Cultural Relevance within Full Service Partnerships

1. Cultural Relevance within Full Service Partnerships Lynne Marsenich, LCSW January 2007 Full Service Partnership Training

3. Three Levels of Human Phenomena First, all human beings share universal characteristics Second, groups of us share cultural norms such as language and ways of socializing our children Third, each of us is unique

4. Framework for Culturally Appropriate Interventions Selection of therapeutic principles and techniques with (potentially) universal relevance Identification of culturally relevant intervention approaches Tailored to individuals Empirical evaluation of intervention outcomes

5. Steps for Identifying Effective AND Culturally Relevant Interventions Core components Theory Mechanisms of change Culturally responsive strategies Use of culturally relevant images, metaphors and stories Acknowledges and addresses cultural values Spirituality and Religion Willingness to inquire about, acknowledge and incorporate spiritual themes generated by clients

6. Effective and Culturally Relevant Interventions Culturally Responsive Strategies Acculturation Creating a safe environment to discuss the stresses involved in navigating and adapting to a new culture Racism, prejudice and discrimination Acknowledge the reality and traumatic impact of such experiences

7. Effective and Culturally Relevant Interventions Must appreciate the heterogeneity within groups Dynamic sizing Knowing when to generalize and be inclusive and when to generalize and be exclusive when working with clients. Dynamic sizing avoids stereotypes while still appreciating the importance of culture (Sue, 2006)

8. Increasing Access and Utilization Concrete barriers � generally imposed by economic limitations or current life circumstances Perceived � informed by an individuals culture, attitudes and previous experiences

9. Concrete Barriers Location of service deliver site Lack of transportation Lack of child care Single parent with care giving responsibilities for adults and children Having children with serious health problems

10. Perceived Barriers Stigma associated with help seeking Lack of social support � friends and/or family not supportive of treatment Previous experiences with help-seeking Feeling misunderstood or disrespected Doubts about the utility of treatment Cultural meaning of help seeking

11. Culturally Relevant and Effective Interventions Some EBP�s have been tested with diverse populations Multisystemic Therapy Parent Child Interaction Therapy Incredible Years Cognitive Behavioral Therapy Interpersonal Psychotherapy for Depression Trauma Focused CBT Multi-Dimensional Family Therapy

12. Culturally Sensitive Interventions Facilitate accessibility of services Make use of methods that are acceptable and appropriate given the cultural values of the client Interventions must be further tailored to each individual client � appreciate the variability that exists within groups (Munoz, 2005)

13. Incredible Years Intervention for young children (3-8) with disruptive behavior disorders Developed by Carolyn Webster-Stratton Goals of treatment Decrease aggressive oppositional behavior Strengthen children�s social competence and self-regulation Promote children�s academic competence, school engagement and school readiness

14. IY-Intervention Methods Group � 10-14 parents 12-14 weeks Videotaped modeling Role Play and rehearsal Home assignments Group support Emphasis on therapeutic relationship ��collaborative process�

15. IY � Fundamental Tenet Parents care about their children�s welfare and would prefer to behave in ways that facilitate their children�s development and success in school

16. IY � Core Components - Theory Social Learning Theory (Bandura, 1977) Embodies principles of behavior change that are potentially applicable across cultures Emphasizes the principle of reciprocal determinism � individuals both shape and are shaped by their environments Teaching adaptive coping strategies are at the heart of the theory

17. IY �Core Components-Mechanisms of Change Play to promote positive parent-child relationships Praise and incentives to promote social competence Effective limit setting to increase cooperation Ignore, distract, redirect and time out to decrease aggressive behavior

18. IY � Culturally Responsive Strategies Parents determine their own goals for themselves and their children Each unique group of parents generates the themes and principles that guide the discussions and exercises The role plays and practices come from the parent�s needs and issues The group process supports members different opinions and goals

19. Themes Commonly Expressed by Immigrant Parents Loss of control or power of parents in the home regarding child rearing Parents are encouraged to try discipline techniques that are compatible with their cultural identity and increase their confidence about parenting in a new culture

20. Common Themes Parents feel they engage in a balancing act between wanting their children to maintain their cultural identity while at the same time making the necessary adaptations so they can be successful in the United States Parents are encouraged to read to children in their own language To continue their oral history by telling stories about their childhoods and countries of origin Strengthening their relationships with their children as a means of strengthening their child�s bond to them and their culture

21. Common Themes Language and communication barriers make it difficult for parents to know how to interact with teachers and support their children�s academic success Parents are helped to know how to collaborate with teachers so they understand what is expected of their child Group leaders contact teachers to find ways of increasing two-way communication between home and school

22. Common Themes Family stress, poverty, long work hours and financial struggles The IY groups alleviate as many of the practical barriers to attendance as possible Help with transportation Offering the group at times families can come Meals Child Care Practical support for school involvement Letting parents decided how much time they can spend on the home assignments

23. Respect for Families� Culture, Individual Values and Goals Terminology and parenting concepts are defined using language that is culturally determined Program materials are translated Models in the vignettes represent different cultural groups Groups leaders need to understand and value parent�s culture Focus groups prior to offering IY to an group of parents from a different culture

24. Empirical Evaluation of Outcomes Incredible Years is a well-validated intervention Carolyn Webster Stratton has conducted 6 random assignment studies and there have been 4 independent replications

25. Multidimensional Family Therapy Family based intervention for substance-abusing adolescents and other problem behaviors Developed by Howard Liddle Goals of treatment Decrease in substance use Decreases in delinquent behavior Improved school functioning (behavior and grades) Improved parent-adolescent communication and relationship

26. MDFT Intervention Methods Community and home-based family therapy Treatment is organized in phases and the full course of treatment ranges between 16 and 25 sessions over four to six months There are 5 assessment and intervention modules Individual Peer Family School Community

27. Theory Adolescent drug abuse is understood in terms of a network of influences Individual Family Peer Community Reductions in drug use and increase in prosocial behavior occur via multiple pathways, in differing contexts and through different mechanisms Changes in parent well-being and in parenting practices is key to change

28. Intervention by Domain Individual Individual session focus on youth�s difficulties in school, in family, legal problems and relationship problems Motivation is enhanced and skills are taught and practiced

29. Intervention by Domain Peer The youth�s peer network is accessed through the youth who is then helped to address the non-adaptive nature of relationships with drug-using and delinquent peers

30. Intervention by Domain Family Family sessions, sessions with parents focus on every day events in the family, particularly family relationships and their improvement The past is explored and addressed to the extent that it still creates family relationship problems

31. Intervention by Domain School Therapists go to the school with parents and youth, sometimes acting as mediator, advocate, or brokers to create new opportunities for the youth in the school or to create opportunities for the youth in a new or different school environment.

32. Intervention by Domain Community Therapists work with families to be more vigilant about the dangers existing or the resources available to them within their local community

33. Culturally Specific MDFT for African American Males Cultural theme engagement module Assessment of and interventions within multiple systems of the adolescent's life An emphasis on facilitating active adolescent involvement in treatment The use of popular culture including music Focused and systematic discussion of cultural themes such as mistrust, anger/rage, alienation, respect/disrespect, spirituality, the journey from boyhood to manhood, racism, racial socialization, hopelessness

34. Culturally Specific Strategies Gaining access through music The journey from boyhood to manhood Therapy becomes the context within which the adolescent inventories his sills and preparedness for manhood Identifying and integrating male mentors is a critical component Opportunities to strengthen the adolescent�s attachments to family and community

35. Culturally Specific Strategies Therapist helps the adults in the adolescent�s life to incorporate the role of mentor or trainer into their parenting Youth of color can experience difficulty when they venture beyond the boundaries of their immediate environments. Therefore teens are helped to gain experience and develop competence in new environments Tutoring Job training programs

36. Culturally Specific Strategies Employing culturally specific strategies are successful at retaining families in treatment longer than in traditional outpatient and residential drug treatment programs (Dakof, Rowe, Liddle, & Henderson, 2003)

37. Outcomes Achieved � Incredible Years Increase in positive parenting Less harsh discipline Decease in child behavior problems 2/3 of the children were functioning in the normal range socially and academically at a 3 year follow up

38. Evaluation of Outcomes with Diverse Populations Reid, Webster-Stratton and Beauchaine, 2001 Asian (Vietnamese), African American and Latino parents Parents reported decreased child behavior problems at one year follow-up and increased parental confidence Parents rated the group discussion, group support and free child care as the most valuable aspects of the program

39. Independent Replications with Diverse Populations Rojas-Flores, 2001 � Latino Families Gross, 2002 � African American families with 2-3 year old children Increase in positive parenting Decrease in harsh discipline Increase in child competence Decrease in behavior problems