The Role of culture in integrating schools and mental health

1. The Role of culture in integrating schools and mental health Presented to the Department of Student Support Services, Hillsborough County Public SchoolsPaul R. Wharton High School, 20150 Bruce B Downs Boulevard, Tampa, FL. 33647 October 17, 2008 Mario Hernandez, Ph.D. and Teresa Nesman, Ph.D. Department of Child and Family Studies Louis de la Parte Florida Mental Health Studies School of Mental Health Studies

2. Purpose • Why is culture important? • Identify issues/challenges faced in serving diverse children and their families • Increase awareness of how recommendations made by school personnel might be perceived by diverse families

3. Assumption Underlying • Culture plays a pivotal role in child development, parenting, learning approaches as well as in mental health and mental illness

4. What Is Culture? • Culture has been defined in various ways by different disciplines and for numerous purposes (Kao, Hsu, & Clark, 2004) • It is often invisible to people until they find themselves in a cross-cultural situation

5. Maslow’s Hierarchy Of Needs: Humanistic Theory Self Actualization Culture: Esteem and Identity Love and Belonging The way we go about meeting our needs Safety and Security Physiologic (e.g., Food, Water) (Cross, Bazron, Dennis, & Isaacs, 1989)

6. Why Is Culture Important To Mental Health? • Life trajectories of diverse children and youth are impacted when disproportionate numbers end up in systems such as child welfare, juvenile justice, and alternative education, etc.

7. Sadly, relatively high levels of severity of a mental health problem are required in order for culturally-diverse individuals to overcome their reluctance to seek help from a professional • This is likely true for all people

8. In The US…. • Emergency rooms are swamped with people with mental health problems with nowhere to go; and the failure to treat those with serious mental health problems has resulted in incalculable cost, in terms of real dollars and human suffering, to the community and individuals (Gruskin & Dickens, 2006, p. 1904). • Schools have born the burden of unmet mental health needs of both children and their families. Gaul, C. E, & Farkas, C. (2007). Public Health and Mental Health: A model for Success. Perspectives in Psychiatric Care. Oct.

9. Global Conditions Experienced By Many Of Our Children And Their Familes • Unfortunately, in most parts of the world, mental health and mental disorders are not regarded with anything like the same importance as physical health, instead, they have been largely ignored or neglected. World Health Organization. (2001). The World Health Report 2001. Mental Health: New Understanding, New Hope. France.

10. Global Conditions Experienced By Many Of Our Children And Their Familes • Most individuals with severe mental disorders and their families are left to cope as best they can with their private burdens such as depression, dementia, schizophrenia, and substance dependence. • Many are victimized for their illness and become the targets of stigma and discrimination. World Health Organization. (2001). The World Health Report 2001. Mental Health: New Understanding, New Hope. France.

11. Examples Of Disparities In Mental Health African Americans • Less likely to seek treatment and when they do seek treatment, they are more likely to use the emergency room for mental health care, and they are more likely than whites to receive inpatient care. For More Information please refer to SAMHSA Surgeon General's Report: Mental Health Fact Sheet for African Americans. Available Online at: http://www.mentalhealth.samhsa.gov/cre/fact1.asp

12. Examples Of Disparities In Mental Health Latinos/Hispanic Americans • In a national survey of high school students, Hispanic adolescents reported more suicidal ideation and attempts than whites and blacks. For More Information please refer to SAMHSA Surgeon General's Report: Mental Health Fact Sheet for Latinos/Hispanic Americans. Available Online at: http://www.mentalhealth.samhsa.gov/cre/fact3.asp

13. Examples Of Disparities In Mental Health Asian American/Pacific Islanders • When they do seek care, they are more likely to be misdiagnosed as "problem-free“. For More Information please refer to SAMHSA Surgeon General's Report: Mental Health Fact Sheet for Asian American/Pacific Islanders. Available Online at: http://www.mentalhealth.samhsa.gov/cre/fact2.asp

14. The Challenges We Face Integrating Mental Health And The Schools • Stigma • Lack of trust • System bias (managed care, Medicaid, etc.) and institutional racism • Navigating unfamiliar systems Hernandez, M. Nesman, T., Isaacs, M., Callejas, L. M., & Mowery, D. (Eds.). (2006). Examining the research base supporting culturally competent children’s mental health services. Tampa, FL: USF, Louis de la Parte Florida Mental Health Institute, Research & Training Center for Children’s Mental Health. Online at:http://rtckids.fmhi.usf.edu/rtcpubs/CulturalCompetence/services/CultCompServices.pdf

15. Cultural Competence

16. Definition Of Cultural Competence • “Cultural Competence” is a set of behaviors and attitudes that come together in a person that enable him or her to work effectively in cross-cultural situations. • The word “cultural” is used because it implies an integrated pattern of human behavior that includes thoughts, language, actions, customs, beliefs, and values shared by a social group, including service providers or school personnel. • The word “competence” is used because it implies having the capacity to learn and function effectively in cross-cultural interactions. (Cross, Bazron, Dennis, & Isaacs, 1989)

17. Essential Elements Of Cultural Competence • Value diversity; • Have the capacity for cultural self-assessment; • Institutionalize cultural knowledge; • Develop adaptations to diversity; and • Be conscious of the dynamics inherent when cultures interact (Cross, Bazron, Dennis, & Isaacs, 1989)

18. Summary Of Cultural Competence Continuum • Cultural Destructiveness • Cultural Incapacity • Cultural Blindness • Cultural Pre-Competence • Cultural Competence • Advanced Cultural Competence (Cross, Bazron, Dennis, & Isaacs, 1989)

19. Consequence Of Well-Meaning Cultural Blindness

20. Compatibility With Our Community Populations

21. Compatibility withCommunity Populations Cultural Competence means developing compatibility • Between schools and populations • Between mental health providers and populations Cultural/Linguistic characteristics of a community’s population Compatibility An organization’s combined policies, structures and processes that support compatibility Hernandez, M., & Nesman, T. (2006)

22. Understanding The Racial, Ethnic And Cultural History Of Your School’s Community • Who lives in the community? • What are population characteristics such as: • Cultural view of mental health • History • Language • Resources • Strengths • Needs • What are the accepted racial and ethnic stereotypes in the community?

23. Creating a Front Porch: Strategies for Improving Access to Mental Health Services • Responsive to both child & family • Supportive family focus • Simplified intake process • Address stigma & adapt mental health terminology • Outreach to community organizations & providers • Broad network of services and supports • System navigation • Flexible, individualized, culturally specific interventions

24. Consequences Of Untreated Mental Health Issues…. • "While mental disorders may touch all Americans either directly or indirectly, all do not have equal access to treatment and services. The failure to address these inequities is being played out in human and economic terms across the nation – on our streets, in homeless shelters, public health institutions, prisons and jails.“ • For our country’s children and youth, the schools are front lines for connecting to, and at times, providing formal mental health services United States Surgeon General Press Release: Sunday, August 26, 2001 http://mentalhealth.samhsa.gov/cre/release.asp

25. Additional Resources http://rtckids.fmhi.usf.edu/rtcpubs/CulturalCompetence/porch/default.cfm http://rtckids.fmhi.usf.edu/rtcpubs/CulturalCompetence/protocol/default.cfm http://rtckids.fmhi.usf.edu/rtcpubs/CulturalCompetence/services/default.cfm

26. References • Cross, T., Bazron, B., Dennis, K., & Isaacs, M. (1989). Toward a culturally competent system of care: A monograph on effective services for minority children who are severely emotionally disturbed. Washington, DC: National Technical Assistance Center for Children’s Mental Health. • Gaul, C. E, & Farkas, C. (2007). Public Health and Mental Health: A model for Success. Perspectives in Psychiatric Care. Oct. • Hernandez, M. Nesman, T., Isaacs, M., Callejas, L. M., & Mowery, D. (Eds.). (2006). Examining the research base supporting culturally competent children’s mental health services. Tampa, FL: USF, Louis de la Parte Florida Mental Health Institute, Research & Training Center for Children’s Mental Health. • Kao, H. S., Hsu, M. T., & Clark, L. (2004). Conceptualizing and critiquing culture in health research. Journal of Transcultural Nursing, 15, 269-277. • Masi, R., & Cooper, J. (2006, November). Children’s Mental Health Facts for Policymakers. http://nccp.org/publications/pub_687.html#10 • Martinez, K., Garay, L. (2008, July). Community Outreach and Engagement. Cultural and Linguistic Competence Pre-Institute. Symposium presented at the Training Institutes 2008, Nashville, TN • Takaki, R. (1993). A different mirror: A history of multicultural America. Boston, MA: Little, Brown and Company. • United States Surgeon General Press Release: Sunday, August 26, 2001. http://mentalhealth.samhsa.gov/cre/release.asp • U.S. Department of Health and Human Services [DHHS]. (1999). Mental health: A report of the Surgeon General. Rockville, MD: Author. • World Health Organization. (2001). The World Health Report 2001. Mental Health: New Understanding, New Hope. France. http://www.who.int/entity/whr/2001/en/whr01_en.pdf