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Understanding culturally relevant treatment needs of persons living with brain injury. Malisa Mallett, LMSW Brain Injury Alliance of Arizona Program Director. Objectives. cultural competence in practice. Awareness or attitudes Knowledge Skills.
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Understanding culturally relevant treatment needs of persons living with brain injury Malisa Mallett, LMSW Brain Injury Alliance of Arizona Program Director
cultural competence in practice • Awareness or attitudes • Knowledge • Skills
Acquired Brain InjuryAn acquired brain injury is an injury to the brain, which is not hereditary, congenital, degenerative, or induced by birth trauma. An acquired brain injury is an injury to the brain that has occurred after birth
Effects of Brain Injury A brain injury can affect how a person feels, thinks, acts, processes information, and learns. Functional/Physical Cognitive Personality/Emotional Psychological/Behavioral These effects can last long after medical treatment and rehabilitation are completed.
cultural competence in practice • Awareness or Attitudes • We move from being culturally unaware to being aware and sensitive to our own cultural heritage and to valuing and respecting differences. • We are aware of our own values and biases and of how they may affect diverse clients. • We are comfortable with differences that exist between ourselves and our clients in terms of race, gender, sexual orientation, and other sociodemographic variables. Differences are not seen as deviant. • We are sensitive to circumstances (personal biases; racial, gender, and sexual orientation identity; sociopolitical influences, etc.) that may dictate referral of clients to members of their own sociodemographic group or to different therapists in general. • We are aware of our own racist, sexist, heterosexist, or other detrimental attitudes, beliefs, and feelings.
cultural competence in practice 2. Knowledge • We are knowledgeable and informed about culturally diverse groups, especially the groups we are most likely to work with. • We are knowledgeable about the factors that influence the treatment of this group • We are knowledgeable about institutional barriers such as racism that prevent some diverse clients from accessing social services, privileges and advantages.
Special PopulationHomeless • In one recent study of 904 homeless men and women in Toronto, Ontario, 53 percent reported some type of traumatic brain injury. Studies in Milwaukee and Boston offer similar statistics of 48 and 67 percent. • The Toronto study found that for those who had experienced a brain injury, 70 percent had suffered the injury prior to becoming homeless. And although there is no clear cause and effect, the results suggest that TBI could be at least one contributor to some individuals’ homelessness. Topolovec-Vranic et al.; licenseeBioMed Central Ltd. 2012
Special PopulationsMental Illness • Research has shown an increased risk of depression(8x), delusional disorder, and personality disorder in people who have sustained a TBI (Koponen et al., 2002). • Research has also shown that people with brain injuries are at increased risk for schizophrenia – two to three times more likely than the general population (McAllister and Ferrell, 2002). • Some research indicates that people with brain injuries are twice as likely to present as suicidal. (Journal of Neurology, Neurosurgery & Psychiatry 2001)
Special PopulationsSubstance Abuse • People who sustain a TBI are twice as likely as others in the community to have issues with substance abuse (BrainLine July 25, 2008) • In a review of five studies of people in substance abuse treatment, estimates for prior TBI ranged from 38 percent to 63 percent. (HHS Publication No. (SMA) 10-4591) • In another study of 7,784 adults in State-funded substance abuse treatment programs, almost one-third of persons assessed at intake reported a history of one or more head injuries. (HHS Publication No. (SMA) 10-4591) “Substance abuse is a risk factor for having a traumatic brain injury and traumatic brain injury is a risk factor for developing a substance abuse problem." – John D. Corrigan, PhD, ABPP Ohio State Neurological Institute
Special Populationsdomestic violence According to the Centers for Disease Control and Prevention (CDC), in 2000, 4.8 million women were known to experience physical violence by an intimate partner each year. New estimates suggest TBI from domestic violence may affect up to 20 million women. In An AZ Study of 115 patients with a history of head trauma as a result of domestic violence. 88% reported more than one injury and 81% reported a history of loss of consciousness associated with their injuries. 85% had a history of abuse in adulthood, 22% had experienced abuse in both childhood and adulthood, and 60% of the patients abused as children went on to be abused as adults. (Glynnis Zieman, Ashley Bridwell, and Javier F. Cárdenas.Journal of Neurotrauma.Feb 2017)
Special PopulationsCriminal Justice • According to jail and prison studies, 25-87% of inmates report having experienced a head injury or TBI as compared to 8.5% in a general population reporting a history of TBI (https://www.cdc.gov/traumaticbraininjury/pdf/prisoner)
consideration Neuro fatigue – physical and mental Over stimulation may cause headaches, confusion and affect their ability to think clearly and may lead to emotional outbursts.
cultural competence in practice 3. Skills • We are able to generate a wide variety of verbal and nonverbal culturally sensitive responses. • We are able to communicate (send and receive both verbal and nonverbal messages) accurately and appropriately. • We are able to anticipate impact of our service delivery and our limitations on persons with brain injury. • We are able to communicate in easy to understand language that is linguistically and culturally appropriate when working with diverse clients.
cultural competence in practice operates at three levels in our work: • The individual level encompasses – the knowledge, skills, values, attitudes and behaviors of individual service providers. • The service level encompasses – management and operational frameworks and practices, expectations, including policies and procedures • The system level encompasses – how services relate to and respect the rest of the community, agencies, and the target population.
cultural competence in practice Implementation • Incorporate brain injury screenings • Train employees on brain injury • Utilize brain injury appropriate resources / providers
