News & Announcements

Program-Level Cultural Competency Assessment Scale: Implications for Disparity Reduction

Posted: July 09, 2012

The Nathan Kline Institute (NKI), Center of Excellence in Culturally Competent Mental Health, has just released its Program-Level Cultural Competency Assessment Scale 2.1.  It can be used for program-level self-assessment and care coordination to monitor change over time. The Scale is organized into program level activities of cultural competency (CC) related to engagement, service delivery and supports using 14 criteria.  It is not intended to measure the personal cultural competency of an individual caregiver nor the cultural appropriateness of a specific service. Its use is maximized when it is used in conjunction with the NKI Agency-Level Cultural Competency Assessment Scale (CCAS) that measures the organizational cultural competency of the program's parent organization in terms of its policies and procedures.

A study on the assessment scale was published in the journal Administration and Policy in Mental Health and Mental Health Services Research. The study is titled The Nathan Kline Institute Cultural Competency Assessment Scale: Psychometrics and Implications for Disparity Reduction. An excerpt from the discussion of the study:

The CCAS criteria and the activities they define serve as a roadmap for the introduction of CC activities into an agency, as well as a marker of progress. The range of scores observed in the study is indicative of the differential progress of the participating agencies. Factor analysis suggests that there are three stages in the process of becoming increasingly culturally competent. In the first stage the emphasis is on administrative elements (agency has a commitment, receives community input from a CC committee and conducts staff training). In the second stage, the agency engages in activities designed to better understand and serve their communities (collects data, institutes recruiting/hiring/retention policies and creates translated and easy to read service descriptions and educational materials). The third stage is comprised of activities that are directly associated with clinical care (has interpreters, bilingual, bicultural staff and reviews, adapts and institutes new services). Notably, none of the administrative items, including conducting staff training, contributed to the prediction of reduced service outcomes disparities. In contrast, all of the clinically related items had an impact. Administrative activities, such as showing commitment by having a mission statement, are essential elements of the CC process, but were insufficient in and of themselves to reduce odds ratios. However, it seems self evident that these activities must be in place before activities more closely related to direct care, such as adapting a service to a cultural group, can commence. Surprisingly, training activities were not predictive of disparity reduction. This may be a consequence of the often heard criticisms that existing training curricula are of mixed quality, overly broad and too distant from the clinical process.

Download the assessment scale (pdf). Read the full-text of the Journal article.

Sexual Orientation and Substance Use among Adolescents and Young Adults

Posted: July 07, 2012

A recent study published in the American Journal of Public Health found that same-gender sexual experience and sexual attraction are more strongly associated with substance use than sexual identity.

Previous studies have found higher rates of alcohol and substance use among lesbian, gay, or bisexual (LGB) youth. Many researchers theorize that this increased risk-taking is a manifestation of “minority stress,” the psychosocial toll of stigma and prejudice related to minority status. However, the lack of consensus about how to measure sexual orientation has made it difficult to test this theory and identify substance use trends among youth. This study sought to determine whether sexual identity, attraction, and experience are concordant measures of sexual orientation among youth. The study also examined the prevalence of substance use among youth across all three measures of sexual orientation. The authors used data on teens and young adults from the National Survey of Family Growth Cycle 6 (NSFG-6), a random survey developed by the National Center for Health Statistics. The sample consisted of 3,963 youth between the ages of 15 and 24. The researchers captured sexual orientation by creating categorical and binary variables to represent sexual experience, sexual identity, and sexual attraction. The outcome variable of interest was substance use. All respondents were asked about marijuana use, the use of any other drugs, and binge drinking. Female respondents also were asked about cigarette smoking. The study found that sexual attraction and experience do not align with self-reported sexual identity and concluded they are essentially different measures. The study also found that there is a higher prevalence of substance use among sexual minority youth, consistent with previous studies. However, sexual identity was not predictive of substance use. In addition, among female respondents, sexual experience with both genders and same sex attraction were both significantly associated with greater substance use. Among males in the sample, sexual experience with both genders was not associated with increased substance use but same-gender attraction was more strongly associated with the use of “other drugs” (cocaine, etc.). However, the direction of the association between substance use and same-gender sexual experience remains unclear. 

The authors highlighted the need for a more sophisticated understanding of sexual orientation that includes behavioral, affective, and cognitive dimensions. The researchers also suggested that substance abuse intervention programs may need to become more inclusive of sexual minority youth in order to reduce substance use disparities.

Read more on the Kaiser Family Foundation website. Read the abstract of the study.


Community-Defined Solutions for Latino Mental Health Care Disparities

Posted: July 05, 2012

Lahi Moheno holds what some would call health retreats for farmworkers in the San Joaquin Valley. There, she pulls workers aside for a forum on health education – mental health, really – without ever using such loaded terms as las enfermedades mentales, Spanish for "mental illness." Moheno, an activist who holds a master's degree from the University of Texas, knows well her audience and how to reach it. "When I talk to them in forums, or out in the fields, I don't use words like 'mental health,' " Moheno said Monday. "I say, 'Are you interested in having a better life, a life of tranquility?' I had to change my wording in order to reach people."

Moheno's story nicely illustrates lessons learned in a landmark, two-year research study conducted in 13 cities throughout California and unveiled Monday by the UC Davis Center for Reducing Health Disparities. The study, released at UC Davis' Mind Institute in Sacramento, takes a long, hard look at current best practices, based on evidence, and how well they translate in California's growing Latino communities, projected to comprise 52 percent of the state's population by 2050. The report, called Community-Defined Solutions for Latino Mental Health Care Disparities, provides a catalog of sorts for what works in reaching Latinos. The list highlights a smattering of programs throughout California, such as those using schools, churches, community centers and other grass-roots gathering places to talk to Latinos about what can help reduce the disparities.

The short answer: Western medicine's best doesn't seem well tailored to reduce mental health care disparities in Latino communities, a stubborn problem in which the population has been underserved and lacking quality care for decades. According to Sergio Aguilar-Gaxiola, the study's lead author and director of the health disparities center, up to 75 percent of Latinos who do seek mental health services opt not to return for a second appointment. Cultural, social and language barriers are too high to surmount. The report, based on input from more than 550 Latinos, including some in Sacramento, found that the current workforce of psychologists and psychiatrists is ill-equipped to penetrate the disparities and bridge the cultural gulf.

More needs to be done to reach out to communities on their terms, including recruiting and training more Latino mental health professionals. Stigma and shame over mental health issues are enough to stop some Latinos from seeking assistance, the study's authors said. And without someone to speak to in a shared language, reticence can become more acute. Moheno, for example, said two or three people in her large family experienced mental health issues. "However, we couldn't always find doctors. The family was a little embarrassed in this situation," Moheno said. "My mother said, 'No espanol, no sabe nada,' or 'If they don't know Spanish, they don't know how to take care of him,' " Moheno said of an ailing sibling.

Indeed, the report recommends that since Latinos do access health care through primary-care facilities, primary- care doctors should consider taking on the task of mending the mental health care gap. The key is in getting feedback and suggestions from the ground level up vs. from a top-down Western medical model.

Read more on the Sacramentoo Bee website. Read the full report (pdf).


Rehabilitation and Counseling Program for Homeless with Mental or Drug Abuse Problems

Posted: July 03, 2012

Panhandle homeless with mental or drug abuse problems will be able to improve their lives and integrate with the community thanks to a new program the Texas Panhandle Centers will be offering. They're partnering with the city of Amarillo and all its shelters to make this outpatient treatment program successful.

Diane Gilmore with Amarillo Downtown Women's Center says, "This has been long time coming. And all of the shelters are very excited. Because we know if someone goes through a 30 day residential treatment program, that they're going to have a better chance of making it work with our program. And their opportunity for staying clean and sober will increase tremendously."

Substance abuse and mental health go hand in hand. And they're the number one reason people are homeless in our country and community. The 30 day outpatient program will offer psychiatric and crisis services as well as life skills training during the day. Then at night the homeless return to an area shelter.

They hope Amarillo will also be able to provide its own residential treatment program, for people who can afford it, in the near future. Texas Panhandle Centers Director of Planning and Public Information Jim Womack says, "We also hope to partner with other agencies, maybe integrated healthcare in the future. Just address the whole person not just specific issues because that way if we're addressing all the issues. Be gainful employed, be back in a home instead of being out on the streets."

Read more on the WorldNow website.

No Shame Day: Working to Eradicate Mental Illness Stigma in the Black Community

Posted: July 02, 2012

It is the family folklore, whispered into humid huddles in the corners of summer reunions: She ain't been right since that no-count husband of hers left her; all she needs is a good man and she'll come back to herself. It's the code words, the shorthand, the oversimplification: Oh, he ain't never been quite right in the head. and "Something's" wrong with her. It's myth of the church-going cure: This ain't nothin' but a demonic attack and prayer can cast it out. It's the blame-placing and illogical advice: It's because she used to drink. If he stayed away from them drugs, his head would clear. Get saved. Eat better. Get a better job and be more self-sufficient. Forgive everyone who wronged you (Grudge-holding poisons the mind).

Our need for the first annual observation of No Shame Day on Monday, July 2 could be traced to any number of get-right-quick antidotes. Despite the growing number of mental illness diagnoses in the black community, many are loath to accept their legitimacy. According to the National Institute of Mental Health and the American Psychiatric Association, just one in three African-Americans who need mental health care receives it, and those who do are likelier to stop treatment early or receive follow-up care.

The Siwe Project, founded by Nigerian writer and mental health advocate Bassey Ikpi in memory of her teenage friend, Siwe Monsanto, is working toward providing that culturally competent care by instituting the first ever day international day of advocacy for people of color who are coping with mental illness and their family, friends, and allies.

No Shame Day encourages all those affected to share their personal stories about the various ways in which mental illness has affected their lives on The Siwe Project's official website, as well as on Twitter.

Those who intend to participate are being asked to provide only the parts of their experience that they feel comfortable sharing. At minimum, The Siwe Project asks that you answer the following: Who are you? What mental illness are you or your loved one living with? How were you or he/she diagnosed? What propels you to speak publicly about the illness? How are you or your loved one treating the illness (therapy, meds, support groups, exercise, etc) and what prompted you/them to seek treatment? In the interest of uniformity and solidarity, please begin and end your stories with "My name is ____, and I have No Shame." Participants who will be using Twitter as their chosen social media platform should include the hashtag #NoShame at the end of each related tweet. Raise your voice on July 2 in support of the first ever No Shame Day. July is also National Minority Mental Health Month.

Read more on the Huffington Post website. Visit The Siwe Project's official website.

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