Cultural Competency in Your Drug Court

1. Cultural Competency in Your Drug Court Joe Lunievicz, BA, RYT Director Training Institute/Executive Director NDRI-USA, Inc. – www.training.ndri.org

2. Cultural Competency - Lunievicz Agenda • Cultural Competency/Proficiency • Cultural Assessment • Simulation • Case: African American Young Adult

3. Cultural Competency - Lunievicz Key Component 4 • Drug courts provide access to a continuum of alcohol, drug, and other related treatment and rehabilitation services. • Treatment designs and delivery systems are sensitive and relevant to issues of race, culture, religion, gender, age, ethnicity, and sexual orientation.

4. Cultural Competency - Lunievicz Key component 10 • Forging partnerships among drug courts, public agencies, and community-based organizations generates local support and enhances drug court program effectiveness. • The drug court hires a professional staff that reflects the population served, and the drug court provides ongoing cultural competence training.

5. Cultural Competency - Lunievicz Culture 'Culture' refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. US Department of Health & Human Services, Office of Minority Health, http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=11

6. Cultural Competency - Lunievicz Cultural Competence Model Cultural Blindness Cultural Proficiency Cultural Destruction Cultural Incapacity Cultural Competence Cultural Pre-Competence

7. Cultural Competency - Lunievicz Cultural Competence Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. US Department of Health & Human Services, Office of Minority Health, http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=11

8. Lunievicz TM & culture Cultural Proficiency • A systems level approach that adds to the knowledge base of culturally competent practice by conducting research, developing new service delivery approaches, and disseminating results of demonstration efforts. • Team members are culturally competent; teams are culturally proficient

9. Why Cultural Competency? 7 Cultural Competency - Lunievicz • Higher retention rates • Higher graduation rates • Enhanced quality assurance • Lower attrition rates

10. Cultural Competency - Lunievicz Competency Assessment • On the practitioner/client level, assessing the client’s cultural perspective is pertinent to their engagement and motivation to succeed in the program. • Cultural competence is a process that involves continual self assessment. • Consciousness of one's personal reactions to people who are culturally different. • Social science research indicates that our values and beliefs may be inconsistent with our behaviors, and we ironically may be unaware of it.

11. Cultural Competency - Lunievicz Dyad: Cultural Competency Self-Assessment • Fill out assessment • Score assessment • Talk to you partner about • How did you do? • How would the other members of your team score? • Where do you need help?

12. Cultural Competency - Lunievicz What is Privilege? • An unearned right, advantage or immunity granted to or enjoyed beyond the common advantages of all others; an exemption in many certain cases from burdens of liabilities. • Those with privilege rarely understand it’s full impact on those who do not have privilege. • When only certain members of society enjoy privileges, it creates inequities.

13. Cultural Competency - Lunievicz White Privilege • I can move wherever I want to move • I can do well in a challenging situation without being called a credit to my race • I can go into a supermarket and find the staple foods which fit my cultural traditions • I can take a job without my coworkers suspecting I got it because of my race • My medical provider will be aware of cultural values and traditions related to my healthcare

14. Cultural Competency - Lunievicz Male Privilege • When competing against a female for a job, the odds are probably in my favor • My odds of being raped are low • I can be assertive without being called a b*&%# • If I have sex with a lot of people, it will not make me an object of contempt or stereotyping • I am not expected to spend my entire life 20-40 pounds underweight

15. Cultural Competency - Lunievicz Simulation: Activity Instructions • A group of explorers will be removed from the group and given instructions to prepare for exploration of the BETA Culture. • BETA participants will set up their society • First wave of Observers will visit BETA society • Second wave of Observers will visit BETA society • Process in large group

16. Cultural Competency - Lunievicz Small Group Process: Explorers: • Feelings or thoughts when you explored the BETA society? • How easy or difficult was it to visit another society? • What did you notice about yourself in terms of assimilating into another group? BETAs: • What did you notice about yourself as you played? All: • How does this relate to your drug court work?

17. Cultural Competency - Lunievicz Large Group Process • What assumptions did you make about the other society? • What does this teach us about social processes and structures? • What is the impact of not knowing about another culture on your perception of it?

18. Cultural Competency - Lunievicz What is the Dominant Culture in the US? What is the impact of this on the judicial system? Drug Treatment?

19. Cultural Competency - Lunievicz Case Example Young Adult African American Male

20. Cultural Competency - Lunievicz Drug Court YA challenges • Little motivation to succeed • Denial of drug abuse • Low frustration tolerance • Minimal family support • Negative peer influences • Lack of role models • High rates of trauma & victimization

21. Cultural Competency - Lunievicz These lead to… • Young adults stay in the first phase of treatment longer than other drug court participants • More court sanctions and incarcerations • Higher rate of placement in treatment facilities than level of addiction • Less positive outcomes

22. Cultural Competency - Lunievicz “No matter how articulate the practitioner may be, the words may not be comprehended if the speaker lacks understanding of the effects of drug use on adolescent cognitive development and the individual’s ability to comprehend the court proceedings in which he/she is involved, to comply with court orders and conditions of release, and most important, to be motivated to change his/her behavior over the long term.” Cooper, Adolescent Drug Users, 2008

23. Cultural Competency - Lunievicz Brain changes in Young Adulthood Maturation of brain from back to front Prefontal Cortex Myelination: adding white matter Synaptic Pruning: decreasing number of connections Connections among regions

24. Cultural Competency - Lunievicz Prefrontal Cortex Executive Suite Matures last (ages 25-26 for full maturity) Calibration of risk & reward “On second thought… ” Problem-solving Prioritizing Thinking ahead Self-evaluation Long-term planning Regulation of emotions

25. Cultural Competency - Lunievicz Racial DisparitiesHuman Rights Watch, World Report 2011: United States Given… • Blacks and whites engage in drug offenses at equivalent rates • Blacks constitute 13% of the population Why? • Blacks 34% of drug arrests (2-11x higher) • Blacks 44% of convicted drug felonies in state court • Blacks make up 56% of people in state prisons for drug offenses • 60% of people in prison are racial/ethnic minorities

26. Behavior Sloppy dress Refusal to look in the eyes Tardy, no show, incomplete tasks/assignments Non-verbal War stories Perception Disrespectful Anger/hostility Resistant/lack of commitment Refusal to develop rapport Defeatist attitude 21 Cultural Competency - Lunievicz Attitudes & Behaviors Which Might be Presented by African Americans Entering Drug Court:(Darryl Turpin, Director, Jefferson County Drug Court)

27. Cultural Competency - Lunievicz Applying Experience into Practice Practitioner: a. perceived client behavior and sanctions  Communication: a. translations and interpreter b. materials Treatment a. engagement and program retention b. individual and group sessions  Support systems      a. 12 step        b. family       c. spiritual

28. Cultural Competency - Lunievicz Staffing • What percent of the program/agency/organization’s staff reflects the composition of the population(s) served? • What percent of the staff is bilingual or multilingual? • What percent of minorities or persons representative of the dominant cultures in your community are on the program’s/organization’s board of directors/advisory committees? • What percent of minorities or persons representative of the dominant cultures in your community hold administrative or management positions in the program/organization/agency?

29. Cultural Competency - Lunievicz Prior Experience • What linkages have been made with minority organizations, churches, NGO’s, and other institutions in the community that serve the same groups? • Have contracts been awarded to diverse cultural service providers who specialize in issues or needs of minority populations? If not, do you know why? • Do the clients have input into or give feedback to the program/agency’s management team about design issues and effectiveness? • Is the program located in the community it serves or is it is accessible to its target population?

30. Cultural Competency - Lunievicz Prior Experience • Are needs assessments and issue identification strength-based and culturally specific? • Does the program/agency environment/offices reflect an appreciation of the culture of the target populations? • Does the program/agency have its materials translated into the dominant languages of the target populations? • Has an independent evaluator/researcher ever analyzed the program/agency’s outcomes by race, gender, ethnicity, sexual orientation, education, etc.?

31. Cultural Competency - Lunievicz NREEP: SAMHSA National Registry ofEvidence Based Programs and Practices • Moral Reconation Therapy • Helping Women Recover and Beyond Trauma • Brief Strengths-Based Case Management for Substance Abuse • Dialectical Behavior Therapy • Motivational Enhancement Therapy http://www.nrepp.samhsa.gov/AdvancedSearch.aspx

32. Cultural Competency - Lunievicz Selected Resources on Cultural Competency • The New Jim Crow: Mass Incarceration in the Age of Colorblindness, Michelle Alexander, 2012 • Cultural Competence: The elements of Culture that Affect Treatment Outcomes, Suzette E. Brann (http://www1.spa.american.edu/justice/documents/199.pdf) • Core Competencies Guide Adult DCPI Trainings • NDRI: Cultural Proficiency for Drug Court Practitioners Training Curriculum, (updated 2010) • The Sentencing Project, Racial Disparities (http://www.sentencingproject.org/template/page.cfm?id=122)