Toolkit for Modifying Evidence-Based Practices to Increase Cultural Competence

Size: px

Start display at page:

Download "Toolkit for Modifying Evidence-Based Practices to Increase Cultural Competence"

Leona Welch
6 years ago
Views:

1 Toolkit for Modifying Evidence-Based Practices to Increase Cultural Competence Judith Samuels, PhD Research Scientist: Center of Excellence in Culturally Competent Mental Health at The Nathan Kline Institute for Psychiatric Research Asst. Research Professor: Child Study Center at New York University School of Medicine Consultant: SP 3 Innovation

2 Today s Agenda Who we are and what we do Introduce Toolkit methodology Other tools available in the Toolkit Case study: Modifying an EBP for African American Community

3 NKI Center of Excellence in Culturally Competent Mental Health What we do: Study the intersection of mental health and culture Develop tools to help agencies achieve a high level of cultural competence in the delivery of services Train agencies and practitioners to apply tools within their organizations with the goal of engaging consumers and improving outcomes

The Need to Modify EBPs There is a need for effective mental health interventions for cultural groups o EBPs have not been developed for specific

specific cultural groups, but materials such as training manuals do not reflect the breadth of cultures served Registries include a growing list of

4 The Need to Modify EBPs There is a need for effective mental health interventions for cultural groups o EBPs have not been developed for specific cultural groups o EBPs have been developed, but not tested for effectiveness for specific cultural groups o EPBs have been developed and tested for specific cultural groups, but materials such as training manuals do not reflect the breadth of cultures served Registries include a growing list of effective interventions (e.g, NREPP, findyouthinfo, cebc4cw, APA) There is no systematic method for considering adaptations to EBPs for cultural groups

5 Toolkit Uses Populations Children Adults Seniors Intervention Types EBPs and other practices Treatment Prevention Cultural Groups

6 CASE STUDY Introducing Agency X Agency X is a state-licensed, not-for-profit agency that has been a leader in mental health, home health care, developmental disabilities and human services for over 70 years, serving all people living or working within their catchment area. Multiple-sites across catchment area. The site featured in this case study provides a host of services to children and families including mental health services for adults and children, school-based mental health services, support groups for senior citizens, services for those with intellectual disabilities, and, most recently, support services for those impacted by Hurricane Sandy.

7 Toolkit for Modifying Evidence- Based Practice to Increase Cultural Competence

8 Toolkit for Modifying Evidence- Based Practice to Increase Cultural Competence

9 Toolkit for Modifying Evidence- Based Practice to Increase Cultural Competence

10 Toolkit for Modifying Evidence- Based Practice to Increase Cultural Competence

11 Toolkit for Modifying Evidence- Based Practice to Increase Cultural Competence

12 Toolkit for Modifying Evidence- Based Practice to Increase Cultural Competence

13 Toolkit for Modifying Evidence- Based Practice to Increase Cultural Competence

14 Toolkit for Modifying Evidence- Based Practice to Increase Cultural Competence

15 Toolkit for Modifying Evidence- Based Practice to Increase Cultural Competence

16 Toolkit for Modifying Evidence- Based Practices to Increase Cultural Competence

17 CASE STUDY Agency X s Problem Clinic staff wanted to adapt Parent Management Training (PMT) for the African-American families they served. They believed that the program, as it was practiced, did not necessarily meet the community s specific needs.

18 CASE STUDY About PMT PMT is an evidence-based intervention used to address problem behaviors in children and adolescents Target of intervention: parents Theoretical underpinnings: operant conditioning Positive reinforcement Punishment and extinction

champions within the organization and the agency Establishing the collaborative process

19 Working with Communities: The Working Group Identifying the types of individuals needed for a successful working group Requesting individuals to serve on the working group Encouraging champions within the organization and the agency Establishing the collaborative process communication and meetings Establishing working group goals and processes Putting the working group into action

hinges on the development and activities of a working group: Determining who to

20 Working with Communities Goals: Increase knowledge about cultural groups and their mental health needs Increase acceptance of services Community involvement hinges on the development and activities of a working group: Determining who to work with and why Working together on modifications Working through implementation issues

21 CASE STUDY Working with Communities Who to include in the Working Group? Grandparents School social worker Minister Coach at the local boxing club Describing the project to potential community members: In response to the many requests for help with the management of children s behavior, we are looking to adapt our parenting program to the African-American culture in the community. We are assembling a working group because we want to bring together the clinical expertise of staff and practical expertise of parents and community members. Since every community has distinct needs and challenges, we are looking to modify the protocol to address the specific characteristics of this community.

22 AUDIENCE INPUT Working with Communities Who would you include in your Working Group? How would you describe your project/program to community members? How would your language differ? How would your description of the intervention differ?

23 Selecting an EBP 1. Identify possible EBPs 2. Evaluate the cultural appropriateness of EBPs Determining cultural fit Pragmatic considerations Identifying the need for cultural adaptations 3. Making a final decision

24 Selecting an EBP in an Agency Setting NREPP Evaluation at HSRI sp?stmode=start

25 Basis for Selection Collaboration between organization administrators, Working Group, and clinic director

26 AUDIENCE INPUT Basis for Selection What do you consider key factors for selection? What do you think your community considers key factors? How else have you thought about fit?

27 Modifying EBPs 1. Breaking down the EBP into components using the helping process model and determining which components to modify 2. The process of modification 3. Documenting modifications 4. Piloting the modified EBP 5. Evaluating the success of the modification

28 A Framework for Identifying Components Engagement Work Termination/Discharge Access Specific Cultural Factors

Health Family Worldview One place to get more

29 Identifying Relevant Specific Cultural Factors Views of mental health and illness Social positioning Lifestyle Health Family Worldview One place to get more information about specific cultural groups: NKI Center of Excellence

30 Toolkit Tables

31 CASE STUDY Modifying PMT at Agency X Develop rapport and relationships with families prior to introducing PMT. Be up front regarding Child Protective Services what is and is not reportable and clinicians roles in reporting. Explore parents life experiences regarding corporal punishment. Address families crises first. Understand families coming with an expectation that you will help them and assist them in fixing their crisis. Consider separating generations in a group setting

32 CASE STUDY More on Modifying PMT Offer PMT in a neutral setting. Consider universal programming. Thoroughly assess who lives or helps in the home and who is in charge. Understand that multiple generations or extended family may reside in the home and there may be a fluid back and forth transfer of power among adults. Be aware of the notion of respect. Families will not buy into the notion of ignoring what they perceive to be disrespectful behavior. Reframe parents intervention as choosing not to get emotionally involved. For example, instead of ignoring back talk, parents can state that conversation can take place later when the child is calm.

33 AUDIENCE INPUT Modifying EBPs Are there components of your intervention that should NOT be modified? Can you identify components of your intervention that fall in these categories: Access Engagement Work Termination/discharge How do you think your Working Group can help you integrate the community s Cultural Factors?

34 Implementation Issues Evaluating organizational readiness for change Evaluating the organization s current level of cultural competence Training Final implementation

35 CASE STUDY Implementation Issues at Agency X No formal readiness for change assessment; however, they prefer to develop readiness for change in incremental steps in order to get where we want to go with change. Committee focusing on race, diversity, and cultural competence Extensive cultural competence training for administrators, staff, supervisors

36 Other tools available in the Toolkit Workbook checklist and templates to help you complete the tasks in your organization Annotated bibliography Instruments to help assess your organization s level of cultural competence and readiness for change Case Studies

37 Sections in the Toolkit correspond to. templates to help you complete the work. Connecting the Toolkit and Workbook

38 Case Studies 1. Native Hawaiians: Adaptation of Wellness Recovery 2. NY City Children: ParentCorps, Adaptation of a Prevention Intervention 3. Russian Speaking Seniors: Adaptation of Problem Solving Therapy 4. African American Children: Adaptation of Parent Management Training

39 Questions and/or Comments?

Toolkit for Modifying Evidence-Based Practices to Increase Cultural Competence: Checklist and Workbook. Wendy Schudrich, MSW

Toolkit for Modifying Evidence-Based Practices to Increase Cultural Competence: Checklist and Workbook Wendy Schudrich, MSW Center of Excellence in Culturally Competent Mental Health, The Nathan Kline