Cultural Competency in Disaster Mental Health Recovery

1. Cultural Competency in Disaster Mental Health Recovery Cecilia Rivera-Casale Ph.D., Senior Project Officer 301-443-4735 CCasale@samhsa.gov Cathy Cave B.S., Cultural Competence Coordinator NYSOMH, 518-408-2026 ccave@omh.state.ny.us

2. We don’t see things as they are, we see them as we are. Cultural Care Anais Nin

3. CROSS-CUTTING PRINCIPLES SAMHSA Matrix Priorities Cultural Competency & Eliminating Barriers Community and Faith-based Approaches Financing Strategies and Cost Effectiveness Rural and Other Specific Settings Data and Evidence-Based Outcomes Collaboration with Public and Private Partners Recovery/reducing Stigma and Barriers to Services Trauma and Violence Workforce Development PROGRAMS/ISSUES Co-occurring Disorders A Life in the Community for Everyone Building Resilience and Facilitating Recovery Substance Abuse Treatment Capacity Seclusion and Restraint Prevention and Early Intervention Children and Families New Freedom Initiative Terrorism/Bioterrorism Homelessness Aging HIV/AIDS and Hepatitis C Criminal Justice

4. Access to Supportive Services Cultural Adaptation of Outreach Approaches and Services Equity in Service Benefit “More often, culture bears upon whether people even seek help in the first place, what types of help they seek, what coping styles and social supports they have, and how much stigma they attach to mental illness.” (DHHS,2001) Cultural Competence Addresses:

5. Clinical Standards Skills Tailored Service Approaches Techniques (Outreach) Marketing Programs (Public Education) Cultural Competence Definition Knowledge, Information and Data from and aboutIndividuals and Groups Integrated and Transformed INTO That match the individual’s culture and increase both the quality and appropriateness of health care and health outcomes. (King Davis, 1997)

6. Cultural Competence Definition • Expressed Differently Depending Upon One’s Culture • Meaning of “Sacred Place”, “Shrine”, “Burial Ground” • Personal and Family Rituals • Ritual Helps to Face Loss and Accept Reality

7. Bias and oppression are part of people’s history. Differences in expressions of distress, due to cultural variability in mourning, grief and ritual. Our view of the world is the world. Language and value differences. Challenges to Recovery: Stigma, Mistrust and Discrimination

8. Outreach to individuals and families provides assistance and connection to available community supports. Recognize and utilize indigenous healing networks and practices. Emotional conditions are identified and counseling services are provided. Elements of Recovery for Individuals and Families

9. Honeymoon(Community Cohesion) ReconstructionA New Beginning “Heroic” Pre-disaster Disillusionment Warning Threat (Coming to Terms) Working Through Grief Impact Trigger Events and Anniversary Reactions Inventory Typical Phases of Disaster 1 to 3 Days -------------------TIME-------------------------------------------1 to 3 Years Zunin/Meyers

10. Ethnicity Race Gender Age Socioeconomic Status Language and Dialects English Proficiency Country of Origin Prior Trauma Exposure Housing Spirituality/Religion Literacy Level Sexual Orientation Employment Geography (urban/rural) Physical Ability/Limitation Immigration Status Acculturation Criminal Justice Education Systems Cultural Considerations

11. Customs and traditions in trauma and loss Natural support networks Grief and grieving Role of Culture in Recovery

12. Expressed Differently Depending Upon One’s Culture Meaning of “Sacred Place”, “Shrine”, “Burial Ground” Personal and Family Rituals Ritual Helps to Face Loss and Accept Reality Grief and Grieving

13. Recognize the importance of culture and respect diversity. Maintain a current profile of the cultural composition of the community. Recruit disaster workers who are representative of the community or service area. Provide ongoing cultural competence training to disaster mental health staff. Guiding Principles for Cultural Competence in Disaster Recovery

14. Ensure that services are accessible, appropriate, and equitable. Recognize the role of help-seeking behaviors, customs and traditions, and natural support networks. Involve as “culture brokers” community leaders and organizations representing diverse cultural groups. Guiding Principles for Cultural Competence in Disaster Recovery

15. Ensure that services and information are culturally and linguistically competent. Assess and evaluate the program’s level of cultural competence. Guiding Principles for Cultural Competence in Disaster Recovery

16. Personal attributes Knowledge areas Skills Recruit Indigenous Staff

17. Cultural values and traditions Family values Linguistics and literacy Immigrant/refugee experiences and status Help-seeking behaviors Cross-cultural outreach techniques and strategies Avoidance of stereotypes and labels Provide Ongoing Cultural Competence Training

18. Establish partnerships with community leaders and organizations representing diverse cultural groups in service design and delivery. Civic and social clubs Neighborhood groups Interfaith/mutual aid Volunteer Healthcare/social service Nonprofit advocacy organizations Culture Brokers

19. Recognize Differences Within Communities Train Bilingual and Bicultural Staff Disseminate Educational Material Languages other than English Adapt Printed Materials Ensure Cultural and Linguistic Competence in Service Delivery

20. Within the overall disaster recovery evaluation process, assess the level of cultural competence Focus group Survey Open Forum Key Stakeholder Interviews Involve Indigenous People as Evaluators Assessment