Toolkit for Modifying Evidence-Based Practices to Increase Cultural Competence

1. Toolkit for Modifying Evidence-Based Practices to Increase Cultural Competence Wendy Schudrich, LMSW Charles Auerbach, PhD, LCSW-R Yeshiva University, New York, NY

2. Presentation Topics • Development of the Toolkit • Overview of the methodology • How has the Toolkit been used? • Community benefits • Future activities • Questions?

3. Toolkit Development • Developed with funding from NKI Center of Excellence in Culturally Competent Mental Health • Study the intersection of mental health and culture • Develop tools to help agencies achieve a high level of cultural competence in the delivery of services • Train agencies and practitioners to apply tools within their organizations with the goal of engaging consumers and improving outcomes • Multidisciplinary collaboration

4. The Need to Modify EBPs • There is a need for effective mental health interventions for cultural groups • EBPs have not been developed with cultural groups in mind • EBPs have been developed, but not tested for effectiveness for specific cultural groups • EPBs have been developed and tested for specific cultural groups, but materials such as training manuals do not reflect the breadth of cultures served • SAMHSA’s registry of EBPs include a growing list of effective interventions • There is no systematic method for considering modifications to EBPs for cultural groups

5. An Overview of the Process

6. Working with Communities Goals: • Increase knowledge about cultural groups and their mental health needs • Increase acceptance of services Community involvement hinges on the development and work of a working group: • Determining who to work with and why • Working together on modifications • Working through implementation issues

7. Selecting an EBP • Identify possible EBPs • Evaluate the cultural appropriateness of EBPs • Determining cultural fit • Pragmatic considerations • Identifying the need for cultural modifications • Making a final decision

8. Modifying EBPs • Breaking down the EBP into components using the helping process model and determining which components to modify • The process of modification • Documenting modifications • Piloting the modified EBP • Evaluating the success of the modification

9. A Framework for Identifying Components Specific cultural factors Access

10. Toolkit Tables

11. Implementation Issues • Evaluating organizational readiness for change • Evaluating the organization’s current level of cultural competence • Final implementation

12. Other resources in the Toolkit • Checklist and workbook to help users complete the process • Annotated bibliography • Specific instruments for helping organizations change: • Organizational cultural competency • Organizational readiness for change • In progress – program-level measure of cultural competence

13. NKI Conducted Implementation Study at these 2 Agencies We provided: • Training at each agency to provide an overview of the methodology • All existing Toolkit materials • Technical assistance throughout the project In exchange: • Attended all meetings related to the cultural modification project • Received all agency-based exchanges (e.g., notes, e-mails, handouts) that were a product of the project

14. Use of the Toolkit in Practice • Agency 1 – largest social service agency in a large northeastern city. • Problem to address: large number of Russian speaking seniors presenting with symptoms of depression • Agency 2 – large provider of social services in predominantly urban/suburban region. • Problem to address: poor participation among African-Americans in an existing evidence-based parenting program in a small upstate city.

15. What We Have Learned • Agencies can do this with Master’s-level staff! • Initial training for agency staff was critical for understanding the methodology and the scope of the project • While agencies do work with community members, forming the working groups proved challenging • Identifying a constellation of group members that was appropriate • Getting away from mental/behavioral health • Figuring out how to explain the project in layperson’s terms and asking for participation • Learning to identify possible EBPs required more skills than some agency staff had • The process can be streamlined based upon agency and community needs – 3 meetings with working group seems sufficient

16. Agencies and community members appreciated the project “It [the Toolkit project] was helpful. We got feedback about what the community needs…. The Toolkit process gave us direction and resources and strategies.” • Project Lead “I was skeptical at first. The community wasn’t asking for this. I felt it was our idea, and I had my doubts. Now I understand that there is rampant discrimination. This process has helped me understand what is going on in your community.” • Agency working group member “The project was really helpful to us. We are planning to repeat the process in the Latino community.” - Director of Social Services

17. Follow-ups: • The Toolkit and Workbook should be updated to reflect useful examples from the implementation study. • Continue to provide technical assistance and begin to create a learning community for those doing cultural modifications. • Study the degree to which cultural modifications using the Toolkit methodology improve outcomes for clients.

18. Questions? Thank you! Wendy Schudrich – schudric@yu.edu Charles Auerbach – auerbach@yu.edu To access the Toolkit and Workbook: http://ssrdqst.rfmh.org/cecc/index.php?q=node/86