Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Welcome. I'm Deborah Howell. And today, we'll learn how understanding and respecting diverse cultural perspectives and socioeconomic contexts is vital in providing effective and inclusive mental health support for children. Our guest is Dr. Ioana Pal, a clinical psychologist at the Stramski Children's Developmental Center at MemorialCare Miller Children's and Women's Hospital, Long Beach.

Hello, Dr. Pal. So glad you're with us today.

Dr. Ioana Pal: Thank you so much for having me again, Deborah.

Host: Oh, it's wonderful. So, how do cultural beliefs and practices influence the perception and treatment of children's mental health issues?

Dr. Ioana Pal: It's a very important and very complicated question. But basically, culture influences everything from perception, acceptance, and ultimately treatment of mental health issues, not just in kids, but also in adults. Because through culture, we have norms, expectations. We shape our values. And also, culture determines what's acceptable in terms of coping strategies. And it varies not just with culture, but generation, level of acculturation. It influences so many things, even how much or how willing a parent is to bring their child in for a particular problem or issue, whether it's serious or not. And it can dictate also how parents respond through a lens of shame, for instance, and how we internalize or see labels or diagnoses.

Host: And that brings us to access. What role does socioeconomic status play in determining access to mental health resources and services for children?

Dr. Ioana Pal: That one, as probably everybody knows and has experienced at some point, definitely varies with insurance, service area, and even transportation options, right? It determines when, how often, and even how a family accesses their resources. So, we can tell someone, "Hey, just take this card and go to your next appointment," right? But if they can't really get there or they have to switch three different buses to get there, their access to care is there, it's just very far away versus someone who can get in their car and get there no problem, take off from work, right? So, socioeconomic status often goes hand in hand sometimes with education, with jobs and other opportunities, which is why it's even more important to use appropriate language and make realistic suggestions and recommendations if we know kind of what area we're dealing with, the population in that area, and their barriers, even if they're not cultural barriers. So, just looking at the statistics and being informed of who you're serving as a provider or an agency.

Host: Yeah. That makes perfect sense. How does cultural diversity impact the understanding and acceptance of mental health disorders among different communities?

Dr. Ioana Pal: Basically, we need to keep in mind, are we dealing with a marginalized group? Are we dealing with a group who believes in collectivism? Are we dealing with a family who has a view of their child as being individual, unique and no problems are really problems?

Let's take the example of ADHD, right? In some countries, it's not even ADHD. It's just something else. But here in the U.S., we have this ADHD diagnosis that's relatively common and for the most part is accepted, right? In certain communities, this may be okay to say, "I think my child maybe on the ADHD spectrum somewhere. We just need a diagnosis so we can move forward and get the interventions," right? But there are also some cultures, some areas, some groups where the use of language needs to be very careful, very well thought out. So if a child is active in one group or more energetic, they might not accept the word hyperactive or inattentive or ADHD, right? So, the questions we ask, the data we gather, how we understand behavior and emotions is very important so that we can deliver the information in a way that is actually taken in. So, we need to be mindful of how we come across, even our tone of voice, right? Sure, knowing SES culture, you know, where we are, where we're providing the services is important. But sometimes, just relating to a parent and being aware of how old we are, whether we're male or female, how we're dressed that day, and how we're providing that information, whether it's rushed or taking the time to make sure that they're understanding the words that are coming out of our mouth with the caveat that they're not really accepting of ADHD or they don't understand what ADHD is.

And sometimes, marginalized groups may also be more cautious or mistrusting of a diagnosis because at first there's that denial period of, "No, not my child," or it could be, "I think you're just picking on my child," or "Why is my child being diagnosed with that where no one else would have said that my child has ADHD?" So, we just need to be very, very careful in terms of knowing what that family's background is. We also don't know any trauma, right? In the beginning, when someone walks into our office, we don't know what they're dealing with. And maybe we remind them of something or someone that has either discriminated against them. So then, they're not even hearing us, even if we're giving the right information or what we think is the right information, right?

Host: Yes. Now, I want to ask you, in what ways do cultural and societal expectations affect the mental well-being of children from various backgrounds, and what challenges can arise if they're not taken into account?

Dr. Ioana Pal: This one again is a very complex question. And again, we can't think of all the different factors that enter into this. We can't talk about all the societal expectations, but let's pretend just for a minute that it's as easy as saying, "We need to know more, do more, faster," right? Let's take that premise. When kids can't really do that or they're having some other difficulties achieving whatever needs to be achieved at school or at home, it becomes problematic, right? So, there's cultural expectations, familial expectations, societal expectations, academic expectations, right? But again, culture plays a major role. So, let's, for example, think of a child who is getting straight A's, is doing really well on the outside, but struggles a lot with anxiety, fear of failure, of not letting their family down, that sort of thing. You have a lot of kids actually who are in that situation, but they're afraid to say, "I have worries, I have fears, I can't sleep. My stomach hurts because I'm anxious before every test," right? They're just doing what they think is expected. But acknowledging that there's a problem, that's what brings it to the forefront and that's what helps kids get the help that they need. So for whatever reason, there are always barriers in terms of talking, especially to parents if it's something serious. But that communication or the lack of communication is what sometimes leads to more serious mental health problems. So, that's what we want to avoid. If we want to say have a conversation with your parent or have a conversation with a friend who's willing to talk to the parent and explain that it's really serious. You're really like sweaty palms. You're going to the bathroom. You're not able to think and focus on anything else until that test is over, right? If the parent doesn't know and sees the straight A's, they're going to assume everything is fine until it isn't. And we want to make sure we acknowledge and we talk about those issues before they become actual diagnoses, actual disorders.

Host: You know, it all comes down to communication. So, how can parents and caregivers effectively navigate conversations about mental health with their kids, taking into consideration cultural nuances?

Dr. Ioana Pal: Deborah, to be honest with you, I think we need to think about it the other way around too. I feel like kids are more open nowadays and they see more on TikTok and they bring up more of, "I think I have this," or "I would like to be tested for this." So, I think we need to acknowledge that kids are doing their own research and sometimes they're the ones bringing it up. But for the parents, I think just being open, really open to having a conversation and not giving the impression to their children that they're not listening or that they'll be punished for saying there's something wrong. And again, culture plays a significant role in that because some families are brought up more to, "We don't talk about that in the family," or "We don't discuss this, or" "We sweep it under the rug." So, I think being open and being willing to listen is going to make a huge difference. And of course, it really matters in terms of where the parents are in terms of acculturation, whether or not they are believing or taking in the expectations of, let's say, here of the U.S., or they are still holding on to their beliefs from a different country, a different culture they came with, right? So, that's going to determine how quickly they may be willing to actually listen and have that conversation. But I would say being open.

Host: Yeah. And Dr. Pal, what role does the Stramski Children's Center play in addressing cultural and socioeconomic backgrounds?

Dr. Ioana Pal: I would like to think that we are very person-centered in terms of our perspective. And we, as a group here, are actually very diverse and come from different backgrounds, very different educational backgrounds, cultural backgrounds. So, I would like to believe that that helps us a little bit in being more aware and being more willing to sit down and really notice those little differences, taking into consideration all factors by asking questions, staying informed, asking parents if they would like to speak with someone else, being flexible in terms of our treatment recommendations, starting where the parent is willing to listen rather than bombarding families with a million things they should be doing, right?

And sometimes, depending on the culture, the best recommendation that we can make at Stramski is not therapy, but can you go back to your pastor and discuss this further? Are you willing to talk to your family about what's going on? And I think that's still helping what we do here at Stramski, because we're making sure that parent will come back to ask a more serious question or to say, "I took your advice, but now I need something different."

Host: Right. Okay. And what would you recommend to parents who need support? What should they do to just help their children?

Dr. Ioana Pal: I think that big piece that I mentioned in terms of being open, courage, right? Having the courage to step out of your comfort zone, being self-aware, and just connecting either with other parents, other culturally similar families, other communities. Connecting to community and just taking that first step to make a call. So for instance, at Stramski, we take a variety of insurances. So, I think sometimes it's just making a call, deciding where do you want to start, and then just following through.

Host: It's so important to just start, right?

Dr. Ioana Pal: Yes.

Host: Where can our listeners go to find out more info?

Dr. Ioana Pal: I believe a phone call to our clinic would be great and also going online. We are part of Miller Children's and Women's Hospital overall website. And parents and anybody interested can definitely go there. So, it's millerchildrens.org. And if they click on specialties, they can find Stramski Children's Developmental Center, or they can call our general line, which is 714-377-6993. But overall, just googling Stramski will definitely find their way to us somehow.

Host: Thank you so much, Dr. Pal, for your time and your expertise today. We really, really enjoyed having you back on the podcast.

Dr. Ioana Pal: Thank you so much, Deborah.

Host: And for more info or to listen to a podcast of this show, please visit memorialcare.org. That'memorialcare.org. org. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.