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Lee Underwood Rm Strategies


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Lee Underwood Rm Strategies

  1. 1. Farley Center at Williamsburg Place Barry Robinson Center St. Brendans Harbor <ul><li>Competency and Motivational </li></ul><ul><li>Engagement Strategies </li></ul><ul><li>April 22, 2011 </li></ul><ul><li>Lee A. Underwood, Psy.D., </li></ul><ul><li>USA Consulting Group, LLC </li></ul>
  2. 2. Class Objectives <ul><li>Define terms associated with Cultural Competency </li></ul><ul><li>Discuss the Cultural Competency Continuum </li></ul><ul><li>Discuss perceptions and how communication miscues occur </li></ul><ul><li>Discuss Motivational strategies for youth </li></ul><ul><li>Review Case Study to identity possible Cultural Competency issues </li></ul><ul><li>Identify tips to becoming more culturally competent </li></ul>
  3. 3. Definitions Let’s make sure we are all on the same page by defining some words associated with…Cultural Competency
  4. 4. Related Terms <ul><li>Institutionalized Racism </li></ul><ul><li>Also referred to as Structural or Systemic Racism </li></ul><ul><li>A form of racism which is structured into political and social institutions </li></ul><ul><li>Occurs when institutions, including corporations, governments and universities, discriminate either deliberately or indirectly, against certain groups of people to limit their rights. </li></ul><ul><li>Reflects the cultural assumptions of the dominant group, so that the practices of that group are seen as the norm to which other cultural practices should conform </li></ul>
  5. 5. Related Terms <ul><li>Institutionalized Racism cont’d </li></ul><ul><li>More subtle, less visible, and less identifiable than individual acts of racism, but no less destructive to human life and human dignity. </li></ul><ul><li>The people who manage our institutions may not be racists as individuals, but they may well discriminate as part of simply carrying out their job, often without being aware that their role in an institution is contributing to a discriminatory outcome. </li></ul>
  6. 6. Cultural Competence Continuum Ignorance Awareness Sensitivity Understanding Competence
  7. 7. Ignorance is… <ul><li>the state or fact of being ignorant : lack of knowledge, education, or awareness </li></ul>
  8. 8. What Ignorance looks like? Unaware of biases, prejudices or their impact on others. Unaware of pain and damage to others Unaware behavior is offensive. Accept stereotypes as facts.
  9. 9. Cultural Awareness… <ul><li>being cognizant, observant, and conscious of similarities and differences among cultural groups </li></ul>
  10. 10. What Awareness looks like? Aware of biases and prejudices. Aware that their behavior offends others. But still may behave in ways that reinforce and reward bigotry.
  11. 11. Cultural Sensitivity is…. <ul><li>the ability to adjust one’s perceptions, behaviors, and practice styles to effectively meet the needs of different ethnic or racial groups </li></ul>
  12. 12. What Sensitivity looks like? Aware of biases in selves and others. Work on their prejudices, reluctant to address inappropriate behavior of others. Play it safe by saying nothing. Silent supporters.
  13. 13. Cultural Understanding is… <ul><li>understanding the needs and emotions of your own culture and the culture of others </li></ul>
  14. 14. What Understanding looks like? Aware of biases in selves and others. Willing to take action when they encounter inappropriate words, behaviors. Respond in way that is fair to others.
  15. 15. Cultural Competency is… <ul><li>a set of skills, knowledge and attitudes, which enhance an individual’s: </li></ul><ul><li>awareness of his or her own assumptions and values as well as other prevailing attitudes toward culture; </li></ul><ul><li>understanding of and respect for other’s values, beliefs and expectations; and </li></ul><ul><li>the ability to adapt his or her interactions to be more in touch with other’s expectations and preference. </li></ul>
  16. 16. What Competency looks like? Constantly aware of any behaviors that seems to be biased or prejudiced.   Question actions of others and confronts people about such behaviors.
  17. 17. Iceberg Metaphor Only 10% of an iceberg is visible (conscious) whereas the other 90% is beneath the water (preconscious and unconscious). The Preconscious is allotted approximately 10% -15% whereas the Unconscious is allotted an overwhelming 75%-80%. ------------------------------------- -------------------------------------
  18. 18. Cultural Biased Assumptions <ul><li>Culturally Biased Assumptions </li></ul><ul><li>We all share a single measure of “Normal” behavior. </li></ul><ul><li>“ Individuals” are the basic building blocks of society. </li></ul><ul><li>Problems are defined by a framework limited by “academic” discipline boundaries. </li></ul><ul><li>Others will understand our “abstractions” in the same way as we intend. </li></ul><ul><li>Independence is desirable and dependence is undesirable. </li></ul>USA Consulting Group
  19. 19. Cultural Biased Assumptions <ul><li>Formal systems of support are more helpful than natural informal support systems </li></ul><ul><li>Everyone depends on linear thinking to understand the world around them. (Cause and Effect) </li></ul><ul><li>Individuals need to change to fit the system, not the system needs to fit the individual </li></ul><ul><li>History is not relevant for a proper understanding of current events. </li></ul><ul><li>We already know all of our assumptions. </li></ul>USA Consulting Group
  20. 20. Perceptions
  21. 21. Contact/Decision Points <ul><li>Contact Points (identified by OJJDP): </li></ul><ul><li>Arrest, Referral, Diversion, Detention, Petition/Charge, Delinquent Finding, Probation, Residential Treatment, Residential Group Home, Secure Confinement, Transfer to Adult Court </li></ul><ul><li>Also – assignment of minimum length of stay </li></ul>
  22. 22. Contact/Decision Points <ul><li>What are they for most systems? </li></ul><ul><ul><ul><ul><ul><li>Classification </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Eligibility for Special Unit </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Stages of Change </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Juvenile Community Re-integration Board </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Parole Revocation </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Absolute Discharge </li></ul></ul></ul></ul></ul>
  23. 23. Cultural Miscues <ul><li>Brief and commonplace daily verbal, behavioral or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory or negative racial slights and insults. </li></ul><ul><li>People are generally unaware that they engage in such communication when they interact with racial/ethnic minorities. </li></ul><ul><li>A taxonomy (list) of examples was created through a review of the literature </li></ul>
  24. 24. Examples of Cultural Miscues When a person is assumed to be foreign born Where are you from? Where were you born? You speak good English. You are not American. You are a foreigner. THE THEME THE STATEMENT THE MESSAGE Assigning intelligence You are a credit to your race. You are so articulate People of color are generally not as intelligent. It is unusual for someone of your race to be so intelligent Criminality /assumption of criminal status A white man or woman clutches purse or wallet as a person of color passes. A store owner following a customer of color around the store You are a criminal. You are dangerous. You are going to steal.
  25. 25. Offensive Statements <ul><li>“ Indian giver” </li></ul><ul><li>“ That’s so gay.” </li></ul><ul><li>“ She welshed on the bet.” </li></ul><ul><li>“ I jewed him down” </li></ul><ul><li>“ That’s so white of you.” </li></ul><ul><li>“ You people . . .” </li></ul><ul><li>“ We got gypped.” </li></ul>
  26. 26. <ul><li>Does the youth have a problem(s) behaviorally, emotionally, in relationships that are of sufficient severity and duration to cause distress, disability or disadvantage? </li></ul><ul><li>If there is a problem(s), is the youth profile consistent with a recognizable pattern? </li></ul>Critical Motivational Questions
  27. 27. <ul><li>What are the sustaining forces that maintain the problem(s) and behaviors? </li></ul><ul><li>What are the strengths, resiliencies and competencies? </li></ul><ul><li>What, if any, program services have successfully benefited the youth in the past? </li></ul>Critical Motivational Questions
  28. 28. <ul><li>What is the motivation and readiness level for change? </li></ul><ul><li>What is the extent of substance use and insight? </li></ul><ul><li>What types of brief counseling interventions are most likely to be effective? </li></ul><ul><li>What is the nature of the offense and how is it related to future risk? </li></ul>Critical Motivational Questions
  29. 29. Motivational Strategies <ul><li>Applying stages of change. </li></ul><ul><ul><ul><li>Resolving ambivalence. </li></ul></ul></ul><ul><ul><ul><li>Reframing techniques. </li></ul></ul></ul><ul><ul><ul><li>Support compliance. </li></ul></ul></ul><ul><ul><ul><li>Establishes partnership . </li></ul></ul></ul><ul><ul><ul><li>Consistent feedback. </li></ul></ul></ul><ul><ul><ul><li>Going beyond resistance. </li></ul></ul></ul>
  30. 30. <ul><li>Key Components of Effective Treatment </li></ul><ul><ul><li>Solution Focused Strategies </li></ul></ul><ul><ul><li>Address Here & Now Issues </li></ul></ul><ul><ul><li>Understand the Role of Etiology </li></ul></ul><ul><ul><li>Assume Active Oriented Stance </li></ul></ul><ul><ul><li>Relational Issues Should Be Change Targets </li></ul></ul>Motivational Strategies
  31. 31. <ul><ul><li>Strengths-based Approaches Must Be Incorporated </li></ul></ul><ul><ul><li>Integrated & Evidence-based Treatments Should Be Incorporated </li></ul></ul><ul><ul><li>Family Inclusion Must Drive Treatment </li></ul></ul><ul><ul><li>Practical Approaches Are Preferred </li></ul></ul>Motivational Strategies
  32. 32. <ul><li>Understand family history </li></ul><ul><li>Recognize learning style </li></ul><ul><li>Be aware of psychiatric issues </li></ul><ul><li>Get a detailed psychosocial history </li></ul><ul><li>Open channels of communication </li></ul><ul><li>Use passionate confrontations </li></ul>Motivational Strategies
  33. 33. <ul><li>Express empathy </li></ul><ul><li>Display acceptance and understanding </li></ul><ul><li>Skillful reflective listening </li></ul><ul><li>Ambivalence is normal </li></ul><ul><li>Awareness of consequences is critical </li></ul><ul><li>Discuss present behavior and valued goals </li></ul>Motivational Strategies
  34. 34. <ul><li>Understand the power play used by juveniles </li></ul><ul><li>Separate juvenile fear from manipulation </li></ul><ul><li>Allow some digression to clinically conceptualize </li></ul><ul><li>Use technique of immediacy to confront discrepancies </li></ul><ul><li>Control the interview </li></ul>Motivational Strategies
  35. 35. <ul><li>Judging breeds defensiveness </li></ul><ul><li>Resistance is a signal of change </li></ul><ul><li>Skillful reflective listening is needed </li></ul><ul><li>Roll with resistance </li></ul><ul><li>Mutually negotiate solutions </li></ul><ul><li>Hope is motivating </li></ul>Motivational Strategies
  36. 36. <ul><li>Juvenile is responsible for choosing and initiating </li></ul><ul><li>Certain behaviors lead to desired outcomes </li></ul><ul><li>Rapport and commitment must be established </li></ul><ul><li>Challenge without becoming defensive </li></ul><ul><li>Acceptance of person does not mean agreement of behavior </li></ul>Motivational Interviewing
  37. 37. <ul><li>Ask open ended questions </li></ul><ul><li>Ask how and what questions rather than why questions </li></ul><ul><li>Raise consciousness of juvenile </li></ul><ul><li>Encourage self-reflection and awareness </li></ul><ul><li>Cure is impossible, conditioned management is forever </li></ul>Motivational Strategies
  38. 38. <ul><li>Use silence for power </li></ul><ul><li>Structure the interview </li></ul><ul><li>Confirm juvenile understands questions </li></ul><ul><li>Respect harmfulness of offense behavior </li></ul><ul><li>Only continue a positive strategy </li></ul>Motivational Strategies
  39. 39. <ul><li>Understand one-upmanship issues </li></ul><ul><li>Avoid arguing, it’s a set up </li></ul><ul><li>Modify crazy-making behavior </li></ul><ul><li>Understand the win & lose mentality </li></ul><ul><li>Derailing conversations by juvenile controls interview </li></ul><ul><li>Victim stance is used to offset </li></ul>Motivational Strategies
  40. 40. <ul><li>Ignore mood, talk reason </li></ul><ul><li>Actualize known assumptions </li></ul><ul><li>Role of personal responsibility </li></ul><ul><li>Causality is used for conceptualizing </li></ul><ul><li>Responsible thinking is used as techniques </li></ul><ul><li>Focus on the nonverbals </li></ul>Motivational Strategies
  41. 41. <ul><li>Discuss details, do not ruminate </li></ul><ul><li>Know role and purpose of fixations </li></ul><ul><li>Eliminate victim re-victimization </li></ul><ul><li>Rely on the data as a guide </li></ul><ul><li>Focus on here & now issues </li></ul>Motivational Interviewing
  42. 42. <ul><li>Know youth’s attitude toward treatment </li></ul><ul><li>Understand level of denial and accountability </li></ul><ul><li>Type and chronicity of criminal behavior </li></ul><ul><li>Manifest level of violence </li></ul><ul><li>Degree of criminal pride </li></ul><ul><li>Capacity for remorse and empathy </li></ul><ul><li>Resource availability </li></ul>Motivational Strategies
  43. 43. Case Study
  44. 44. <ul><li>Billy is a 16 year old juvenile who has resided on a mental health unit for (15) months. According to his case records and feedback from the MDT, Billy has done well in treatment. He has completed the mental health program and is on treatment stage IV. Additionally, he has been placed on the highest behavioral level. Billy was recommended for release to his mother’s custody. Most recently, Billy has shown a sexual interest in boys and has allegedly propositioned a male peer. </li></ul>“Billy”
  45. 45. “Billy” cont’d <ul><li>Upon further inquiry, the proposition was void of any force, coercion or threat. Since then, the treatment team has changed its recommendation to transfer him to his mother’s home and has decided to transfer him to a locked residential treatment facility for additional treatment services apparently to address issues pertaining to “gender issues”. When queried regarding the justification for his continued stay, the treatment team remained adamant with their recommendation. </li></ul>
  46. 46. Case Study Discussion <ul><li>What are some of the reasons the members of the treatment team would want Billy to transfer to a locked residential treatment facility? </li></ul><ul><li>Even though the literature on recidivism is absent in the area of mutual and same sex relationships, what are additional reasons members of the treatment team would see Billy as dangerous? </li></ul><ul><li>Discuss alternative ways to address Billy’s needs without having to transfer him to a locked facility. </li></ul>
  47. 47. Tips to Becoming More Culturally Competent <ul><ul><li>Understand the need and rationale for being culturally competent </li></ul></ul><ul><ul><li>A desire to want to improve </li></ul></ul><ul><ul><li>A recognition of personal weaknesses/limitations </li></ul></ul><ul><ul><li>A permissive work climate </li></ul></ul>
  48. 48. Tips to Becoming More Culturally Competent <ul><ul><li>Attend specialized training in cultural competency and human relations </li></ul></ul><ul><ul><li>Seek out assistance from someone who is from the cultural group you are interested in gaining more insight about </li></ul></ul><ul><ul><li>An opportunity to try out new ideas </li></ul></ul><ul><ul><li>Willingness to adapt ethnic and cultural beliefs, values, and practices to those held by others </li></ul></ul>
  49. 49. <ul><li>Define terms associated with Cultural Competency </li></ul><ul><li>Discuss the Cultural Competency Continuum </li></ul><ul><li>Discuss perceptions and how communication miscues occur </li></ul><ul><li>Discuss Motivational strategies with juveniles </li></ul><ul><li>Review Case Study to identity possible Cultural Competency issues </li></ul><ul><li>Identify tips to becoming more culturally competent </li></ul>Class Objectives: Did We
  50. 50. <ul><li>1) I walk down the street. </li></ul><ul><li>There’s a hole in the sidewalk. </li></ul><ul><li>I fall in….I am lost….I am helpless </li></ul><ul><li>It isn’t my fault. </li></ul><ul><li>It takes forever to find a way out. </li></ul>Autobiography in Five Short Chapters
  51. 51. <ul><li>2) I walk down the same street. </li></ul><ul><li>There’s a deep hole in the sidewalk. </li></ul><ul><li>I pretend I don’t see it. </li></ul><ul><li>I fall in again. </li></ul><ul><li>I can’t believe I am in the same place again. </li></ul><ul><li>But, it isn’t my fault. </li></ul><ul><li>It still takes a long time to get out. </li></ul>Autobiography in Five Short Chapters
  52. 52. Autobiography in Five Short Chapters 3) I walk down the same street. There’s a deep hole in the sidewalk. I SEE it is there. I still fall in….it’s a habit…but….. my eyes are open….I know where I am. It is my fault. I get out immediately.
  53. 53. Autobiography in Five Short Chapters 4) I walk down the same street. There’s a deep hole in the sidewalk. I walk around it. 5) I walk down another street. Portie Nelson