$69K per year for a clinical psychologist (TBD). $75K per year for consultant (Walters).
Recruit one graduate student to assist in observation and one postdoctoral student to assist in facilitation of treatment. (Total: $69K per year for each)
Contractual: $39K a year for two outpatient counselors providing culturally sensitive treatment.
Total Personnel: $120,000 + $100,000 = $220,000
Total Fringe Benefits: $109,200
Total Travel: $6,356
Total Equipment: $8,800
Total Supplies: $600
Total Contractual: $39K + $69K +
Severity in Scope versus altruism: working against organ donation's realizati...Michele Battle-Fisher
(Nov. 2011) Severity in Scope versus Altruism: Working Against Organ
Donation’s Realization of Goals- An Essay. [electronic version] OJHE Online Journal
of Health Ethics. 7(2). Retrieved from http://ojhe.org/.
Jerker Edstrom: Constructing AIDS: Contesting perspectives on an evolving epidemic. Presentation given at STEPS Centre Epidemics workshop, Dec 8-9 2008
Caring for a vulnerable person should be a noble calling, inspired by love and affection for the individual and sustained by the support of a caring community. The reality of life as a Carer for most people in South Africa cannot be further removed from this ideal.
A critical consideration of the potential of design and technology for the ca...GERATEC
Florence Nightingale gives some of the first words of advice on design in her “Notes on Nursing” - “But the fewer passages there are in a hospital the better”, referring to the fact that hospital design can impact the need for fresh air, that in her opinion is essential to the healing process (Nightingale, F. 1860). In 1943 Maslow developed his hierarchy of needs, starting with the physical need to be safe and secure, above which is the need to be loved, connected and belong, followed by the higher needs of understanding, knowing and self-actualization. The relationship between the physical buildings/environment and the impact on quality of life of the people living with dementia is the focus of this assignment.
The World Health Organization Quality of Life Assessment Group (1998) includes the physical environment as one of the dimensions of the quality of life. The quality of life of people living with dementia has been in the spotlight over the past years, and Ready and Ott (2003) did a review of the measurement tools, pointing out the differences and complexities of trying to determine exactly what constitutes quality of life for people living with dementia. The transactional interaction between people living with dementia, their care partners (both formal and informal), the new role of technology and the design of buildings and cities are explored in terms of the role it plays in constructing a new discourse for improvements in the quality of life of people living with dementia.
Caring for a family member with dementia is fraught with burden and stress: A...GERATEC
The title “Caregiving for a family member with dementia is fraught with burden and stress” elicits more questions than answers. Who is this caregiver – husband or wife, son or daughter, second husband or wife, stepson or –daughter, daughter- or son-in-law, grandchild – a list with endless variations. Would the experience be different when caring for a mother to that of caring for a father, husband or wife, brother, uncle, aunt, cousin, and nephew? Can the term “caregiver” be considered a singular entity with a singular emotional experience? What is the role of - amongst others - culture, ethnicity, gender, sexual orientation, language, religion, age, personality, social environment and education? What role does the type of dementia of the care recipient play? Do all people deal with burden and stress in the same way, and if not, why not? What constitutes burden and stress, and how are these defined within the heterogeneous environment of caregiving?
It is often said, “If you have met one person with dementia, you have met one person with dementia”. The same might very well apply to the family caregiver. Nolan et al (2002) refer to Dilworth-Anderson and Montgomery & Williams (2001) when saying that “In essence the message is clear – caregiving can only be fully appreciated and adequately supported in its appropriate context”.
A critical assessment of the research literature that explores the disclosure...GERATEC
Being diagnosed with dementia can impact on an individual’s emotional, vocational, spiritual, physical, social, intellectual and personal dimensions of wellness (Montague, 2013). The stigmatisation that comes with the diagnosis can be as devastating as the disease itself. For this reason alone, seeking a diagnosis when suspecting that there could be something wrong with one’s cognitive functioning, is not a simple or easy decision.
Christine Bryden, in her book “Dancing with Dementia” (2005), makes the statement “It took me three years before I could speak openly about my diagnosis, overcoming the hopelessness and depression that exacerbated my dementia and took me on a downward spiral of dysfunction” (Bryden, 2005, p39).
The psychological impact of a diagnosis (Lee et al., 2014) is severe, taking some individuals up to six months to adjust and cope with the feelings of loss before they can start to create new coping strategies and mechanisms of living with dementia.
Dementia diagnosis in lesser developed countries like those on the African continent, where research is scarce and stigmatisation can put lives in danger (Kalula and Petros, 2011), is in itself problematic. Bunn et al. (2010) allude to the transferability of research findings that are mostly geographically limited, implying that the disclosure of a diagnosis might be even more complex in non-western cultures.
Not disclosing a diagnosis raises ethical concerns (Rai, 2009) that seem to be missing in much of the research.
Severity in Scope versus altruism: working against organ donation's realizati...Michele Battle-Fisher
(Nov. 2011) Severity in Scope versus Altruism: Working Against Organ
Donation’s Realization of Goals- An Essay. [electronic version] OJHE Online Journal
of Health Ethics. 7(2). Retrieved from http://ojhe.org/.
Jerker Edstrom: Constructing AIDS: Contesting perspectives on an evolving epidemic. Presentation given at STEPS Centre Epidemics workshop, Dec 8-9 2008
Caring for a vulnerable person should be a noble calling, inspired by love and affection for the individual and sustained by the support of a caring community. The reality of life as a Carer for most people in South Africa cannot be further removed from this ideal.
A critical consideration of the potential of design and technology for the ca...GERATEC
Florence Nightingale gives some of the first words of advice on design in her “Notes on Nursing” - “But the fewer passages there are in a hospital the better”, referring to the fact that hospital design can impact the need for fresh air, that in her opinion is essential to the healing process (Nightingale, F. 1860). In 1943 Maslow developed his hierarchy of needs, starting with the physical need to be safe and secure, above which is the need to be loved, connected and belong, followed by the higher needs of understanding, knowing and self-actualization. The relationship between the physical buildings/environment and the impact on quality of life of the people living with dementia is the focus of this assignment.
The World Health Organization Quality of Life Assessment Group (1998) includes the physical environment as one of the dimensions of the quality of life. The quality of life of people living with dementia has been in the spotlight over the past years, and Ready and Ott (2003) did a review of the measurement tools, pointing out the differences and complexities of trying to determine exactly what constitutes quality of life for people living with dementia. The transactional interaction between people living with dementia, their care partners (both formal and informal), the new role of technology and the design of buildings and cities are explored in terms of the role it plays in constructing a new discourse for improvements in the quality of life of people living with dementia.
Caring for a family member with dementia is fraught with burden and stress: A...GERATEC
The title “Caregiving for a family member with dementia is fraught with burden and stress” elicits more questions than answers. Who is this caregiver – husband or wife, son or daughter, second husband or wife, stepson or –daughter, daughter- or son-in-law, grandchild – a list with endless variations. Would the experience be different when caring for a mother to that of caring for a father, husband or wife, brother, uncle, aunt, cousin, and nephew? Can the term “caregiver” be considered a singular entity with a singular emotional experience? What is the role of - amongst others - culture, ethnicity, gender, sexual orientation, language, religion, age, personality, social environment and education? What role does the type of dementia of the care recipient play? Do all people deal with burden and stress in the same way, and if not, why not? What constitutes burden and stress, and how are these defined within the heterogeneous environment of caregiving?
It is often said, “If you have met one person with dementia, you have met one person with dementia”. The same might very well apply to the family caregiver. Nolan et al (2002) refer to Dilworth-Anderson and Montgomery & Williams (2001) when saying that “In essence the message is clear – caregiving can only be fully appreciated and adequately supported in its appropriate context”.
A critical assessment of the research literature that explores the disclosure...GERATEC
Being diagnosed with dementia can impact on an individual’s emotional, vocational, spiritual, physical, social, intellectual and personal dimensions of wellness (Montague, 2013). The stigmatisation that comes with the diagnosis can be as devastating as the disease itself. For this reason alone, seeking a diagnosis when suspecting that there could be something wrong with one’s cognitive functioning, is not a simple or easy decision.
Christine Bryden, in her book “Dancing with Dementia” (2005), makes the statement “It took me three years before I could speak openly about my diagnosis, overcoming the hopelessness and depression that exacerbated my dementia and took me on a downward spiral of dysfunction” (Bryden, 2005, p39).
The psychological impact of a diagnosis (Lee et al., 2014) is severe, taking some individuals up to six months to adjust and cope with the feelings of loss before they can start to create new coping strategies and mechanisms of living with dementia.
Dementia diagnosis in lesser developed countries like those on the African continent, where research is scarce and stigmatisation can put lives in danger (Kalula and Petros, 2011), is in itself problematic. Bunn et al. (2010) allude to the transferability of research findings that are mostly geographically limited, implying that the disclosure of a diagnosis might be even more complex in non-western cultures.
Not disclosing a diagnosis raises ethical concerns (Rai, 2009) that seem to be missing in much of the research.
A critical comparison of the strengths and limitations of the pyschological a...GERATEC
The phrase “Understanding Dementia” is perhaps the ultimate oxymoron. For how can we even begin to “understand” something of which we know neither the cause nor the cure? In his introduction to Al Power’s book “Dementia beyond drugs” (Power, 2011), Bill Thomas, founder of The Eden Alternative says: “Conventional wisdom, if you can call it that, holds that dementia represents a peculiar, deadly, and completely irredeemable kind of decline.” (p.ix). A phenomenon that has been around as long as human beings themselves have been around, dementia presents an existential crisis to humanity in that it threatens everything that most people aim for – superficial or not – in living what Socrates described as a long, good life. In Jewish tradition it is customary to wish someone a long life when a relative passes away. Is this a good, happy wish or is it a curse when someone is diagnosed with Dementia every four seconds in the world? (World Health Organization, 2012)
The Psychological and the Gerontological approaches constitute an expansion on the purely biomedical perspective of the disease, exploring the impact that dementia has on the individual living with it, as well as the impact that it has on the broader community. It is argued in this assignment that while Psychology and Gerontology have expanded on the narrow viewpoints of the biomedical approach, the heterogeneous nature of the manifestations of dementia, especially in the Developing World where research is not on the political agenda, leaves the world none the wiser in how to deal with this epidemic.
Child and Family Impacts of the Coronavirus Syndemic: Developmental, Family, ...Université de Montréal
My presentation is part of the WASP-WPA Interorganizational Symposium for the WPA 21st Virtual World Congress of Psychiatry, Catragena, Colombia, October 16-21, 2021
Session Description
At this time, the death toll from COVID-19 is approaching 3 million people worldwide. The full toll of COVID-19 far exceeds
even this sobering number. Beyond the direct biological impacts of an infectious disease, the global impact of COVID-19 is
revealing and magnifying pre-existing fractures in our social structures. COVID-19 has led to significant differential impacts
among groups across age, health and socio-cultural variables, whether through increased direct illness morbidity and
mortality in the elderly or those with mental illness, or through indirect impacts associated with widespread societal and
health system changes, including youth impacted by confinement and social isolation impinging on development of prosocial
skills, increased caregiver and family stresses ranging from financial distress to violence, and further disenfranchisement of
already marginalized and vulnerable groups. At the same time, heightened public awareness and outcry about such
disparities has the potential to fuel new alliances, challenging and perhaps dismantling some historical stereotypes of race,
ethnicity, gender, sexual orientation, age, disability and illness. Rather than a pandemic, the global impacts reveal a
syndemic – multiple pandemics along different lines, both the viral/biological pandemic, plus a social pandemic superimposed
on pre-existing fault lines of inequity, poverty, mental illness, racism, sexism, ableism, ageism and other forms of stigma and
discrimination. This session will include discussion of the varied impacts of COVID-19 and exploration of their root causes
from a social psychiatry perspective.
Ressler, Bradshaw, Gualtieri and Chui: Communicating The Experience Of Chro...pkressler
Communicating the Experience of Chronic Pain and Illness through Blogging -- formative study exploring blogging behavior and psychosocial benefits of blogging for patients with chronic pain or illness.
Advancing the field of cultural competency by providing the first structural competency certificate program in the country. Online, on-demand and FREE, including free continuing education credits. Live trainings coming soon. Give me a call!
Social Unrest and Mental Health
World Association of Social Psychiatry (WASP) Symposium
at the American Psychiatric Association Annual Meeting 2021
Vincenzo Di Nicola, MPhil, MD, PhD, DFAPA, FCPA President, CASP; President-Elect, WASP Professor of Psychiatry, University of Montreal, QC
Learning objectives
To understand the association between social unrest and mental health …
Specifically, to:
Identify the social determinants of unrest
Offer case examples of social unrest
Review WHO prevalence estimates and overall mental health impacts of social unrest
Discuss special considerations for children, youth & families
Plan for presentation
Social unrest and mental health: 30-45 minutes – V Di Nicola Social determinants: Triggers, aggravators & attenuators, circularity
Case examples (evidence-based studies)
Hong Kong Protests Black Lives Matter
WHO Prevalence Estimates (data)
Protests, Riots & Revolutions: A systematic review
Children, Youth & Families: Special considerations
Towards a Critical Health Equity Research Stance: Why Epistemology and Method...Jim Bloyd, DrPH, MPH
Qualitative methods are not intrinsically progressive. Methods are simply tools to conduct research. Epistemology, the justification of knowledge, shapes methodology and methods, and thus is a vital starting point for a critical health equity research stance, regardless of whether the methods are qualitative, quantitative, or mixed. In line with this premise, I address four themes in this commentary. First, I criticize the ubiquitous and uncritical use of the term health disparities in U.S. public health. Next, I advocate for the increased use of qualitative methodologies—namely, photovoice and critical ethnography— that, pursuant to critical approaches, prioritize dismantling social–structural inequities as a prerequisite to health equity. Thereafter, I discuss epistemological stance and its influence on all aspects of the research process. Finally, I highlight my critical discourse analysis HIV prevention research based on individual interviews and focus groups with Black men, as an example of a critical health equity research approach.
The Experimental Child - Child and Family Impacts of the Coronavirus SyndemicUniversité de Montréal
The Experimental Child - Child and Family Impacts of the Coronavirus Syndemic
Abstract
Not only is the coronavirus crisis a natural laboratory of stress offering health and social care services a unique historical opportunity to observe its impact on entire populations around the world, but the responses to the crisis by international health authorities, such as the WHO, along with national and local educational institutions and health care and social services, are creating an unprecedented and unpredictable environment for children and youth. This hostile new environment for growth and development is marked by the sudden and unpredictable imposition of confinement and social isolation, cutting off or limiting opportunities for the development of cognitive abilities, peer relationships, and social skills, while exposing vulnerable children and youth to depriving, negligent, or even abusive home environments.
For this reason, this crisis has been renamed a syndemic, encompassing two different categories of disease—an infectious disease (SARS-CoV-2) and an array of non-communicable diseases (NCDs). Together, these conditions cluster within specific populations following deeply-embedded patterns of inequality and vulnerability (Horton, 2020). These pre-existing fault lines of inequity, poverty, mental illness, racism, ableism, ageism create stigma and discrimination and amplify the impacts of this syndemic. And children are the most vulnerable population around the world. The impact on children is part of a cascade of consequences affecting societies at large, smaller communities, and the multigenerational family, all of which impinge on children and youth as the lowest common denominator (Di Nicola & Daly, 2020).
This exceptional set of circumstances—in response not only to the biomedical and populational health aspects but also in constructing policies for entire societies—is creating an “experimental childhood” for billions of children and youth around the world. With its commitment to the social determinants of health and mental health, notably in light of the monumental Adverse Childhood Events (ACE) studies (Felitti & Anda, 2010), social psychiatry and global mental health in partner with child and family psychiatry and allied professions must now consider their roles for the future of these “experimental children” around the world. The parameters for observing the conditions of this coronavirus-induced syndemic in the family and in society, along with recommendations for social psychiatric interventions, and prospective paediatric, psychological, and social studies will be outlined.
Keywords: Children & families, COVID-19, syndemic, ACE Study, confinement, social isolation
Cultural Family Therapy: Integrating Sytemic Family Therapy with Cultural Psy...Université de Montréal
This workshop was submitted for presentation at the Annual Meeting of the American Psychiatric Association in May 2016 Atlanta, GA, USA and was accepted November 13, 2015.
This interactive, case-based workshop is designed for clinicians who work with families presenting mental health challenges across cultures. The workshop leader will present Cultural Family Therapy (CFT), a synthesis of systemic family therapy and sociocultural psychiatry. In numerous publications and international workshops over the last 30 years, the workshop leader has elaborated a model of CFT, presented in his book, "A Stranger in the Family: Culture, Families, and Therapy" (NY: Norton, 1997). CFT weaves together family stories that express their mental and relational predicaments and conceptual tools for conducting clinical work.
The concept of empowerment is of increasing interest to researchers, practitioners and citizens concerned about mental health issues. In some respects, empowerment is a new buzzword. As Edelman (1977) has noted in relation to language and the politics of human services, sometimes new language is used to describe the same old practices. Others believe that empowerment language can actually lead to raised awareness (Rappaport, 1986). Regardless, a growing number of people are searching to understand the meaning of empowerment and ways it can be used to change their settings and lives. Empowerment can begin to be understood by examining the concepts of power and powerlessness (Moscovitch and Drover, 1981). Power is defined by the Cornell Empowerment Group as the "capacity of some persons and organizations to produce intended, foreseen and unforeseen effects on others" (Cornell Empowerment Group, 1989, p.2).
There are many sources of power. Personality, property/wealth, and influential organizations have been identified by Galbraith (1983) as critical sources of power in the last part of this century. Others have pointed out that the class-dominated nature of our society means that a small number of people have vast economic or political power, while the majority have little or none (Moscovitch & Drover, 1981) At the individual level, powerlessness can be seen as the expectation of the person that his/her own actions will be ineffective in influencing the outcome of life events (Keiffer, 1984). Lerner (1986) makes a distinction between real and surplus powerlessness. Real powerlessness results from economic inequities and oppressive control exercised by systems and other people. Surplus powerlessness, on the other hand, is an internalized belief that change cannot occur, a belief which results in apathy and an unwillingness of the person to struggle for more control and influence.
Powerlessness has, over the years, come to be viewed as an objective phenomenon, where people with little or no political and economic power lack the means to gain greater control and resources in their lives (Albee, 1981). As an illustration of powerlessness, Asch (1986) has noted that generally people with disabilities;
The notion of interdependence and its implications for child and family polic...Ya'ir Ronen
The authors claim that the recognition of interdependence
as a guiding principle of child and family policy has the potential to
transform legal systems to make them less punitive and more constructive, less judgmental towards individuals and more empathic to the protection of relationships and self-constructed identities. By embracing the notion of interdependence, our societies can be moved toward greater recognition of our common humanity to the great benefit of children and
their families, particularly those who are most vulnerable.
Four lenses are articulated in this paper: Therapeutic jurisprudence,
preventive law, family systems theory, and culture. The paper shows
how these lenses point toward more supportive rather than punitive
types of interventions in the lives of children and their families. The paper demonstrates that, despite the fact that questionable parental behavior may initially engender feelings of anger and aversion, an empathic public response–one that recognizes the reality of the interdependence between parents and children–not only comports with current enlightened interdisciplinary approaches, but also promotes child and family well-being. The authors suggest that such a response not only be contemplated and understood, but that it should also reframe child and family policies and practices. The family group conference model represents a tool for such reframing
Changelings: Children, Culture and Trauma
Vincenzo Di Nicola
Harvard Program in Refugee Trauma
Global Mental Health Course
Educational Objectives
The presentation will sensitize participants to appreciate basic questions about working with traumatized children and their families across culture to create trauma-informed care:
Why development matters – and how it changes the clinical presentation of trauma at different ages
Why family matters – and how it creates models for the experience of trauma that attenuate or amplify both developmental neurobiology and sociocultural influences
Why culture matters – and how it offers or limits the range of socially privileged perceptions and culturally sanctioned solutions
Outline
Children, Culture and Trauma: Three lenses
Children & Culture: “Looking Across at Growing Up”
Children & Trauma: “Changelings”
“The Nightmare of Childhood”
“The Longest Shadow”
“The Experimental Child”
Culture & Trauma: “Two trauma communities”
Clinical and cultural trauma studies
Healing
Rebrith
Aporias/Puzzles
How does bringing childhood, culture, and trauma together affect our understanding of each?
What does an archaeology of trauma reveal?
(R Mollica: What is the nature of trauma?)
What can be done?
A critical comparison of the strengths and limitations of the pyschological a...GERATEC
The phrase “Understanding Dementia” is perhaps the ultimate oxymoron. For how can we even begin to “understand” something of which we know neither the cause nor the cure? In his introduction to Al Power’s book “Dementia beyond drugs” (Power, 2011), Bill Thomas, founder of The Eden Alternative says: “Conventional wisdom, if you can call it that, holds that dementia represents a peculiar, deadly, and completely irredeemable kind of decline.” (p.ix). A phenomenon that has been around as long as human beings themselves have been around, dementia presents an existential crisis to humanity in that it threatens everything that most people aim for – superficial or not – in living what Socrates described as a long, good life. In Jewish tradition it is customary to wish someone a long life when a relative passes away. Is this a good, happy wish or is it a curse when someone is diagnosed with Dementia every four seconds in the world? (World Health Organization, 2012)
The Psychological and the Gerontological approaches constitute an expansion on the purely biomedical perspective of the disease, exploring the impact that dementia has on the individual living with it, as well as the impact that it has on the broader community. It is argued in this assignment that while Psychology and Gerontology have expanded on the narrow viewpoints of the biomedical approach, the heterogeneous nature of the manifestations of dementia, especially in the Developing World where research is not on the political agenda, leaves the world none the wiser in how to deal with this epidemic.
Child and Family Impacts of the Coronavirus Syndemic: Developmental, Family, ...Université de Montréal
My presentation is part of the WASP-WPA Interorganizational Symposium for the WPA 21st Virtual World Congress of Psychiatry, Catragena, Colombia, October 16-21, 2021
Session Description
At this time, the death toll from COVID-19 is approaching 3 million people worldwide. The full toll of COVID-19 far exceeds
even this sobering number. Beyond the direct biological impacts of an infectious disease, the global impact of COVID-19 is
revealing and magnifying pre-existing fractures in our social structures. COVID-19 has led to significant differential impacts
among groups across age, health and socio-cultural variables, whether through increased direct illness morbidity and
mortality in the elderly or those with mental illness, or through indirect impacts associated with widespread societal and
health system changes, including youth impacted by confinement and social isolation impinging on development of prosocial
skills, increased caregiver and family stresses ranging from financial distress to violence, and further disenfranchisement of
already marginalized and vulnerable groups. At the same time, heightened public awareness and outcry about such
disparities has the potential to fuel new alliances, challenging and perhaps dismantling some historical stereotypes of race,
ethnicity, gender, sexual orientation, age, disability and illness. Rather than a pandemic, the global impacts reveal a
syndemic – multiple pandemics along different lines, both the viral/biological pandemic, plus a social pandemic superimposed
on pre-existing fault lines of inequity, poverty, mental illness, racism, sexism, ableism, ageism and other forms of stigma and
discrimination. This session will include discussion of the varied impacts of COVID-19 and exploration of their root causes
from a social psychiatry perspective.
Ressler, Bradshaw, Gualtieri and Chui: Communicating The Experience Of Chro...pkressler
Communicating the Experience of Chronic Pain and Illness through Blogging -- formative study exploring blogging behavior and psychosocial benefits of blogging for patients with chronic pain or illness.
Advancing the field of cultural competency by providing the first structural competency certificate program in the country. Online, on-demand and FREE, including free continuing education credits. Live trainings coming soon. Give me a call!
Social Unrest and Mental Health
World Association of Social Psychiatry (WASP) Symposium
at the American Psychiatric Association Annual Meeting 2021
Vincenzo Di Nicola, MPhil, MD, PhD, DFAPA, FCPA President, CASP; President-Elect, WASP Professor of Psychiatry, University of Montreal, QC
Learning objectives
To understand the association between social unrest and mental health …
Specifically, to:
Identify the social determinants of unrest
Offer case examples of social unrest
Review WHO prevalence estimates and overall mental health impacts of social unrest
Discuss special considerations for children, youth & families
Plan for presentation
Social unrest and mental health: 30-45 minutes – V Di Nicola Social determinants: Triggers, aggravators & attenuators, circularity
Case examples (evidence-based studies)
Hong Kong Protests Black Lives Matter
WHO Prevalence Estimates (data)
Protests, Riots & Revolutions: A systematic review
Children, Youth & Families: Special considerations
Towards a Critical Health Equity Research Stance: Why Epistemology and Method...Jim Bloyd, DrPH, MPH
Qualitative methods are not intrinsically progressive. Methods are simply tools to conduct research. Epistemology, the justification of knowledge, shapes methodology and methods, and thus is a vital starting point for a critical health equity research stance, regardless of whether the methods are qualitative, quantitative, or mixed. In line with this premise, I address four themes in this commentary. First, I criticize the ubiquitous and uncritical use of the term health disparities in U.S. public health. Next, I advocate for the increased use of qualitative methodologies—namely, photovoice and critical ethnography— that, pursuant to critical approaches, prioritize dismantling social–structural inequities as a prerequisite to health equity. Thereafter, I discuss epistemological stance and its influence on all aspects of the research process. Finally, I highlight my critical discourse analysis HIV prevention research based on individual interviews and focus groups with Black men, as an example of a critical health equity research approach.
The Experimental Child - Child and Family Impacts of the Coronavirus SyndemicUniversité de Montréal
The Experimental Child - Child and Family Impacts of the Coronavirus Syndemic
Abstract
Not only is the coronavirus crisis a natural laboratory of stress offering health and social care services a unique historical opportunity to observe its impact on entire populations around the world, but the responses to the crisis by international health authorities, such as the WHO, along with national and local educational institutions and health care and social services, are creating an unprecedented and unpredictable environment for children and youth. This hostile new environment for growth and development is marked by the sudden and unpredictable imposition of confinement and social isolation, cutting off or limiting opportunities for the development of cognitive abilities, peer relationships, and social skills, while exposing vulnerable children and youth to depriving, negligent, or even abusive home environments.
For this reason, this crisis has been renamed a syndemic, encompassing two different categories of disease—an infectious disease (SARS-CoV-2) and an array of non-communicable diseases (NCDs). Together, these conditions cluster within specific populations following deeply-embedded patterns of inequality and vulnerability (Horton, 2020). These pre-existing fault lines of inequity, poverty, mental illness, racism, ableism, ageism create stigma and discrimination and amplify the impacts of this syndemic. And children are the most vulnerable population around the world. The impact on children is part of a cascade of consequences affecting societies at large, smaller communities, and the multigenerational family, all of which impinge on children and youth as the lowest common denominator (Di Nicola & Daly, 2020).
This exceptional set of circumstances—in response not only to the biomedical and populational health aspects but also in constructing policies for entire societies—is creating an “experimental childhood” for billions of children and youth around the world. With its commitment to the social determinants of health and mental health, notably in light of the monumental Adverse Childhood Events (ACE) studies (Felitti & Anda, 2010), social psychiatry and global mental health in partner with child and family psychiatry and allied professions must now consider their roles for the future of these “experimental children” around the world. The parameters for observing the conditions of this coronavirus-induced syndemic in the family and in society, along with recommendations for social psychiatric interventions, and prospective paediatric, psychological, and social studies will be outlined.
Keywords: Children & families, COVID-19, syndemic, ACE Study, confinement, social isolation
Cultural Family Therapy: Integrating Sytemic Family Therapy with Cultural Psy...Université de Montréal
This workshop was submitted for presentation at the Annual Meeting of the American Psychiatric Association in May 2016 Atlanta, GA, USA and was accepted November 13, 2015.
This interactive, case-based workshop is designed for clinicians who work with families presenting mental health challenges across cultures. The workshop leader will present Cultural Family Therapy (CFT), a synthesis of systemic family therapy and sociocultural psychiatry. In numerous publications and international workshops over the last 30 years, the workshop leader has elaborated a model of CFT, presented in his book, "A Stranger in the Family: Culture, Families, and Therapy" (NY: Norton, 1997). CFT weaves together family stories that express their mental and relational predicaments and conceptual tools for conducting clinical work.
The concept of empowerment is of increasing interest to researchers, practitioners and citizens concerned about mental health issues. In some respects, empowerment is a new buzzword. As Edelman (1977) has noted in relation to language and the politics of human services, sometimes new language is used to describe the same old practices. Others believe that empowerment language can actually lead to raised awareness (Rappaport, 1986). Regardless, a growing number of people are searching to understand the meaning of empowerment and ways it can be used to change their settings and lives. Empowerment can begin to be understood by examining the concepts of power and powerlessness (Moscovitch and Drover, 1981). Power is defined by the Cornell Empowerment Group as the "capacity of some persons and organizations to produce intended, foreseen and unforeseen effects on others" (Cornell Empowerment Group, 1989, p.2).
There are many sources of power. Personality, property/wealth, and influential organizations have been identified by Galbraith (1983) as critical sources of power in the last part of this century. Others have pointed out that the class-dominated nature of our society means that a small number of people have vast economic or political power, while the majority have little or none (Moscovitch & Drover, 1981) At the individual level, powerlessness can be seen as the expectation of the person that his/her own actions will be ineffective in influencing the outcome of life events (Keiffer, 1984). Lerner (1986) makes a distinction between real and surplus powerlessness. Real powerlessness results from economic inequities and oppressive control exercised by systems and other people. Surplus powerlessness, on the other hand, is an internalized belief that change cannot occur, a belief which results in apathy and an unwillingness of the person to struggle for more control and influence.
Powerlessness has, over the years, come to be viewed as an objective phenomenon, where people with little or no political and economic power lack the means to gain greater control and resources in their lives (Albee, 1981). As an illustration of powerlessness, Asch (1986) has noted that generally people with disabilities;
The notion of interdependence and its implications for child and family polic...Ya'ir Ronen
The authors claim that the recognition of interdependence
as a guiding principle of child and family policy has the potential to
transform legal systems to make them less punitive and more constructive, less judgmental towards individuals and more empathic to the protection of relationships and self-constructed identities. By embracing the notion of interdependence, our societies can be moved toward greater recognition of our common humanity to the great benefit of children and
their families, particularly those who are most vulnerable.
Four lenses are articulated in this paper: Therapeutic jurisprudence,
preventive law, family systems theory, and culture. The paper shows
how these lenses point toward more supportive rather than punitive
types of interventions in the lives of children and their families. The paper demonstrates that, despite the fact that questionable parental behavior may initially engender feelings of anger and aversion, an empathic public response–one that recognizes the reality of the interdependence between parents and children–not only comports with current enlightened interdisciplinary approaches, but also promotes child and family well-being. The authors suggest that such a response not only be contemplated and understood, but that it should also reframe child and family policies and practices. The family group conference model represents a tool for such reframing
Changelings: Children, Culture and Trauma
Vincenzo Di Nicola
Harvard Program in Refugee Trauma
Global Mental Health Course
Educational Objectives
The presentation will sensitize participants to appreciate basic questions about working with traumatized children and their families across culture to create trauma-informed care:
Why development matters – and how it changes the clinical presentation of trauma at different ages
Why family matters – and how it creates models for the experience of trauma that attenuate or amplify both developmental neurobiology and sociocultural influences
Why culture matters – and how it offers or limits the range of socially privileged perceptions and culturally sanctioned solutions
Outline
Children, Culture and Trauma: Three lenses
Children & Culture: “Looking Across at Growing Up”
Children & Trauma: “Changelings”
“The Nightmare of Childhood”
“The Longest Shadow”
“The Experimental Child”
Culture & Trauma: “Two trauma communities”
Clinical and cultural trauma studies
Healing
Rebrith
Aporias/Puzzles
How does bringing childhood, culture, and trauma together affect our understanding of each?
What does an archaeology of trauma reveal?
(R Mollica: What is the nature of trauma?)
What can be done?
Cultural Competence and PovertyExploring Play Therapists’ AOllieShoresna
Cultural Competence and Poverty:
Exploring Play Therapists’ Attitudes
Lauren Chase and Kristie Opiola
Department of Counseling, University of North Carolina at Charlotte
This article reports the findings of a survey that investigated attitudes toward poverty
among play therapists (N � 390) and its relation to demographic information. Multi-
variate analyses of variance (MANOVA) were used to measure the relationship
between play therapists’ demographics and their attitudes toward poverty, specifically
their structural, personal deficiency, and stigma scores. Results indicated that both
region and age resulted in differing views on poverty. Participants living in the
Northeast held stronger structural views of poverty than participants in the South.
Similarly, participants in the 50 –59 and 60 plus age groups disagreed to strongly
disagree with a personal explanation toward poverty than participants in the 30 –39 age
group. The importance of play therapists’ examining their attitudes toward poverty and
the direct impact on their work is discussed. Finally, implications of the results,
including overall findings, are explained.
Keywords: play therapy, attitudes of poverty, cultural competence
Culturally competent training is an element
of credentialing requirements that ensures men-
tal health providers offer adequate and respon-
sive care to diverse populations. Although the
mental health field has embedded cultural com-
petence in their standards and guidelines, there
are discrepancies in the way the profession as-
sesses and measures competence (Sue et al.,
1996). Researchers have investigated attitudes
toward poverty in the helping professions
(Levin & Schwartz-Tayri, 2017; Noone et al.,
2012; van Heerde & Hudson, 2010; & Wit-
tenauer et al., 2015), but no study has focused
on play therapists’ attitudes toward poverty.
The purpose of this study is to fill a gap in the
literature regarding play therapist’s attitudes to-
ward poverty because awareness and knowl-
edge are key elements to implement culturally
responsive services and skills with diverse chil-
dren in a variety of settings.
Cultural Competence
Cultural competence is an important compo-
nent of professional practice, and practitioners
are expected to develop skills and understand-
ing pertaining to diverse clientele. Researchers
define cultural competence as the set of beliefs,
knowledge, and skills mental health providers
possess in order to deliver effective interven-
tions and services to members of various cul-
tures (Gilbert et al., 2007; Sue, 2006). The New
Freedom Commission on Mental Health (2003)
recognized disparities in mental health delivery
and viewed the lack of cultural competence for
minority populations as a persistent problem.
Culturally competent health care is essential to
providing effective care to all populations. To
aid practitioners in their ability to increase their
cultural competence, leading professional men-
tal health associations have published ...
Running Head SOCIOLOGY IN NURSING 1 SOCIOLOGY IN NURSING .docxtodd521
Running Head: SOCIOLOGY IN NURSING
1
SOCIOLOGY IN NURSING
2
Sociology in nursing: A look from different perspectives
Name
Institution
Introduction
Health literacy is the acquisition and application of knowledge to daily practices for the improvement of the general health of an individual as well as the community. This influences the response to symptoms of illness, approach to treatment and preventive measures. While it may seem like common knowledge, the difference in the cultural and social background comes into play during the stated health literacy skills. Nurses are tasked with the provision of elementary care to culturally diverse communities and thus necessitating cultural competency.
Different concepts exist with regard to cultural composition and diversity in the community under evaluation. Singleton & Krause (2009) identify these to include: Magico-religious, biomedical and deterministic concepts. These concepts are always evolving with arising situations. Regular training on cultural competence is recommended as it is considered a threat to patients (Kaihlanen, Hietapakka & Heponiemi, 2019). This paper will look at nursing from different sociology perspectives to demonstrate the need for training.
Health literacy from sociological perspectives
Functionalist perspective
Health concepts are shared among a group of people sharing in other aspects of life as well. This is a source of continuity in identity recognized from doing things in a certain way. This is well demonstrated in Mayhew (2018), where an initial visit to a health facility, the nurse provides treatment options, which is met by indecisiveness, which turns around on the second visit following consultation with family members on the best course of action (Mayhew, 2018) for the ailing family member. The consultation gives the young mother confidence and a sense of unity in the family due to their collectivist approach. The institution of marriage is revered as well as nursing, as the mother takes time to understand all that pertains to the provided options.
Conflict perspective
Cultural diversity presents different approaches to decision making on health issues. Despite expert knowledge, a nurse must operate under ethical codes by respecting the patient's autonomy. This means that the decision reached, and failure thereof, must be upheld. For instance, a magico- religious culture may bar ailing members from procuring blood transfusions, even though their condition may only be helped by one. A nurse, while offering this option to them, can only do so much but respect this culture.
Conflict may also arise when actions taken in an emergency situation, maybe in opposition to patient beliefs, such as first aid to the opposite sex.
Symbolic interactionism perspective
This perspective demonstrates the difference in dialects and jargon used by different societies. Nursing uses professional language and jargon, which patients may not decipher. Equally, nurses are fac.
Running Head SOCIOLOGY IN NURSING 1 SOCIOLOGY IN NURSING .docxjeanettehully
Running Head: SOCIOLOGY IN NURSING
1
SOCIOLOGY IN NURSING
2
Sociology in nursing: A look from different perspectives
Name
Institution
Introduction
Health literacy is the acquisition and application of knowledge to daily practices for the improvement of the general health of an individual as well as the community. This influences the response to symptoms of illness, approach to treatment and preventive measures. While it may seem like common knowledge, the difference in the cultural and social background comes into play during the stated health literacy skills. Nurses are tasked with the provision of elementary care to culturally diverse communities and thus necessitating cultural competency.
Different concepts exist with regard to cultural composition and diversity in the community under evaluation. Singleton & Krause (2009) identify these to include: Magico-religious, biomedical and deterministic concepts. These concepts are always evolving with arising situations. Regular training on cultural competence is recommended as it is considered a threat to patients (Kaihlanen, Hietapakka & Heponiemi, 2019). This paper will look at nursing from different sociology perspectives to demonstrate the need for training.
Health literacy from sociological perspectives
Functionalist perspective
Health concepts are shared among a group of people sharing in other aspects of life as well. This is a source of continuity in identity recognized from doing things in a certain way. This is well demonstrated in Mayhew (2018), where an initial visit to a health facility, the nurse provides treatment options, which is met by indecisiveness, which turns around on the second visit following consultation with family members on the best course of action (Mayhew, 2018) for the ailing family member. The consultation gives the young mother confidence and a sense of unity in the family due to their collectivist approach. The institution of marriage is revered as well as nursing, as the mother takes time to understand all that pertains to the provided options.
Conflict perspective
Cultural diversity presents different approaches to decision making on health issues. Despite expert knowledge, a nurse must operate under ethical codes by respecting the patient's autonomy. This means that the decision reached, and failure thereof, must be upheld. For instance, a magico- religious culture may bar ailing members from procuring blood transfusions, even though their condition may only be helped by one. A nurse, while offering this option to them, can only do so much but respect this culture.
Conflict may also arise when actions taken in an emergency situation, maybe in opposition to patient beliefs, such as first aid to the opposite sex.
Symbolic interactionism perspective
This perspective demonstrates the difference in dialects and jargon used by different societies. Nursing uses professional language and jargon, which patients may not decipher. Equally, nurses are fac ...
22CHAPTER 2 Cultural CompetencyAchieving cultural .docxrobert345678
22
CHAPTER
2 Cultural Competency
Achieving cultural competence is a learning process that
requires self-awareness, reflective practice, and knowl-
edge of core cultural issues. It involves recognizing one’s
own culture, values, and biases and using effective patient-
centered communication skills. A culturally competent
healthcare provider adapts to the unique needs of patients
of backgrounds and cultures that differ from his or her
own. This adaptability, coupled with a genuine curiosity
about a patient’s beliefs and values, lay the foundation for
a trusting patient-provider relationship.
A Definition of Culture
Culture, in its broadest sense, reflects the whole of human
behavior, including ideas and attitudes, ways of relating to
one another, manners of speaking, and the material products
of physical effort, ingenuity, and imagination. Language is
a part of culture. So, too, are the abstract systems of belief,
etiquette, law, morals, entertainment, and education. Within
the cultural whole, different populations may exist in groups
and subgroups. Each group is identified by a particular
body of shared traits (e.g., a particular art, ethos, or belief;
or a particular behavioral pattern) and is rather dynamic
in its evolving accommodations with internal and external
influences. Any individual may belong to more than one
group or subgroup, such as ethnic origin, religion, gender,
sexual orientation, occupation, and profession.
Distinguishing Physical Characteristics
The use of physical characteristics (e.g., gender or skin
color) to distinguish a cultural group or subgroup is inap-
propriate. There is a significant difference between distin-
guishing cultural characteristics and distinguishing physical
characteristics. Do not confuse the physical with the cultural
or allow the physical to symbolize the cultural. To assume
homogeneity in the beliefs, attitudes, and behaviors of all
individuals in a particular group leads to misunderstandings
about the individual. The stereotype, a fixed image of any
group that denies the potential of originality or individuality
within the group, must be rejected. People can and do
respond differently to the same stimuli. Stereotyping occurs
through two cognitive phases. In the first phase, a stereotype
becomes activated when an individual is categorized into
a social group. When this occurs, the beliefs and feelings
(prejudices) come to mind about what members of that
particular group are like. Over time, this first phase occurs
without effort or awareness. In the second phase, people
use these activated beliefs and feelings when they interact
with the individual, even when they explicitly deny these
stereotypes. Multiple studies have shown that healthcare
providers activate these implicit stereotypes, or unconscious
biases, when communicating with and providing care to
minority patients (Stone and Moskowitz, 2011). With this
in mind, you can begin learning cult.
Journal of Consulting and Clinical Psychology1991, Vol. 59, .docxcroysierkathey
Journal of Consulting and Clinical Psychology
1991, Vol. 59, No. 6,799-812
Copyright 1991 by the American Psychological Association. Inc.
0022-006X/91/S3.00
Cultural Diversity and Treatment of Children
Roland G. Tharp
University of California, Santa Cruz
The increasing cultural diversity of child clients has produced a cascade of new issues and concerns
for psychological practice, theory, and research. Available evidence and pertinent theory are re-
viewed on such topics as the predictive utility and treatment consequences of ethnic membership,
whether treatments should be generic or specific to cultural groups, the degree of privilege that
should be accorded to same-culture therapists, and the relative desirability of different modalities
of treatment for children of different cultural groups. The concept of cultural compatibility of
treatment is explored and evaluated. A broad agenda of hypotheses for research and development is
suggested, and some guidelines for clinical practice and policy are proposed. It is concluded that
insofar as possible, treatment for all children should be contextualized in their family's and commu-
nity's structure of meanings, relationships, and language.
The culturally diverse society that our nation has become
provides a challenge to our politics, our schools, our science,
and our profession. As reiterated by concerned commissions,
agencies, professional organizations, and review articles in-
cluding the current Guidelines for Providers of Psychological
Services to Ethnic andCulturatty Diverse Populations (American
Psychological Association, 1990), we are instructed that "Psy-
chologists should recognize ethnicity and culture as significant
parameters in understanding psychological processes" (p. 4)
before delivering services. What will be necessary to satisfy this
new imperative? Self-examination? New specialized training?
Anthropological indoctrination, religious and spiritual relativ-
ism, multilingualism, "politically correct" thought? And most
to the point, what are the required practical clinical actions? In
discussing these questions, Pedersen and Marsella (1982) con-
clude that to know all and do all that a psychologist should is a
goal that accelerates beyond us.
The task is to bring some order out of this cascade of new
issues and concerns, in the light of available research evidence
and pertinent theory. I will suggest here that some broad out-
lines for strategy are emerging, with enough clarity at least to
pose an agenda of hypotheses for research and development,
and possibly even to provide an initial set of guidelines for
clinical practice and policy. These strategies can be stated
clearly enough to allow them to be tested by both formal evalua-
tion and clinical experience.
Not to overpromise, it should be said that research on cul-
tural issues in clinical treatment is scant, particularly research
addressing such issues with children. We must rely on evidence
from other age grou ...
The U.S Healthcare System, African Americans and the Notion of Toughing It Ou...Chelsea Dade, MS
This project presentation will explore whether or not African American adults are less engaged patients, and whether the notion of toughing it out plays a significant role regarding how African Americans interact with their healthcare.
The Tuskegee Experiment was not the first time that African Americans were experimented on for scientific gain. One book that examines this history is titled Medical Apartheid (Washington, 2006). The novel dives into the dark history of medical experiments on Blacks, including, but not limited to inhumane slavery assessments and Marion Sims’ gynecologic obscenities on Black women (Wall, 2006). Though these debacles occurred decades ago, I propose that these events may continue to play a role in the way African Americans interact with the American healthcare system. Today, there are rules in place to prevent such issues with consent. However, after historically being placed in positions marked by humiliation and mistreatment based on skin color, I wanted to obtain a clearer understanding of whether or not African Americans have responded to the effects of these events by limiting their trust of other people, creating gender norms within their communities, and “toughing it out”.
The structure of this power point presentation for my final paper from HLTHCOMM440, Engaging Patients in Care, will begin by defining this demographic by its key cultural attributes. Second, the paper will highlight research on how one health belief, “toughing it out”, effects African American patient engagement levels. Third, the paper will summarize and discuss the methodology and results from a standardized patient engagement survey, and compare them to the existing literature. Finally, this paper will highlight a hypothetical federally funded health care program, titled “Mandating Mental Health First Aid in Chicago Businesses”, which will require all mid-size and large companies in Chicago to train human resources professionals in “Mental Health First Aid”. This intervention not only benefits African American employees in Chicago, but entire staffs in Chicago in general. In this way, the program does not target African Americans, but seeks to offer helpful resources on mental health that due to either a lack of access or stigmatization, some African Americans may or may not have be aware of. Therefore, the point of having this program is to help employees , especially newer employees, feel supported as the manage the many facets of their lives. Whether or not resources are utilized will depend on many individualistic factors that are including in this presentation. However, the first step towards health equity is to offer equal resources, to everyone.
For access to the standardized survey, please contact Chelsea Dade via email (chelseadade2018@u.northwestern.edu).
Running head CULTURAL SENSITVITY1CULTURAL SENSITVITY2.docxsusanschei
Running head: CULTURAL SENSITVITY1
CULTURAL SENSITVITY2
Cultural Sensitivity
Name
Institution
Cultural Sensitivity
Introduction
Cultural sensitivity refers to the awareness as well as the sensitivity to culture and other practices. Cultural sensitivity can encompass examining different cultures and how they should be accurately approached in the health care. It also includes how to communicate according to within the health care setting. Cultural sensitivity is important area because it can impact the way people work in the health care facilities. It also encompasses valuing differences so as harassment and discrimination, either intended or not, do not happen. Culture is a fundamental and complex concept with consist of broad aspects of people in the health care setting (Campinha-Bacote, 2003). It includes the concepts of sexual orientation, gender, faith, age, disability, race, ethnicity, profession and socioeconomic status. Cultural sensitivity stems from this understanding in that; it is must encompass interpersonal skill as well as the knowledge that will allow the providers of health care, appreciate, understand, and work with individuals from different cultures other than theirs. It also consists of acceptance and awareness of the people’s cultural differences, knowledge, self-awareness of the cultures of the patient and adapting to the skills. Many cultural groups, including lesbian and gay people, individuals with disabilities, lower socio-economic groups and ethnic minorities, for example, African-Americans (Campinha-Bacote, 2003). Cultural sensitivity is considered one of the reasons peoples do not access quality health care services because people are not aware as well as understand the effects attached to one’s culture and how it may be perceived by others. An individual's culture should not appear to be dominant in the place of work.
Healthcare Disparities and How they Relate to Cultural Sensitivity in the Healthcare Setting
Health care disparities, by definition, refer to the differences in health as well as healthcare between population groups. It typically involves a higher burden of illness, mortality experienced in the health care setting, disabilities, and injury by one population group about another. Moreover, it refers to the differences between groups in the health care facilities regarding provision of care services, its access, and quality given. This issue are related to the people’s cultural sensitivity in that the issue surrounds this concept are based on socioeconomic status, gender, sexual orientation, age, and disability status. Similarly, cultural insensitivity arises from disparities that in return causes care limit as well as continued improvement in overall quality of cares (Campinha-Bacote, 2003). Health care disparities can be exacerbated by looking at some things that comprise specific health conditions, provider biases, differences in access to care, poor patient-provider comm ...
Tangible Needs and External Stressors Faced by Chinese Ameri.docxperryk1
Tangible Needs and External Stressors
Faced by Chinese American Families with
a Member Having Schizophrenia
Winnie Kung
This article examines the tangible needs and external stressors experienced by Chinese
American families with a member living with schizophrenia, in the context of a six-month
pilot study of family psychoeducation. Therapists’ notes from 117 family and group sessions
were analyzed. The families expressed concerns regarding housing, finance, work, study, and
the shortage of bilingual psychosocial services. Interacting with government offices and
social services agencies caused anxiety and frustration, partly due to the high stakes involved
given their low socioeconomic status, and partly due to the bureaucracy. As immigrants,
study participants had needs for language translation, knowledge about resources, and advo-
cacy by case managers. This study also highlights the importance of interventions beyond
the micro individual level to the mezzo and macro levels, where changes in organizations
and policies are necessary.
KEY WORDS: caregivers; Chinese Americans; environmental stressors; ethnic sensitivity;
schizophrenia
This study aims to address the knowledge gap in understanding the challenges faced by Chinese American families with a member
living with schizophrenia in relation to their tangible
needs and external stressors from the environment. I
conducted this research in the context of an interven-
tion study of family psychoeducation that I previously
developed and pilot-tested as an ethnic-sensitive pro-
gram for Chinese Americans ( Kung, Tseng, Wang,
Hsu, & Chen, 2012). Family psychoeducation has
been proven effective in reducing caregiver stress and
the relapse rate of individuals with schizophrenia
( Jewell, Downing, & McFarlane, 2009; Lefley, 2010;
McFarlane, Dixon, Lukens, & Lucksted, 2003). The
intervention protocols focus on educating the fami-
lies about the nature of the illness, promoting better
communication, and helping family members re-
solve conflicts ( Anderson, Reiss, & Hogarty, 1986;
McFarlane, 2002) to reduce “expressed emotions”
such as criticism and overinvolvement, which highly
predict relapses ( Butzlaff & Hooley, 1998; Hooley,
2007; Leff & Vaughn, 1985; Marom, Munitz, Jones,
Weizman, & Hermesh, 2005). Few studies had been
conducted with Chinese American families, many of
whom face unique challenges due to their immigrant
status and cultural values ( Kung, 2003).
To more thoroughly understand the stresses ex-
perienced by these families so as to better meet their
needs and to refine the family psychoeducation pro-
tocol, a qualitative inquiry was conducted using the
clinicians’ session notes from the intervention study.
Whereas the family psychoeducation model in its
original design focused on resolving the psycho-
logical and relational issues within the families, this
investigation noted that these families’ struggles were
closel.
Cumulative Lifetime Adversity and Depression Among a NationalOllieShoresna
Cumulative Lifetime Adversity and Depression Among a National
Sample of U.S. Latinx Immigrants: Within-Group Differences in
Risk and Protective Factors Using Data From the HCHS/SOL
Sociocultural Ancillary Study
Daniel K. Cooper
The Pennsylvania State University
Rahel Bachem
Tel Aviv University
Maya G. Meentken
Erasmus University Medical Center–Sophia
Children’s Hospital, Rotterdam, the Netherlands
Lorena Aceves
The Pennsylvania State University
Ana G. Perez Barrios
Universidad Católica Andres Bello
Latinx immigrants are exposed to multiple stressors before, during, and after migration.
However, most past research has assumed the effects of these stressors are uniform across
Latinx groups despite considerable within-group variation. The purpose of this study was
to (a) assess the moderating effects of several risk and protective factors on the association
between cumulative lifetime adversity and depression among U.S. Latinx immigrants and
(b) examine the extent to which risk and protective processes differed between Latinx
subgroups. Data came from a cross-sectional secondary dataset, called the Hispanic Com-
munity Health Study/Study of Latinos Sociocultural Ancillary Study. The sample (N �
2,893) was identified using stratified random probability sampling in four of the largest
Latinx metropolitan areas: the Bronx, New York; San Diego, California; Chicago, Illinois;
and Miami, Florida. We included four Latinx subgroups in our study: Puerto Ricans,
Cubans, Mexicans, and Dominicans. Results from multigroup regression analyses sug-
gested that social support moderated the association between cumulative lifetime adversity
and depression. However, further subgroup analyses showed the moderation effect was
only present for Cuban and Dominican immigrants. We also found that perceived discrim-
ination moderated the association between lifetime adversity and depression for Cuban
immigrants and ethnic identity moderated the relationship between lifetime adversity and
depression for Dominican immigrants. Our results provide preliminary evidence for the
presence of within-group differences in responses to adverse events among Latinx immi-
grant groups. Results can be used to inform the development of mental health interventions
tailored to the specific needs of various Latinx immigrant populations.
This article was published Online First December 5, 2019.
X Daniel K. Cooper, Methodology Center, The Pennsyl-
vania State University; Rahel Bachem, I-Core Research Cen-
ter for Mass Trauma, Tel Aviv University; Maya G.
Meentken, Department of Child and Adolescent Psychiatry/
Psychology, Erasmus University Medical Center–Sophia
Children’s Hospital, Rotterdam, the Netherlands; Lorena
Aceves, Department of Human Development and Family
Studies, The Pennsylvania State University; Ana G. Perez
Barrios, Universidad Católica Andres Bello.
Funding was provided by Innovatiefonds Zorgverze-
keraars, Stichting Hartekind, and Vereniging EMDR
Nederland (Maya ...
1. Department of Health and Human Services Substance Abuse and Mental Health Services Admin
Funding Opportunity (FOA) Number SM-16-010: Cooperative Agreements for Tribal Behavioral Health
Historical Trauma: Culturally Sensitive Treatment in Indigenous Communities
Kaitlyn Welch, Sara Cole, Raven Knapp, & Lars Boettcher
University of Washington
June 1, 2016
2. Introduction
There isan extensiveamountof literaturesurroundinghistorical traumaanditseffectson
indigenouscommunities. We will focusprimarilyonindigenouspopulationsandwe will be reviewing
differentapproachestotreatment,suchasthe westernclinical formof treatmentandtraditional
indigenoushealinganditsrole inthe healthof the community.A large bodyof literature hasbeen
writtenonresearchthat showssuccessful preliminaryresultsof indigenoushealingpractices(Bigfoot&
Dunlap,2006; Braveheartet.al 2011, Castledenetal.2007, Gone & Alcantara2007). Withfurther
research,we hope toimprove the efficacyanduse of culturallysensitive treatment.Itisourgoal thatby
investigatingthe currentclimate of culturallybasedtreatmentandevidence basedcare we will finda
more comprehensive interventionmodel.
The social isolation,poverty,andlackof healthcare servicesthatplague the country’s
reservationshave encouragedalcoholism, drugabuse,andalcohol-relatedcrime intheseareas
(Braveheart,2003; Clark2006). Studieshave shownthatIndigenouspeople have a75% higherchance of
beingassaultedintheirlifetime,andthe childrensexual abuse ismore thansix timesthe national
average (Payne,2013). AmericanIndianscontinue tobe confrontedbydiscriminationandracismwhich
has affectednative tribesforhundredsof years,deeplyrootedtothe historical traumathataffectstheir
everydaylives(Braveheartet.al,2011; Gone & Alcantara2007; Sunrise House,2016; Walters,2004).
There are five racial groupsthatSunrise House,atreatmentprogramand a drug rehabcenter
that has beenhelpingpeople foroverthirtyyears,aswell asconductingresearchforbettertreatment
and increasedawareness,focusedtheirresearchonthe populationproportionthatabusedsubstances.
The races that data was collectedonwere AsianAmericans,HispanicAmericans,CaucasianAmericans,
AfricanAmericans,andNative American,Native Americansscoredthe highestat12.3%, comparingto
the secondhighestof 10.5% of AfricanAmericansmore likelytouse substancestocope withtheir
trauma. Fromthisdata, we can deduce thatindigenous populationscurrenttreatmentandhealing
methodsdonot reduce the ratesof substance abuse (Sunrise House,2016).
Eventhoughindigenouspeoplehave highratesof depression,anxiety,andotherformsof
mental illness,the reservationssufferfromalack of mental healthprofessionals(McCabe,2013; Payne,
2007). Mental healthclinicsontribal landsare limitedandhighturnoverratesfortreatmentstaff pose
additional challenges.Addressingtheseproblemsrequiresanational focusonthe healthconcernsof
indigenouspeople,alongwithawillingnesstodevote more resourcestoeducation,prevention,and
rehabfor marginalizedgroupsof people.
NotedscholarPembercomments,“The science of epigenetics...proposesthatwe passalong
more than DNA in ourgenes;itsuggeststhatour genescan carry memoriesof traumaexperiencedby
our ancestorsandcan influence howwe reacttotrauma and stress”(2015). Trauma experiencedby
earliergenerationscaninfluence the structure of ourgenes,makingthemmore likelytoexpress
negative responsestostressandtrauma.Historical traumais a three part process.“Inthe initial phase,
the dominantculture perpetratesmasstraumaona populationinthe formof colonialism,slavery,war
or genocide.Inthe secondphase the affectedpopulationshowsphysical andpsychological symptomsin
3. response tothe trauma.In the final phase,the initial populationpassesthese responsestotraumato
subsequentgenerations,whointurndisplaysimilarsymptoms”(Pember,2015). Accordingto
researchers,highratesof addiction,suicide,mental illness,sexualviolenceandotherillnessesamong
Native peoplesmightbe,atleastinpart,influencedbyhistorical trauma.
There are currenthealthcare provisionsthatindigenouspeoplereceive thatdonoteffectively
improve theirmental health.Modernmedicinefocusesononlythe scientificandothermechanicsof
medicine inthe body(Weiser,2015).The indigenousstyle of healingnotonlyusedherbsandplantsas
medicine,aswell asinclusionof spirituality.Thisiscrucial tohealingthe bodyaswell asimprovingthe
emotional wellnessof apersonand the harmonytheyexperience withtheircommunityand
environment.Indigenoushealingmayhave otherchallengesandlimitations.Forinstance,itisstill
unable tocure some of the diseasesintroducedduringcolonial introductiontothe states.Hospitals,
especiallynearreservations,are startingtobecome more acceptingof the indigenousstyle of healing.
Throughthiscollectedbodyof researchwe will identifythe bestformof treatmentforthese indigenous
groups.LookingintobothWesternmedicineaswell asindigenouspractices,inordertocreate an
effectivetreatmentprogramthatwill positivelyenhancethe outcomesof substance abuse andmental
illnessrecovery.We will thenseektoanswerourresearchquestion:How hasthe efficacyof traditional
healingpracticesbeenmeasured?Whyhasthere beenlimitedstudiesfurtheringeffective indigenous
healingpractices?
Purpose statement
The purpose of thisstudyis to determine the mostbeneficialtreatmentservicesforindigenous
people thathave experiencedhistorical traumaandare currentlyfacingissueswithsubstance abuseand
mental illness.Thisstudywillanalyzeexistingdataonthe efficacyof indigenoustraditional healing,in
comparisonwiththe effectivenessof westerntherapypracticessuchasCommunityBasedParticipatory
Research.Withour findings,we will developanessential preliminarytrainingprogramforcounseling
professionalsworkingwithinindigenous communitieswhichare currentlylacking(Gone &Alcantara,
2007).
Literature Review
Themesthatemergedfromourresearchare traumafrom abuse (sexual andphysical),historical
trauma,substance abuse,mental illness,traumainformedcare,andcommunitybasedparticipatory
researchmethods.Grayshieldet.al conductedone of the firstknownstudiesof itskind(2015).The
authorsof thisresearchstudyare eitherindigenous,aminoritypopulation,orhave astrong connection
to a Native Americancommunity.Importantqualitative dataemergedfromthisNative Americanelder
perspective onwaysinwhichtoheal historical traumaastheyare highlyrespectedmembersintheir
4. community,andmanyof themhave experiencedhistorical traumathroughouttheirlifetime.Existing
researchshowsthathistorical traumahas largelybeencollectedandstudiedfromawesternized
perspective (Grayshieldetal.2015 as citedbyBrave Heart& DeBruyn,1998; Duran, 2006; Whitbecket
al.,2004). The recommendationsfromthe communitythatemergedare:focusonthe positive,
awarenessandeducation,returntocultural andspiritual waysof life,andlanguage learning.Further
suggestionsincludedintegratingastrengthsbasedpsychotherapy“toshiftthe focusof therapyfroma
deficit(e.g.,disordered)modeltoa strengthsmodel”(Smith2006 as cited byWallerstein&Duran)
Thisapproach has similaritiestoa community-basedparticipatoryresearchmodel,whichhas
alsoaddedto the literature of effectivetreatmentandcare withinindigenouscommunities.Community
basedparticipatoryresearch(CBPR) hasgainedmomentuminthe lastfew decadeswiththe “capacityto
reduce or eliminateracial/ethnichealthdisparities”(Wallerstein&Duran2010). Insteadof conducting
researchon a community,CBPRseekstoinvolvethe communitymembersasequal contributorstothe
researchprocess.
A relativelynewwesterntreatmentmethodistrauma- informedcare,thismeansthatstaff are
trainedtobe sensitivetotraumathat patientshave facedinorderto betterserve the needsof these
typesof patients.The Women,Co- occurringDisordersandViolence Study(WCDVS)wascreatedto
quantitativelymeasure the effectivenessof trauma- informedcare forwomencopingwithtrauma,
mental illness,andsubstance use disorders.The resultsshowedthattrauma- informedcare practices
improvedpatient’smental healthoutcomes.
Grayshieldetal.’sstudy onthe possible treatmentsforhistoricaltraumaasrecommendedby
Native Americanelders,provide recommendationsforculturallysensitive treatment,developedby
those affected.Asforthe Women,Co- occurringDisordersandViolenceStudy(WCDVS),trained
professionalstreatingtraumadonot have personal experience withsaidtrauma,therefore the
epistemological frameworksoffercompletelydifferent approaches.The methodologieswe have
analyzedare as follows.Anindigenousstrengthbasedcounselingmodelinwhichcounselorsand
patientsidentifypersonal strengthsandhow touse themwiththemselvesandotherscanprove very
effectiveinindigenouscommunities(Grayshieldet.al).Communitybasedparticipatoryresearchfocuses
on the intersectionof science,communityinvolvementandsocial actiontobenefitequalityof health
care (Wallerstein,2011).Strengthsbasedpsychotherapychangesthe focusfromdeficitsintostrengths
(Smith2006 as citedby Grayshieldetal.2015). Evidence basedpractice strivestodiscoverthe best
treatmentmethodsthatcan be usedto effectivelytreatpatientsandisbasedonthe currentbodyof
knowledge producedbyleadresearchersinagivenfieldof study.Traumainformedcare isatreatment
approach thatfocusesoneducatingtreatmentstaff onthe wide arrayof trauma experience patients
face and howto bestrespondto patient’s needs.
There have beenseveral questionsraisedaswe have reviewedthe literature.Whoisdiagnosing
individualswithco- occurringdisorders?Whatare the challengesof diagnosisinmental illnessesand
substance abuse issues?Misdiagnosiscanpotentiallyoccurandcreate additional barrierstoan
individual’sabilitytorecoverorbenefitfromtreatmentservices.Whatlimitationsconstrainthe
differentmethodologieswe have lookedat?ForInstance,evidence basedpractice islimitedbythe
5. amountof data,both qualitativeandquantitative,incirculationonacertaintopic.Who isbeingleft
out?A considerable questionwe hadinthisprocess waswhetherornot the researchaccountedfor
those whoare tooscared or too proudto come forth abouttheirtrauma or theirsubstance abuse.We
have discussedwhetherornotresearchersleftroomforthose intheirresearchor if theyexcludedthis
populationintheirresearch.Manypeople inthesecommunitieswill be supportive of those theyknow
are sufferingabuse,yetnotconfrontthe situationheadon.Ourcontinuedresearchisdirectingus
towardsfindingamore comprehensive interventionutilizing indigenousperspectivesasthere hasbeen
limitedresearchinthisphenomenological framework(Grayshieldetal.2015). Our desiredapproachis
to upgrade healthcare providerstrainingtoinclude differentculturesandspiritualfixtures.
Methodologyand Epistemological Framework
It isour goal thatthrough thisresearch,we will begintodevelopanextensive trainingprogram,
incollaborationwiththe indigenouscommunityanditsmental healthprofessionalsforcontinued
practice and implementation.In ordertoachieve this,we wanttodevelopapartnershipwiththe
indigenouscommunity.We will be analyzingexistingdataasour methodological approachbyusing
secondarydata analysisandfocusingoncommunitybasedparticipatoryresearch(CBPR).Gone and
Alcantara(2007) foundthe available dataonoutcomesof any numberof culturallysensitive treatments
islimited.IllustratedbyWallerstein&Duran(2010), the continuedpractice of these interventionsisnot
alwayscarriedoutafter studiesare conducteddue tofundinglimitations.
The epistemological frameworksthatourresearchincludesare CommunityBasedParticipatory
Researchandevidence-basedculturallysensitivetreatment.CommunityBasedParticipatoryResearch
(CBPR) isan ideal epistemological frameworkforconductingresearchwithmarginalizedcommunities
and the mental healthdisparitiestheyface (Wallerstein&Duran2010). Castleden,Garvin&Huu-aht-
FirstNation(2008) state that CBPR“attempt(s) todevelopculturallyrelevantresearchmodelsthat
addressissuesof injustice,inequalityandexploitation”.Culturallysensitive treatmentandpractices,
such as the Tribal ParticipatoryResearchmodel,asdevelopedbyFisher&Ball (2003) incollaboration
withCBPR, can strengthenmental healthoutcomesandraise social capital.“CBPRresearchwithina
postcolonial traditionseekstouncoverandhonorcommunityexplanationsandnarrativesof the
conditionof people’slives”(Duran&Duran,1995; Walters& Simoni,2002; as citedby Minkler&
Wallerstein,2008). If implementedsuccessfully,there ispotentialtobe as muchof a communitybenefit
as there isfrom a researchstandpoint.Thispartnershipemploysthe abilitytoradicallychange
communitiesthroughsocial outreach.
Withour evidence based,culturallysensitive practices,we wanttoconducta programthat has
similarcomponentsof the PathwaytoHope Program.AccordingtoPayne et al.,thisprogramhas data
that supportsthe “community-baseddialogueandwisdomof Native eldersandspiritual leaders”paired
withoutpatientcounselorsthatare trainedtowork withindigenouscommunitiesinordertoenact
change for future treatment(Payne etal.,2013).The Pathwayto Hope Programworksat all levels,
6. helpingthe indigenouscommunitylearn,share,helpandheal togetherasa communityinhopesforan
endto the denial andsilence aroundsexualabuse forthe native community.
Conclusion
Loss of indigenousland,culturaltraditions,andtheirpeople has largelycontributedtothe
disproportionateratesof substance abuse andmental illnessamongIndigenouspeople.We have the
chance to buildupona treatmentmodel withpreliminarysuccessthatwill helplowerratesof these
occurrences.Treatmentpracticesthatare culturallyspecificin combinationwithcommunitybased
participatoryresearchare absolutelyimperative.Itwill notonlybe designedtoserve indigenous
communities,butothermarginalizedgroupsaswell will benefitfromCBPRanditsabilitytoaddress
specificgroups’social issues.We anticipate thismodel servingasaprototype forfuture researchersto
builduponandstrengthenasadditional researchisconducted.Byfundingthisstudy,yourorganization
isvalidatingthe livesof millionsof people whohave beenotherwise erasedfromthe hegemonic
structuresinplace.
7. AppendixA. Budget
Personnel (salaries)
ResearchDirector- $60,000/yr
Communitypartner- $60,000/yr
Data analyst- $50,000/yr
ResearchAnalyst- $50,000/yr
Fringe Benefits
$21,840 each
Travel
Hotel and FlighttoRockville,Maryland(SAMHSA Office) ($622 PerPerson- TwoPeople)(twicea
year)
Hotel and FlighttoBethesda,Maryland(NIHOffice)($722 PerPerson- TwoPeople) (twice a
year)
Rental Car inMaryland (about$245 for5 days inMaryland) (twice ayear)
Equipment
CPU ($1500 per person)
Monitor($350 perperson)
Othermaterials(keyboard,mouse andresearchsoftware) ($150 perperson)
Printermulti-purpose($200)
Video/Recordingdevices$600
Supplies
Pens,inkcartridges,coloredink cartridges,paper,etc.($50 per month)
Contractual
Treatmentcenterstaff- 2 outpatientcounselorsprovidingculturallysensitive treatment($150a
day eachperson) ($39K a year) for a six hour day,theywill eachgetpaid$25.00/hr, one working
witha group of patientsandone workingone onone withpatients.
Clinical Psychologist –TBD($69K a year)
KarinaL. Walters,PhD (Director,IndigenousWellnessResearchInstitute) ($75Ka year)
Other
At thistime,inlieuof payingresearchparticipants,free counselingserviceswill be offered.
Total:
8. Salaries:60,000 * 2 = $120,000
50,000 * 2 = $100,000
Fringe benefits:21,840 * 5 = $109,200
Travel:2,488 + 2,888 + 980 = $6,356
Office Equipment:2,000* 4 = 8,000 + 200 + 600= $8,800
Office Supplies:50* 12 = $600
Collaborators:$69K a year fora clinical psychologist(TBD).$75K peryear for consultant
(Walters).
Recruitone graduate studenttoassistin observationandone postdoctoral studenttoassistin
facilitationof treatment.(Total:$69Kper year).
$39K a yearfor treatmentcenterstaff
$596,956 peryear isthe budget
Part 2: Budgetnarrative/planforresearch
The mediansalaryof Social ScientistsinWashingtonState is$66,470 (O*Net,2015). We decided
on $60,000 for the four of us to allotmore funding towardourtreatmentimplementation.
We cappedour fringe benefitsat$21,840 for each employee tohave healthcare and5 days
PTO.
Total travel expenses,notincludingpersonalexpenses,we calculatedtobe about$622 per
personto go to Rockville,MD, (locationof SAMHSA).We will sendtworesearcherstocut down
on cost.Whengoingto Bethesda,MD (locationof NIH) the flightandhotel isabout$722 per
person,withtworesearchersattendingthismeetingaswell.A rental carisabout $245 forthe 5
dayswe are downthere.We will meetwitheachorganizationtwiceayearto reporton research
and our preliminaryfindings.
The equipmentwe willneedinouroffice includesCPU’sforeachperson,whichwill cost$1,500
for eachof us.We will alsoneedamonitorforeach of the CPU’s and a printer,withcopyandfax
capabilities,whichisabout$200.
The suppliesthatwe will needsuchaspaper,pens,paperclips,staplers,will costusabout$50,
thisamountallowingforextrasupplieswhenneeded.
Our researchoffice islocatedinNorthEverett,WA andthe indigenouscommunitythatwe will
be work withisthe TulalipTribe inTulalip,WA thisisabouta 20 minute drive locatedabout12
milesapart.
For our contractual staff,thanksto KarinaL. WaltersPhD.,a notedscholarin indigenous
research,we have createda relationshipwithalocal treatmentcenterthatprovidesculturally
sensitivetreatment.We will payeach(2) outpatientcounselors$39,000 peryear.Walters,who
isthe Directorof the IndigenousWellnessResearchInstitute,hasdone extensive researchinthis
fieldandherexpertisewill helpusdevelopourobjective.Herconsultingserviceswill costus
$75,000 peryear.
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