DAILY NEWS CLIP: January 22, 2025

How cultural humility is central to build trust between medical providers and their patients in CT


The Hour – Wednesday, January 22, 2025
By Cris Villalonga-Vivoni

BRIDGEPORT – Ruth Gomez was mad at everyone when she first met the Child and Family Guidance Center staff in Bridgeport. At the time, her youngest son, Casper, was experiencing behavioral health issues at school and in mental health programs meant to help him. She simultaneously felt out of options and worried for her son’s well-being after receiving a referral for care.

She admittedly fought back with staff out of fear but grew to trust them after connecting with the care coordinator, who was also a Latina mother. Gomez said their conversations ranged from God to the pressures of being a Latina woman to what support her family needed.

Over time, Casper made a complete “360” degree turnaround and is back to being his happy self, Gomez said. Her own life was changed by the staff, who aimed to connect on a deeper level through using cultural humility in order to build trust.

To the center’s president and CEO, Michael Patota, cultural humility in medical care requires providers to set aside their biases, prejudices, and world experiences and actively listen to their patient’s stories to better meet their medical and social needs.

“We work with people who have suffered a lot and it’s easy to be judgmental,” he said. “I think our folks set that aside, and they say, ‘What do I need to do to work with you? I’m not here to rebuild you. I’m here to work with you?’ You only do that when you’re at the same level as they are.”

The center serves 3,000 people annually, primarily in Fairfield County, according to data provided to CT Insider by center staff. An estimated 89% of their clients identify as non-white while 85% are low-income.

Of 125 staff at the center, 44% are Latino; 30%, are Black; 25% are white; and 1% are Asian, according to the provided data. In addition, around 60% of the staff is bilingual. Patota said there’s value in working with a provider who looks like the patient, speaks the same language, and understands cultural values.

Part of the staff’s role at the center is educating families, especially those who recently migrated, about their new surroundings, the process of accessing services and medical conditions. For example, Patota said many Latinos don’t have the vocabulary of words to explain mental health issues, which may be dismissed as “crazy,” and the importance of therapy and medication to help them treat the problem.

Virginia Lopez, director of family support services at the center, said families seek services for various reasons. Many of them include single parent households who have been exposed to some trauma or adverse childhood experiences. Lopez said that exposure to trauma at a young age — such as domestic violence and housing insecurity — can impact a person’s overall functioning later in life. Opening up about that trauma also is often layered with a sense of guilt and shame, so Lopez said staff need to work to destigmatize through education and cultural humility.

To her, cultural humility is working with the same level of respect and compassion for all families, regardless of their background and circumstances. Lopez said actively listening to patients and answering questions or asking about their life experiences can lead to better dialogue between provider and patient. It also creates a safe environment for clients to share their feelings without fear of judgment.

“A lot of our families come to us very guarded, and I don’t blame them. I wouldn’t tell a stranger everything about my life immediately, and yet, that’s what we’re asking them to do,” Lopez said.

Finding help

Originally from New York City, Gomez moved with her three sons, mother, and husband to Bridgeport in 2020 during the COVID-19 pandemic.

Her youngest son, Casper, is a “smart and bright kid,” Gomez said. However, she said he struggled to express himself and react in situations outside the home. He started to act out more in school in 2023 after Gomez and her husband separated.

Gomez said she’d receive a call from Casper’s school almost daily about his behavior. She’d often have to suddenly leave her day job to pick him up because the school staff didn’t have the support to help him and they were planning to call a mental health hotline or police. She even considered homeschooling Casper despite being a full-time working single mother of three, because she felt like she was running out of options.

“I did not have a life. I couldn’t even eat, I couldn’t even breathe, because I felt like they was gonna call me,” Gomez said.

Casper’s school connected Gomez and her son with an intensive psychiatric outpatient program, which diagnosed Casper with ADHD. Gomez said that her son continued to struggle despite being a part of a program meant to help him. She said she was receiving calls from the staff asking her to pick him up when he was uncooperative and had concerns for the safety of other students.

Gomez became frustrated and felt like the program was an added burden for her and Casper, so she discharged him. She was referred to several other support services, with the Child and Family Guidance Center being the first to reach out, but Gomez was hesitant to work with them.

“I couldn’t be mad at Casper, so it was like I was just mad at everybody. I was mad at the program. I was mad at everybody to the point that when I got introduced to [the Child and Family Guidance Center], I fought with them,” she said, adding: “I said, ‘I don’t want to do this program. I don’t know who you guys are, y’all probably like the other program, and I don’t got time for this.'”

Instead of pushing, Gomez said the staff on the other line understood her immediately and she could call them back whenever she and Casper were ready. A week later, Gomez said she reached out to learn more about the program, share her concerns and set up an initial appointment.

She said after meeting their care coordinator, Elizabeth Hernandez, it was like the pieces of her life fell into place. Any need or idea that Gomez voiced to support Casper and her other sons, Hernandez was able to meet it — from paying for school uniforms with center funds to buying Casper baseball gear so he can go to the batting cage with his brothers.

Gomez said she and Hernandez quickly bonded over their shared cultural identities as Latina mothers. Many of their conversations mixed English and Spanish together, showing how comfortable they were with each other.

When providers take the time to respect and understand their patient’s backgrounds and beliefs, Hernandez said it is easier to meet their medical needs. She said having cultural humility and awareness is more than just addressing language barriers — it’s also having a willingness to learn about people and their culture.

She remembers working with one Venezuelan family who believed in praying to the Catholic saints. Although Hernandez didn’t personally have a connection to the saints, she said that she asked the family about their beliefs without judgement to better understand the role faith played in their life and find a way to incorporate it into their care.

This step-by-step trust building with patients ultimately allows providers, especially those at the center, to push their clients out of their comfort zone and accomplish their goals, like finishing their education, learning English and more. She said this confidence, or “confianza,” is the result of taking a culturally humble approach to care.

Gomez said they would lift each other up and candidly talk about what supports she needed, struggling with being dismissed as an angry Latina woman, and her faith. Hernandez would relate with her and even share some of her experiences and the ways she overcame them as an example that it is possible. Gomez said she felt understood by Hernandez without needing to say much and knew how to meet whatever need her family had.

“It was just so easy to speak to her, like there was no judgment ever,” Gomez said.

Outside of the center, Gomez said Hernandez would often swing by her workplace to chat about Casper and check in on her without greatly disrupting her workday. She said Hernandez was well-known and liked by her fellow co-workers and boss.

She said Hernandez would also make visits to the Gomez household to get to know her other sons and her mom, who lives with them, and quickly became part of the family herself.

“It was constant communication between me and Elizabeth … she was always there and I know that I’m not only person she deals with, but the fact that I felt like Casper was the only kid she dealt with meant a lot,” Gomez said. “She gave significant attention to her clients that made them feel like they were the only client she was servicing. She was that good.”

The change in Casper was also significant, Gomez said. Casper was at first hesitant to meet with Hernandez and his new therapist at the center but over time grew to love coming in for his sessions. She said his eyes would light up whenever he was about to see his clinician and loved every interaction with them.

It wasn’t long before Casper started receiving improvement awards at school. Gomez said teachers congratulated her and said they’ve never seen such a major change in a student.

Hernandez said she noticed Casper’s hesitancy to work with her, but through patience and persistence she gained his trust. She said her relationship with Gomez and Casper helped her grow as a professional, mother and woman because of how much she learned from them too.

“It sort of reminds me that I love my job … this is my motivation every day, to see the family grow,” Hernandez said.

More than just culture

Practicing cultural humility can extend to more than just racial and ethnic groups as shown by Dr. Ahmed Abdelmageed, University of Saint Joseph Dean of Pharmacy and PA Studies, who created training sessions to show medical providers the best way to care for Muslim patients.

He said the first section of the training acts as an introduction to the Islamic religion, its basic foundations and the international demographics of the Muslim community.

Due to Islam’s international reach, the community encompasses a diverse population of people with a variety of experiences. Abdelmageed said someone like him, a Palestinian Muslim who immigrated to the U.S., will have a vastly different life experience than an African-American Muslim. One of the goals of the training is to demystify the belief that the identity of “Muslim” comes with a monolith experience.

The the second half of the training focuses on how providers can adequately and respectfully provide care. For example, Abdelmageed said some Muslim patients wouldn’t take certain cold medication due to its alcohol content. A provider taking the time to chat with a pharmacist to find an alternative without alcohol is an example of being culturally aware and understanding of their patient’s needs.

The goal of a medical provider is to offer the best possible care for their patients. However, Abdelmageed said they can’t do that fully without setting aside their own biases. Cultural humility and awareness in medical care works best when patients help their providers fill in the gaps of their life circumstances and beliefs to better deliver care. Sometimes taking the extra minutes to listen to a patient’s concern can make the world of difference for them, he said.

“I’m the trained professional, I understand their disease state, but if I don’t understand all the other influences that they have in their life about their approach to their disease management, or how they consider the disease, and so on and so forth. I might fall short in delivering the best care for them,” Abdelmageed said.

Abdelmageed said he remembers helping translate for a female patient who had immigrated from Yemen and spoke only Arabic for the doctor who was a Midwestern white male who didn’t speak the language.

Throughout the interaction, Abdelmageed said he noticed how welcoming, humble and understanding the doctor was with the patient — providing the patient space and respectfully asking questions. He said the patient also worked hard not to disappoint him, as a result. The patient would write down her diabetes monitor numbers on a piece of paper and bring it back to show him how she’s doing.

“He reduced that barrier and that anxiety that they have, ‘I don’t speak the language, I don’t understand this interaction. I’m sick on top of all of that,’ and this person who was culturally humble, who was respectful, helped her be at ease and be receptive to the treatment that he was suggesting for her.”

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