O R A N G E C O U N T Y H E A LT H C A R E A G E N C Y ( O C H C A )

B E H AV I O R A L H E A LT H S E R V I C E S ( B H S )C E N T E R O F E X C E L L E N C EM I N H - H A P H A M , P S Y. D .

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C O - P R E S E N T E R S W I T H L I V E D E X P E R I E N C E

UNDERSTANDING CLIENT CULTURE & JOURNEYS

1. Client culture, world views, self concept, and relationship dynamics within their cultural and family systems

2. The cultural responsive considerations in working

with behavioral health clients and their families

3. The personal challenges faced through interaction with the health care systems and/or substance use issues, and as individuals and care giver/family member

4. Resilience and recovery journey

Presentation Objectives

“Culture” refers to the shared attributes of a group of people.

People can share a culture, regardless of their race or ethnicity.

◊ Race: “socio-biological category” associated with visible physical characteristics such as hair, skin tone ◊ Ethnicity: heritage of a particular group

Definitions of Culture

More on Culture

“Culture” is broadly defined as a

◊ Common heritage ◊ Learned set of beliefs◊ Norms and values◊ Shared attributes

(U. S. Department of Health and Human Services, 2001)

Cultural Traits: Traditions Language Ethnicity Geography Foods Values History Experiences Spiritual beliefs Identity

It is essential to recognize diversity ◊ Diversity is expressed through both groups and individuals

◊ Diversity exists not only amongst, but within various populations (i.e. seeing both the “forest” and the “tree” metaphor)

Understanding and respect:

◊ Accepting that each individual is unique ◊ Recognizing our individual and collective differences ◊ Exploration of differences with a safe, positive, and nurturing

approach ◊ Understanding each other’s uniqueness and moving beyond simple tolerance

Recognizing Diversity & Embracing Uniqueness

Client culture shares some common attributes in

that the life conditions or disability of a client, the attitudes and practices of the health care system, and ethnic/cultural contexts in many ways affect and mold the values, beliefs and lifestyles of the client, as well as his/her family system.

Definition of Client Culture

A landmark book by Judi Chamberlain (1978) On Our Own: Patient-Controlled Alternatives to the Mental Health System alerted care providers across the country about the stigma and discrimination against mental illness and mental health consumers.

The Client/Consumer/Survivor Movement: A Civil Rights Paradigm

The Disabilities Movement: Independent Living Philosophy

Recovery Philosophy: Empowerment and Self-Determined

Landmark & Movement

Factors Defining Client Culture

Important factors

shaping client culture: ◊ Stigma ◊ Poverty ◊ Labeling (“patient,

client, consumer, survivor”)

◊ Consumer Movement

◊ Recovery Philosophy

◊ Employment as a behavioral health professional

Fear of discrimination is the key barrier that keeps many people from revealing symptoms and seeking help, services and treatment.

Stigma does not only reside with having mental health issues but also with substance use. Both are not mutually exclusive, and both are heavily judged by society, communities, cultures, families and workplace.

Stigma leads to low self-esteem, low self-efficacy, a sense of being misunderstood, hopelessness.

Stigma also deters people from socializing or working with, renting to, or employing behavioral health clients.

The Negative Impacts of Stigma

Contact with people who have behavioral health issues tends to decrease stigma

Understanding the lived experience of individuals with behavioral health and /or substance abuse issues weakens people's tendency to link these conditions to violence

Changing Stigma

People with behavioral health issues can and often do recover

◊ with the support of their peers, family, friends and communities

◊ by working with mental health and/or substance abuse professionals for proper diagnosis, treatment and medication

People with mental health and/or substance abuse issues can and do make important contributions to their family and community systems and to the behavioral health professions

Recovery is culturally based and influenced. Values, traditions, and beliefs determine a person's journey and unique pathway to recovery. Services should be culturally grounded, personalized and responsive.

Key Facts About Recovery

Along with housing, employment has consistently ranked as one of the highest priorities for clients of the behavioral health system (as well as for people with other disabilities).

The inclusion of people with the lived experience of mental health and substance abuse issues into behavioral health professions is transforming both client culture and the health care systems.

This stance also promotes equity in health services, social justice and advocacy for clients, family members and care providers.

From “Client” to Colleague

From humility and a culturally responsive perspective, health care systems, agencies and professional providers of services to clients/consumers should utilize a set of values, skills, attitudes and policies in working effectively together in cross-cultural situations.

This should include a recognition of and sensitivity to client culture, as well as to other cultural variables.

Culturally Responsive Practice

In order to become effective, provider’s awareness of his/her own cultural values and biases is the pre-requisite for being able to accept and embrace similarities and differences of client’s worldviews.

A holistic understanding of a client’s experiences, life change events, spirituality and worldview, cultural and family systems leads to a more comprehensive understanding of a client’s development, emotional, functional and cognitive processes and behaviors.

Culturally Responsive Health Care Providers

With a best-practices approach, Health Care Providers:

Work to understand a person’s perspective on their own behavioral health and/or substance abuse issues

Incorporate a strength-based, recovery-oriented approach to create and maintain a cultural responsive, supportive, collaborative, spiritual integrative, empowering and engaging therapeutic relationship

Effective Health Care Delivery

Show respect and genuine understanding in the form of active listening:

◊ Take complaints seriously ◊ Evaluate and re-evaluate if necessary ◊ Attend to thorough follow-ups ◊ Collaborate ◊ Be patient and communicate effectively

Coordinate with other professional providers to deliver and link necessary care, from housing to community-based supports, in a timely manner

Effective Delivery As A Care Provider

Be self-aware with the ability to acknowledge one’s own cultural orientations and limitations

Practice humility without having to be an expert and learn from your clients (i.e. asking what has been working and healing in the clients’ context, culture and community)

Advocate with your clients

Effective Delivery

Aguilar-Gaxiola, SA, Elliott, K, Deeb-Sossa, N, King, RT, Magana, CG, Miller, E, Sala, M, Sribney, WM, Breslau, J (2008). Engaging the underserved: Personal accounts of communities on mental health needs for prevention

and early intervention strategies.Sacramento: UC Davis Health System. Chamberlin, Judi (1978). On Our Own: Patient Controlled Alternatives to the Mental Health System. Mcgraw-Hill. Corrigan, P.W. (2005). On the stigma of mental illness: Practical strategies for research and social change .

Washington, D.C.: APA. Krzyzanowski, R. (2011). Understanding Client Culture: An Experiential Workshop. Retrieved on June 15, 2012 from http://workingwelltogether.org/dnn/LinkClick.aspx?fileticket=7oqU1DhNOCM%3D&tabid=117&mid=529 Pescosolido, B.A., Jensen, P.S., Martin, J.K., Perry, B.L., Olafsdottir, S., & Fettes, D. (2008). Public knowledge and

assessment of child mental health problems: Findings from the National Stigma Study—Children. Journal of the American Academy of Child & Adolescent Psychiatry, 47, 339–349.

SAMHSA News (2012). Study finds one-in-five American adults with mental illness, Winter issue, 20, 1, 8. Tervalon, M., Murray-Garcia, J. (1998). Journal of Health Care for the Poor and Underserved, 9, 2, 117-125. U.S. Department of Health and Human Services (2006). Developing cultural competence in disaster mental health

programs. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. Center for Mental Health Services.

U.S. Department of Health and Human Services (2001). Mental health: Culture, race, and ethnicity- A supplemental to mental health: A report of the Surgeon General. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. Center for Mental Health Services. Veccio, V. (2012). SAMHSA’s Working Definition of Recovery Update. Retrieved on June 25, 2012 from

http://blog.samhsa.gov/2012/03/23/defintion-of-recovery-updated/

References

John, Team Lead, OC Wellness Center

Minni Lucas, Outpatient Recovery Services Coordinator, Mental Health Association-OC

Nicole Lehman, Director, Recovery Education Institute, Pacific Clinics

Greg Wright, Family Member, MHSA-OAC, Mental Health Board, Art for Wellness & OC Stigma Elimination Task Force

Experiential Journeys & Perspectives

"If you focus on the competence of people with

mental illness, that tends to lead to greater tolerance.”

Pescosolido

“In the attitude of silence, the soul finds the path in a clearer light”

-- Mahatma Gandhi

“ When I dare to use my strength…

Then it becomes less and less important

whether I am afraid.”

Andre Lorde

“We need to give each other the space to grow, to be ourselves, to exercise our diversity. We need to give one another space so that we may both give and receive such beautiful things as ideas, openness, dignity, joy, healing and inclusion.”

--Max de Pree

Until

  Until I eliminate the stigma within me, the

changes I wish to see in the world will never happen. No matter where that voice came from, I must silence that voice or continue to be part of the problem.

Melody Marler

Patient Rights Advocate

OC HCA/BHS

“It is not what we read but what we remember that makes us learned; and not what we profess but what we practice that gives us integrity.”

--Francis Bacon

 

Each of us shines in a different way, but this doesn't make our light less bright.

Albert Einstein

“Dreams are renewable. No matter what our age or condition, there are still untapped possibilities within us and new beauty waiting to be born.”

--Dr. Dale Turner

Go On and Be

I see a beautiful you,Thoughtful and warmI see sunshine beyond the golden hair,A yearning for freedomLike those waves at seaI see an unlimited skyIn your endless blue eyes beckon to Go on, love on and be precious wonderful you…

Minh-Ha Pham, Psy.D.

“Darkness cannot drive out darkness; only light can do that.”

Accept finite disappointment, but we must never lose infinite hope.”

--Martin Luther King, Jr.

Hope

For every heart that has known hurt,Hope casts a lightThat shines through darkness To find a path To a healing place.Hope is the golden threadThat gathers courage and strength.It is where a soul can be restored through forgiveness.Hope brings the magic of Spring;Renewal through the wonder of transformation, Awakening dormant hearts With real meaning, at last Minh-Ha Pham, Psy.D.

“To accomplish great things, we must not only act, but also dream; not only plan, but also believe.”

--Anatole France