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Region 8 Co-Occurring Disorders (Wk 6)
- 1. Christina Boyd, LSCSW,LCAC Co-Occurring Disorders EPL
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- 3. • Welcome andCheck in • Review Learning Activity around Cultural Competence Welcome • Need for Culturally Sensitive Services • Overview of Cultural SensitivityPresentation • Review and Wrap up of series! • Final QuestionsSummary Agenda
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- 5. (Sufrin, ACOG, 2018) Needfor Cultural Sensitivity in Treatment • As US populations become more diverse, increased need to provide Culturally and Linguistically Appropriate Services (CLAS) • Each health care interaction occurs in context of three cultures o Healthcare provider’s lived experiences o Experiences of person seeking care o Culture of healthcare system itself • Wide variations in attitudes, beliefs, behaviors exist among all individuals o This includes bias • Can we really become “competent” in another person’s culture? • Is “competence” a skill we can master? o We should try to learn about cultural specificities of particular groups and populations we work with, recognize variations within those groups, and try to understand overlaying general experiences of each population
- 6. Addiction Counseling Competencies,https://store.samhsa.gov/product/TAP-21- Addiction-Counseling-Competencies/SMA15-4171 Used With Permission From: Diana Padilla Awareness • Differences of culture and one’s own • Value diversity Attitude • Aware of own biases, values & belief systems • Acknowledgement & respect for cultural differences Knowledge • Inherent cultural trends of population • Current research on effective practice Skills • Use of appropriate name or pronouns • Engagement approaches Cultural Competence Core Elements
- 7. Used With PermissionFrom: Diana Padilla Self reflection • Incorporate an understanding of culture, relational dynamics and differences • Develop self awareness and identify personal cultural perspectives • Recognize and address personal bias Self-reflection activity: Take time each evening to reflect on your behavior for the day. How do you perceive yourself? How do others perceive you? What can I learn from observing my behavior today? Before Working with a Diverse Person
- 8. Used With PermissionFrom: Diana Padilla • Inclusive environment • Initial approach and greeting • Fostering a rapport Recovery oriented language is strength based and person centered, which is foundational to culturally informed practice. Engage
- 9. Used With PermissionFrom: Diana Padilla Botticelli-Koh-Changing-the-Language-Addiction, JAMA 2016 • People with mental illness were labeled as “lunatics” and sequestered into “insane asylums.” • Early days of HIV, patients were referred to as having “gay-related immune deficiency.” (GRID) • For someone struggling with addiction or substance use disorder, language can be impactful. • Stigma and shame are typically uniformed biases, that can further depress potential motivation needed for recovery. When Language Impacts
- 10. Used With PermissionFrom: Diana Padilla • Changing language, (and policies and programs) will take time. For instance, the word “abuse” continues to appear in the titles of highly respected addiction journals and in the names of federal government agencies despite the changes in the DSM5. • By beginning to change the language of addiction, it is possible to foster a better future for people with SUDs and remove barriers that hold back people from committing to treatment they need. Working on Change
- 11. • UA waspositive for X substance • She has a Substance Use Disorder and needs help • She is a person in sustained recovery from opioids • She had a slip or a relapse • There is always HOPE that people can change (It doesn’t guarantee they will and sometimes it is not on our timeframe) Use This INSTEAD… • Sally’s UA is dirty • “Another junkie in room 5” • She is an old addict • She keeps screwing up • You are never going to change Think about NOT saying… Words Become our World
- 12. Used With PermissionFrom: Diana Padilla • Familiarity with inherent cultural trends of communities being served can be helpful in guiding interactions • Stay abreast of culturally and linguistically appropriate evidence based practices and interventions Practitioner Knowledge
- 13. • What aresome of the cultural considerations that you need to be aware of in your community? • How do these cultural norms or beliefs affect services in your agency? • Are there any biases in the SUD treatment world around Mental Illness?Group Discussion
- 14. What are somethings that you see in your practice setting that have to do with culture that get in the way of people getting better? -Please use your chat function to write in your thoughts or unmute your microphone and talk about it! What are some positive things your agency or community is doing in the area of cultural sensitivity? Hurdles to effective treatment
- 15. Used With PermissionFrom: Diana Padilla NDRI, Cultural Proficiency in Drug Court Programs curricula, Contrasting Values, Attitudes and Behaviors, 2002 Eye contact • It is best to look at people directly in the eye when talking to them; otherwise, you are seen as dishonest or uncaring. • It is very rude and hostile to look at people directly in the eye when talking. Contrasting Values, Attitudes, Behaviors
- 16. Used With PermissionFrom: Diana Padilla NDRI, Cultural Proficiency in Drug Court Programs curricula, Contrasting Values, Attitudes and Behaviors, 2002 Control over illness • We all have the power to help ourselves get better. • There is nothing we can do about being sick, because our fate is in the hands of a higher power. Contrasting Values, Attitudes, Behaviors
- 17. Used With PermissionFrom: Diana Padilla Source: C. Storti, (1994). “Cross-cultural Dialogues.” 1. Don’t assume sameness 2. What you think of as normal human behavior may only be cultural 3. Familiar behaviors may have different meanings. Same behaviors may not mean the same thing 4. Don’t assume that what you meant is what was understood 5. Don’t assume that what you understood is what was meant 6. You don’t have to like or accept “different” behavior, but you can try to understand where it comes from 7. Most people do behave rationally, you just have to discover the rationale 7 Lessons in Cross Cultural Dialogue
- 18. Used With PermissionFrom: Diana Padilla 1. Tell me about your racial /ethnic /religious background and share something about the commonly held values and beliefs of people in your community. 2. How are you the same as others in your community? 3. How are you different from others in your community? 4. What two things would help the program deliver effective services to you? Culturally Informed Questions
- 19. It is importantto remember that a significant component of entrenched beliefs comes from cultural experience. Specific racial and ethnic groups hold beliefs that are rooted in their cultural experience and are completely valid in that context, although they may appear “dysfunctional” if one doesn’t understand the cultural context. A culturally competent counselor will recognize that questioning or challenging a belief has to be done in the context of understanding cultural underpinnings and must be undertaken in a respectful, sensitive, accepting, and open manner. –TIP 48 (Center 48) Treatment Implications…
- 20. Week Agenda/Topic AssignmentsDATE Orientation to Technology Session COMPLETED! One Welcome/Overview of Workwise Series and of Co- Occurring Disorders COMPLETED! Two Overview of DEPRESSIVE Disorders COMPLETED! Three A Closer Look at ANXIETY Disorders and TRAUMA COMPLETED! Four Starting to understand PERSONALITY Disorders COMPLETED! Five Integration of BH into SUD treatment COMPLETED! Six Cultural Intelligence and Wrap up Almost Done! Co-Occurring Disorders EPL Series
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- 23. What is onething that stands out from this series for you? PLEASE TYPE IT IN THE CHAT BOX! What did you learn?
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- 25. Do something to furtheryour practice to help those with a co-occurring disorder! As this series ends…
- 26. For your ValuableTime and Attention
- 27. •Addiction Counseling Competencies,https://store.samhsa.gov/product/TAP- 21-Addiction-Counseling-Competencies/SMA15-4171 •Botticelli-Koh-Changing-the-Language-Addiction, JAMA 2016 •C. Storti, (1994). “Cross-cultural Dialogues.” •Center for Substance Abuse Treatment. Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery. Treatment Improvement Protocol (TIP) Series, No. 48. HHS Publication No. (SMA) 13-4353. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2008. •NDRI, Cultural Proficiency in Drug Court Programs curricula, Contrasting Values, Attitudes and Behaviors, 2002 •Sufrin C, Davidson A, Markenson G, ACOG Committee Opinion No. 729: Importance of Social Determinants of Health and Cultural Awareness in the Delivery of Reproductive Health Care. Obstet Gynecol. 2018 Jan;131(1):e43-e48. doi: 10.1097/AOG.0000000000002459. References: