Mutta,B., Nelson, G., & Ochocka, J. (2009). From the ... · A booklet in Punjabi, Hindi, & Urdu...

Taking Culture Seriously in Community Mental Health - www.takingcultureseriouslycura.ca

From the Margins to the Core :A Case Example of aCultural Community

Leading Innovative Practice in OntarioPresented by:

Geoff Nelson, Wilfrid Laurier UniversityBaldev Mutta, Punjabi CHS

Joanna Ochocka, Centre for Community Based Research

Making Gains in Mental Health and AddictionsToronto, November 4, 2009

www.communitybasedresearch.ca/takingcultureseriouslyCURA

Mutta,B., Nelson, G., & Ochocka, J. (2009). From the Margins to the Core: A case example of a cultural community leading innovative practice in Ontario. Presented at the Making Gains Conference, Toronto, ON, November 2009.


Taking Culture Seriously In Community Mental Health

• Five-year (2005-09) research and community mobilization initiative bringing together university and community partners in Toronto and Waterloo Region

• To explore, develop, pilot and evaluate mental health services and supports that are culturally effective for the multicultural Canada

• Modeling reciprocal collaboration among communities, academics, service providers and policymakers



Three Phases

Phase I: Exploring Ways of Thinking about Mental Health Problems and Practice with Cultural Communities (2005-2007)

Product: A framework and strategies for culturally effective mental practice.

Phase II: Developing Culturally Effective Practice (2007)

Product: Funding proposals for demonstration projects

Phase III: Evaluating Demonstration Projects (2008-2009)

Product: Evaluation results and final conference



Innovative Demonstration Projects

• Acknowledge the disconnections between the mental health system and Canada’s cultural diversity

• Engage multi-disciplinary researchers, a range of practitioners and diverse cultural communities in reciprocal collaboration

• Consider both issues of power and culture

• Give priority to the voices of people from cultural-linguistic communities



Utilization-focused, Participatory Evaluation

Designed to be of use to:

• Punjabi CHS

• The Punjabi community in Brampton and Mississauga

• Other mental health practitioners

• Funders and policy-makers

• The research community

Evaluation designed in close collaboration between CURA researchers and Punjabi CHS staff



Punjabi Community

Health Services

Demonstration Project

Logic Model

Diversity

training for

MH providers

INPUTS: Director & Staff of PCHS; Case manager Services of a Registered Nurse; CW-LHIN Funds; TV program slot

Food for Participants;

Van for home visits; Link with 4 South Asian Psychiatrists; Network with WHO & peel Public Health; CURA evaluation services

PCHC office spaceA

C

T

I

V

I

T

Y

A

C

T

I

V

I

T

Y

Mental health

promotionSupport for women

with mood disordersPrenatal Support

A

C

T

I

V

I

T

Y

ACTIVITY

Outputs:

Ten sessions of 4 hour

each in partnership with

Peel Public Health to

educate families about

pregnancy related issues;

Referral to family

physicians and MH

workers

Family stops blaming the mother;

More knowledge about medical, biological, and family dynamics impacting on pregnant women

PCHS has plans for a

curriculum on mood

disorders in partnership with

Peel public health;

A booklet in Punjabi,

Hindi, & Urdu with basic info

on mental health issues will

be distributed to all South

Asians in Brampton

Weekly ½ hour

telecast to raise awareness

About mental health issues

(going since four years);

PCHS director and co.

host shows with guest

health care professionals

on mental health topics

PCHC conducts 4

full day seminars for

service providers at

CMHA, York Region,

and Credit Valley MH

organizations about

working with South

Asian clients;

More knowledge about

mental health issues and

available services;

Insight into the manner in

which culture and family

dynamics contributes to

mental illness or health

Practitioners acquire

knowledge and skills about

culturally sensitive practice

More collaboration

between MH system and

cultural community orgs.

Reciprocal capacity

building

Wife-in laws-husband

triad of conflict reduces

and support increases;

Mothers are linked to

mental health system

leading to less

depression



TREATMENT

Individual Counseling Family Education

Output 11 on1 sessions for

clients with depression

anxiety, OCD, addictions

Output 2Case

management

Output 4Assessment &

Referral

Services

INPUTS (Resources) PCHS director, Staff, & Case Manager; CW-LHIN Funds; Food for Participants – Community support;

CURA Evaluation Services

INPUTS:

Van for home visits; Link with 4 South Asian Psychiatrists; Network with WHO & Peel Public Health;

Space at PCHS

Outcomes for

Health System

Linkage with mainstream

mental health

and addiction services

Output 3Home

visits

Output 51/month mental

health education

Sessions for families

ACTIVITIES


Outcomes

for individuals & families

More knowledge;

More support to loved ones;

Fewer symptoms;

Less family conflicts

Outcomes for

Communities

Culturally & linguistically

appropriate services to the

South Asian Community


Evaluation Part 1:Mental Health Promotion: Community

Connection & Complicated Issues

• Community Connection and Complicated Issues

– Community Connection is a half an hour program dedicated to raise awareness of the community

– “Complicated Issues” is a hour long talk show on television which also discusses health and social issues



Evaluation Part 1:Mental Health Promotion: Community

Connection & Complicated Issues

• Online survey of South Asian community asking about:

– Perceived quality of programs

– Frequency of viewing or listening to the programs

– Knowledge of mental health issues and services

– Insight into how culture and family dynamics contribute to mental health issues

– Stigma

• We want to see if the people who watch or listen to the programs are more knowledgeable and have more insight into mental health issues and their community



Evaluation Part 2:Cultural Competency Training

• Brief description of cultural competency training workshops– Trainings for Board, Staff and Volunteers on

cultural competency

• Brief description of cultural competency consultations with organizations– How would an organizations undertake a

“change”?

– Three aspects to change:• Change with no costs

• Change with minimal costs

• No change possible without money



Evaluation Part 2:Cultural Competency Training

• Paper and pencil survey given out to participants at the end of the training sessions asking about:

– Knowledge and skills in culturally sensitive mental health service practice

– Collaboration between mental health services and Punjabi CHS

• We want to see if the people who attend training are more knowledgeable and have more insight into mental health issues and culturally diverse communities



Evaluation Part 2:Cultural Competency Consultation

• Case study of a mental health organization that is working closely with Baldev to become more culturally competent in its services

• We want to document the major elements of change a mental health organization goes through when becoming more culturally competent



Evaluation Part 3:Prenatal Support Program

• Prenatal support program

– Punjabi women recruited for six sessions programs• 6 evenings or 6 Saturdays

– 3 hours each

– Curriculum to discuss• Medical aspects

• Cultural aspects



Evaluation Part 3:Prenatal Support Program

• Paper survey given out to participants at the beginning and at the end of the program asking about:

– Marital and family conflict, social rejection, family and social support

– Knowledge about cultural and mental health issues and pregnancy

– Satisfaction with the program

• Focus groups about program outcomes

• We want to see if the people who attend the program have more positive interactions within the family and social support, and are more knowledgeable about mental health after the program



Evaluation Part 4:Treatment Services

• Mental health case management– Assessment– Treatment plan– Follow up– Engage family– Link with other resources – Psychiatrist available

• Alcoholism and addictions treatment– Assessment– Treatment plan– Follow up– Engage family– Link with other resources – Case management and day program



Evaluation Part 4:Treatment Services

• Paper survey given out to those in treatment and, with their permission, one close family member, while on the waiting list, just before starting treatment, and after 3 months of being in treatment asking about:

– Social rejection, family and social support, symptom distress (for clients only), and family burden (for family members -family burden)

– Knowledge about cultural and mental health issues and use of and satisfaction with mental health services

• Focus groups about program outcomes

• Four case studies (2 with mental health issues, 2 with addictions), with input from those in treatment, close family members, and treatment staff

• We want to see if the people who attend services have more positive interactions within their family and social systems, have less symptom distress, and are more knowledgeable about mental health and mental health services



Conclusion

• It is important to develop and support culturally responsive mental health services

• These services should include not just treatment, but education and prevention

• It is important to rigorously evaluate the implementation and outcomes of culturally responsive services, so that we can better learn how to develop the most effective practices

• Mental health researchers need to work collaboratively with practitioners to develop useful evaluations of culturally responsive mental health services



Questions???

Comments???



(

Contact Information

www.takingcultureseriouslyCURA.ca

Centre for Community Based Research,

73 King Street West, Suite 300

Kitchener, ON, N2G 1A7

Phone: (519) 741-1318

Website: www.communitybasedresearch.ca

Punjabi Community Health Services

11730 Airport Road

Brampton, On, L6R 0C7

Phone: (905) 790.0808

Website: www.punjabiservices.com


http://www.takingcultureseriouslycura.ca/

http://www.communitybasedresearch.ca/

http://www.punjabiservices.com/

Mutta,B., Nelson, G., & Ochocka, J. (2009). From the ... · A booklet in Punjabi, Hindi, & Urdu...

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