Practice Modification to Embrace Multiculturalism: Balancing the Individual and the Evidence

1
Practice Modification to Embrace
Multiculturalism Balancing the Individual and
the Evidence
Preconference Workshop PC1 October 15, 2015

• Samantha Pelican Monson, Psy.D., Psychologist,
  Denver Health Medical Center
• K.C. Lomonaco, Psy.D., Psychologist, Denver
  Health Medical Center

Collaborative Family Healthcare Association 17th
Annual Conference October 15-17, 2015 Portland,
Oregon U.S.A.
2
Faculty Disclosure

• The presenters of this session have not had any
  relevant financial relationships during the past
  12 months.

3
Learning Assessment

• A learning assessment is required for CE credit.
• A question and answer period will be conducted
  throughout this presentation.

4
Learning Objectives

• At the conclusion of this session, the
  participant will be able to
• Describe the impact of multicultural patient
  presentations on current integrated primary care
• models.
• Identify viable solutions to preserve efficiency
  and population-based care, while embracing
  patient
• diversity.
• Cite relevant evidence to support practice
  innovation that incorporates multiculturalism.

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Agenda 1) Multicultural Reflections
Personal, Professional, Systemic2) Integrated
Behavioral Health as Culturally Competent
Care3) Clinical Pearls
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As we go around the room, please state a
privilege you hold. For example, I hold the
privilege of education.
7
The multicultural assessment and privilege
activity remind us we all have multiple human
contexts. Does anyone have reflections on how
this comes up for you in day to day life (e.g.,
at home or in social interactions)?
8
How do you bring your multicultural identity in
to your clinical work with patients?
9
Adding another layer of complexity is the nature
of the settings in which we work, represented by
the multicultural practice-assessment. When do
you tolerate the suboptimal versus pushing for
improvement?
10
Integration is a first step by being here you're
already enabling progress. Which components of
integrated behavioral health are culturally
responsive?
11
Evidence for Integrated Behavioral Health as
Multicultural Practice1-6

• Team-based care decreases disparities
• When done correctly, warm handoffs create a
  seamless extension of the trusted relationship
  with the primary care provider
• Mental health is brought into primary care, where
  minority populations more often seek and
  follow-through with care
• Population-based care expands reach

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How can we push integrated behavioral health
further toward multicultural competence while
maintaining model fidelity?5
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Clinical Pearl 1 Add culture-based questions to
standard practice.4, 7-11

• What do you think caused the problem?
• What kind of treatment do you think you should
  receive?
• What are the most important results you hope to
  get from treatment?
• How does your culture shape your medical
  decision-making?
• Acknowledge the differences in the room

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Clinical Pearl 2 De-individualize assessments
and interventions.8, 12-16

• Validated modifications of evidence-based
  treatments often
• Bring patients together in groups
• Utilize a trusted community leader
• Host at a non-clinical site

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Clinical Pearl 3 Advocate for social justice to
decrease biases in care.2, 15, 17-22

• Microwithin the care team
• Promote cultural competence through education
• Mutual feedback among colleagues about
  stereotyping or prejudice
• Seek to culturally match staff to patient
  population
• Macrooutside the care team
• Encourage flexibility of policies (e.g.,
  inclusion of non-Western approaches) to align
  with multicultural patient populations

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Clinical Pearl 4 Acculturation may bring new or
increased symptoms.5, 22-23

• Prevalence of common mental health problems is
  lower immediately after migration and increases
  over time
• Patients may not be prepared for the racism and
  discrimination they will face

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Clinical Pearl 5 When ethics are unclear,
consult!24

• How do ethical principles adapt to be culturally
  responsive?
• Dual relationships/conflict of interest
• Touch
• Self disclosure

18
During the break, please think of 2-3 action
items to which youd like to commit. Consider
personal, professional, and systemic areas.
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Discussion to share/steal action items.
20
Questions? Comments?Thank you!
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Bibliography / Reference

1. APA Guidelines for Providers of Psychological
   Services to Ethnic, Linguistic, and Culturally
   Diverse Populations. http//www.apa.org/pi/oema/re
   sources/policy/multicultural-guidelines.aspx?item
   1
2. Kohn-Wood, L.P. Hooper, L.M. (2014). Cultural
   competency, culturally tailored care, and the
   primary care setting Possible solutions to
   reduce racial/ethnic disparities in mental health
   care. Journal of Mental Health Counseling, 36,
   173-188.
3. Horevitz, E., Organista, K.C., Arean, P.A.
   (2015). Depression treatment uptake in integrated
   primary care How a warm handoff and other
   factors affect decision making by Latinos.
   Psychiatric Services, 66, 824-830.
4. McColl, M.A., Aiken, A., McColl, A., Sakakibara,
   B., Smith, K. (2012). Primary care of people
   with spinal cord injury. Canadian Family
   Physician, 58, 1207-1216.

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