evidence-based practices and effective services to multicultural populations: are they the same?...

Evidence-Based Practices and Effective Services to Multicultural Populations: Are They the Same?

Vivian H. Jackson, Ph.D.Senior Policy AssociateNational Center for Cultural CompetenceGeorgetown University Center for Child and Human DevelopmentWashington, DC

June 16, 20082008 NAMI ConventionOrlando, FL

Service Request Seeking relief from physical signs and symptoms Resolution with troubles in interpersonal

relationships Difficulty with functioning in social roles effectively Difficulty with functioning in in culturally defined

roles effectively Searching for opportunity to flourish – living your

life’s purpose

V. Jackson, Ph.D., NCCC, 2008

Organizational responsibility Facilitate environment to achieve resolution of issue

as quickly and thoroughly as possible with minimum burden on client and family

EBPs the answer? But….

Context and external validity Transportability Adoption –fidelity and consistency Diffusion – impact on organize culture and climate –

tension between fidelity and modifications


Slide Source: National Center for Cultural Competence,2008

Cultural Competence

behaviors

attitudes

policies

structures

practices

requires that organizations have a clearly defined, congruent set of values and principles, and demonstrate behaviors, attitudes, policies, structures, and practices that enable them to work effectively cross-culturally

(adapted from from Cross, Bazron, Dennis and Isaacs, 1989)

PracticesWhat does culture have to do with it?


CULTURECulture is an integrated pattern of human behavior which includes but is not limited to:

thought

languages

values

beliefs

customs

practices

courtesies

ritualscommunication

roles

relationships

expectedbehaviors

… of a racial, ethnic, religious, social, or political group; the ability to transmit the above to succeeding generations; dynamic in nature.

manners ofinteracting

Slide Source: The National Center for Cultural Competence, 2008

An Iceberg Concept of Culture

dressage

race/ethnicitygender language

eye behaviorfacial expressions

body language sense of self

concept of justice value individual vs. group

notions of modestyconcept of cleanliness

emotional response patterns rules for social interaction child rearing

practicesdecision-making processes

approaches to problem solving

perceptions of mental health, health, illness, disability

patterns of superior and subordinate roles in relation to status by age, gender class

and much more…

Adapted by the NCCC

ImprovedOutcomes

and Satisfaction

?

Africentric Practice?

Africentric Perspective?

Intervention


Issue of Concern

Engagement

Culture SpecificElement

Culture Specific Intervention

Culture Specific Outcome

Participation

Fundamental Question:Does the use of Africentric Practice Make a difference for African Americans?


Vivian Jackson, 2007

EBP Considerations Therapeutic alliance (EBP theory of change)

Concordance of issue to be addressed What does a symptom mean? Therapeutic goal – what are you trying to change

Role of helper Expert? Guide? Helper?...

Strategy to receive help therapeutic procedures – how you facilitate change


EBP Considerations Population of study

Cultural representation within sample

Analysis of findings for the cultural subset


EBP Considerations Structured

Well defined entry criteria

Focal problems Structured assessment Sequence of defined

intervention procedures

Scripts Forms Charts Fidelity

Strategic Broad/problem entry

criteria Complex presentations Systemic assessment Sequence of

therapeutic goals/treatment phases

Menu of therapeutic procedures with guidance

Prototypical cases Variation in

therapeutic procedures Therapeutic

competence


EBP Considerations Administrative implementation (mandate/choice)

Program level implementation (NIRN perspective) Resources Training Coaching Time CQI loop

EBP Choice? # of people with minimal fidelity/ Number of people who NEED that intervention …problem agency

embarks upon use of measure sufficient number of people who meet the eligibility criteria


EBP Considerations Interpretation of static or negative outcomes

Modification of intervention? (but what about fidelity?)

Blame practitioner? (did the practitioner do it correctly?)

Blame client? (is it the client, the theory or the implementation?)


EBP Considerations Organizational Context

Organizational Culture Organizational Climate


Community Based Practice Portability not necessary for

effectiveness Context matters


Clinician decision How can I best help? What’s offered Training Cost Career advancement Financial rewards

V. Jackson, Ph. D, NCCC, 2008

Administrator Decision Good service Stay in business Costs Better than what we are already doing? Advance the agency (respond to mandate)


Client Decision Feel better? Perform better Time required Money? Can I afford it? Worth it ..how much work?


Recommendations for Advocacy Is there an EBP that addresses my distress as I interpret my distress (faith question

vs compliance question)

Is the organization attempting to use cultural adaptation as a substitute for becoming organizationally culturally competent

Does the EBP address my world view – in domains of theory of change, who provides the service, strategies for intervention, etc.

Has the EBP been analyzed for my cultural group?

What about the value of community based evidence

For those practices that work? Can people who need it access it?


It’s all about the children, youth, consumers, peers and their families!

evidence-based practices and effective services to multicultural populations: are they the same?...

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