Alina Camacho-Gingerich, Susan Branco-Rodriguez, Raúl Pitteri, Rafael Javier. Handbook of Adoption: Implications for Researchers, Practitioners, and Families. Editor: Rafael A Javier, Amanda L Baden, Frank A Biafora, Alina Camacho-Gingerich. Sage Publication. 2007.
In the United States, as well as in several other countries, the practice of adopting children from foreign countries emerged in the post-World War II period (Lovelock, 2000; McRoy, 1991; Weil, 1984) as a response to the needs of the displaced children of Europe during and after the war. The first provision for intercountry adoption into the United States was President Truman’s directive of December 22, 1945, which allowed for the migration of refugees and minors not accompanied by family members (Lovelock, 2000). The children came primarily from Poland, Czechoslovakia, Hungary, and Germany. The responsibility for caring for these children fell on both the federal government and private agencies. Some of the younger children were adopted by citizens of the United States.
By the 1950s, international adoption of children became an established practice. Since then, the availability of children from other nations for adoption has always been shaped by political unrest, civil wars, natural disasters, and domestic family policies in the Third World countries. The practice of international adoption of children has been conceptualized as having occurred in two waves (Alstein & Simon, 1991; Lovelock, 2000; Westhues & Cohen, 1998). The first wave, from the end of World War II to the mid-1970s, was considered a mostly humanitarian response to children in need of families from poor and war-torn countries. The second wave, from the 1970s to the present, although also inspired by the desire to provide a nurturing family environment for children from poor countries in political turmoil, was also driven by falling fertility rates and the diminishing supply of healthy Caucasian infants available for adoption domestically.
As the demand for healthy Caucasian infants exceeded the availability domestically, prospective parents in the United States increasingly turned to international adoption. However, there were no legislative provisions in place to facilitate this process (Carlson, 1988; Forbes & Weiss, 1985; Lovelock, 2000). The U.S. military intervention in Asia prompted the United States in 1953 to institute special provisions to facilitate military and government employees stationed in Korea to adopt Korean orphans (Carlson, 1988; Lovelock, 2000). The Refugee Act of 1953 was the first legislation to explicitly address international adoption and the demands of prospective parents domestically. This act, geared at citizens fleeing the Eastern Block countries, also allowed 4,000 special nonquota visas for orphans (Forbes & Weiss, 1985). For the first time, prospective parents in the United States had a nonrestrictive international adoption immigration policy available to them (Lovelock, 2000). Between 1954 and 1958, when this act expired, about 10,000 children were adopted from abroad by families in the United States. Many of these children were from Germany, Japan, and Korea, adopted by military personnel stationed in those countries (Lovelock, 2000; Pettis, 1958).
Permanent provisions for the international adoption of children in the United States were not made until 1961 with the passing of the Immigration and Nationality Act of that year (Carlson, 1988). In the 1960s, international adoption became more frequent, and by the 1970s, it was a fully accepted way to complete a family. The vast majority of these adoptions were interracial (Tristeliotis, 1991). By the mid-1970s, the Latin American and Caribbean nations had become significant sources for U.S. parents looking to adopt children. These adoptions represent the turning point from the first wave of migration of children to the second wave (Lovelock, 2000). The main motivation for prospective parents in these cases was infertility and the inability to adopt domestically. Different from previous international adoptions, these adoptions were not associated with U.S. military involvement or any international political conflict. Many of these adoptions were interracial, and of children unknown to the prospective adoptive parents (Hoksbergen, 1986; Lovelock, 2000).
In the late 1980s and 1990s, Latin America continued to be a significant region for parents looking to adopt children. With the increased demand came more opportunities for corruption. In many cases, large amounts of money were paid by prospective parents to intermediaries who controlled the supply. These intermediaries pressured poor women to put up their babies for adoption. Black markets became common in some Latin American countries as well as in Asia. A few sensationalized reports of “baby farms” emerged in Honduras, Brazil, Peru, and Sri Lanka, among other places (Lovelock, 2000). It seemed that the welfare of the children to be adopted was at best secondary; nobody seemed to care about the biological or adoptive parents. The Latin American nations involved responded in some cases by attempting to regulate the international adoptions; in other cases, they prohibited these adoptions until some measures were taken that allowed these countries to supervise and regulate the adoptions.
Responding to these abuses, the Organization of American States attempted to introduce some uniformity in the adoption of Latin American children (Lovelock, 2000). The Inter-American Convention on Conflicts of Laws Concerning the Adoption of Minors of 1984 tried to define questions of applicable law and jurisdiction (Carro, 1994; Lovelock, 2000). The Inter-American Convention on International Traffic in Minors, adopted in Mexico, DF, on March 18, 1994. It tried to reconcile regional laws on adoption with international conventions on the protection of minors internationally. It was an attempt to meet the requirements of the UN Convention of the Rights of the Child adopted by the UN General Assembly in November of 1989 (Carro, 1994; Lovelock, 2000). All these measures were intended to address the abuses in the adoption of children from Latin America. Although these measures were a good start, most experts believe abuses continue to take place, especially with independent adoptions, the most prevalent form of international adoption in the United States (Lovelock, 2000). The needs and the well-being of the child to be adopted as well as those of the biological family should be of paramount importance. In the United States there was no policy that protected the welfare of the child migrating for adoption until the recommendations of international conventions of 1993.
Psychological and Mental Health Issues for Adoptees in International Adoption
In 2004, more than 22,000 children became sons and daughters of U.S. citizens through intercountry adoption (Encyclopedia of Adoption, 2006). Since 1971, more than a quarter million international adoptees (INAs) have been adopted in the United States. As indicated earlier, these children arrived and continue to arrive from countries such as China, Russia, Guatemala, India, and Colombia, to name a few. Restrictions in adoption laws in some of the Latin American countries, such as Argentina, had made it more difficult to adopt from these countries (Puhl, 1999), and hence, the number of adoptees from these countries are low. As the INA population grows, the need to explore and examine the unique challenges that members of this group face as they develop throughout their life span has become more poignant.
Much of the current research on INAs tends to focus on adolescent identity development and grief and loss issues. It is clear that adoptive parents will be in a much better position to address issues that are likely to emerge in their adopted children if they acquire a better understanding of common developmental issues their INA children are likely to encounter as they progress in their developmental trajectory in the new country. Mental health practitioners, too, must become knowledgeable of typical challenges encountered by the INA, particularly during adolescence and young adulthood, to provide appropriate and efficacious services. This chapter will present a review of current INA research with regard to adjustment issues and will review some of the legal restrictions that countries such as Argentina have in place and that affect the extent to which INA adoption from these countries is possible. All the literature cited contains Central/South American adoptees in their samples and, thus, allows us to gain some general understanding of the international adoption experience in Latino children. The chapter will then describe a small focused group study that one of the authors of this chapter conducted with adult Colombian adoptees to identify factors that they found helpful in their development.
Challenges in Identity Development in International Adoption
Erik Erikson (1968, 1980), well-known for his human development theory and also an adoptee, spent a great deal of his professional life explaining the different challenges the individual tends to face as he or she progresses through his or her developmental path. It was his belief that the extent of success at a specific developmental stage was a function of the success of the previous stage. Focusing specifically on the period of adolescence, he believed that the central issue to be resolved is the issue of ego identity versus identity confusion. He defined identity as a subjective sense of self that remains stable over time and that is validated and shared by others and that defines the quality of one’s relationships with the world. The question is how these issues played out in adoptees, especially in those coming from another country. We believe that during adolescence and young adulthood, INAs encounter a unique situation where challenges to identity development are particularly poignant. Since international adoption requires the adopted child to leave his or her country of origin and to acquire a new culture and language, part of the process of identity development involves coming to terms with what it means to lose one’s connection to one’s biological heritage and birth country. For those adopted by parents from different ethnic and racial groups, it also involves coming to terms with their ethnic and racial dissimilarity to their adoptive families. In most nonadoptive families, adolescents incorporate their family of origin’s history, culture, race, and ethnicity into their own identity schema, giving them an important point of reference for personal meaning. In the case of the INA, the adolescent does not have access to such identifying information and could experience what Brodzinsky (1987) calls “genealogical bewilderment.” According to Brodzinsky, this term is used to describe confusion, uncertainty, and disconnection to one’s biological origins. Additionally, INAs who are ethnically and racially dissimilar from their adoptive families may potentially experience more distress during identity development because of the additional challenges with which they have to come to terms.
Mental Health Issues in INAs
Many INA adolescents experience increased mental health concerns and adjustment difficulties. One study in Sweden (Hjern, Lindblad, & Vinnerljung, 2002), the home of the largest INA population in Europe, compared INAs (11,320) with a general population group (85,419) as well as an immigrant group (94,006) using data from the country’s national register. Additionally, they analyzed separately a sibling group (2,342) who were children with one or more biological parents with an INA sibling group. They found that INAs were referred to child and adolescent psychiatric clinics at a higher rate than nonadopted children. However, these authors emphasized the need for caution about these findings because the above average referral rates could be more of a product of “active help seeking parents” (p. 444) than chronic mental illness. Even with this consideration, they found that adolescent INAs were three to four times more likely to have serious mental health problems, such as suicide, suicide attempts, and psychiatric admissions, than the general population group. Furthermore, adolescent INAs examined in this study were five times more likely to commit crimes than the nonadopted population with similar socioeconomic backgrounds.
In contrast, another smaller Swedish adoption study (Cederblad, Hook, Irhammer, & Mercke, 1999) compared 211 INA adolescents to 187 Swedish-born adolescents. They found INAs exhibited no significant differences in mental health compared with the Swedish-born group of similar age and socioeconomic background. Some of the INAs in this study reported experiencing teasing about their physical appearances and being treated as immigrants. However, no significant difference was found between groups regarding identity confusion, as measured by clinical interviews and self-report checklists. Interestingly enough, 90% of the INAs identified themselves as Swedish and 70% reported no connection to their birth country.
Similar findings were also reported by another study in Canada of INAs that yielded no significant results to directly correlate maladjustment to international adoptive status. Adolescent and young adult INAs from several countries were interviewed to assess their level of family integration, self-esteem, acceptance by peers, and ethnic and racial identity (Westhues & Cohen, 1998). The researchers described this INA sample as “a well-adjusted group” (p. 129). Although the majority of INAs reported feeling comfortable with their ethnic identity, most reported experiencing racial and or ethnic slurs by peers or others. Such incidents included the following: peers refusing to play with them, bullying, staring from adults, and stereotypical assumptions made by others. Over half (59.8%) strongly agreed with the statement, “Some people would argue that visible minority children in this country face a lot of discrimination” (p. 128). The researchers concluded that discrimination and racism could potentially be a damaging factor to healthy INA development in Canada.
These findings notwithstanding, other research in different countries confirms previous findings about negative outcomes in INA development. In a Dutch study (Verhulst & Versluis-den-Bieman, 1995), for instance, 1,538 INAs were studied to determine, among other things, the developmental pattern of problem behaviors from middle childhood through adolescence. They found that INAs who scored high on the Child Behavior Checklist (CBCL) at ages 11 to 14 continued to do so when they were 14 to 17. Some even exhibited increased problematic behaviors. Overall, the INA group, when compared with nonadopted populations of the same age, demonstrated an increase of maladaptive adjustment during adolescence. The researchers emphasized that they could not “conclude that differences in ethnicity between the parent and the INA” (p. 155) were responsible for the increased maladjustment scores. However, they did consider ethnic and racial dissimilarity to the adoptive family to be an important factor in increased maladaptive behaviors with regard to experiencing racism and difficulty constructing an ethnic identity.
One of the few studies of identity development and adjustment among Latino adoptees in the United States indicated that those adoptees raised by ethnically similar adoptive parents fared better than those raised by ethnically dissimilar parents. Andujo (1988) examined the self-esteem and identity development among Mexican American adopted adolescents. She compared one group of 30 adoptees with Mexican American adoptive parents and one group of 30 with Caucasian adoptive parents in an attempt to discern differences in development. She found that the adoptees with Caucasian adoptive parents presented with differences in identity and physical self-concept and were less likely to identify themselves as Mexican Americans. Andujo hypothesized that adoptees with Mexican American parents will be better prepared to manage and cope with ethnic and racial discrimination based on learning from their parents’ experiences.
Andujo’s study remains relevant despite the fact that the adoptive sample could be considered more a domestic sample than an INA sample. Most INAs tend to be of minorities adopted into Caucasian families. Andujo states, “Once the adoptees are beyond the confines of their immediate families, they will experience the same interactive threats all minorities experience in society, and ultimately will experience some role confusion” (1988, p. 534). This is the same issue that was raised in the Canadian study that found that INAs suffered racial and/or ethnic discrimination. As suggested by Brodzinsky (1987), experiencing prejudice can create adjustment problems. Such incidents are often not reported by the INA to adoptive parents, and when they are, they are frequently minimized, possibly out of parents’ feeling helpless to effectively offer guidance in these situations (Andujo, 1988). Myrna Friedlander (1999), a family therapist, expresses similar concern about young adult INAs encountering racism and warns that the adolescent/young adult is “part of two cultures but feels alienated by both” (p. 564).
Legal Complications: The Argentina Case
Adopting children from Latin American countries into the United States and other countries is full of complications, particularly precipitated by the increased concern that the financial gains to those involved in facilitating the adoption transactions tend to encourage questionable and criminal practices with less concern for the well-being of the child and the birth parents (Chavanneau, 1977; Videla, 1997). Some of the countries have even placed moratoria on international adoptions because of these abuses, while others, such as Argentina, have not only refused to adhere to international adoption procedures (Di Lella, 1997; Meeting on the Rights of Children, 1995, Commission No. 2) but have refused to sign on agreements with other countries to facilitate international adoption of their children. In the case of Argentina, part of the reason for this reluctance is the belief that domestic adoptions should take precedence over international ones and the fact that it is difficult to monitor the quality of the adoption experience in the international arena. This is not to say that there are not children who are taken out of the country to be adopted abroad, but when it happens, it takes place outside the legal framework (Vidal, 2005).
Adoption in Argentina has changed significantly in the last 10 years, concerning both its legal and social aspects (Giberti & Chavanneau de Gore, 1991). The Argentine government has provided a regulated framework within which adoptions are to take place, but it is often transgressed (Family Court Cases at the province of Chaco, 2005). These legal measures have the child’s best interests at heart, but more often than not the slowness of the process and the relatively easy way “to get a child” outside the established legal system tend to seriously harm the chances of registered couples who wish to become adoptive parents following the legal route. The fact of the matter is that legal adoptions in Argentina are not a private contract between parties but a matter of state and can only be granted by a competent judge in the matter (Oppenheim, 1999). These procedures are followed to protect the best interests of the child.
In the last few years, the existence of this legal procedure has intensified the conflict with individuals who make a profit out of providing children for adoption clandestinely (Puhl, 1999); it has also come into conflict with the custom, deeply rooted in cultural practice, by which a birth mother (usually extremely poor) would leave her child with a family (often belonging to a higher social class) who wished to adopt (Family Court Cases at the province of Chaco, 2005). Such a practice is discouraged to safeguard the child from falling into the hands of unscrupulous and unknown people. The fear is that the birth mother, when not driven by monetary gain, is often under duress because of the inherent social inequality (Chavanneau, 1977; Videla, 1997). Thus, guided by the need to protect the best interest of the child, the Argentinian legal system has delineated clear sets of procedures that anyone interested in adoption is expected to follow.
- First, it is mandatory for adoptive parents to sign up in the Registry of Adoptions.
- Those wishing to adopt must satisfy a series of requirements, such as a psychological evaluation and home study assessment performed by a psychologist and social worker provided by the court (Adoption Law No. 24779).
- Once these requirements are satisfied, when there is a child potentially available for adoption, the adopting parents are called from a numerical waiting list where they have been placed.
The term potentially available for adoption is not to be confused with a needy child. Not all needy children are available for adoption, but only those termed in abandoned conditions. These children have spent most of their lives in institutions because their birth parents were either unable to provide adequate care or have not as yet relinquished their parental rights (Puhl, 1999). The sooner this fact is known by the Family Court, the faster a decision can be made about adoption, so that these children don’t have to extend their stay at institutions unnecessarily. It is a well-known fact that the older the child, the harder his chances for adoption (Family Court Cases at the province of Chaco, 2005). The only time children are put up for adoption at once is when there are clear signs that they have suffered from various forms of neglect and abuse. The easiest but less frequent situation is presented when the birth mothers themselves voluntarily come to the court and offer their child up for adoption.
Additional Mechanisms to Ensure Adequate Protection of the Child’s Rights
There are other characteristics pertaining to the Adoption Law in Argentina that are important to emphasize because they are specifically designed to offer the best protection of the child’s rights.
- The adoptive parents are expected to commit themselves to tell the child his or her real life story and to help the child get to know his or her background and origin so as to be able to develop his or her personal narrative. Indeed, the importance of making sure that the child was not deceived was an important consideration when laying the foundations for the Adoption Law (Adoption Law No. 24.777)
- The law requires a postplacement supervision, normally a 6-month period, which is expected to begin as soon as the child is placed in the adoptive family’s care. This includes home visits to supervise how the adoptive parents and child develop family ties. These visits are more frequent and of the utmost importance in adoptions of children older than 2 years of age since bonding is not always easy for either side (Giberti, 1997).
- The law makes provision to ensure the rights of the adopted child, when he or she is of age, to have access to his or her adoption file and find out about his or her birth parents or siblings. This amendment was made in 1997, and it is still being debated since the long-term effect of this measure is yet unknown (Di Lella, 1997).
The emphasis of the law on the right to self-identity of the adopted child could be seen as a residue or a social defence mechanism arising from the bloodshed years of the 1970s. The military regime in power at the time organized the systematic disappearance of adults and the illegal misappropriation of young children after the murder-disappearance of their parents (conclusions and recomendations from the meeting on “The Right of Children in the New Constitution”).
International versus Domestic Adoption
There are poignant questions regarding international adoptions that are of great concern for those interested in making sure that children going into international adoption are properly cared for. Thus, questions such as the following arise:
- Who will evaluate the adoptive parents?
- How will this be done?
- Who will control postplacement supervision? Should the role of the countries “exporting-sending” these children abroad be limited to merely handing them over and waiving their rights or should their own laws be applied?
These issues are particularly complex when these children are no longer infants
The feelings of loss and cross-cultural issues the child will likely face require supervision that cannot be easily handled by the adopted child’s native country alone (Giberti, 1997). One of the main reasons why international adoptions have not been legalized in Argentina is because a large number of domestic adoptive parents are on a waiting list (National and Provincial Adoption Registry). In the Province of Chaco, for instance, with an estimated population of 1 million people, there are currently 90 adoptive parents who have signed up at the Adoption Registry waiting for a child (Family Court at the Adoption Registry Chaco Province). According to some statistics, there are about 220 additional registered adoptive parents from different parts of the country, including Buenos Aires (Family Court at the Adoption Registry Chaco Province), and some adoptive parents have already been to different registries throughout the country. Since the year 2000, the Province of Chaco instituted a Single Registry of Adoptions and has recorded close to 300 adoptions, an average of 60 per year (Family Court at the Adoption Registry Chaco Province).
Again, it is important to keep in mind that a large number of children are adopted outside the legal process (mainly by people not entered in the Registry of Adoptions) for clear financial gain for those who facilitate the transaction. They are often adopted by foreigners who are prepared to pay a large sum of money (Vidal, 2005). If we take into consideration the fee for international adoptions (between $15,000 and $20,000) that foreign adoptive parents are willing to pay and compare it with the average yearly salary of an Argentine citizen ($3,000), it is easy to see how this might come about.
It is not uncommon to see foreign couples traveling throughout the northeastern part of Argentina looking for children to adopt. The reason for seeking children for adoption from that part of the country may be that many of the Europeans that immigrated to Argentina through the 1960s were Eastern European, and they settled in the provinces of Misiones and Chaco. This is a way to increase the likelihood that the child adopted will come from an Eastern European background and thus be closer to the parents’ preferred race.
Assessing Factors Affecting Identity Development in Latino Adoptees
Since many of the international Latino adoptees tend to come from countries with different ethnic and cultural configurations, international Latino adoptees are often faced with serious challenges as to how to define themselves in this cultural context. It is clear that research findings lead toward the belief that racial and ethnic issues play a role in INA identity development (Verhulst & Versluis-den Bieman, 1995). What is not clear is what sort of experiences can be helpful in helping the adoptees develop a sense of belonging and personal centeredness as they try to adjust to a new family and new country with different cultural and linguistic demands. The need to identify what experiences are perceived by the adoptees as helpful or unhelpful in contributing to developmental adjustment is of paramount importance.
In an attempt to find some possible answers to this question, one of the authors of this chapter asked a series of questions to a group of Colombian adoptees in the form of a focus group and more in-depth individual interviews. Both the focus group and individual interviews reported similar themes in positive factors that enhanced their adjustment as Colombian adoptees. These factors primarily revolved around feeling accepted by the Latino community at large. Many found association with other Latino groups as helpful in fostering identity development and a feeling of inclusion. Some group members indicated that relationships with other Colombian adoptees helped in normalizing their self-perceptions through sharing common thoughts, feelings, and life stories. Additionally, important to note is that all 12 participants in the focus group described themselves as Latino/Hispanic or Colombian. This suggests that even though most were raised by Caucasian families, they perceive themselves to be ethnically or racially different.
It is not surprising that factors identified as not helpful were nearly the opposite of those found helpful in adjustment. The two most commonly reported unhelpful experiences, perceived rejection or exclusion by the Latino/Colombian community and experiencing racism, both reflect current research findings in Canada, Europe, and the United States that describe experiencing racism or prejudice as contributors to maladjustment (Verhulst & Versluis-den Bieman, 1995). Some reported feeling isolated and rejected from other Latino communities because of language inabilities, being perceived as “White” by other Latinos, and feeling shamed by negative stereotypes of their country of origin. It should be noted that three of the five interview respondents were raised in homogeneous Caucasian communities and all three reported feeling uncomfortable initially when encountering Latino people because of their unfamiliarity with the culture.
Implications for Adoptive Parents and Professionals
Regarding advice to parents and professionals, respondents emphasized the importance of prospective adoptive parents accepting the child’s birth country and birth family and demonstrating acceptance of these aspects. Some of those interviewed in our study suggested learning Spanish, visiting the country, and learning about its history and culture as important in becoming more prepared to address issues of INAs. Many felt that preadoptive screening via the home study process should include mandatory workshops on INA development. Several stressed that individual INA testimonials would also greatly benefit potential adoptive parents. Some emphasized the need for pre-, post-, and lifelong adoption counseling to address common concerns that both INAs and adoptive parents encounter. Counseling during adolescence “when identity development becomes so important” was also suggested.
INAs and their families are a growing population in the United States. The Immigration and Naturalization Service reports that in 2004 more than 22,884 international children were adopted by United States citizens (U.S. Department of State, 2005). Of this number, 3,729 were adopted from Latin American countries such as Guatemala, Colombia, Mexico, and Brazil. Legal restrictions in some Latin American countries have made international adoption problematic, thus contributing to the illegal and unregulated adoption of children from these countries.
Of importance in this regard is the fact that Argentina is not a signature to the Hague Convention and thus making irrelevant to Argentinian children and parents a series of rules and procedures that have been established to ensure proper protection of children for adoption in the international arena. In this chapter, we sought to develop a descriptive analysis of the adaptive factors that shape international adoption by using data obtained from a sample of Colombian adoptees as an example. The chapter offers specific recommendations as to how adoptive parents and mental health professionals can better support INAs in their developmental adjustment efforts.
It is evident that identity development, particularly during adolescence and young adulthood, is a crucial time when INAs may need additional family and possibly professional support to assist in adaptive adjustment. Based on the issues raised in this chapter and findings discussed earlier, the following best practices apply:
- Latino adoptive INA families should consider residence in an area with a Latino presence, hence facilitating easier access to and participation in the culture.
- Latino adoptive INA parents should actively seek organizations or groups with other Latino INA families in an effort for their children to connect with others with a similar background.
- Latino adoptive INA parents need education, guidance, and support on managing and responding to racism or prejudice that may be experienced by their children.
- Mental health professionals should normalize and validate difficulties faced by Latino INAs during adolescence and young adulthood while educating their families on this developmental stage and offering recommendations on how to be supportive to their children during this developmental stage.
- In places where the possibility for abuse and misappropriation of children by groups guided by financial gains exists, it will be important to create not-for-profit organizations with the specific task of helping to develop a better and more organized and centralized control mechanism regarding the children available for adoption so that they will not fall prey to illegal adoptions. This may not only shorten domestic waiting lists but also result in developing a mechanism to facilitate and open up the possibility for international adoptions.
- What differences can be found between the adoption proceedings in Latin American countries and the United States? Mention advantages and disadvantages.
- Do you think that adoptions that take place through child placement agencies promote unequal or equal chances in developing countries?
- How do you think parents could be helpful when adolescent Latino INAs experience racism in their community, at school, or with relatives?
- What are potential barriers to identity development in Latino INAs?
- How can mental health professionals best serve the individual Latino INA and his or her family?