Workshops
| A
| B
| C
| D
| E
|
Workshop
B-8: Bringing culture into the picture: new tools and new approaches for
communities, organizations, and patients
Project Salaam:
Facilitating Mental Health among Middle Eastern & North African Community
Members in San Diego
Project Salaam is a joint effort of the Islamic Center of San
Diego and San Diego State University’s Center for Behavioral &
Community Health Studies. It is a multi-faceted service model designed
to assist Middle Eastern and North African community members as they attempt
to cope with increased stressors and resulting mental health issues.
Numerous sources have identified mounting incidents of trauma related
disturbances (e.g., PTSD & PTSD-like symptoms) among adults and children
of Middle Eastern and North African origin or descent. These symptoms
have often surfaced in response to powerful TV images (e.g., the extensive
and continuous media coverage of US intervention in Iraq) and a large
(roughly 750% in San Diego) rise in hate crimes directed at members of
US Middle Eastern communities since the 9/11 terrorist attacks. Given
on-going US military actions in Iraq and Afghanistan, it seems unlikely
that this trend will abate in the near future.
While the hate crime statistics are dramatic, they do not begin to tell
the whole story. Formal documentation of such crimes is, for example,
substantially limited because many are not reported. Others do not meet
law enforcement’s intervention criteria (e.g., verbal harassment
with no physical assault; children being intimidated /harassed at school
by their peers). The high prevalence of such incidents is, however, widely
known in the community. This fosters broad-based fear and apprehension.
Stressors brought on by hate crimes, harassment, and the constant public
focus on US-Middle East conflicts can significantly disturb quality of
life. Possible consequences include a multitude of anxiety and depression-based
psychological symptoms. As a result, school performance can decline among
children. Adults are also frequently less able to perform activities of
daily living, including at work. At the same time, access to appropriate
clinical, social, and other services is often limited. Few mental health
and social service providers have the linguistic and cultural competence
required to work with this group. In addition, few resources pinpoint
appropriate services. Many persons of Middle Eastern or North Africa birth
or descent also lack adequate (or any) health insurance. While these problems
are widely recognized in impacted communities, an absence of formal needs
statistics and descriptions have limited the attention and response they
require.
This workshop presents an integrated response model to the problems
described above. The Salaam model is designed to deliver services
to Middle Eastern and North African Communities and educate key health
care providers, law enforcement members, and educators in the broader
population.. Specific components are as follows:
- Conduct of a comprehensive needs assessment of San Diego’s Middle
Eastern or North Africa community’s health/mental health needs.
Funded by the California Endowment, the assessment is currently underway.
Results will help (a) raise awareness, (b) guide the development of
culturally effective interventions, thus reducing current mental health
care access barriers, (c) galvanize stakeholder networks/ infrastructure
that can secure additional funding and resources, (d) develop a model
for similar projects in other Middle Eastern and North African communities
in the US, and (e) guide appropriate policy development / implementation.
- Development and implementation of a series of culturally and linguistically
appropriate psycho-educational meetings, delivered by lay community
health workers form Middle Eastern and North African groups, that orient
community members to basic mental health resources and coping;
- Creation of a referral network and resource directory that facilitates
direct professional culturally and linguistically competent mental health/health
services for those needing substantial care;
- Delivery of cultural competence and awareness training workshops
to key "front-line" persons and systems (e.g., clinic personnel,
individual providers, school counselors, police officers, etc.) that
interact with and/or attempt to serve Middle Eastern and North African
communities.
Dr. Rodríguez-Reimann is a Research Assistant Professors
of Public Health at San Diego State University's Center for Behavioral
& Community Health Studies and also practices clinical psychology
/ organizational consulting through Professional & Personal Excellence
International (www.excellenceinternational.com).
She is a licensed psychologist and Diplomate of the American Board of
Psychological Specialties. As a contracted provider for Survivors of Torture
International, Dr. Rodríguez-Reimann has substantial experience
delivering mental heath services to San Diego’s Middle Eastern and
North African community members. Much of Dr. Rodríguez-Reimann’s
research focuses on investigating the relationship between health behaviors
and acculturation, acculturative stress, and access to service barriers.
In this process she has received grant support form the US Office of Minority
Health, the National Center for Minority Health Disparities, and the National
Cancer Institute.
Dr. Rodríguez-Reimann also routinely consults and lectures on
cultural competence to medical students/residents, mental health providers,
and other healthcare professionals. She recently served on the California
Board of Psychology's Work Group on Human Diversity.
Salaam Co-Investigators: Mehboob Ghulam, MD; Joachim
Reimann, Ph.D.
Dolores I. Rodríguez-Reimann, Ph.D.
The Center for Behavioral & Community Health Studies
Graduate School of Public Health
San Diego State University
9245 Sky Park Court, Suite 110
San Diego, CA 92123
Phone 619-991-0591
Fax: 858-536-9637
dreimann@projects.sdsu.edu
Improving Accessibility and implementing Cultural Competence organizational
change: The Experience of a Canadian Mental Health Agency
Community Resources Consultants of Toronto (CRCT) is a non-profit community
mental health agency funded by Ontario’s Ministry of Health and Long
Term Care to provide community based services to adults with serious and
persistent mental health problems. We provide our services through our
Case Management, Court Support, Hostel Outreach, Family Support and Consultant
Services programs.
We are located in Toronto, which is one of the most racially, and culturally
diverse cities in the world. Although the formal mental health planning
process in the city has acknowledged this growing diversity, to date,
there is little evidence of any significant systemic change to better
serve Toronto’s diverse population.
CRCT has imparked in a process of organizational change to significantly
improve its ability to respond to the ethnic, racial, religious, linguistic
and cultural diversity of Toronto’s residents. The process was to
enable the organization to identify and reduce barriers to accessibility
and to provide services that are relevant for a greater proportion of
Toronto’s diverse communities. This meant identifying and removing
structural, skill and knowledge barriers, which might impede employment
and service access.
In this workshop I will describe our cultural competence organizational
change as a community mental health organization in Toronto, whose staff
were predominantly white and unilingual, to be more accessible and responsive
to Toronto's diverse ethnic communities. The workshop focuses on events
and opportunities of that process and the connections being established
between the organization and Toronto’s diverse community.
I will explain some of the challenges encountered when establishing
credibility with CRCT’s consumer/survivors, staff, and external partners
and communities. In this process, you might encounter individuals that
are not completely sold on this commitment to change. There might even
be some level of active resistance to the agenda. I will give some of
our organization’s strategy in dealing with this challenge.
Our Increasing Accessibility Project operated in limited resources in
an environment of virtually unlimited need for more accessible and culturally
competent services. I will describe some of the strategies and models
of service that enabled CRCT programs to increase accessible mental health
services in Toronto, using our work with two newcomer communities as an
example, the Tamil and the Somali communities.
Deqa Farah is a Community Mental Health Consultant with Community
Resources Consultants of Toronto. Deqa has extensive work and volunteer
background in access, equity, social justice issues, antiracism and cultural
competence and organizational change. She is a community organizer, researcher,
trainer, and facilitator.
Deqa has been working with refugees and immigrants in over the past
ten years in the areas of: counselling, crisis intervention, organisation
and facilitation of support groups as well as program co-ordination, research,
planning and evaluation, board development program and leadership building.
She has been involved in training staff at Refugee and Immigrant Service
agencies and mental health agencies. She has made numerous presentations
locally nationally and internationally.
Deqa has extensive experience in creating and maintaining partnerships.
She worked with groups and organizations in the area of program development,
funding proposals, board development, improving service delivery, organizing
forums and conferences and coalition and team building. She received BA,
honours degree from the University of Toronto in Environmental Studies
and Sociology.
Deqa Farah
Community Mental Health Consultant
Community Resources Consultants of Toronto
366 Adelaide St. E., Suite 230
Tel: 416-482-4103 Ext: 223
dfarah@crct.org
http:// www.crct.org
Measuring
Cultural Competence from the Perspective of Treatment Recipients
It has been well documented that racial and ethnic minorities have less
availability and access to services, a lower likelihood of receiving needed
services, and a greater likelihood of receiving poorer quality of care.
Providing culturally competent care has been identified as a means of
eliminating such disparities in health care. Nationally there is a push
to identify feasible measures of cultural competence. Instruments have
been developed to measure cultural competency at the provider and organizational
level. Few studies have investigated cultural competency from a recipient
perspective.
Described in this workshop will be the development of the Cultural Acceptability
of Treatment Survey (CATS) an instrument to investigate from the perspective
of recipient’s of mental health services: preferences for including
cultural elements in their care; the frequency and manner in which cultural
elements are included; and satisfaction with the inclusion of cultural
elements and frequency of inclusion. The CATS was pilot tested in Massachusetts,
Hawaii, and Pennsylvania. Presented in the workshop will be results from
the initial testing of the CATS.
Discussed will be the challenges of selecting cultural elements for
inclusion in the survey and of culturally sensitive and appropriate wording.
Overcoming the challenges involved a detailed review of the cultural competence
literature, the involvement of research team members from different racial
and ethnic backgrounds and fields, and cognitive testing of the survey.
Lessons learned from the development and testing of the CATS include
the importance of cognitive testing the survey with different populations,
of asking recipients about their preference for cultural elements, and
that recipients of care in our sample were comfortable responding to questions
about race and ethnicity. The CATS includes cultural elements that can
be transferable actions for reducing disparities of ethnic and racial
minorities in health care. Sample instrument questions will be shared
during the workshop.
Teresita Camacho-Gonsalves, Ph.D. is a sociologist at Human Services
Research Institute (HSRI). Dr. Camacho-Gonsalves is a Project Manager
at HSRI and Assistant Director of the Evaluation Center@HSRI. She has
worked in the areas of cultural competency, survey design and analysis,
and quality and performance measures. Prior to joining HSRI, she worked
in the Office of Multicultural Affairs of the Massachusetts Department
of Mental Health. The American Public Health Association gave Dr. Camacho-Gonsalves
an award for her dissertation on depression among Dominicans.
Teresita Camacho-Gonsalves, Ph.D.
Project Manager
Human Services Research Institute
2269 Massachusetts Avenue
Cambridge, MA 02140
Phone: (617) 876-0426 ext. 2504
Fax: (617) 497-1762
tcamacho@hsri.org
HSRI Website: http://tecathsri.org/
The Evaluation Center@HSRI Website: http://tecathsri.org/
Smedley BD, Stith AY, Nelson AR, eds. Unequal treatment: confronting
racial and ethnic disparities in health care. Washington D.C: Institute
of Medicine, National Academy Press, 2002.
Karen Scott Collins et al, Diverse Communities, Common Concerns: Assessing
Health Care Quality for Minority Americans – Findings from the Commonwealth
Fund 2001 Health Care Quality Survey, Commonwealth Fund, March 2002
Fortier JP, Shaw Taylor Y, Cultural and Linguistic Competence Standards
and Research Agenda Project, Part One: Recommendations for National Standards,
May 1999
|
