Title: Delivering Culturally Effective Care Florence S' Coleman, M'D', M'P'A Chief Special Mental Health Pr
1Delivering Culturally Effective CareFlorence S.
Coleman, M.D., M.P.AChief Special Mental Health
Programs Dayton VA Medical Center
- 2007 Healthy Start Grantee Meeting
- Crystal Gateway Marriott
- Arlington, Virginia
- August 6, 2007
2Delivering Culturally Effective CareThis
presentation will help you
- Formulate a plan to practice the delivery of
- culturally effective care in the clinical
setting. - Describe ETHNIC, a tool used to elicit a
clients history in a cultural context . - Explain the effects of mental health
- disparities.
- Explore the epidemiology of depression across
cultures
3CULTURE
- Definition
- Culture is a pattern of beliefs, customs, and
behaviors which a people acquire socially and
transmit from one Generation to another through
symbols and shared meanings. - It provides the tools by which people of a given
society adapt to their physical environment,
social environment, and to one another.
4 Self Assessment Worlds
Major Religions
- 1. Judaism ---- Attempts to deal
with problems of human existence such as - suffering
and death the end of suffering is in the
extinction of - desire and
emotion, and ultimately, the unreal self
- 2. Taoism ---- Considered a
philosophy or a system of ethics for living, - rather
than a religion that teaches how people should
act toward - one
another. People are born good. - 3. Shintoism ---- All people are
assigned to castes cows are sacred - 4. Confucianism ---- Reverence for ancestors
and the traditional Japanese way - of life is
emphasized - 5. Buddhism ---- Obeying Gods law
through ethical behavior and ritual - obedience
earns the mercy and justice of God - 6. Islam ---- Most popular
religion in the world. Brotherly love is - emphasized
in the world, Brotherly love is emphasized in
acts of - charity,
kindness and forgiveness. - 7. Hinduism ----Means the way and
promotes a doctrine and code of - behavior
- 8. Christianity ----God rewards the
good and punishes the sinful Peace is - gained
through submission to Allah (the only God)
5What is cultural competence?
- Cultural competence is defined as a set of
congruent behaviors, attitudes, and policies that
come together in a system, agency, or among
professionals and enables that system, agency, or
those professionals to work effectively in
cross-cultural situations (Cross et al., 1989)
6Competence
- Competence is used because it implies having the
capacity to function in a particular way The
capacity to function within the context of
culturally integrated patterns of human behavior
defined by a group.
7Cultural Competence Continuum
- I------------I------------I------------I----------
--I------------I - Cultural Cultural
Cultural - Destructiveness Blindness
Competence - Cultural Cultural
Cultural - Incapacity Pre-Competence
Proficiency
8Diversity
- The mosaic of people who bring a variety of
backgrounds, styles, perspectives, values, and
beliefs as assets to groups and organizations
with which they interact.
9Keys to REACH for DIVERSITY!
- R - Respect
- E - Educate
- A - Awareness
- C - Collaborate
- H Honesty
10R E S P E C T
-
- Realize Equality
- Share
- Experience and
- Create Trust.
11Race
- A concept under which human beings traditionally
chose to group themselves. Physical, biological,
genetic connotation are fully integrated in the
definition.
12A DISPARITY IS AN INEQUALITY
13US POPULATION (2000)
- Hispanic 35.3 million 12.5
- African American 33.9 million 12.1
- Asian or Pacific 10.5 million
3.7 - Islander
- Native American 2.1 million
0.7
14US Population 2000
15RACIAL DISPARITIES
- Disparities White Women AA Women
- Infertility 6.4
10.5 - Maternal
- Mortality 2.6
6.3 - (ratio)
- Preterm births 83.7/1000
160.9/1000 - Prenatal care 85
73 - (1st trimester)
16Conceptualizing Disparities
- Prevalence Rehabilitation
- Incidence Participation
- Services Outcomes
- Treatment Access
- Prevention Quality
- Recovery Use of Medication
King Davis, 2003
17 DISPARITIES IN MENTAL HEALTH CARE
FOR RACIAL AND ETHNIC MINORITIES
- Minorities have less access to, and availability
of, mental health services - Minorities are less likely to receive needed
mental health services - Minorities in treatment often receive a poorer
quality of mental health care - Minorities are underrepresented in mental health
research - Mental Health Culture, Race, and Ethnicity,
a Supplement to the Surgeon Generals Report on
Mental Health -
18An Expanded View of Disparities
Crime Victims
Maternal/ Infant Deaths
Sickle Cell
Criminal Justice
Nutrition
Literacy
Uninsured
Low Birth Weight Babies
Diabetes
Sentencing
Housing Homelessness
Cardiovascular Disease
Periodontal Disease
Political Office
Voting
HIV
Asset Accumulation
Alcohol Abuse
Environmental Pollution
Cancer
Obesity
Low Income
Graduation Rates
Cocaine Use/Sale
Mental Retardation
Schizophrenia
Depression
Bipolar
Domestic Violence
Homicides
Personality Disorder
Dementia
Capital Punishment
Unemployment
King Davis, 2003
19Prospective Frequency Of Illness
Source Davis, King., Johnson, Toni,
McClendon,A. (2002). Guidebook. Baltimore Casey
Foundation Mental Health A Report of the Surgeon
General, DHHS, 1999.
20 Need for Behavioral Health Care
- Latinos/Hispanic Americans
- Overall rates of MI similar to non-Hispanic
whites - Higher rates of some disorders
- Anxiety-related and delinquency behaviors,
depression and drug use, more common among Latino
youth - Higher rates of depression among elderly Latinos
- Culture-bound syndromes
- Susto (fright), nervios (nerves), mal de ojo
(evil eye), and ataque de nervios - Access to behavioral health services is limited
21 Need for Behavioral Health Care
- Asian Americans/Pacific Islanders
- Limited data on prevalence of MI
- Existing data suggests overall rates similar to
whites - Higher rates of depression, PTSD
- Somatic complaints of depression
- Culture-bound syndromes
- Lower suicide rates - except elderly women who
have the highest suicide rates in U.S. - Refugees with PTSD
- Language barrier limits access to services
22 Need for Behavioral Health Care
- African Americans
- Overall rates of mental illness similar to
non-Hispanic whites - Differences in prevalence of specific illnesses
- Suicide rates lower but on the rise
- Environmental, economic and social factors
- Exposure to violence, homelessness,
incarceration, social welfare involvement - Less access to behavioral health services
23 Need for Behavioral Health Care
- American Indians and Alaska Natives
- Limited data on prevalence of MI
- One small study with 20 year follow-up found 70
lifetime prevalence of MI - Increase rise of depression among older adults
- Suicide rate 1.5xs national average with young
males accounting for 2/3 of suicides - 2nd decade of life has highest mortality rate
- Alcohol dependence, alcohol related deaths
- Little information on service utilization
patterns
24Racial Disparities
25Racial Disparities
- REPRODUCTIVE HEALTH
- White women AA women
- Infertility 6.4
10.5 - Maternal 2.6
6.3 mortality (ratio) - Preterm births 83.7/10000 160.9/10000
- Pre natal care 85 73
- (1st trimester)
26Racial Disparities
- Endometrial Cancer
- AA women with endometrial cancer sere
significantly less likely to undergo primary
surgery.
27Racial Disparities
- Ovarian Cancer
- The incidence of ovarian cancer is lower among AA
women compared with white women, the relative
survival of AA women is poorer. The national
Cancer data base study revealed that AA women
with advanced epithelial ovarian cancer were
treated less aggressively than white women were
twice as likely not to receive appropriate
medical therapy.
28Definitions
- Discrimination, Stereo typing, Ethnicity, Sexual
Orientation, Religion, Discrimination, Racism,
Culture, Ethnicity - 1.________ a population or group distinguished by
customs, characteristics, language, common
history, and national origin. - 2.________a set of beliefs that often involve a
code of ethics and a philosophy. - 3.________the sum total of shared behavior
patterns, arts, beliefs, institutions thought,
feeling characteristics of a group, community or
a society. - 4._______an action or behavior, which favors some
people/groups and disadvantaged others. - 5._______ partiality or prejudice
29Background heterogeneous
- 11 Million Asian Americans
- 43 Ethnic subgroups
- 60 Born outside of the US
30Screening for depression
- Have you been able to enjoy the things you
usually do? - Have you been feeling down, sad, or blue most of
the day?
31Strategies to facilitate the Asian-American
Interview
32Clients Culture
- Communication styles
- Symptoms
- Coping strategies
- Family
- Community Support
- Willing to seek treatment
33Clinicians Culture
- Perceptions
- Understandings
- Diagnosis
- Treatment
- Service delivery
34Symptoms of Depression
- Sad Mood
- Loss of interest
- Hopelessness
- Guilt, worthlessness
- Appetite or weight change
- Low energy
- Thoughts of death or suicide
- Poor concentration
- Persistent Physical Symptoms
- May include psychotic Sx
35Suicidality
- Asian American Women
- 2nd highest suicide rate between ages 15 and 24
- Highest suicide rate among women 65 and older
36Communication
Basic Values Class
Non-confrontation and social harmony vs. Open
expression of interpersonal conflict
Psychosomatic vs. Sociosomatic
Reticence and Restraint vs. Gregarious and
Assertive
37Judaism
- Obeying Gods law through ethical behavior and
ritual obedience earns the mercy and justice of
God.
38Taoism
- Tao means the way and promotes a doctrine and
code of behavior.
39Shintoism
- Reverence for ancestors and the traditional
Japanese way of life is emphasized.
40Confucianism
- Considered a philosophy or a system of ethics for
living, rather than a religion that teaches how
people should act toward one another. People are
born good
41Buddhism
- Attempts to deal with problems of human existence
such as suffering and death. - The end of suffering is in the extinction of
desire and emotion, and ultimately, the unreal
self.
42Islam
- God rewards the good and punishes the sinful.
- Peace is gained through submission to Allah (the
only God)
43Hinduism
- All people are assigned to castes
- Cows are sacred
44Christianity
- The most popular religion in the world.
- Brotherly love is emphasized in acts of charity,
kindness, and forgiveness.
45CROSS-CULTURALCOMMUNICATION
- L Listen with sympathy and understanding to the
patients perception of the problem. - E Explain your perceptions of the problem.
- A Acknowledge and discuss differences and
similarities. - R Recommend treatment.
- N Negotiate an agreement.
46RECOMMENDATIONS
- 5 Steps to becoming culturally competent
- Awareness and acceptance of differences
- Self-awareness
- Dynamics of Differences
- Knowledge of an Individuals Culture
- Adaptation of Skills
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