Culturally competent care for nontraditional family structures
Cultural competency applies not only to minority ethnic or religious groups but also to nontraditional family structures. A review of the evidence based literature and clinical practice tips will be highlighted for the following family types: children being raised in multicultural or bilingual families, children of same gender parents, children being raised by grandparents or in multigenerational families, and transracial adopted children. Same sex parenting alone does not appear to be a risk factor for poor outcomes in children. There is no statistical certainty that distinguishes the developmental, psychological, or social outcomes of children raised by same gender parents to that of children raised by opposite gender parents, when socioeconomic levels of the families are equal. Conversely, children raised by grandparents have an increased incidence of behavioral and emotional disturbances and therefore may require extra attention to mental health needs. Grandparents may face many challenges when they unexpectedly have to step in to care for a grandchild: housing difficulties, financial, feelings of guilt or grief, loss of independence, and work limitation, thus, the grandparents themselves have an increased likelihood of depression and several other chronic medical conditions. There have been a vast number of studies on domestic and international adoption, which demonstrate that transracial adoption itself does not place a child at a higher risk for emotional and behavioral problems. Children of racial or ethnic minorities who are adopted into a family of the ethnic or racial majority, however, are at a potential risk for ethnic identity confusion. Feelings of discrimination and ethnic identity confusion appear to be less prevalent in transracial adopted children whose parents engage in a variety of cultural socialization strategies. Hispanics are more likely than non Hispanic whites to live in multicultural households. Certain child rearing practices may be interpreted as abusive if the provider is unfamiliar with the family's culture, thus being familiar with the cultural practices of the most common local ethnicities is critical. Utilization of professionally trained medical interpreters if bilingual providers are not available can assist with language barriers as well as clarification of cultural beliefs. As the family physicians of these children and their parents or caregivers, we not only need to be informed about and be sensitive to their special concerns, but also have a responsibility to incorporate current evidence based information in our approach.