The Power of Culture :Embracing Diversity to Promote Recovery

1. The Power of Culture:Embracing Diversity to Promote Recovery Kim Bisset, Ed.D., CPRP Radiate Career Consulting Nikki Pashka, MS Side By Side Supported Living, Inc. USPRA CONFERENCE, Boise Idaho June 2010

2. Recovery Literature Recovery from Severe Mental Illnesses: Research Evidence and Implications from Practice(Davidson, Harding and Spaniol, 2005) • Recovery involves the development of a new meaning and purpose in one’s life as one grows beyond the catastrophic effects of psychiatric disability (Anthony, 1993). • Recovery refers to the…real life experiences of persons as they accept and overcome the challenge of the disability (Deegan, 1988). Center for Psychiatric Rehabilitation at Boston University, 2009

3. PRINCIPLES OF MULTICULTURAL PSYCHIATRIC REHABILITATION (USPRA, 2008) • Principle 1: PSR practitioners recognize that culture is central, not peripheral, to recovery, as culture is the context that shapes and defines all human activity. Center for Psychiatric Rehabilitation Boston University, 2009

4. Disparities Are Eliminated.President’s Freedom Commission Improve access to quality care that is culturally competent. Improve access to quality care in rural and geographically remote areas. Center for Psychiatric Rehabilitation Boston University, 2009

5. Aspects of DiversityExercise Identity Acculturation Discrimination Economic Status Level of Education Ethnicity Trauma Gender Illness/Disability Traditions Extended Family Country of Origin Race Religion Sexual Orientation Language

6. Healthy People 2010 • To eliminate racial and ethnic disparity, professional care providers and organizations need to become more culturally and linguistically competent. • We need to challenge and confront racism, sexism, classism, and other forms of prejudice and discrimination that occur in encounters as well as in the society-at-large. (Adapted from Betancourt, J. R. and R. C. Like. 2000. “Editorial: A New Framework of Care” Patient Care Special Issue, Caring for Diverse Populations: Breaking Down Barriers, May 15, 2000, pp. 10-12) Center for Psychiatric Rehabilitation Boston University, 2009

7. Stated that racial and ethnic minorities receive lower quality healthcare even when access to insurance and socioeconomic status are controlled. In addition to race and ethnicity, lower quality healthcare is often associated with a person’s national origin, limited English proficiency, religion, age, social class, gender, age, disability level, immigration status and obesity. Unequal Treatment: Confronting Racial and Ethnic Barriers in Health Care, March, 2002 Center for Psychiatric Rehabilitation Boston University, 2009

8. Mental health: Culture, Race, and Ethnicity-A supplemental for Mental Health (U.S.DHHS) 2001 • Racial and Ethnic Minorities bear a greater burden from unmet mental health needs, in Census 2000-30% of the US population. Projected for the year 2025 it will be 40% • 2000 Census data from Massachusetts states that 15.5% of the state population can be considered part of a minority group

9. Immigration Trends • The largest minority group in the USA now are Latinos followed by African Americans • The United States admits between 700,000 and 900,000 legal immigrants each year. • Those numbers refer to the total number of people who were granted permanent residence, half of whom are already living in the U.S., some illegally, some legally on temporary visas. Center for Psychiatric Rehabilitation Boston University, 2009

10. The shifting demographics in this country require providers to be CULTURALLY COMPETENT to effectively accomplish its mission According to the census, by 2050, Latino and Asian populations will double, and the Black population will grow by 71%. The US will attract 1 million immigrants a year, most of Latino or Asian origin. By 2030, 1 in 4 US residents will be Latino or Asian. Center for Psychiatric Rehabilitation Boston University, 2009

11. Key Components Ethnicity Race Multiculturalism Cultural Competence Racism Oppression Disability Center for Psychiatric Rehabilitation Boston University, 2009

12. The Process of Becoming Culturally Competent Center for Psychiatric Rehabilitation Boston University, 2009

13. FACTORS THAT IMPACT CULTURAL DIVERSITY ABILITY/ DISABILITY & AGE FAMILY/ COMMUNITY SUPPORT GENDER & SEXUAL ORIENTATION OPPRESSION EXPERIENCE URBANICITY CULTURAL DIVERSITY SOCIO- ECONOMIC STATUS IMMIGRATION STATUS EDUCATION ACCULTURA- TION RELIGION KNOWLEDGE OF RIGHTS & SERVICES RACE SENSE OF ENTITLEMENT LANGUAGE BELIEFS/ VALUES SOCIAL IDENTITY Center for Psychiatric Rehabilitation Boston University, 2009

14. DEFINITIONS OF KEY CONSTRUCTS RACE: • The biological bases of race have no consensual definition (there is greater within -group variation than between-group variation) • Therefore, race is the category to which others assign individuals on the basis of physical characteristics, such as skin color or hair type, and the generalization of stereotypes is made as a result. Center for Psychiatric Rehabilitation Boston University, 2009

15. Definitions (continued) ETHNICITY: • The acceptance of the group norms and practices of one's culture of origin and the concomitant sense of belonging. • People may have multiple ethnic identities which operate with different salience at different times. Center for Psychiatric Rehabilitation Boston University, 2009

16. Definitions (continued) MULTICULTURALISM: • Recognizes the broad scope of dimensions of race, ethnicity, language, sexual orientation, gender, age, disability, class status, education, religion/spiritual orientation, and other cultural dimensions; they are part of a person's ethnic/racial and personal identity. Center for Psychiatric Rehabilitation Boston University, 2009

17. Definitions (continued) RACISM: • Differential treatment based on race. Exclusion from full participation in any area of society merely on the basis of someone’s race. Center for Psychiatric Rehabilitation Boston University, 2009

18. Definitions (continued) OPPRESSION: • A state of domination in which the oppressed suffer the consequences of deprivation, exclusion, discrimination, exploitation, control of culture, and sometimes violence (Prilleltensky & Nelson, 2002). Center for Psychiatric Rehabilitation Boston University, 2009

19. Definitions (continued) DISABILITY: • Involves the interaction of individuals experiencing a physical, sensory, behavioral/emotional impairment and the social and environmental conditions that limits their functioning • Most individuals with disabilities experience some sort of oppression due to social or contextual barriers Center for Psychiatric Rehabilitation Boston University, 2009

20. Believing in Possibilities Slide presented from Lynn Legere, Direction of Education of the Transformation Center, 2009

21. Culturally Competent Care Culturally competent care is defined as the knowledge, skills and attitudes required to provide quality clinical care to patients from different cultural, ethnic and racial backgrounds. It involves tailoring delivery to meet the patients’ social, cultural and linguistic needs in an effort to improve outcomes and eliminate disparities in health care. http://medwed.med.harvard.edu/cccec Center for Psychiatric Rehabilitation Boston University, 2009

22. Understandable and Respectful Care Diverse Staff and Leadership Ongoing Education and Training Language Assistance Services Right to Receive Language Assistance Services Competence of language Assistance Patient- Related materials Written Strategic Plan Organizational Self-assessments Patient/Consumer Data Community Profile Community Partnerships Conflict /Grievance Processes Implementation Culturally and Linguistically Appropriate Standards (CLAS) Office of Minority Health Center for Psychiatric Rehabilitation Boston University, 2009

23. Person-centeredness and Multiculturalism Each individual presents varied perspectives, values, beliefs and behaviors regarding health and well being. Center for Psychiatric Rehabilitation Boston University, 2009

24. PRINCIPLES OF MULTICULTURAL PSYCHIATRIC REHABILITATION (USPRA, 2008) Principle 1: PSR practitioners recognize that culture is central, not peripheral, to recovery, as culture is the context that shapes and defines all human activity. Center for Psychiatric Rehabilitation Boston University, 2009

25. PRINCIPLES OF MULTICULTURAL PSYCHIATRIC REHABILITATION (USPRA, 2008) Principle 2: PSR practitioners study, understand, accept, and appreciate their own cultures as a basis for relating to the cultures of others. Center for Psychiatric Rehabilitation Boston University, 2009

26. PRACTICAL SKILL: KNOW YOURSELF • Identify one’s own cultural learn assumptions to promote culturally competent collaborative relationships with psychiatric disabilities and their natural support systems • Active role in your clinical supervision

27. PRINCIPLES OF MULTICULTURAL PSYCHIATRIC REHABILITATION (USPRA, 2008) Principle 3: PSR practitioners engage in the development of ongoing cultural competency, in order to increase their awareness and knowledge, and to develop the skills necessary for appropriate, effective cross-cultural interventions. Center for Psychiatric Rehabilitation Boston University, 2009

28. PRACTICAL SKILL: ACTIVELY ENGAGE • What changes has the your agency seen with regards to the diversity of its demographic population?

29. PRINCIPLES OF MULTICULTURAL PSYCHIATRIC REHABILITATION (USPRA, 2008) Principle 4:PSR practitioners recognize that thought patterns and behaviors are influenced by a person’s worldview, ethnicity and culture of which there are many. Each worldview is valid and influences how people perceive and define problems; perceive and judge the nature of help given; choose goals; and develop or support alternative solutions to identified problems. Center for Psychiatric Rehabilitation Boston University, 2009

30. PRINCIPLES OF MULTICULTURAL PSYCHIATRIC REHABILITATION (USPRA, 2008) Everyone can be successful with the right supports Examples of how important it is use open, supportive, diverse and inclusive practices when working with clients Center for Psychiatric Rehabilitation Boston University, 2009

31. PRINCIPLES OF MULTICULTURAL PSYCHIATRIC REHABILITATION (USPRA, 2008) Principle 5: PSR practitioners recognize that discrimination and oppression exist within society; these take many forms, and are often based on perceived differences in color, physical characteristics, language, ethnicity, gender, gender identity, sexual orientation, class, disability, age, and/or religion. Center for Psychiatric Rehabilitation Boston University, 2009

32. PRACTICAL SKILL: REMOVE BARRIER • Remove institutional barriers that sustain stigma, discrimination, add prejudice in order to provide culturally competent services

33. PRINCIPLES OF MULTICULTURAL PSYCHIATRIC REHABILITATION (USPRA, 2008) Principle 6: Practitioners apply the strengths and wellness approach to all cultures Briefly define “strength” (i.e. strength vs. skill) and “wellness” (i.e. more building blocks/$ in the bank to stay well) (balance) Center for Psychiatric Rehabilitation Boston University, 2009

34. PRACTICAL SKILL: Embracing Strengths Making your space supportive Pictures Positive role models Language capacity Center for Psychiatric Rehabilitation Boston University, 2009

35. PRINCIPLES OF MULTICULTURAL PSYCHIATRIC REHABILITATION (USPRA, 2008) • Principle 7: PSR practitioners show respect towards others by accepting cultural values and beliefs that emphasize process or product, as well as harmony or achievement. • They demonstrate that respect by appreciating cultural preferences that value relationships and interdependence, in addition to individuality and independence. Center for Psychiatric Rehabilitation Boston University, 2009

36. PRINCIPLES OF MULTICULTURAL PSYCHIATRIC REHABILITATION (USPRA, 2008) Principle 8: PSR practitioners accept that solutions to any problem are to be sought within individuals, their families (however they define them), and their cultures. Center for Psychiatric Rehabilitation Boston University, 2009

37. PRACTICAL SKILLS:Families and/ natural supports Natural systems (e.g., family, community, church, healers) are the primary mechanisms of support for many individuals and populations. Individuals are served in various ways and to varying degrees by their natural system. We need to find ways to partner with those natural supports.

39. PRINCIPLES OF MULTICULTURAL PSYCHIATRIC REHABILITATION (USPRA, 2008) Principle 9: PSR practitioners provide interventions that are culturally syntonic, and accommodate culturally determined strengths, needs, beliefs, values, traditions, and behaviors. Center for Psychiatric Rehabilitation Boston University, 2009

40. PRACTICAL SKILLS: TEACH • Teach persons with psychiatric disabilities and their natural support systems the skills to recognize and overcome cultural barriers.

41. PRINCIPLES OF MULTICULTURAL PSYCHIATRIC REHABILITATION (USPRA, 2008) Principle 10: PSR practitioners are responsible for actively promoting positive inter-group relations, particularly between the people who attend their programs and with the larger community. Discuss examples of Asian positive inter-group relations-i.e. cooking and meal/family time Discuss cultural/Asian stigma and how that is a barrier to preventing Asian people and others from seeking out metal health services. Discuss how stigma can also make it more difficult for Asian people and others to be re-integrated into society. Center for Psychiatric Rehabilitation Boston University, 2009

42. PRINCIPLES OF MULTICULTURAL PSYCHIATRIC REHABILITATION (USPRA, 2008) • Discuss cross-cultural research in the field of mental health that is needed • Discuss and give examples of ways to respect and celebrate cultural values Center for Psychiatric Rehabilitation Boston University, 2009

43. PRINCIPLES OF MULTICULTURAL PSYCHIATRIC REHABILITATION (USPRA, 2008) • “Making All the Difference” Stigma hurts Outcasted by your own culture Afraid of family’s eyes, Scared of not knowing genuine friendships Constantly crying, hurting inside, But suddenly someone respects my cultural values Understands my cultural needs And realizes what personally defines the essence that is Me. Someone gives me a genuine smile, Envelops me in a warm embrace of a hug. And that someone makes all the positive difference in my life. Giving me the courage to smile, hug, and take and travel the risky roads to transform and make all the positive difference in the lives of others. I leave us all then, with this challenge: Let’s all make a positive cultural difference in the field of mental health. Written By Janel Tan

44. Questions • Where Am I in relationship of this principles? • Where is my agency?

45. Time for Questions and Answers

46. Resources • www.uspra.org • Chapter 11: Diversity and Cultural Competence, Psychiatric Rehabilitation Skills in Practice: A CPRP Preparation and Skills Workbook, Executive Editor Mark S. Salzer, USPRA, 2006.