Cultural Competence in an MST and related programs for African American Males in the Juvenile Justic

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Cultural Competence in an MST and related
programs for African American Males in the
Juvenile Justice System

• David G. Stewart, Ph.D., C.D.P.
• December 6, 2005

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Prime Time/ FIT Team

• Eric Trupin, Ph.D.
• David Stewart, Ph.D., C.D.P.
• Ann Vander Stoep, Ph.D.
• Terry Lee, M.D.
• Leonard Irving, C.D.P.
• Greg Terry
• Anthony Houston, M.S.W,C.D.P.
• My Banh, Psychology Resident
• Tracy Jones, Psychology Resident

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Disproportionality
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Prime Time Project

• Youth in King County Detention
• 2 or more admissions
• Serious and/or violent offence
• Evidence of psychiatric disorder
• Evidence of substance use disorder
• Reside in Seattle or near suburbs
• Live with a caregiver
• Age 12-17.5
• Priority Population African American males

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Family Integrated Transitions (FIT)

• Ages 11 to 17 at intake
• Substance abuse or dependence disorder AND
• Axis 1 Disorder OR currently prescribed
  psychotropic medication OR demonstrated suicidal
  behavior in past 6 months
• At least 4 months left on sentence
• Residing in service area

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Demographics of Prime Time Youth 1995-2003 (n195)

• Race
• African American 69
• White 21
• American Indian 4
• Hispanic 3
• Asian 3
• Male 62
• Median Age 15

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FIT vs. Comparison Groups
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Elements of MST programs

• Small caseloads (4-6)
• Intensive training, supervision and consultation
• 24/7 availability of MST therapist
• Services provided in home and community

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Social-Ecological Model
Neighborhood
School
Peers
Caregivers
Teen
Siblings
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School Attached to school Achieving-moving toward
graduation
Peers Positive Peers Peers are involved in
activities
Caregivers High Monitoring Consistent
Discipline Low Conflict Expressed Warmth
Teen Positive Behavior
Neighborhood Multiple adult() models -
Recreational Activities Jobs/ training -
Religious/Spiritual Guidance
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Engagement, Accountability and Cultural
Competence in the MST Model
   
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Keys to Engagement

• Treatment team responsible for engagement and
  provide services unconditionally
• Therapists are strength-focused
• Family members full collaborators therapists
  align with parents
• Services individualized and comprehensive
• Services provided in natural ecology (i.e.,
  family home)

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Creating an Environment of Alignment and
Engagement
      My family and the therapist were honest
and straightforward with each other.   The
sessions were lively and energetic.   Family
members were not engaged in power struggles with
the therapist.  
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Alignment and Engagement
My family and the therapist worked together
effectively.
My family and the therapist had similar ideas
about ways to solve problems.
Family members and the therapist agreed upon the
goals of the sessions.
A lot was accomplished during the therapy
sessions.
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Cultural Competence

• Interventions are designed to empower families
  to intervene in multiple systems, including ones
  that may be perceived as coercive or punitive
• 2. Interventions are provided by therapists who
  are
• Culturally Competent and often
• Culturally Matched
• 3. Interventions are designed that are
  respectful of and consistent with the cultural
  values of the family and community.
• 4. Cultural strengths are recognized and
  developed as keys to change

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(No Transcript)
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Case Presentation

• H., a 15 y.o., Eritrean-American male
• Marijuana Dependence, Ecstacy Alcohol Use
• Oppositional Defiant Disorder
• Hx of thefts, domestic violence, truancy and
  noncompliance with probation
• Attending alternative school due to disruptive
  behavior and truancy
• At Risk Youth Petition

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Ethnic Identity Development Hypothesis Client is
developing an identity and lacks/disregards
positive role models

• Discuss with family in session
• Discuss with cultural consultant
• Confirmed Youth is struggling with issues of
  identity development and acculturation

• Disassociated from negative peers
• Successful enrollment in public school
• More integrated identity development

• Provide positive African American role models
• Exit alternative school and enroll in public
  school with diverse African American peer group
• Enroll in activities to foster positive identity
  development- Martial arts, African language
  course, African American History group
• MST-PLUS Relapse Prevention

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Engagement and Completion (n80)

• Engagement (gt1 month of treatment)
• African American 88
• White 64
• c2(80,2)6.00, p.05
• Treatment Completion
• African American 72
• White 60
• c2(80,2)1.20, pns

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Performance Indicators for FIT teams

• Engagement and Treatment Dose (n94)
• Total Team 1 Team 2
• Engaged in Services Post-Release 80
  79 80
• Avg. Days of Service Prior to Release 52
  59 33
• Avg. Hours of Pre-release Service 35
  30 39
• Avg. Number of Weeks
• of Service Post-Release 16 16
  17
• Avg. Hours per Week
• of Face to Face Services with youth 2.0
  1.8 2.1

note an additional 2-3 hours per week are
provided in family and community/ case management
interventions
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Adherence Ratings
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Prime Time Project Clinical Outcomes 1997-2002
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c2(1,97)5.68, plt.05
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Conclusions

• MST as an ecological model of intervention lends
  itself to culturally competent adaptation
• Culture is a strength that can be leveraged by
  the culturally competent therapist
• Cultural specificity and matching are helpful but
  not sufficient to ensure positive outcomes
• Supervision, consultation and therapist/client
  collaboration are important elements of
  culturally competent practice
• Structured techniques like Cultural Hypothesis
  Testing enhance cultural competence, especially
  in a CBT oriented model