Providing Culturally Relevant Services

Rachael Hall, LCPCRama Deen, LCSW

Tidwell Social Work Services and Consulting

Objectives To learn or deepen understanding of what culturally relevant

services are

How culturally relevant services affect the treatment process and impact overall treatment outcome

Gain better insight into the value of the therapeutic relationship (what it looks like/how to develop it)

Better understand the importance of peer support in the healing process

How to identify and build on client's strengths to promote healing and return to “pre-morbid level of functioning”

What are the challenges??Pre-resettlement Post-resettlement

Fragmentation

Instability

language barriers

severe staff shortages

(Cravens et al, 1991)

frequent misdiagnosis

inappropriate use of interpreters and paraprofessionals

culturally inappropriate treatment methods

Why is this important?Client Therapist

Client buy-inValidated and

UnderstoodHelps the therapeutic

relationshipAccomplished/optimisticEnhance client’s outlookPositive treatment

outcome

Understanding clientIncrease confidence in

skillsJob satisfactionPrevent burnoutPositive treatment

outcome

Conventional Psychotherapeutic interventions…

culturally appropriate????

Things to consider…-Treatment approaches used by Mainstream Mental Health Providers -Client expectations regarding the duration, frequency and nature of treatment

-Therapist knowledge or appreciation of culturally sanctioned healing practices within refugee communities

-The nature of settings in which difficulties arise

(Cravens et al, 1991)

More things to consider…- linguistic challenges

--Lack of expertise in cross-cultural diagnostic skills

-Limitations related to diagnostic issues - – misdiagnosis of pathology

(Cravens et al, 1991)

More things to consider cont…

– misdiagnosis of pathology

- Somatization- Suspiciousness and paranoia- Psychosis- PTSD-related symptoms- Evaluating for Organic impairment

(Cravens et al, 1991; Mollica & Lavelle, 1988; Kinzie et al., 1982; Westermeyer, 1986).

So what does work????

3 Therapeutic ApproachesBeing a “culturally sensitive” therapist

Culturally sensitive therapy

Culture as the main focus of the therapy

(Cardemil, 2008)

Culturally sensitive therapist

•Focus is on being “culturally sensitive” with regard to client

•Ability to understand and develop a strong therapeutic relationship with client

•A general awareness and understanding of issues of difference, power, and marginalization

Culturally sensitive therapy

•Adapting empirically supported therapies to meet cultural diversity

•Requires cultural competency and focus on culturally relevant issues

•Make it “make sense”

Culture as the central focus of therapy

•Culturally-centered therapy•Using culture as the guiding principal to promote the development of well-being•Requires therapist to be well versed in the culture and heritage AND to be culturally sensitive •Focus is less on resolving pathology; more on developmental well-being

(Cardemil, 2008)

ParaprofessionalsInterpreterTranslatorCounselorCase workerculture brokeroutreach workerCommunity advocate

(Egli, 1987)

Group discussions…

Case Scenario 1Profound Acceptance

Case Scenario 2Withholding Judgment

Case Scenario 3Honoring spiritual/Religious beliefs

Case Scenario 4Receiving gifts

Case Scenario 5Self disclosure

Case Scenario 6Attending important ceremonies

Case Scenario 7Participating in ceremonies related to healing

Case Scenario 8Knowledge and understanding of the history

of where client came from

Case Scenario 9Strengths-based

References-Murray, K.E. et al (2010): Review of Refugee Mental Health Interventions Following Resettlement; Best Practices and Recommendations; American Journal of Orthopsychiatry Vol 80 No 4; 576-585-Cravens, R.E. et al (1991): Clinical Issues in Mental Health Service Delivery to Refugees; American Psychologist, American Psychological Association Vol 46 No 6; 642-648-Mollica, R. E, & Lavelle, J. P. (1988). The trauma of mass violence and torture: An overview of the psychiatric care of the Southeast Asian refugee. In L. Comas-Diaz & E. H. Griffith (Eds.), Clinical guidelines in cross-cultural mental health (pp. 262-303). New York: Wiley-Cardemil, Esteban V. (2008). Commentary: Culturally Sensitive Treatments: Need for an Organizing Framework. Culture Psychology. (can be found at: http://cap.sagepub.com/content/14/3/357)-Kinzie, J. D., Manson, S. M., Do, T V., Nguyen, T T., Bui, A., & Than, N. E (1982). Development and validation of a Vietnamese-language depression rating scale. American Journal of Psychiatry, 137, 1276-1281.-Westermey~ J. (1986). Migration and psychopathology. In C. L. Williams & J. Westermeyer (Eds.), Refugee mental health in resettlement coun‘-tries (pp. 113-130). Washington, DC: Hemisphere.-Egli, E. (1987). The role of bilingual workers without professional mental health training in mental health services for refugees (Contract No. 278-85-0024CH). Washington, DC: National Institute of Mental Health.