LIFE IS PRECIOUS: A PROMISING COMMUNITY DEFINED EVIDENCE PRACTICE-BASED MODEL

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LIFE IS PRECIOUSA PROMISING COMMUNITY DEFINED
EVIDENCE PRACTICE-BASED MODEL

• ROSA M. GIL, DSW
• FOUNDER, PRESIDENT CEO
• ROUND TABLE DISCUSSION LATINA TEEN SUICIDE
  SPONSORED BY NEW YORK STATE COALTION FOR
  CHILDRENS MENTAL HEALTH SERVICES. FEBRUARY 7,
  2011, ALBANY, NEW YORK

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COMUNILIFE, INC.

• WHO WE ARE
• Comunilife is a Latino multi-service,
  not-for-profit organization created in 1989 to
  expand access to the continuum of housing,
  behavioral health and social services for Latinos
  and other diverse communities in New York City.
• Comunilife Pioneered the Multicultural Relational
  Approach for Diverse Populations that is based
  on a community-centered practice that
  incorporates the worldview, cultural values,
  beliefs and endemic knowledge in the definition,
  assessment, treatment interventions of behavioral
  health problems with Latinos. (Gil Genijovich,
  1994)

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COMUNILIFE, INC. (CONTINUED)

• WHO WE ARE
• Comunilife developed the Multicultural Relational
  Assessment Instrument to enable clinicians to
  incorporate clients cultural knowledge and
  concerns into treatment interventions, treatment
  plans that includes goals, objectives and
  outcomes. (Gil Genijovich, 1994)
• Life is Precious, a suicide prevention program
  for Latina adolescents was developed based on the
  principles of the Multicultural Relational
  Approach for Divers Populations. It is a
  promising community-defined evidence based
  practice to be discussed later in this
  presentation. (Gil, Rendon Cifre, 2007)

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Hispanic Disparities in Mental Health Care and
Research

• Disparities in mental health care for Latinos and
  other multicultural populations are greater in
  comparison to white populations. The
  inequalities are more prevalent in the areas of
  access, availability, quality and outcome of
  care. (Callejas and Martinez, 2009)
• Collectively, ethnically/racially diverse
  populations experience a greater disability
  burden from emotional and behavioral disorders
  than do white populations (Huang, 2002
  Department of Health and Human Services, 2001)
• Between 1986 and 2001, nearly 10,000 participants
  were included in randomized controlled trials
  evaluating the efficacy of interventions for four
  mental health conditions (bipolar disorder,
  schizophrenia, depression and ADHD) and included
  only
• 561 African Americans (5.6)
• 99 Latinos (.01)
• 11 Asian American and Pacific Islanders
  (.001)
• No single study analyzed the efficacy of the
  treatment by
• ethnicity or race. (Miranda et
  al, 2003)

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Current Evidence-Based Practice (EBP)

• In an attempt to provide the best treatment
  available, policymakers, researchers and funders
  have promoted the
• use of evidence-based practice (EBP)
• But, is the EBP Gold Standard culturally
  appropriate?
• Most EBP trials are conducted with White,
  educated, verbal and
• middle class individuals and
  may not generalize to ethnic/racial
• groups and third world
  communities (Bernal Sharon-del-Rio, 2001)
• Empiricism (upon which
  randomized-controlled trials are
• based) is a western
  epistemological modeldoes not support
• other knowledge bases.
  (Callejas and Martinez, 2009).
• Frequently dont take the following aspects
  into consideration
• ? Historical trauma
• ? Cultural values, beliefs, traditions and
  preferences
• ? Contextual, transactional and societal
  variables relating to the
• environment in
  which the individuals lives.

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Current Evidence-Based Practice (EBP) (Continued)

• The central problem is that treatments that have
  been validated in efficacy studies cannot be
  assumed to be effective when implemented under
  routine practice conditions (Hoagwood et al.,
  2001).

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An Alternative Community-Defined Evidence (CDE)

• The Community Defined Evidence Project CDEP, a
  partnership between the National Latino
  Behavioral Health Association (NLBHA) and the
  National Network to Eliminate Disparities (NNED)
  in Behavioral Health. (NNED, 2007)
• Community-defined evidence (CDE) is a set of
  practices that communities have used and
  determined to yield positive results as
  determined by community consensus over time and
  which may or may not have been measured
  empirically but have reached a level of
  acceptance by the community (Martinez, 2008)
• CDE includes worldview, historical and
  contextual aspects, and transactions processes
  that are culturally rooted and do not limit to
  one manualized treatment
• Emphasize the importance of community input in
  development, implementation and evaluation of
  practices.

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An Alternative Community-Defined Evidence (CDE)
(Continued)

• The central goal of the CDEP is to discover and
  develop a model for establishing an evidence
  based using cultural and/or community indices
  that identify community-defined and based
  practices that work.
• CDEP was designed to identify successful
  community defined-based practices to support
  overall good health and well-being among Latinos.
• With the support of SAMSHA the University of
  South Florida in partnership with NLBHA and NNED
  has conducted research of community defined-based
  practices in 16 Hispanic agencies throughout the
  country.
• Comunilifes Life Is Precious program, grounded
  on our Multicultural Relational Approach for
  Diverse Populations has been selected as one of
  the CDE practice in the University of South
  Floridas research study.

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DEFINITION OF THE PROBLEM

• Latina adolescents are much more likely than
  black and white adolescents to report attempt
  suicide (CDC YRBS, 2009) in the nation.
• New York City Latina adolescents have suicide
  attempt rates that are higher than the national
  average (11 versus 14.7).
• Latina teens generally attempt suicide at a rates
  far greater than their non-Hispanic counterparts
  more than twice the rate of white youth in New
  York City (14.7 versus 6.2) and 44 more
  frequently than teenage African-American girls
  (14.7 versus (10.2).
• More than one Latina teenager out of every five
  living in Brooklyn attempted suicide during 2009
  a rate that was almost twice the level just two
  years earlier. Brooklyn has the highest rate of
  attempts suicide by Latina teen than any other
  locality in the country.

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• The levels of suicide attempts by Latina
  teenagers were also shockingly high in the Citys
  other boroughs 16.5 in Staten Island, 15.3 in
  the Bronx, 12.2 in Queens and 11.7 in
  Manhattan.
• This mental health disparities have been
  neglected by policy makers and researchers since
  1995 CDC RBS, 1995.
• Central and South American and Caribbean
  countries had some of the lowest suicide rates in
  the world (Carpinello, 2006)
• Lack of research on efficacy of Latino community
  defined practice based models of care.
• Most current clinical practices not normed on
  Latino populations.
• Failure of traditional treatment programs due to
  a poor fit with Latino community.

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LIFE IS PRECIOUSDEVELOPMENT OF A COMMUNITY
DEFINED PRACTICE-BASED MODEL

• Mobilized the following sectors to create
  awareness, education and actions to address the
  problem
• ? Latino and English Speaking media
• ? Latino business community
• ? Latino and non elected officials
• ? Latino Grass root organizations
• ? Government Agencies
• ? Latino and Non-Latino mental health
  providers
• ? Community at large

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• Conducted a qualitative marketing research
  focused on Latino parents and teens in the Bronx
  with the following research objectives
• to assess awareness and attitudes towards teen
  suicide and prevention
• to determine awareness of existing resources and
  programs
• to better understand the target populations
  lifestyles and preferences
• to seek suggestions for program design to address
  Latina teen suicide

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QUALITATIVE MARKETING RESEARCH FINDINGS

• Huge communication gap between Latina adolescents
  and parents driven by acculturation stress and
  immigration
• Adolescents believe that their worries and
  problems could lead to suicide parents do not
  believe so.
• Cultural differences increase stress and can play
  a role in suicide ideation and attempts.
• Daughters increased independence is perceived as
  falta de respeto. Respect is a major Latino
  cultural value (Gil Vazquez, 1996)

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• Adolescents identify family members as role
  models but do not seek their help due to lack of
  confidentiality in the family.
• Parents usually turn to family for help and to
  mental health services only as a last resort.
• Parents and adolescents shared a strong
  anti-medication bias for treating emotional
  distress.

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QUALITATIVE MARKETING RESEARCH FINDINGS(CONTINUED
)

• Parents and adolescents do not believe that
  traditional mental health services and schools
  are responsive to their needs.
• Parents and adolescents are UNAWARE of suicide
  prevention programs or suicide hotlines in
  English or Spanish.
• Adolescents communicate through My Space.
• Adolescents suggest programmatic activities peer
  counselors academic tutoring and internet café
  fun activities such as discovering their
  talents.
• Mothers suggest activities to foster
  socialization to decrease their sense of
  isolation.
• Mother suggested family oriented activities.

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LIFE IS PRECIOUS

• GOALS AND OBJECTIVES
• Decrease suicidal behavior
• Improve communication between parents and
  adolescents
• Improve academic performance
• Increase self-esteem
• Improve social relationships
• CRETERIA FOR ADMISSION
• Latina teens between 12 and 16 years old
• In treatment in a mental health clinic
• Diagnosis of mood disorder with hx of suicidal
  ideation or attempts
• Must be in school
• PROGRAM HOURS
• Monday through Friday 330 PM to 730 PM
• Saturdays 10 AM to 2 PM

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LocationsBronx Program open in 2008 (6 days
a week) Brooklyn Program open in 2009 (3 days
a week)

• PROGRAM ACTIVITIES
• Tertulias for mothers and Dominos for fathers
• Saturdays family day
• Creative art therapy
• Tutoring
• Youth ambassadors (peer mentors) - (Promotores de
  Salud Mental)
• Internet café
• School advocacy
• Case management to help families with socio
  economic stressors
• Indigenous volunteers, madrinas, padrinos and
  youth ambassadors (Promotores de Salud Mental)
• Community coalition to reduce suicide among
  Latina adolescents

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PROGRAM OUTCOMES

• More than 100 Latina adolescents have
  participated in the program in the last two
  years.
• Decreased suicidality only 5 teens were
  readmitted during the two years of the program
  in the Bronx. .
• Strengthened family communications and
  relationships with mothers, friends and others.
• Sixty six percent (66) of the girls improved
  academic performance
• Forty four percent (44) of parents agreed teens
  had better coping skills and 86 of girls felt
  they handled their daily lives better than they
  used to

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PROGRAM OUTCOMES (CONTINUE)

• Adolescents discovered personal talents, improved
  self-esteem and increased optimism about life.
• Level of satisfaction by participants indicates
  this model is culturally appropriate for parents
  and adolescents
• Twenty eight (28) padrinos, madrinas and
  youth ambassadors participated in the program
  (Promotores de Salud Mental)
• Lack of research resources to analyze all the
  data collected in the Life Is Precious program.
• Program is funded by New York Community Trust
  Van Ameringen Foundation and New York State
  Office of Mental Health

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References Cited

• Bernal, G. Sharon-del-Rio, M.R. (2001). Are
  empirically supported treatments valid for ethnic
  minorities? Toward an alternative approach for
  treatment research. Cultural Diversity and Ethnic
  Minority Psychology, 7 328-342.
• Carpinello, S. (2006). Suicide in 2 Ethnic Groups
  is Topic at Assembly Hearing. New York Times,
  December 8, 2006
• Gil, R. Genijovich, E. (1994). The
  Multicultural Relational Approach for Diverse
  Populations. Comunilife, Inc.
• Gil, R. Genijovich, E. (1994). The
  Multicultural Assessment Form. Comunilife, Inc.
• Gil, R. M. Vazquez, C. (1996). The Maria
  Paradox. G.P. Putnams Sons, New York, NY
• Gil, R., Rendon, M. Cifre, R. (2007). Life is
  Precious. Comunilife, Inc.
• Hoagwood, K., et al. (2001). Evidence-based
  practice in child and adolescent mental health
  services. Psychiatric Services, 521179-1189.
• Huang, L. (2002). Reflecting on cultural
  competence A need for renewed urgency. Focal
  Point, 16 , 4-7.

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References Cited (Continued)

• Miranda, J., Nakamura, R., Bernal, G. (2003).
  Including ethnic minorities in mental health
  intervention research A practical approach to a
  long-standing problem, Culture, Medicine
  Psychiatry, 27 , 467-486.
• U.S. Department of Health and Human Services
  .(2001). Mental health Culture, race, and
  ethnicity A supplement to mental health A
  report of the Surgeon General. Rockville, MD
  U.S. Department of Health and Human Services,
  Substance Abuse and Mental Health Services
  Administration, Center for Mental Health
  Services.