents want to be involved in andkept informed of their child’s mental healthproblems. Open communication with theparent and family is key.

• More collaborative and community-basedmodels where agencies coordinate diverseservices under one roof and serve as a “onestop” service delivery site should be developed.

• Hispanic parents are sometimes put off whenHispanic staff members refuse to speak tothem in Spanish. They can experience this as a form of discrimination. If Hispanicprofessionals are not able to speak Spanish,they should acknowledge it and indicate to the parent the level of their Spanish languageproficiency.

• Agencies should ensure that they are providingcultural competency training programs thathelp to increase knowledge on diverse cultures,including Hispanic children and their families.

Ana M. Leon, PhD, MSW, LCSW is an Associate Professor, School ofSocial Work and Vice Chair of the university’s Institutional ReviewBoard, University of Central Florida, Orlando, Florida. She can becontacted at leon@mail.ucf.edu.

ReferencesComas-Díaz, L. (2006). Latino healing: The integration of ethnic

psychology into psychotherapy. Psychotherapy: Theory, Research,Practice, Training, 43(4), 436-453.

DeGarmo, D. S., & Martinez, Jr., C. R. (2006). A culturally informedmodel of academic well-being for Latino youth: The importance ofdiscriminatory experiences and social support. Family Relations,55, 267-278.

Demographic Estimating Conference Database (2005) Retrieved fromhttp://edr.state.fl.us/population/web11.xls on April 1 2000

Flores, G., Fuentes-Afflick, E., Barbot, O., Carter-Pokras, O., Clauido,L., Lara, M., et al. (2002). The health of Latino children: Urgentpriorities, unanswered questions, and a research agenda. Journalof the American Medical Association, 288, 82-90.

Lara, M., Akinbami, L., Flores, G., & Morgenstern, H. (2006).Heterogeneity of childhood asthma among Hispanic children:Puerto Rican children bear a disproportionate burden. Pediatrics, 117, 43-54.

Lopez, C., Bergren, M.D. & Painter, S.G. (2008). Latino disparities in child mental health services. Journal of Child & AdolescentPsychiatric Nursing, 21(3), 137-145.

Silva, M. A. (2005). La familia Latina en America: Culturally sensitivefactors to consider in the psychotherapeutic setting with immigrantfamilies. (Doctoral Dissertation, University of Hartford, 2005).Dissertations Abstracts International: Section B, 66(6-B), 3426.

NASW offers free professional courses on the WebEd portal site. CAYA Sectionmembers may be interested in UnderstandingAdolescent Health: The Social Worker’s Role,available at wwwnaswwebed.org.

Issue Two – 2008 • Children, Adolescents, and Young Adults 6

Research tells us that children who have betterimpulse control do better in almost every area of their lives. They are: • more successful academically (Nietfeld and

Bosma, 2003);

• less likely to have behavioral problems(Wulfert et. al., 2002);

• better at getting along with people and makingfriends (McMurran, Blair, & Egan, 2002);

• better able to handle stress and other emotions(d’Acremont & Van der Lindon, 2007;Mulsow, 2001); and

• healthier (Grano, 2008).

The primary reason why these children are moresuccessful is because they spend more timeanalyzing information and restraining primaryurges in order to consider healthier courses ofaction. Children who lack impulse control are at risk for a range of problems. According toHollander and Evers (2001):

The ability to moderate pathologicalimpulsivity is of great clinical andpublic health relevance becauseimpulsive disorders incur large costs to society and are associated withsubstantial morbidity, mortality, social,family, and job dysfunction, accidents,suicide, violence, aggression, criminalityand excessive use of health-care,government, and financial resources …[impulsivity is] a core behavioralsymptom domain that cuts acrossvarious psychiatric disorders andcontributes to substantial societal costs.

Yet research has shown promising results forcognitive/behavioral interventions with impulsivechildren (Barkley, et. al., 2000; Teeter, Rumsey,

Natoli, Naylor, & Smith, 2000). Some of thestrategies that have been used in theseinterventions include:

• Verbalized Self-Talk. Because impulsivechildren have limited self-talk skills, socialworkers should coach them on how to talk to themselves. Initially this should be out loud. When beginning a task, the child can be coached to say, “O.K., what am I doinghere?” or “What is my goal here?” As the taskprogresses, the child can use phrases like, “Ineed to pay attention,” or “I’m doing O.K.,” or“Just a little more and I’m finished,” etc. Afterseveral sessions, the child should whisper thesephrases and then, ultimately, just think them.

• Problem-Solving. Problem-solving is lacking in impulsive children. Whenever a child faces a problem or decision, the social workershould stop and ask the child for severalsuggestions on how to solve the problem. Thisallows the child to reflect on multiple solutionsrather than simply trying the first solution thatcomes to mind. Giving the child hypotheticalproblems to brainstorm solutions is also aneffective exercise.

• Looking Ahead. Being able to anticipate theconsequences for an action requires reflectivity.Social workers should ask questions that causethe child to consider what might happen in thefuture if a particular course of action is taken(i.e., “What might happen if you tried to jumpover a mud puddle in your good clothes?” or“What might happen if you called out theanswer to the teacher’s question withoutraising your hand?”). Activities and gameswhich involve looking ahead are also helpfulin building impulse control, such as mazes,chess, checkers, and games like Simon Says,Mother May I? and Red Light/Green Light.

IMPULSE CONTROL: TEACHING CHILDREN HOW TO SLOWDOWN AND THINK

Tonia Caselman, LCSW, PhD

7 Children, Adolescents, and Young Adults • Issue Two – 2008

• Role Playing. Most impulsive children havecertain situations or settings in which they are particularly impulsive. For some, it is when they feel angry; for others it is whenthey are in larger groups of children. Socialworkers can role play these specificproblematic situations so that the child has practice using impulse control.

• Reinforcement. Social workers should give the impulsive child positive feedback for timeswhen she or he does use impulse control orreflects on a particular situation. This allowsthe child to see exceptions to the problem inher or his life and to feel proud of her or hispositive behavior. Impulsive children can alsobe asked to report their impulse controlsuccesses each week by using the statement, “I had the impulse to [fill in the blank], butI stopped and thought [fill in the blank] anddecided to [fill in the blank] instead.”

There are also therapeutic games available thatare designed to teach impulse control, includingLook Before You Leap; The Impulse ControlGame; Stop, Relax and Think; and RemoteControl Impulse Control. Providing interventionsfor impulse control development promotesefficient learning and pro-social behavior. Also, it gives children the opportunity to control theirimpulses and lead more rewarding lives, ratherthan allowing impulses to control them.

Tonia Caselman, PhD, LCSW, is an associate professor at the School ofSocial Work, University of Oklahoma. She can be reached attcaselman@ou.edu.

ReferencesBarkley, R.A., Shelton, T.L., Crosswait, C., Moorehouse, M., Fletcher,

K., Barrett, S., Jenkins, L., & Metevia, L. (2000). Multi-methodpsycho-educational intervention for preschool intervention forpreschool children with disruptive behavior: Preliminary results at post-treatment. Journal of Child Psychology and Psychiatry,41(3), 319-332.

D’Acremont, M. & Van der Lindon, M. (2007). How is impulsivityrelated to depression in adolescence? Evidence from a Frenchvalidation of the cognitive emotion regulation questionnaire.Journal of Adolescence, 30(2), 271-282.

Grano, N. (2008) Impulsivity, health-related behaviour and disease:A prospective study. Retrieved from https://oa.doria.fi/bitstream/handle/10024/33679/impulsiv.pdf?sequence=1

Hollander, E. & Evers, M. (2001). New developments in impulsivity.Lancet, 358(9286), 949-950.

Nietfeld, J. & Bosma, A. (2003). Examining the self-regulation ofimpulsive and reflective response styles on academic tasks.Journal of Research in Personality, 32, 118-140.

Teeter, P. A., Rumsey, R., Natoli, L., Naylor, D., & Smith, R. (2000).Therapeutic interventions to increase social competence in teenswith impulse control deficits. Journal of Psychotherapy inIndependent Practice, 1(4), 49-70.

Wulfert, E., Block, J. A., Santa Ana, E., Rodriguez, M. L., & Colsman,M. (2002). Delay of gratification: Impulsive choices and problembehaviors in early and late adolescence. Journal of Personality,70(4), 533-552.

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Issue Two – 2008 • Children, Adolescents, and Young Adults 8

Although there is a great deal of current researchregarding mental illness among the Amish, thereis little information regarding substance abuse.The reason for this is simple: few practitionersrealize that a deep cultural understanding is keyto providing effective addiction treatment to theAmish (Straussner, 2001).

Understanding the Amish

Most Amish are of Swiss-German descent, andspeak a German dialect known as PennsylvaniaDutch. They are a conservative Christianreligious sect with beliefs that are similar to thoseof certain Fundamentalist and Evangelical groups.Amish people choose to live separate from thedominant culture because they believe the“English” (their word for the non-Amish) worldis a place of temptation and sin (Kraybill, 2001).

Rumspringa Offers Teenagers aGlimpse at the Outside Word

When Amish teenagers turn 16, they participatein rumspringa (literally, “running around”),which lasts until they are baptized in their early20s. During this period, youth are allowed toown cars, TVs, and radios, and wear stylish hairand clothing, and young women are allowed towear make-up. Although not explicitly stated,they are allowed and even expected to usealcohol and tobacco. Amish parents, rather thanconfronting their children’s negative behaviors,take a hands-off approach. The expectation is forAmish youth to return to the community and finda spouse, reject English ways, join the church, getmarried, and begin a family of their own(Schachtman, 2007).

Key Barriers to Treatment

The Amish believe a person can “give up”alcohol and drug use whenever they choose.This belief ignores the etiology of the disease ofaddiction, and it ignores the reality thatmethamphetamine and cocaine are also becomingpervasive in Amish communities. Another barrieris the Amish belief that mental illness is caused byGod due to sin, and that confession of sin is theonly method for gaining relief. Making a publicconfession is viewed as a near-magical cure formental illness, addiction, or sexual perversion. Ifthese behaviors persist after a confession, theperson is seen as the problem. The strongestbarrier, however, is that they view psychiatrictreatment with severe skepticism. Amish leadersfear that therapists will try to convince Amishyouth to leave the repression of the Amishcommunity (Kraybill, 2001).

My experience with Amish youth is thatmodeling is the primary motivation for substanceuse. Once they start drinking, they find that it isan effective tool for numbing feelings ofanxiety, fear, or anger, and negative cognitionsassociated with shame, low self-esteem, andexcessive guilt common to many conservativereligious groups (Yoder et al, 2003).

Effective Treatment Methods

For treatment to be effective, comprehensivepsycho-education must occur so Amish youthcan conceptualize the problem. Many of themhave not heard of the disease model ofalcoholism prior to treatment. Recommendationsfor the following treatment approaches are basedon my direct experiences and have not yet beenempirically validated.

TREATMENT OF SUBSTANCE ABUSE IN OLD ORDER AMISHYOUTH

Ronald A. Chupp, MSW

9 Children, Adolescents, and Young Adults • Issue Two – 2008

Social skills training is particularly effective asmany Amish youth have anxiety aboutsocializing and dating “the English.” Role-playing engages them and helps them feelconfident with appropriate social behaviors.Assertiveness training helps them to learn to sayno when offered alcohol, but care must be takento ensure they understand the limits on beingassertive.

Anger management can be helpful as long as theword “anger” is avoided since the Amishview anger on the same plane as murder, andrefuse to acknowledge it. Using phrases foranger, such as “frustration” or “What gets onyour nerves?” can work well. Training inproblem-solving skills helps Amish youth developalternative coping skills. Cognitive restructuringis effective in helping interrupt automaticthoughts that lead to drinking.

Once tested and found invalid, using thoughtscan be replaced with non-using thoughts.Since many Amish youth enter treatment duringrumspringa, they tend to be at the less severeend of the addiction continuum. Therefore,behavioral self-control is another effectivemethod. Using this method, therapist and clientnegotiate limits on alcohol and drug use basedon the client’s identified low-risk guidelines. Theclient fills out a drinking diary and a dailyactivity log. They are then taught to identifytriggers to using and employ techniques to copewith or avoid them.

Additional Guidelines for Workingwith the Amish

In my experience, certain guidelines must befollowed for successful intervention whenworking with Amish people (DeRue, Schlegel, &Yoder, 2004). More specifically, one should:

• Never use God’s name in vain. If this were tohappen, an Amish client would not return fortreatment. (A working knowledge of the Bible,and of Anabaptist history, would be invaluablewhen working with this population.)

• Take care when discussing family orcommunity problems, as a client may not havepermission to discuss these issues withoutsiders. Learn the difference betweenprivacy, which should be respected, andharmful secrets (e.g., incest) that need to beexposed.

• Be sensitive to gender roles—the Amish havevery old-fashioned views of gender, andchallenging them will result in Amish leadersforbidding church members from receivingtreatment at your agency.

• Be wary of counseling instincts that lead youto encourage someone to leave the Amishcommunity. Since you cannot understand whatit means for an Amish person to leave thegelassenheit of their community, this decisionis not for you to influence in any way.

• Respect Amish requests for separateness fromthings they deem too “worldly” for them (forexample, it is important that one not attempt

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Issue Two – 2008 • Children, Adolescents, and Young Adults 10

to videotape a therapy session). Amish youthwho struggle with substance abuse issues willbe better served if one keeps all these points inmind, so that interventions are both culturallysensitive and therapeutically beneficial.

Ronald A. Chupp, MSW, ICAC II, NCAC, ICADC, is a substance abusecounselor at Northeastern Center, Inc., a community mental health centerin northern Indiana. Ron has Amish ancestors, and grew up in andaround the Old Order Amish. He may be reached at rchupp@nec.org

ReferencesDeRue, D. S., Schlegel, R., & Yoder, J. (2004). Amish needs and

mental health care. Retrieved fromwww.marshall.edu/jrcp/sp2002/ amish.htm on April 24, 2008.

Krabill, D. B. (2001). The riddle of Amish culture. Baltimore: JohnsHopkins University Press.

Miller, Nathan (2002) Drug use in Lancaster county: Environmentalcauses and implications for the future. Retrieved fromwww.missouri.edu/~rsocjoel/rs150/t3millerfs01.html on January24, 2008.

Reiling, Denise M. (2002) Boundary maintenance as a barrier tomental health help-seeking among the old order Amish. TheJournal of Rural Health, Summer 2002, Vol. 18, No. 3.

Schachtman, J. (2007). Rumspringa: To be or not be Amish. NewYork: North Point Press.

Straussner, S. L. A. (2001). Ethnocultural factors in substance abusetreatment: An overview. In S. L. A. Straussner (Ed.) Ethnoculturalfactors in substance abuse treatment. New York: The GuilfordPress, 1-3.

Yoder, F. Yutzy, G. Miller, E. & Bontrager, V. (2003). Devil’sPlayground [DVD-ROM]. New York: North Point Press.

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11 Children, Adolescents, and Young Adults • Issue Two – 2008

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