samhsa’s children’s mental health initiative. building culturally competent and diverse...
TRANSCRIPT
SAMHSA’SCHILDREN’S MENTAL HEALTH INITIATIVE
Building Culturally Competent and Diverse Organizations and Systems of Care Conference, 9/26/2013, Lansing, MI
Presenters:Saginaw Max System of CareLula Haynes, Parent Support Partner (ACMH)Yalonda Freeman, Secretary of the Empowered to Reach and Teach Families TeamWardene Talley, Director Dalia Smith, Cultural and Linguistics Competency Coordinator
One Community’s Experience Implementing the California
Brief Multicultural Competence Scale
Multicultural Training with System, Community, and
Family Partners
Describe 4 indicators within a system that would identify a need for Multicultural Training.
Identify 8 key partners to assist with developing a community wide cultural competence training plan.
List 6 biases that impact clinical practice.
Today’s Objectives
Richard Dana, Portland State UniversityGlen Gamst, University of La Verne
Aghop Der-Karabetian, University of La Verne
With Contributions From:Leticia Arellano-Morales, University of La Verne
Marya Endriga, California State University, SacramentoRobbin Huff-Musgrove, Patton State Hospital
Gloria Morrow, Private Practice
With Generous Support From:California Department of Mental Health
Office of Multicultural ServicesEli Lilly Foundation
California Mental Health Directors AssociationCalifornia Institute of Mental HealthUniversity of La Verne, La Verne, CA
Acknowledgements
Select a partner and ask the following questions over the next five minutes. Be prepared to introduce your partner based on the information shared after seeking your partners permission: What is you name? Is there a story to your
name? Are you named after someone? Where do you work and how does the work
you do fit with your personal philosophy of life?
Name one cultural fact about yourself that we would not be able to tell by looking at you.
Conocimiento Activity(knowledge through sharing)
The Danger of the Single Story
Chimamanda Ngozi Adichie
Urgency Community Demographics:
Saginaw County pop. 198,353 Saginaw City pop. 50,790 2nd highest rate of poverty in MI:
• Saginaw County 18.6%• Saginaw City 36.9%
3rd Most Violent City in Nation 2013 FBI ranking (per capita)
2013 Statistics: Saginaw County – 25 confirmed homicides as of
9/13/13• Saginaw City - 23
Milton Hall Saginaw is a traumatized
community!
Saginaw County:• Hispanic/Latino/a 19.4%• Black/African American 7.9%
Saginaw City:• Hispanic/Latino/a 46.1%• Black/African American 14.3%
(U.S. Census QuickFacts, 2010 and 2012)
Another Story
Milton Hall
Convened Saginaw Max Evaluation Advisory Team (January 2011) Made up of multiple system, community and family partners.
Completed a Strengths and Needs Assessment (Spring 2011) Identified a need for multicultural training for system partners.
Created a Logic Model (June 2011) Approved by the Coordinating Council (Saginaw Max’s decision making body).
Took advantage of a training opportunity offered by the Technical Assistance Partnership (August 2011) CBMCS Multicultural Training
Began work on Saginaw Max Strategic Plan (September 2011) The strategic plan outlines the action steps to achieve Saginaw Max objectives
including cultural and linguistic competency.
Collaborative Decision Making Process
Saginaw County Youth DataWhy We Need a System of Care
Between May 2004 and January 2013, 5,739 MAYSI-2 mental health screens were completed by juveniles
under the jurisdiction of the Saginaw County Circuit Court - Family Division. In 1,974 of these screens (34.4%), youth admitted that they have personally witnessed someone get severely injured or killed.
Juveniles complete a MAYSI-2 screen every time they are adjudicated or every three months during a lengthy sentence. As of January 2013, MAYSI-2 screens were completed by 3,004 individual youth of which 40.3% (1,212) admitted at least once that they personally witnessed someone get severely injured or killed.
Of the 5,739 MAYSI-2 screens completed by juveniles under the jurisdiction of the Saginaw County Circuit Court - Family Division between May 2004 and January 2013, 4,213 screens (73.4%) indicated that the youth appears to have a mental health concern in one or more areas.
In 2008, Saginaw County Community Mental Health Authority and the Saginaw Department of Human Services collaborated to determine the extent of mental health needs of youth in foster care. Based on assessments conducted with a representative sample of all Saginaw County youth in foster care at the time, results revealed that as many as sixty-nine percent (68.75%) of children in foster care in Saginaw County had moderate to critical mental health needs.
Between January 2004 and June 2009, 41% of youth who were originally involved with the court due to neglect and abuse were eventually charged with crimes
Data Informed
Saginaw Max has provided CBMCS Multicultural Training to 77 individuals in Saginaw County (2013) Saginaw Public Health Department (April 2013) Saginaw Department of Human Services (June 2013) Disproportionate Minority Contact Initiative (September 2013)
Disproportionate Minority Contact (DMC) Initiative There is disproportionality in our juvenile court and child welfare systems. Gearing up to implement a countywide multicultural training program.
Health and Social Equity Advisory Group sponsored by Project LAUNCH Ties into our PHD Community Health Improvement Plan (CHIP). Priority 1 of 3 - Infant Mortality:
• Saginaw County (3.7)• Saginaw City (4.4)
Saginaw Max System of Care (SAMHSA funded site) Cultural and Linguistic Competency (CLC) Team
Alignment Saginaw
Saginaw County System of Care Partnerships
The CBMCS was developed as a response to the Surgeon General’s Report and Supplement Report on mental health.
Goal: Develop a Multicultural Competence Scale easily administered and scored. 1999 Scale Developed 2000 lengthy Questionnaire 5-Scale (137 questions) 2000-01 #1,244 CA practitioners participated 2001 Client/Family members reviewed 2001-02 Training manual – Richard Dana, PhD 2002-03 From manual to training.
California Brief Multicultural Competence Scale (CBMCS) Development
Summer 2004, 40 MH cultural competence experts participate in review of CBMCS Training, representing 14 counties and state DMH
CBMCS 4 Modules were revised Summer 2005/06 15 experts revised the CBMCS
training from MH provider input Fall 2006 Pilot of CBMCS begins The CBMCS represents a true partnership
between State and Local Mental Health and University evidence based research and development.
Development of CBMCS Training
5 Counties selected from original 14 counties that participated in early review
Kern County – training completed Oct. 2006San BernardinoSacramentoSanta ClaraSan FranciscoAll pilots to be completed by February 2007
Selected CBMCS Pilot Sites
CBMCS Training for Trainers and Staff Training Nationwide
Between 2006 – present: Yreka County, CA Imperial County, CA Ventura County, CA Forth Worth, Texas Alameda County, CA Solano County, CA
(CIMH) Pittsburg, PA Hartford, CT Ontario, CA (hosted by
Dr. Morrow where trainers came from all across the United States)
Plainview, Texas Merced County, CA
(CIMH) Stanislaus County, CA
(CIMH) Commissioned by Ken
Martinez to provide CBMCS training in Denver, CO and Atlanta, GA
Egyptian Health Department, IL
The development group identified 5 self-report cultural competence instruments: CCCI-R La Fromboise, et al. MAKSS D’Andrea, et al. MCAS-B Ponterotto, et al. MCCTS Holcomb-McCoy MCI Sodowsky, et al.
Most of these instruments were 45-60 items long and developed on university student populations.
Reviewed Existing Literature
This scale consists of 4 subscales: Multicultural Knowledge Awareness of Cultural Barriers Sensitivity and Responsiveness to Consumers Sociocultural Diversities
An 8-hour training program is available for each subscale. 32 multicultural training CEUs offered
The CBMCS is a 21-item self-assessment of cultural competence.
The California Brief Multicultural Competence Scale and
Multicultural Training Program
The CBMCS can be used by an agency to identify the training needs of the agency staff.
The unique aspect of this scale is that it has its own Training Program that “flows” from the scale.
Utility
Agencies can use the CBMCS scale to target which staff should receive a particular module.
OR
Agencies could run staff through all 4 modules.
The CBMCS scale could be used as a pre-post measure of training effectiveness, along with client outcome or satisfaction measures.
Application
The CBMCS instrument is being used across the country in over 20 sites.
The CBMCS Training Program and the Train the Trainer Program have gone national.
Current Status
It’s very important that participants commit to the entire length of the training. This is an intensive multicultural training. Consistency is needed to create a “safe” learning
environment.
Ground Rules and a “Parking Lot” are important tools.
Review of the Transitional Stages of Change is important. Denial (of differences), defense (against differences),
minimization (bury differences under cultural similarities), acceptance (of cultural differences), adaptation (of behavior and thinking to that difference)
Setting the Tone
1999 U.S. Surgeon General developed a report on mental health, Mental Health: A Report of the Surgeon General.
2001 U.S. Surgeon General created a supplemental report to the one on mental health focusing on the four major minority groups, A Supplement to Mental Health: A Report of the Surgeon General.
African American Latino American Asian American Native American Indian
U.S. Surgeon General’s Report
U.S. mental health system maybe ill prepared to meet the mental health needs of racial/ethnic groups due to deficiencies in level of cultural competence among service providers of all types (e.g. psychiatrists, therapists, case managers).
Unique cultural differences exist among racial/ethnic groups with regard to coping styles, utilization of services, help-seeking attitudes and behaviors, and the use of family and community as resources.
(U.S. Department of Health and Human Services, 2001)
Challenges to the Mental Health System: U.S. Surgeon General’s
Report
Another Story
May be at higher risk of mental disorders than the White population due to socioeconomic differences (Reiger, Narrow, Rae, Manderscheid, Locke & Goodwin, 1993a).
Tend to be underrepresented in outpatient treatment, yet overrepresented (by twice as many) in inpatient treatment (Snowden & Cheung, 1990; Snowden, 2001).
More likely to use emergency room for mental health problems than the White population (Snowden, 2001).
Higher rates of misdiagnosis as compared to the White population and consequently, mistakes lead to the use of inappropriate medications.
Disproportionately represented in homeless, incarcerated, and child welfare populations, and as victims of trauma – all risk factors for mental illness.
(Surgeon General, 2001)
Mental Health Disparities:African Americans
Few epidemiological surveys of mental health and mental disorders.
Depression is a significant problem for many American Indians/Alaskan Natives.
Higher risk of alcohol abuse and dependence.High rates of suicide (50% higher than national rate)U.S. veterans have higher prevalence rates of PTSD
than the White population.
(Surgeon General, 2001)
Mental Health Disparities:American Indian/Alaskan Native
Model Minority Myth and other subgroup stereotypes.
Under utilization due to stigma and shame. Delay seeking services until problems
become very serious.Access barriers due to lack of language
proficiency of service providers.
(Surgeon General, 2001)
Mental Health Disparities:Asian Americans/Pacific Islanders
Prevalence rates of mental disorders in Mexican-born Mexican Americans similar to general population, however,
Prevalence rates for depression and phobias are higher in U.S. born Mexican Americans relative to European Americans.
Limited data is available for some Latino/a groups (e.g. Cuban, Puerto Rican, Guatemalan, etc.).
Latino/a immigrants have very limited access to mental health services.
Latino/a youth are at high risk for poor mental health outcomes.
Historical and sociocultural factors suggest Latinos/as are in great need of mental health services.
As many as 40% of Hispanic Americans report limited English language proficiency.
(Surgeon General, 2001)
Mental Health Disparities:Hispanic/Latino/a Americans
Minority communities have disproportionately high burden of disability from untreated or inadequately treated mental health problems.
Additionally, we must also understand that other groups have experienced oppression throughout the United States and the world. Some of these groups are immigrants from Europe, people who are Jewish, people who are Middle Eastern, women, the LGBTQ community, the disabled, and those who live in poverty.
CULTURE COUNTS!
(Surgeon General, 2001)
Mental Health Disparities:U.S. Surgeon General Report
To be introduced to a historical overview of the CBMCS;
To gain a better understanding of what cultural competence/responsiveness means, and its relevance;
A review of the mental health disparities and historical oppression among children, youth, and parents who are members of the four major ethnic/racial groups;
To become aware of empirical knowledge concerning the mental health status of ethnic/racial groups;
Training Goals
To recognize deficiencies in related research. To critique traditional theories and consider new ones.
To examine how cultural responsiveness is reflected in our system of care;
To explore the cultural responsiveness needs system-wide; Improve sensitivity to experiences and worldview of consumers. Improve sensitivity and responsiveness to the effects of racism,
oppression, and discrimination on consumers mental health services. Improve sensitivity to the impact of provider and consumer social
values and communication styles. Improve sensitivity to the importance of consumer advocacy. Service delivery implications (ex. bad practices = malpractice).
Training Goals (cont.)
Another Story
To discuss the barriers to cultural responsiveness; Self-awareness of personal values, beliefs, and ethnic/racial/cultural
background. Self-awareness of privilege, bias, and stereotypes.
To discuss the benefits of increasing cultural responsiveness using the CBMCS curriculum. To extend the parameters of diversity beyond the limits of
ethnic/racial populations. To explore the interactions of multiple human identity components
Training Goals (cont.)
Another Story
Creates change in the heart (not just the “head”).
8 hours per day may be too much. The best format for training may be 4 consecutive days or 2-2
consecutive days over 2 weeks. Participants may be better able to engage with training content when
the audience is a mixture of system, community, family and youth partners.
Participants are better able to integrate culturally responsive behavior when they do not see it as something that has to be added onto an already heavy workload.
Some materials had to be modified and/or deleted. The addition of more experiential opportunities with more process time
given is necessary. Trainers must be sufficiently skilled in facilitating this type of training. Individuals inevitable find the training experience as emotionally
charged. However, many of the same individuals say the curriculum has changed their lives in positive ways, both personally and professionally.
Lessons Learned
It takes patience to build urgency and gain buy in at all levels.
The community needs to have dialogue around 3 questions: Is cultural and linguistic competency important? If it is important, are we a culturally and linguistically competent community? If we aren’t there yet, what do we need to do to be a culturally and linguistically
competent community?
The community needs to be engaged in a data informed, collaborative, decision making process.
Families, youth, community and system partners need to agree on an objective and strategy that everyone can get behind.
Key leaders need to be engaged (champions).
Preparation for Countywide Multicultural Training:
Secure funding resources. Blended and braided funding. Build into Strategic Plans. Leverage Federal and/or State monies dedicated to CLC issues (DMC, violence, trauma,
health disparities, etc.).
Use an application (and interview) process to identify potential trainers. Publically acknowledge those who have been chosen to be trainers.
Collect and use local vignettes, data, and current events to make the training meaningful to participants.
Trainings may benefit from being off site.
Engage faith based community (needs a different approach).
Planning for Countywide Multicultural Training:
Commitment from system leadership to address barriers. Ex. Encourage and allow staff to attend a 4-day (32 hour) training.
Trainers must be sufficiently skilled in facilitating this type of training. Quality coaching, consultation, and mentoring is essential.
Measure, track, and monitor outcomes.
Think ahead for sustainability. Build a core group of trainers from multiple disciplines (teams of 2). Integrate into core training requirements.
Implementing Countywide Multicultural Training:
Coaching, Consulting and Mentoring
Dr. Gloria Morrow is one of the nation's leading clinical psychologists, who devoted her early career to teaching students in undergraduate and graduate psychology programs. As an academician, clinician and author, her teaching, counseling and books have helped thousands of people find true inner healing. As an academician and researcher, Dr. Gloria has presented the results of her research at professional conferences all over the world, including the University of Cape Town, in Cape Town, South Africa. As a top-rated professional with profound insight in her trade, she has been featured in a host of newspapers, (such as the award-winning Inland Valley News, an African American weekly). In addition to her published work in scholarly journals and books, she has been cited in critically acclaimed national publications such as “Psychology Today,” “Jet,” “Heart and Soul,” “Essence,” “Woman’s Day,” and “Black Enterprise.”
Dr. Gloria is a Master Trainer for the CBMCS (California Brief Multicultural Competency Scale) Training Program, and she helped to develop the training curriculum. This program focuses on the four major ethnic groups: African American, Asian/Pacific Islanders, Hispanic/Latino/Mexican American, and American Indian/Native American. However, includes other diverse communities, such as the Muslim and Middle Eastern cultures in her training. In addition, she has facilitated several workshops and seminars focusing on cultural competency issues, such as the role of Spirituality in recovery. She was commissioned to develop a Spirituality Toolkit for the California Institute of Mental Health.
Dr. Gloria holds an earned PhD in Clinical Psychology from Fielding Graduate University, Santa Barbara, CA; a Master of Science degree in Marriage and Family Therapy from Azusa Pacific University, Azusa, CA; and a Bachelors of Science degree in Psychology from the University of La Verne, La Verne, CA.
Questions
In Closing
Yalonda FreemanSecretary (2013-2014)Saginaw Max Empowered to Reach and Teach Families (ERTFT) [email protected]
Lula HaynesParent Support Partner Association for Children’s Mental Health (ACMH)[email protected]
Contact Information
Contact Information Wardene Talley Project Director 989-797-3562 [email protected]
Dalia Smith Cultural and Linguistics Competency Coordinator 989-498-2270 [email protected]
Willie Hillman Youth Involvement Coordinator 989-272-7232 [email protected]
Keva Clark Lead Family Representative 989-797-3534 [email protected]
Kelley Blanck Technical Assistance Coordinator 989-797-3556 [email protected]
Melissa Lee Social Marketing Coordinator 989-272-7209 [email protected]
Ashley Wilcox Administrative Coordinator 989-272-7229 [email protected]