6. week-6 powerpoint-sbirt_feb-2019

1. Preparing Your Health Center for
SBIRT Implementation
Christina Boyd, LSCSW, LCAC

2. Cultural Considerations
and Co-Occurring Disorders
Week #6

3. Agenda
• Check in-What is important to
you?
• Review Learning Activity-
Observation Checklist
Welcome
• Cultural Aspects to Consider
• Co-Occurring Disorders
Presentation
• Wrap Up and Next Steps
• Questions
Summary

4. How did the
observation
go?
What things
did you
notice?
Anything from
the Checklist
that was
particularly
helpful?
Let’s Talk
about your
Learning
Activity!

5. Remember
why we are
looking at all
of this….

6. Substance
Use
Resources

9. • As US populations become more diverse, increased need to provide Culturally and Linguistically
Appropriate Services (CLAS)
• Each health care interaction occurs in context of three cultures
• Healthcare provider’s lived experiences
• Experiences of person seeking care
• Culture of healthcare system itself
• Wide variations in attitudes, beliefs, behaviors exist among all individuals
• This includes bias
• Can we really become “competent” in another person’s culture?
• Is “competence” a skill we can master?
• We should try to learn about cultural specificities of particular groups and populations we
work with, recognize variations within those groups, and try to understand overlaying general
experiences of each population (ACOG, 2018)
Cultural Sensitivity

10. Used With Permission From: Diana Padilla
Addiction Counseling Competencies, https://store.samhsa.gov/product/TAP-21-
Addiction-Counseling-Competencies/SMA15-4171
Awareness
• Differences of culture and one’s own
• Value diversity
Attitude
• Aware of own biases, values & belief systems
• Acknowledgement & respect for cultural differences
Knowledge
• Inherent cultural trends of population
• Current research on effective practice
Skills
• Use of appropriate name or pronouns
• Engagement approaches
Cultural Competence Core Elements

11. Used With Permission From: Diana Padilla
Self reflection
• Incorporate an understanding of culture, relational
dynamics and differences
• Develop self awareness and identify personal
cultural perspectives
• Recognize and address personal bias
Self-reflection activity: Take time each evening to reflect on
your behavior for the day. How do you perceive yourself?
How do others perceive you? What can I learn from
observing my behavior today?
Before Working with a Diverse Person

12. Used With Permission From: Diana Padilla
• Inclusive environment
• Initial approach and greeting
• Fostering a rapport
Recovery oriented language is strength based and
person centered, which is foundational to
culturally informed practice.
Engage

13. Botticelli-Koh-Changing-the-Language-Addiction, JAMA 2016Used With Permission From: Diana Padilla
• People with mental illness were labeled as “lunatics” and
sequestered into “insane asylums.”
• Early days of HIV, patients were referred to as having “gay-
related immune deficiency.” (GRID)
• For someone struggling with addiction or substance use
disorder, language can be impactful.
• Stigma and shame are typically uniformed biases, that can
further depress potential motivation needed for recovery.
When Language Impacts

14. Used With Permission From: Diana Padilla
• Changing language, (and policies and programs)
will take time. For instance, the word “abuse”
continues to appear in the titles of highly
respected addiction journals and in the names of
federal government agencies despite the changes
in the DSM5.
• By beginning to change the language of addiction,
it is possible to foster a better future for people
with SUDs and remove barriers that hold back
people from committing to treatment they need.
Working on Change

15. • UA was positive for X substance
• She has a Substance Use Disorder and
needs help
• She is a person in sustained recovery
from opioids
• She had a slip or a relapse
• There is always HOPE that people can
change
(It doesn’t guarantee they will and
sometimes it is not on our timeframe)
Use This INSTEAD…
• Sally’s UA is dirty
• “Another junkie in room 5”
• She is an old addict
• She keeps screwing up
• You are never going to change
Think about NOT saying…
Words Become our World

16. Used With Permission From: Diana Padilla
• Familiarity with inherent cultural trends of
communities being served can be helpful in
guiding interactions
• Stay abreast of culturally and linguistically
appropriate evidence based practices and
interventions
Practitioner Knowledge

17. • What are some of the cultural
considerations that you need to
be aware of in your
community?
• How do these cultural norms or
beliefs affect SBIRT in your
agency?
Group Discussion

18. NDRI, Cultural Proficiency in Drug Court Programs curricula,
Contrasting Values, Attitudes and Behaviors, 2002
Used With Permission From: Diana Padilla
Eye contact
• It is best to look at people directly in the
eye when talking to them; otherwise, you
are seen as dishonest or uncaring.
• It is very rude and hostile to look at people
directly in the eye when talking.
Contrasting Values, Attitudes, Behaviors

19. NDRI, Cultural Proficiency in Drug Court Programs curricula,
Contrasting Values, Attitudes and Behaviors, 2002Used With Permission From: Diana Padilla
Control over illness
• We all have the power to help ourselves
get better.
• There is nothing we can do about being
sick, because our fate is in the hands of
a higher power.
Contrasting Values, Attitudes, Behaviors

20. Hurdles to effective treatment
What are some things that you see in your practice setting that have to do
with culture that get in the way of people getting better?
-Please use your chat function to write in your thoughts

21. Source: C. Storti, (1994). “Cross-cultural Dialogues.”
Used With Permission From: Diana Padilla
1. Don’t assume sameness
2. What you think of as normal human behavior may only be cultural
3. Familiar behaviors may have different meanings. Same behaviors
may not mean the same thing
4. Don’t assume that what you meant is what was understood
5. Don’t assume that what you understood is what was meant
6. You don’t have to like or accept “different” behavior, but you can try
to understand where it comes from
7. Most people do behave rationally, you just have to discover the
rationale
7 Lessons in Cross Cultural Dialogue

22. Used With Permission From: Diana Padilla
1. Tell me about your racial /ethnic /religious background
and share something about the commonly held values
and beliefs of people in your community.
2. How are you the same as others in your community?
3. How are you different from others in your community?
4. What two things would help the program deliver
effective services to you?
Culturally Informed Questions

23. Integrating Treatment for
Co-Occurring Disorders

24. of people with a substance
use disorder, have or have
had a psychiatric disorder.-
*Co-occurring disorders program: integrating
combined therapies, 2008 , Hazelden
60-70%

25. of adults with a
Mental Illness also
have a chronic
health condition-
National Council
for Behavioral
Health-2013
68%...

26. • A variety of studies
have concluded that
70% of all
healthcare visits
have primarily a
psychosocial basis.
(Strosahl, 1998;
Fries, et. al., 1993;
Shapiro, et. al.,
1985)Opportunity to touch
more lives

27. Mood Disorders
➢Depression
➢Bipolar
Anxiety
➢Generalized
➢Trauma
Common Mental Health
Disorders

28. https://www.youtube.com/watch
?v=_y97VF5UJcc
Mental
Health: In our
own words

29. Where to get help
Insurance Coverage
➢ ACA changes in benefit coverage
➢ No pre-existing conditions
➢ SA and MH are essential health benefits

30. YOU TELL US!!
1. What resources do you
need to move forward?
(training, materials, tech
support)
2. What is your next step
in using SBIRT to Change
the service delivery in your
agency?Sneak Peek at the
future ….

31. What is 1 thing
that has stood out
for you in this
series?
Group
Discussion

32. Rarely seen
historical
photo….