Keywords

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Introduction

As the mental health needs of children, adolescents, and families continue to grow, so do appropriate settings to provide prevention, early intervention, and clinical treatment. The increase of cultural, ethnic, racial, and linguistic diversity of children and teenagers creates additional challenges as well as unique opportunities. In recent years, schools have come into sharper focus in part due to high-profile incidents including bullying, suicides, and student-on-student violence such as the shootings at Columbine High School and the Virginia Tech massacre. These incidents are not necessarily new. Violence is an everyday occurrence for some, especially in urban areas of poverty, blight, unemployment, and social fragmentation. What may be striking for many are the heightened levels of violence turned toward oneself or others.

The Asian American Pacific Islander (AAPI)* community is one of the fastest growing in the U.S. The purpose of this chapter is to:

  • Understand the “fit” of schools, education, and AAPI students.

  • Emphasize schools and educational institutions as important settings for meeting some AAPI mental health needs.

  • Acknowledge important cultural characteristics and influences to better serve AAPI youth.

  • Describe culturally competent, responsive, and effective mental health practices for AAPI students.

  • Advance research, training, practice, and policies essential for addressing AAPI family needs in schools.

The Virginia Tech shooting on April 16, 2007, was a tragedy of multiple dimensions. In all, 33 people died and countless others were seriously wounded. Now known as the “worst school shooting in American history,” the perpetrator who eventually killed himself was a Korean American immigrant. In the aftermath of these shootings, mental health professionals, school administrators, researchers, policymakers, and politicians theorized why such violence was becoming all too common. Shock and dismay that the shooter was Korean reverberated from Korean American communities to South Korea. The myth of the “model minority” was raised once more as was the question of could this tragedy have been prevented with different mental health intervention (Hong, Cho, & Lee, 2010). Caution was raised to not use Virginia Tech as an event summarizing AAPI needs. This would be single-minded and limiting. Instead, for many, this was yet another unavoidable wake-up call that some AAPI youth and families have less than ideal lives. Like other students, AAPI youth have identity struggles, family conflicts, educational disappointments, and worries about growing up (Hong, 1993; Lee & Mock, 2005a, 2005b; Tewari & Alvarez, 2009). They experience many sources of familial, social, and mental stress.

Throughout this chapter, the voices of AAPI children and adolescents will be provided as examples. These sample comments not only serve as a reminder of diverse AAPI mental health needs but also emphasize the urgency of culturally competent, school-based approaches specific to this population.

The Challenges of Stereotypes for Asian American Pacific Islander Youth

My friends know me as smart and studious, a good student. What they don’t see is that I have doubts about myself, feel lonely sometimes, and my parents put pressure on me. I am successful on the outside, but at what cost on the inside? (13-year-old Chinese American girl)

I was happy to be here in a new school, an exciting place where I had the world to explore. I even learned English pretty quickly. When I heard that I would have to go back home to Japan after my parents finished their work, it was so painful. That’s why I took all of those pills. I eventually told my teacher (16-year-old visiting Japanese high school student).

The “model minority” myth continues to plague AAPI youth contributing to stereotypes they are in less need of mental health services than others. Along these same lines, the image of Asian American students as “whiz kids” is harming them and contributing to hesitancy to seek help. Simplistic, even stereotypical, portrayals of Asian American students as “overachievers,” “overrepresented” in higher education, and as overcoming racial obstacles still faced by other racial and ethnic groups, conveys an incorrect and distorted picture of Asian youth (Lee, 1996; Sue & Okazaki, 1990; Umemoto & Ong, 2006).

An additional challenge is acknowledging that Asian American and Pacific Islander youth in schools are very diverse. In order to advance school-based mental health for AAPI youth and work effectively with them, service providers and policymakers must recognize their different cultural identities, backgrounds, and social influences. In order to provide effective mental health services in schools, cultural complexities must be taken into account. Summarizing a description of current AAPI communities is in order followed by a snapshot of educational successes and concerns.

Asian American Pacific Islanders as a Diverse and Growing Population

The term “Asian American Pacific Islander” (AAPI) refers to a diverse population with origins from over 50 countries. Recent 2010 US census analyses underscore the significant demographics of the Asian American population. In July 2006, the estimated number of US residents who said they were Asian or Asian in combination with one or more other races was 14.9 million. As of 2010, the number of AAPI residents increased to 16.6 million or approximately 5.4% of the total US population. This significant increase in AAPI communities is projected to continue in the future. Nearly two-thirds of AAPIs are foreign-born. Of the foreign-born from Asian countries, 52% are naturalized US citizens (Census Bureau, 2010). Asian American Pacific Islanders are different by geographic origin, histories, languages, customs, beliefs, traditions, values, and generations in the United States. On the west coast, initial immigrants in the early 1900s were primarily Chinese, Japanese, and Filipino. In recent years, the dramatic change in population is attributed to large increases in Korean, Southeast Asian, East Indian or South Asian, and Indochinese migration.

Household income is often cited as one source of Asians being “the model” for others, i.e., studying, achieving in education, then working hard to climb the employment ladder leads to success and the “American Dream.” While the median household income for Asians ($64,238) is higher than other groups, 12.6% of Asians are at or below the poverty rate. Southeast Asian families are overrepresented among these households with Hmong (37.8%), Laotian (18.5%), and Vietnamese (16.6%) struggling with poverty (National Commission on Asian American and Pacific Islander Research in Education, 2008). Economic and resource limitations for AAPI families and others have a profound impact on educational pursuits, and mental and social stress. This will also be described later in this chapter.

It has been noted that some AAPI groups share notable cultural similarities. For example, Chinese, Japanese, Koreans, and Vietnamese share the influences of ancient traditions, though to differing degrees. Buddhism, Taoism, Confucianism, and Shintoism convey generations of beliefs and ways of conducting one’s life. In contrast, Cambodians, Laotians, and to some degree, Thais are influenced by Indian Civilization and Theravada Buddhism. Filipino, Samoan, and other Pacific Islander groups are influenced by histories connected to Polynesian and Melanesian cultures. These common groupings form interethnic differences or ways AAPIs differ from other ethnic, racial, and cultural communities (Chan, 1994; Lee & Mock, 2005a, 2005b; Uba, 1994). This understanding of some common AAPI influences among groups is further complicated by intraethnic differences. Intraethnic refers to contrasts within AAPI communities such as written or oral communication differences, rural or urban origins, immigrant or refugee family status, and first, third, or fifth generation US resident. There are different reasons Asian newcomers left their homelands and different ways they felt received in America.

Asian American Pacific Islanders can often identify at least one common major language spoken within their country-of-origin or region. Over 100 different languages are spoken among AAPI groups. Beyond the official language there are also several dialects that may be similar or sometimes totally distinct from one another. Following Spanish, Chinese is the most widely spoken non-English language in the United States. Vietnamese and Tagalog speakers total more than one million (Hune & Takeuchi, 2008; Census Bureau, 2010). Children of an immigrant or refugee family raised in a monolingual, English-only, or bilingual home have unique experiences that shape their identity. Residing in a homogenous, segregated community versus one that is diverse and multi-racial further contributes to different courses of identity development.

Asian students and their families are also diverse by social and cultural histories in the United States. Early immigrant Chinese were initially brought as temporary workers and laborers with the intent that they would be sent back home. South Asian and Filipino men arrived to temporarily work in farms, and with exposure to Mexican female workers sometimes formed early interracial relationships. The Japanese gained a foothold to American shores through the sugar cane fields of Hawaii. Some would take on picture brides, forming families with females who they only met initially by correspondence and photographs. For some families, their histories and narratives in the United States are rich with generations of textured experiences. Painful stories of racism, sexism, classism as well as other treatment as “undesirables” or depictions as “constant foreigners” contrast with triumphant stories of resilience, tenacity, cultural survival, familial, and community strengths. The cultural tapestries of AAPI families are often colorfully woven and should be acknowledged in educational settings. The past of AAPI families and communities influence present strivings and behaviors of current students in schools (Lee & Mock, 2005a, 2005b; Wong & Mock, 1997). With a consideration for AAPI diversity as a backdrop, AAPI student achievement in schools will now be described.

Asian American Pacific Islanders and the Pursuit of Education

My parents are both academically successful and have jobs to prove it. My interests are just different. I like theater, music and even the arts. I was even encouraged to try out for the varsity basketball team. How do I tell this to my parents who have done so much for me? I feel so much pressure, don’t sleep much and even recently lost some weight. My teacher made me promise that I would come see you (Chinese-Japanese biracial male, high school senior to a school mental health counselor).

As long as I could remember we were supposed to be the “model minority,” the “brainiac” in classes. But model for what and by who? My brother and I live in the projects and take three buses through some of the worst neighborhoods to go to school. How does learning in school help me when I go home every night to this? My teacher thinks I have attention problems. I do because she doesn’t know what I always have to contend with at home then at school (Vietnamese middle school female student during a home visit).

Educational attainment varies among different AAPI groups. The percentage of Asians 25 years or older who have an advanced degree is 20% or double that of all Americans 25 or older. Among Asians, 68% of Asian Indians have a Bachelors degree compared to 24% of Vietnamese. The education concerns for AAPIs break the often portrayed, stereotypical picture. Nearly one out of four AAPI students is Limited English Proficient (LEP) or living in a linguistically isolated household with parents who are LEP. Opposite to being “whiz kids,” the high school drop out rate continues to be of major concern, especially for certain AAPI groups. The drop out rate of Southeast Asian youth is staggering with 40% of Hmong, 38% of Laotian, and 35% of Cambodian students not completing high school. It has also been reported that only 14% of Native Hawaiians and Pacific Islanders 25 years or older have at least a Bachelors degree compared with 27% of the total general population (Hune & Takeuchi, 2008; Umemoto & Ong, 2006).

While a cultural explanation has often been proposed for Asian American academic achievement, it does not explain why some AAPI students do well while others do not. It also does not explain why some AAPIs do not emphasize academic accomplishments in their home countries. An argument having salience here is relative functionalism (Suzuki, 1980). By this it is meant that Asian American immigrants find that education in the United States contributes significantly to future success. Education directly contributes to self-improvement and social mobility. American schools also reward some common existing, valued cultural traits such as respect for authority, obedience, and self-discipline (Lee, 1996; Sue & Okazaki, 1990; U.S. Department of Health and Human Services, 2001).

Asian American Pacific Islander Families: Child and Adolescent Presentation in Schools

(Waverly): “I wish you wouldn’t do that, telling everyone that I am your daughter…why do you have to use me to show off!” (Mother): “Embarrassed to be my daughter?… This girl not happy concerning for us, this family not concerning this girl! (From the film The Joy Luck Club (Stone & Yang, 2003), book by Amy Tan)

I don’t think anyone will truly understand my culture and what it has meant as a student. Sure I am big and tough. I have to uphold my Samoan culture. We are like native people who have roots that have been cut off. Unless we work hard to maintain our histories our family tree will topple. Only my other homeboys understand this. This was never discussed in school (Young adult in lockup to his probation officer).

Teachers, school administrators, and school mental health providers should be aware of shared cultural influences and characteristics specific for AAPI parents and their children. These are significant for understanding behaviors related to schooling. With exposure to similar values of childrearing and parenting, the importance of family as a central concept often informs expectations and relationships between family members. Reciprocity or the importance of give and take between family members throughout the lifespan may be the valued norm. Rather than focus on individualism or goals of ultimate family separation or waning of relationships, AAPI students are often raised with values of connection, obligation to family across generations, awareness of how behaviors impact others, and successes including academically and in school performance as public reflections on one’s upbringing and being parented (Chung, 1997; Lee & Mock, 2005a, 2005b).

Educators, mental health service providers, and school administrators should also be aware that cultural influences play a significant role in AAPI individual and social identity development. Beginning with the centrality of family in conducting one’s life, AAPI families are often organized and operate in a hierarchical manner, from parents or elders to the youngest child. Roles and relationships are often conducted along lines of hierarchical respect, with parents speaking then children listening and obeying. Elders are generally to be revered and given respect. Egalitarianism is not necessarily preferred. The often continued dominance of patriarchy plays out in gender development, identity, and relationships. Studies have shown that AAPI males may be afforded more opportunities than females (Abelmann, 2009; Huang, 1997). Gender role stereotypes culturally passed down generations may contribute to subtle or overt messages that schooling and academic achievement for AAPI girls may be secondary to eventually raising a family or caring for fragile elders. Speaking readily about one’s own issues or concerns runs against lessons of not standing out; to do so may translate into being self-centered or selfish due to a need for attention. While experiencing similar joys, pains, fears, and triumphs as is the human experience, AAPI students may hold back in showing emotional expression.

As in so many cultures, heterosexuality is considered the norm with homosexuality often viewed as a deviance from expectations. For AAPI parents, sex is often still considered a topic not to be directly discussed with their teenagers. While sexual orientation is more than sex, for traditional parents they are often linked. As is the case with other cultures, coming out as gay, lesbian, or bisexual may be extremely difficult, perhaps additionally so given some Asian family expectations. An AAPI teenage male might come out to his father, only to have the father question how he failed to convey masculine traits or turned his son away from taking on the culturally traditional masculine, heterosexual role (Mock, 2008).

For Asians, there has been an increased interest on concepts of “face,” face-saving behaviors and how they relate to family dynamics (Zane & Mak, 2003). “Face” relates to how others see you. With an orientation toward upholding family honor and respect, there should be no interactions that bring shame or embarrassment on oneself as this reflects directly on one’s family. Intra-familial differences play a significant role in family health and social-emotional well-being. Cultural values brought from the homeland have different ways of being transmitted and adhered to with subsequent generations trying to fit into current contexts. For some AAPI families with painful or traumatic histories including those from primary immigration and secondary relocation, there may be family secrets or emotional cutoffs. These intergenerational conflicts often show up in current lives. Different rates of acculturation impact AAPI youth adjustment and mental health. In summary then, in the school context, educators and service providers should be aware of Asian-influenced cultural values of:

  • Importance of and central organizing nature of the family.

  • Respect and interactions based on status and roles.

  • Emphases on hierarchy in relationships and interrelating.

  • Dominance of patriarchy inter-generationally conveyed.

  • Orientation toward the group or collective.

  • Sense of duty and obligation through the life span.

  • Shame, guilt, and the concept of maintaining a positive “face.”

  • Different styles of interpersonal communi­cation.

  • Restraint of self-expression, particularly with strangers.

  • Expectations following from different, sometimes multiple roles.

  • An orientation toward achievement and socially sanctioned measures of success (Lee & Mock, 2005a, 2005b; Uba, 1994).

While cultural values may be taught or carried forward within Asian American families and communities, their meaning and depth of being valued across generations may differ. For some AAPI youth, there may be relevancy of culture in their home life but seemingly less so in their classroom or school environments. For example, traditional foods from home packed as a child’s lunch may be a source of unwanted curiosity or embarrassment among peers unfamiliar with Asian cultures. Unless the environment is one of proactive cultural inclusion, the traditional garb or even ceremonial dress of one culture may be misconstrued as an oddity or open to “exotic curiosity” or “othering” without acceptance. From an historical, relational perspective, often because of physical appearance, a history of discrimination, colonialism, racialization, and racism, AAPIs may be unconsciously or overtly viewed as “foreigners” on some level. While cultural differences are at least tolerated, “fitting in” with others in schools is often a child’s desire. Without significant others “reflecting” or endorsing their cultural, racial, and ethnic identities, AAPI students may be challenged in forming an early positive identity. Classrooms and schools are excellent environments for proactively teaching and practicing social inclusion and acceptance of diversity. Films are excellent sources of rich dialogue affirming Asian American cultural identity (Mock, 2008; Xing, 1998).

The Importance of Schools in the AAPI Socialization Process

Academicians, educators, mental health professionals, and policymakers have contributed to the rich role that schools play in the lives of Asian American youth and families. Given the diverse cultural backgrounds described earlier, the school context is an important one for “testing the waters” along social, intellectual, and emotional lines. For families who grow up more insulated from mainstream culture, schools may represent an early foray into larger society and future possibilities. The learning experience for Asian Americans goes beyond grades, textbooks, and exams.

The importance of education is commonly emphasized among AAPI families and communities. Educational achievement is a tangible source of pride, respect, and accomplishment. For newcomer families, schools are a primary source for learning English, Western-based values, and to acculturate. Learning English fluently is often the goal of AAPI immigrants. Negotiating relationships and daily activities in English is often an indication of adjustment and social acceptance. Good grades and academic achievements are identifiable markers of success not only in the realm of academics but also socially (Lee & Mock, 2005a, 2005b). Graduating to attend a prominent university is climbing the ladder in social standing and class in the community.

For some AAPI families, schools are the primary source for socializing their children in a larger context. Parents often look to teachers in the classroom to instruct their children on ways of behaving, negotiating of challenges in daily living, and teaching successful ways in being with others. For immigrant families, schools also represent an interface between prior home and American cultures (Canino & Spurlock, 1994). Even for Asian American families that have strong, multigenerational roots of being in the United States, they inherit the strong influence of what education means to the family. The book Battle Hymn of the Tiger Mother written by Amy Chua stirred controversy after excerpts were shared depicting some of her practices raising her daughters. For some readers, her dictatorial-like music lessons, physical discipline for lack of adequate studying, and critiquing her daughter with friends using strong, verbal admonishments were viewed as abusive. For others, including the author, husband, and her children, this was viewed as being earnest in the importance of achievement and ways of showing care and investment in a child’s or adolescent’s future (Paul, 2011). Because children are viewed as directly connected to parents through a relational lens, AAPI children or youth that are not successful to a point of needing remediation or summoning of parents may viewed by some as a direct result of parents falling short of giving parental instruction, guidance, or modeling. In other words, children in the school context may be seen as direct reflections of their parents at home. This has ramifications for contacting parents to give consent to mental health treatment for their minor children.

The impact of racialization and the experience of it by AAPI students with others are significant. For acculturated and immigrant AAPI families, schools are a primary component of a liberal ideal that working hard, achieving academically, and thriving in personal development will be rewarded with meeting dreams only imagined by parents or elders. In her ethnographic study and analysis of Korean American students, Abelmann (2009) concludes that ideals of an inclusive modern, American university, in her case the University of Illinois in the Midwest, are compromised by stereotyping and racial segregation. She writes that it is overly simplistic to conclude that the social segregation of Korean American students is self-imposed but more accurately reflects the narrowness of the university experience in expanding issues of race, ethnicity, class, and gender. Rather than inspired and elevated for future possibilities, students Abelmann (2009) interviewed reflected disappointments, identity questions rather than answers and even future doubts about self, family, faith, and community. Opposite from being prepared globally, some students felt in some ways more constrained by their race, ethnicity, and class status at the university. She concluded that the new “family” portrayed in the mission statement of the specific mid-west university under study was a reflection in values and process of a specific type of “family.” In other words, the overall mental health of AAPI students, in this case Korean Americans, may be directly connected to the environment of the school in which they participate.

Asian American Pacific Islander Mental Health Issues and Concerns in Schools

My parents used to fight and my mom even called the police one time on my dad after he hit her. But it is not okay for Asians to divorce. Still, I wish my parents would physically separate because they live separate lives anyway. Sometimes I go right to my room after school because I can’t deal with the tension. And they wonder why I can’t seem to concentrate on my studies (Chinese-American high school student speaking to his counselor).

I am grateful to be here. They won’t talk about our home country much because it was terrible during the war. But I just can’t always tell my parents in English what they only understand in Vietnamese. When I try to help my dad in his new business he used to get frustrated. Now that I am a little older, I think he looks more mad. Who can I talk to? (9-year-old girl with parents from Vietnam)

I don’t know what’s wrong with me. I study twice as much as others. It takes me much longer to read things. My brothers and sisters do well. My parents think I just need to concentrate more. My mother’s parents from the home country think it has to do with the war and my spirit. I saw a brochure in the office about being evaluated for learning needs. What should I do? (15-year-old Hmong teenager in a rural school)

Ongoing research has shown that AAPIs tend to show mental health problems in specific, common ways. Compared to other cultural groups, there is relatively limited information regarding the mental health needs of AAPI youth. Common diagnoses have often included adjustment disorders, post traumatic stress, anxiety, depression, and other mood disorders. Interestingly, more behavioral concerns such as behavioral addictions (e.g., gambling, internet addiction) have been recently identified among AAPI groups. From a culturally competence perspective, it is important to utilize the DSMIV-TR (American Psychiatric Association, 1994; Kramer, Wang, Kwong, Lee, & Chung, 2002) cultural formulation in therapeutic assessment, engagement, ongoing, dynamic hypothesis generating and treatment for continuous, successful outcomes. For some, it may be important to identify culturally bound syndromes which are presentations of problems contextually grounded in a cultural frame. For example, there have been descriptions of Hmong youth having problems due to their spirit not being firmly planted in their physical bodies. Traditional Hmong often turn to elders or shaman to reconnect spirits jeopardized by war, trauma, and ongoing migration stress. As noted previously, the conflicts between traditional family values and more mainstream culture may lead to additional stress, confusion, social fragmentation, and exacerbate anxiety for some AAPI youth.

Longstanding research and multiple studies have indicated that prevalence of mental health problems among AAPI children and youth may be similar to that of other cultural and ethnic groups and minors, in general. However, manifestation and identification of problems may only occur when symptoms and behaviors are more severe (Lee & Mock, 2005a, 2005b; Tewari & Alvarez, 2009). Immigration problems including not only traumas experienced prior to leaving the home country but also after arriving can have a direct impact on the physical and mental health of children and teenagers. Family therapists are quite well versed in understanding how unresolved traumas and losses can be continued in future generations. Between parents and their children there may be intergenerational problems. There may be culture conflicts and disagreements with the previously listed common values and norms of AAPI behaviors. There can be culturally based conflicts in attitudes and lifestyles. Behavioral styles in prior contexts (e.g., home country, rural village, small town) may differ with current situations (e.g., school playground, urban setting, large city, student high school organization) (Chung, 1997; Mock, 1998). Developmentally there are common challenges in becoming a teenager, then young adult. Resolving one’s ethnic, cultural, and racial identity brings additional challenges. The importance of family issues or individual issues viewed through a family frame of reference is critical. Differences in language and even accented English are important to negotiate socially for AAPI children and teenagers.

Awareness of specific problems identified among AAPI children and teenagers such as body image, self esteem, and eating disorders such as bulimia or anorexia, risk of suicide are significant (Huang, 1997; Wong & Mock, 1997). In the fact sheet “Suicide Among Asian American/Pacific Islanders” (Suicide Prevention Action Network, 2007), between 1999 and 2004, suicide ranked as the second leading cause of death for AAPIs between ages 15 and 24 years old. Domestic violence has been identified as a significant issue through several AAPI community service centers. Some AAPI youth groups have formed to intervene early in potential cycles of violence. Learning problems in school for AAPI students must be more accurately and appropriately identified. Some studies have shown that AAPI learning needs and evaluation for learning support are under-identified (Chan, 1994).

Effective Mental Health Service Strategies for Asian American Pacific Islander Students

There are several service strategies that educators, school administrators, and mental health counselors need to acknowledge to effectively serve AAPI students. The first are recognition of barriers. Some of these include language differences, mistaken labeling of achievement problems as solely problems in learning English, and unconscious beliefs the student should be a “model for other minorities” leading to hesitancy in making a service referral. Among parents, issues of shame, stigma, and embarrassment in front of strangers may also be contributors. Eventually, the problems may be viewed as greater than the family can hold private or within the home with a crisis erupting. With a value on saving face, the approaching of problems may need to be identified by a source outside of the family and come from a place of authority.

Familial belief systems rooted in culture have important ramifications for understanding physical, emotional, and mental health needs and ways of help seeking. The different ways one may understand or attribute sources of problems have significant impact on seeking assistance. Early discussions on working with Asian Americans often focused on the importance of understanding somatic complaints. While this still tends to be true, a focus on a more holistic perspective in viewing one’s life may be more instructive. From a holistic perspective, mind, body, spirit, and soul are not separate entities but interact within a larger, whole person. Physical and mental health is often seen as connected. In some AAPI families, a student’s sadness may be attributed to nutritional deficits or being out of physical balance. For some families, hyperactivity may not be pathologized but viewed as a norm reflecting the child’s natural personality and tendencies. Undesirable or unacceptable thoughts may be seen as lack of concentration or inadequate training at home. These beliefs and points of view should be considered in any school-based interventions.

Given some of the described cultural norms and values of many AAPI children, adolescents, young adults, and their families, the school context may be an ideal setting for primary prevention, early intervention, and behavioral health care intervention and treatment. For some AAPI students, mental health concepts are not readily understood or valued within the culture. Tangible physical signs of health may be more understandable or acceptable. Students may reveal emotional, psychological, or familial and relationship concerns to teachers through headaches, stomach problems, or trouble concentrating.

While racism and the experience of power differentials including oppression may be hard to talk about, thinking about these sources of stress while providing service initiation, engagement, and ongoing services can make the relationship more meaningful. Rather than just being culturally competent, the service provider should also be aware of cultural humility and professional compassion. As written elsewhere, cultural competence is best understood as not a final endpoint but an ongoing process of learning. Cultural humility refers the clinician’s acknowledgment that when it comes to culture, we do not know everything and instead continuously strive to respectfully know more. We can never absolutely know another’s experience, but if we listen with an open heart and mind, our expressed compassion can contribute to healing (Mock, 2008).

While a primarily psychologically based problem may be more complex, understanding how the individual and their support system (family, friends, and community) view the situation has important ramifications for interventions in schools. Young AAPI children experiencing stress in their initial classes may find a group for making friends as newcomers as less stigmatizing than being in a remedial classroom. Students identified as having difficulty socializing on the playground or connecting with peers may have some of their needs addressed through a class teaching study skills or supporting cultural ways of communicating and interacting. For AAPI families adjusting to being in America as immigrants, an English-as-a-Second-Language (ESL) class that integrates mental health wellness perspectives in the classroom can be an effective strategy. In other words, a more psychoeducational approach may be more in keeping with cultural norms as well as be less stigmatizing.

Innovative Approaches, Evidence-Based, Effective, and Best Practices in School Mental Health for AAPI Students

Several recommendations emerge for providing school-based services to AAPI youth. I directed mental health services for children, adolescents, and their families in the diverse context of Berkeley, California, for twenty years. We launched comprehensive mental health and related health services for minors from kindergarten through high school. I also led projects to address mental health disparities for multicultural communities throughout California for several years. I have served as an administrator, direct service provider, researcher, and professor throughout my career. There should be a comprehensive network of referral agencies and providers that wraparound and provide an array of services with cultural competence integrated, infused, and integrated throughout service provision. Administrators, teachers, academic counselors, probation officers, juvenile justice providers, social service workers, are important sources of referrals, intervention, and networks of support. Filipino and Korean families, for example, may rely on their religious or faith institutions for support. Research has shown how religious institutions have played important roles in each of these communities (Abelmann, 2009; Tewari & Alvarez, 2009). More recent AAPI immigrants may utilize community leaders or traditional healers. To involve cultural brokers in educational services can be a culturally responsive community intervention.

Due to continuing stigma in directly discussing mental or emotionally related problems by going to a stranger, the school setting poses a culturally appropriate setting for addressing potential problems. Ongoing research, studies, and interviews with AAPI youth and families have yielded important promising, effective, and evidence-based mental health practices. The author managed a project at the California Institute for Mental Health (CiMH), reviewing and collating effective practices specific for different cultural communities (see resources in the Appendix). Titled the Adopting Culturally Competent Practices (ACCP) Project (2006), therapeutic practices were reviewed in the psychological research and practice literature. These practices were demonstrated to be effective for AAPI youth through scientific research testing the actual interventions. Levels of practice evidence were designated as either “effective,” “efficacious,” or “promising.” It has been demonstrated, for example, that many AAPI youth may respond to a more cognitive-behavioral approach to treatment. This seems to fit with a more intellectual emphasis of schools. In contrast, some AAPI communities such as Korean Americans place spirituality at the center of identity along with culture. In Merced, a rural community in central California, Hmong shaman now work collaboratively with medical doctors. Youth are involved in garden projects for the well-being of elders connected to nature and spirits. This reciprocally impacts the well-being of children, youth, and their families. Evidence-based practices have also been adapted for the specific case of Asian Americans. LaFromboise (1995) has researched and promoted an evidence-based curriculum called American Indian Life Skills to address suicide risk among Native American youth. This has led to adaptations and curriculum in Asian American communities. For example, an anti-violence, anti-drug curriculum based on this model has been utilized in Hawaii. Teenage anti-violence programs for AAPIs have been tailored to meet the needs of Samoans, Filipinos, and Vietnamese (Ida & Ja, 2007; Mock, 1998).

In the ACCP Matrix, the list of identified practices culturally responsive to the needs of AAPI youth include: Incredible Years (effective for disruptive disorders); Functional Family Therapy and Multidimensional Treatment Foster Care (each effective for mixed emotional and behavioral problems); Multisystemic Therapy and Wraparound (each promising for serious mixed emotional and behavioral problems); Group Cognitive Behavioral Therapy (effective for depression and anxiety); and Psychoeducational Family Intervention (promising for severe mental health problems like schizophrenia). For more details about each practice and others, the level of research evidence for AAPI populations, recommendations for cultural adaptations and accommodations, staffing potentially needed for school implementation, availability in different Asian languages, refer to the ACCP Matrices on the CiMH website at www.cimh.org. Each of these specific interventions and more are carefully referenced in the matrices provided online. It is significant to note that while there have been studies conducted using AAPI samples, there continues to be a high need in researching therapeutic practices effective for different AAPI groups including those to be implemented in school-based settings. For children and teenagers of diverse cultural backgrounds, policymakers must not only be aware of evidence-based practices but also therapeutic practices that are community-defined, promising, and practice-based evidence (Mock, 2003; U.S. Department of Health and Human Services, 2001). Culturally sensitive research must continue targeting the specific needs, help seeking behaviors and relevance of interventions for the Asian community of interest. For Asian at-risk youth, programs and services that reflect contemporary ways of learning and interacting socially can be very beneficial in schools. In the San Francisco Bay Area, a longstanding program that addresses substance use and abuse, Asian American Recovery Services (AARS) incorporates dramatic role play for teenagers returning to wellness. Another program, Community Health for Asian Americans (or CHAA, formerly known as Asian Pacific Psychological Services) incorporates hip-hop and the sharing of cultural narratives in ways that teenagers speak and relate. Titled BEATZ, the program is described as follows:

BEATZ is a program that seeks to promote youth leadership and development through music, and is housed in the STEP AHEAD building along with Southeast Asian Youth Leaders (SEAYL). With instruction from DJ professionals, students devise, lead, and execute projects promoting community wellness. The BEATZ team recently wrote, produced, and recorded an original album speaking out against violence, and is currently providing DJ training on site at the RYSE Center in Richmond.

Yet another program of CHAA is the Health and Wellness anchor at RYSE, a collaborative in Richmond providing programming and leadership opportunities for youth aged 14–24. In addition to providing traditional counseling services, CHAA offers personalized wellness plans, which all RYSE members are encouraged to complete. Wellness plans provide youths the opportunity to analyze various areas of their lives and pick an area for improvement, such as fitness, school, sexual health, career plans, relationships, and academic progress, among others. Finally, for substance abuse concerns, CHAA has a school involved program Substance Abuse Treatment and Empowering Youth (SATAEY). The program description is as follows:

Community Health for Asian Americans (CHAA) will provide early intervention outpatient Alcohol and Other Drug (AOD) treatment program that targets adolescents age 18 and under with substance abuse issues that affect major areas of functioning. Moreover, SATAEY emphasizes the association of AOD abuse and multicultural issues, especially to recent immigrants and other API youth. The services will be provided in schools and at the clinic in order to promote a healthy community and reduce the harmful effects associated with alcohol and drug use.

The author has talked with his teenage daughter, an accomplished Taiko (Japanese) drumming performer, regarding music embodying cultural traditions as contemporary learning processes for positively embracing cultural identity, a source of strength and resilience. In the face of familial adversity such as domestic violence, being a member of a campus club like Taiko drumming can provide an avenue for belonging, connecting, and sense of cultural sharing further contributing to positive self-identity and esteem. Research is being formulated in this regard.

With the popularity of different social media, curricula reflecting Asian American life and experiences can be quite powerful. Rather than promote usual AAPI stereotypes, a dynamic, carefully crafted class specifically focusing on the needs of students attending can be a powerful, deep, and lasting learning experience. Anecdotally, the author has conducted years of trainings and workshops involving storytelling by AAPI students. Students often reflect on the power this has had in their lives in terms of helpful critique, deep analysis, reflection, and rich, shared experiences. The overall message has often been one of feeling validated in their experiences. Some of these positive comments have been shared even several years after the actual class experiences.

Psychoeducation can be an effective community intervention strategy as well as a primary component of school initiatives. After a serious of consecutive crises and school-related deaths of different Asian identified youth, the author proposed and articulated a prevention curriculum for Asian American middle and high school students. A set of culturally specific workshops were prepared and provided for AAPI students and their families at the beginning of each academic year. Topics were of a practical nature including adjusting to a new school environment, effective study habits, balancing home and school life, making friends, immigration, and foreign status student issues and more. The involvement of students with their families proactively at the beginning of the year before school problems arose seemed to set a healthy tenor for investment and school involvement by Asian families in their child’s lives. The importance of engaging cultural communities in a bi-directional, shared manner is extremely important. In other words, culturally competent approaches for mental health prevention, promotion, and intervention in school contexts are best informed by continuously asking families and communities themselves (Mock, 2003). This keeps services relevant and accountable to the community and may further empower families in the process. From a collective perspective often framed by Asian American and Pacific Islander families and their children, solutions that emanate from families may provide best “fit” in schools.

Conclusion: A Call to Action for AAPI Youth

This chapter initially framed some of the stereotypes and myths perpetuating a false image that AAPI youth have few mental health needs in school contexts. Research and events involving AAPI reported in the media and actual narratives reflected throughout underscore a great need to better understand the mental health and related health needs of the AAPI community. AAPI communities are not monolithic but diverse and complex. As a call to action, there is enough documented information in the educational and psychological fields to argue that AAPI youth need more services responsive to the specific AAPI cultural group. More research documenting effective cultural interventions in schools must be continuously conducted. Direct interventions tied to educational outcomes can reduce stigma and shame, known barriers for help seeking among AAPIs. AAPI families and communities have strong historical legacies of surviving and thriving amid multiple sources of adversity including racism, classism, oppression, anti-immigration, and other forms of social marginalization. Culturally competent interventions that actually work for AAPI children and adolescents are best informed by involving AAPI families and the community. With a group or “we” identity as central to understanding AAPI families, relational and systemic perspectives to mental health intervention and prevention in schools are invaluable. Interventions sensitive to cultural values carry greater credibility for being successful. Lastly, trusting and forming ongoing relationships with AAPI communities can lead to mutual identification and ownership of not only problems but also cultural solutions and experiences of empowerment contributing to overall better mental health.