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Title: Cultural Competence in Disaster Mental Health: Review of concept paper written for the Office of Min


1
Cultural Competence in Disaster Mental
HealthReview of concept paper written for the
Office of Minority Health
  • CDR R. Andrew Hunt Public Health Advisor, SAMHSA
  • Deputy Team Leader, PHS Mental Health Team 1

2
Presenter Background and Experience
  • US Public Health Service Commissioned Corps
    disaster response experience
  • 3 Disaster Mental Health deployments
  • W. Virginia Floods - 2003
  • Red Lake Indian Tribe school shooting - 2005
  • Hurricane Katrina, Gulf Port, Mississippi 2005
  • Currently PHS Mental Health Team 1 Deputy Team
    Leader
  • Experience in cultural competence training
  • Mentored and trained by Terry L. Cross since 1990
  • Provided many local, regional, and national
    training sessions
  • Additional relevant experience
  • Mental health provider with Indian Health Service
    in tribal communities from 1991-2000 with many
    small disasters and community crisis

3
Concept Paper for OMH
  • July 2007 - papers were commissioned on Cultural
    Competence for Emergency Responders including one
    on Disaster Mental Health by CDR Hunt
  • November 2007 Consensus building meeting
    convened by OMH and contractors to begin
    developing concept papers into online curriculum
  • Curriculum to be launched in 2009 online at
  • www.thinkculturalhealth.org
  • Interactive video training will include actors as
    PHS Officers, and civilian MH providers in
    various disaster MH scenarios

4
Intended Audience for the Training
  • Primary audience includes disaster mental health
    providers and program/agency level personnel
  • Examples of specific groups in this audience
    include
  • US Public Health Service Commissioned Corps
    Mental Health Team members
  • American Red Cross mental health staff and
    volunteers
  • State or local government mental health
    responders
  • Other relief organizations that have a mental
    health component to disaster response
  • Individual volunteer mental health responders

5
Overview of Concept Paper
  • There is a need for cultural competency training
    for disaster mental health responders
  • Main concepts included in paper
  • Definition of cultural competence and exploring
    concept of culture
  • The relationship between basic human needs and
    culture
  • Discussion of influences of culture in
    help-seeking and service provision
  • Distinction between cultural awareness and
    competence and developing competency statements
    for workers
  • Review of common disaster mental health models
  • How CLAS Standards may be applied in disaster
    mental health
  • Cultural encounters in disaster mental health

6
Need for Cultural Competency Training in Disaster
Mental Health
  • The term cultural competence is used frequently
    but the concept and its application are not well
    understood
  • Ethnic minorities and other cultural groups
    experience more health disparities and less
    access to mental health services in general, even
    under normal circumstances
  • Disaster response efforts tend to be a one size
    fits all approach, which may not account for
    cultural differences and leave cultural groups
    underserved
  • Disaster mental health workers should be aware of
    cultural differences and be prepared to adapt
    their interventions or services to fit the
    context of different cultures

7
Main Concepts included in Paper
  • Definition of cultural competence and exploring
    concept of culture in the context of disasters
  • Relationship between human needs and culture
  • Discussion of influences of culture in
    help-seeking and service provision
  • Distinction between cultural awareness and
    competence and developing competency statements
  • Review of common disaster mental health models

8
Cultural Competence Model
  • Five elements of the cultural competence model
  • (as defined by Cross et al, 1989)
  • Awareness and acceptance of difference
  • Awareness of own cultural values
  • Understanding and managing for the dynamics of
    difference
  • Development of cultural knowledge
  • Ability to adapt practice to fit the cultural
    context of the client/family

9
Cultural Competence Strategies and
Recommendations in Disaster Mental Health
  • Practical suggestions from the field
  • Review of SAMHSA document
  • Developing Cultural Competence in Disaster Mental
    Health Programs Guiding Principles and
    Recommendations (2003)
  • Relating CLAS Standards to SAMHSA document
  • Implications for training of disaster mental
    health workers

10
Cultural Experiences Encountered by Disaster
Mental Health Responders
  • Communication differences
  • Language, style, protocols, personal space
  • Differences in help-seeking preferences
  • Individual focus vs. family/group interaction
  • Role of helper and who can ask for help
  • Centralized vs. outreach services
  • Community history with outside helpers
  • Distrust, fear, tolerance, acceptance
  • Differences in what brings comfort

11
Promoting visibility of the PHS
The US Public Health Service Flag flies amidst
others during the Katrina response
12
US Public Health Service Mental Health Responders
Hurricane Katrina 2005
PHS Mental Health Team in Gulf Port,
Mississippi (1 week post-Katrina) assembled
under the direction of FEMA
13
Meeting Basic Needs during disaster Donated food
provided post-Hurricane Katrina
German Military Rations Is this comfort food
for anyone in Mississippi?
14
US Public Health Service Mental Health Responders
Red Lake Indian Tribe School Shooting May 2005
Team adjusted at request of the Tribe to not wear
the PHS uniform while providing direct service
for cultural reasons
Team arrived to the site in uniform according to
standard PHS deployment protocol
15
Key References/Resources
  • Cross, T., Bazron, B., Dennis, K. Isaacs, M.
     (1989).  Towards a culturally competent system
    of care A Monograph on Effective Services for
    Minority Children Who Are Severely Emotionally
    Disturbed Volume I Washington, DC Georgetown
    University Child Development Center.
  • U.S. Department of Health and Human Services.
    (2003). Developing Cultural Competence in
    Disaster Mental Health Programs Guiding
    Principals and Recommendations. DHHS Pub. No SMA
    3828. Rockville, MD Center for Mental Health
    Services, Substance Abuse and Mental Health
    Services Administration.
  • National Center for Cultural Competence at
    Georgetown http//www11.georgetown.edu/research/g
    ucchd/nccc/
  • Office of Minority Health Think Cultural Health
    training website www.thinkculturalhealth.org
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