Mental Health and Recovery BoardMental Health and Recovery Board

““Building Bridges to Recovery:Building Bridges to Recovery:

Embracing Local Cultures”Embracing Local Cultures”

LaVina Miller Weaver, RN, PCC-SLaVina Miller Weaver, RN, PCC-S

ObjectivesObjectives

1. Identify cultural competence as a tool for 1. Identify cultural competence as a tool for decreasing stigma related to mental decreasing stigma related to mental illness and substance abuseillness and substance abuse

2. Develop an understanding of how local 2. Develop an understanding of how local culture impacts communication, services culture impacts communication, services access, and service deliveryaccess, and service delivery

Trans-cultural CompetencyTrans-cultural CompetencyFrom “Trans-cultural Counseling” by John McFaddenFrom “Trans-cultural Counseling” by John McFadden

Five “stages” of Trans-cultural Five “stages” of Trans-cultural competencecompetence

The ability to discover another’s “way of The ability to discover another’s “way of knowing.”knowing.”

Stage IStage I

EthnoentropyEthnoentropy

We are alienated from our own We are alienated from our own cultural identity…cultural identity…

• understand little of self or own cultureunderstand little of self or own culture

Stage I Stage I cont’dcont’d

Avoid other ethnic groups and cultures Avoid other ethnic groups and cultures when possiblewhen possible, ,

•great discomfort, not yet able to move “toward”great discomfort, not yet able to move “toward”

Alienated from self/other Alienated from self/other •live out our rejected cultural identity live out our rejected cultural identity •Unable to accept own cultural identityUnable to accept own cultural identity

Stage IIStage II

EthnocentrismEthnocentrism

We believe in the inherent superiority of We believe in the inherent superiority of our own culture our own culture

We see other cultures as inferiorWe see other cultures as inferior

or “wrong”or “wrong”

Stage IIIStage III

EthnosyncretismEthnosyncretism

We begin awareness and acceptance of We begin awareness and acceptance of our own cultural baseour own cultural base

• Dualistic thinking starts being challenged..we/theyDualistic thinking starts being challenged..we/they• What we used to think… no longer fits/worksWhat we used to think… no longer fits/works• Faith crisis… image of God changesFaith crisis… image of God changes

Stage III Stage III cont’dcont’d

We begin accepting outside perspectives We begin accepting outside perspectives and critiques on our own culture without and critiques on our own culture without defendingdefending

• Greater capacity to “contain” differencesGreater capacity to “contain” differences• Less need to correctLess need to correct• No longer need to see things right or wrong…No longer need to see things right or wrong…

but as “different” or “not yet understood”but as “different” or “not yet understood”• Capacity to listen increasesCapacity to listen increases

Stage III Stage III cont’dcont’d

We begin accepting new ideas and We begin accepting new ideas and practices from other cultures as wellpractices from other cultures as well

• May begin exploring new practices/actionsMay begin exploring new practices/actions• Moving from thought to experimentingMoving from thought to experimenting

… …without sacrificing or rejecting our own without sacrificing or rejecting our own cultural identitycultural identity

• Early formation of transcultural coreEarly formation of transcultural core

Stage IVStage IV

TransethnicityTransethnicityWe move beyond, or across, our own We move beyond, or across, our own ethnic group to significantly ethnic group to significantly experienceexperience another ethnic group or personanother ethnic group or person

• Have an encounter/experience that shifts the coreHave an encounter/experience that shifts the core• New way of thinking becomes more comfortableNew way of thinking becomes more comfortable• Relationships may changeRelationships may change

Stage VStage V

PanethnicityPanethnicityWe have developed a transcendent world We have developed a transcendent world viewview

• Anchored and flexible in new understandingsAnchored and flexible in new understandings• Willing to dialogue, find common ground, exploreWilling to dialogue, find common ground, explore• Hold ourselves and our world more lightlyHold ourselves and our world more lightly

We view ourselves as members of ethnic We view ourselves as members of ethnic groups of the worldgroups of the world

• We are only a part of a whole instead of the wholeWe are only a part of a whole instead of the whole

• Can “adopt” from beyond earlier constraintsCan “adopt” from beyond earlier constraints

Stage V Stage V cont’dcont’d

There is a sense of sharing a There is a sense of sharing a common global culturecommon global culture

as well as my own unique cultureas well as my own unique culture

We are now free to We are now free to choosechoose

Integrating from our own heritage is now a choiceIntegrating from our own heritage is now a choice

Characteristics of Trans-Cultural Characteristics of Trans-Cultural CompetenceCompetence

Belief that all persons are worthyBelief that all persons are worthy• Regardless how feeble, how strong, how impairedRegardless how feeble, how strong, how impaired

Understands people as unique individualsUnderstands people as unique individuals• Value discovery of othersValue discovery of others

Is learning from others while also giving to Is learning from others while also giving to others…others…great sense of mutuality and sharednessgreat sense of mutuality and sharedness

Characteristics of Trans-Cultural Characteristics of Trans-Cultural CompetenceCompetence

Believe in the capacity of all people to Believe in the capacity of all people to develop their highest potentialdevelop their highest potential

• Less of a need to compare Less of a need to compare • Great capacity to inspire others toward their bestGreat capacity to inspire others toward their best

See ethnicity as an opportunity for See ethnicity as an opportunity for personal growth and understanding…personal growth and understanding…

• Great capacity learn and internalize experiences Great capacity learn and internalize experiences • Can allow themselves to be changed…ongoinglyCan allow themselves to be changed…ongoingly

Why Cultural Competence?Why Cultural Competence?

1. We will be far less likely to stigmatize, to 1. We will be far less likely to stigmatize, to disregard, to set others apartdisregard, to set others apart

if we allow ourselves to grow toward if we allow ourselves to grow toward cultural competencecultural competence

Why Cultural CompetenceWhy Cultural Competence

2. Lack of cultural understanding can cause 2. Lack of cultural understanding can cause us to unintentionally violate and hurt our us to unintentionally violate and hurt our clientsclients

3. It can keep people from seeking the help 3. It can keep people from seeking the help they may desire because they feel unsafethey may desire because they feel unsafe

Why Cultural CompetenceWhy Cultural Competence

4. We will be more likely to speak up when 4. We will be more likely to speak up when

we hear people being disregarded, we hear people being disregarded,

sidelined, or stigmatizedsidelined, or stigmatized

Our CommunityOur Community

96.52% = White96.52% = White 1.57% = Black1.57% = Black 0.16% = Native American0.16% = Native American .66% = Asian.66% = Asian .75% = Hispanic/Latin.75% = Hispanic/Latin 40% ..speak German or Penn Dutch 40% ..speak German or Penn Dutch

(Holmes and Wayne County) (Holmes and Wayne County)

The Heart of The Heart of

AmishnessAmishness

Donald B Kraybill, “The Riddle of Amish Culture”Donald B Kraybill, “The Riddle of Amish Culture” “ “On the Back Road to Heaven”On the Back Road to Heaven”

G e l l a s e n h e i tG e l l a s e n h e i t A paradigm that under girds A paradigm that under girds

all of Amish Lifeall of Amish Life

Has ideas of Has ideas of

Letting go, Surrender, Letting go, Surrender, YieldingYielding

GelassenheitGelassenheit

Gelassenheit orders the entire social Gelassenheit orders the entire social structure…it forbids the use of force structure…it forbids the use of force in human relationshipsin human relationships

Dimensions of Gelassenheit from “The Riddle of Amish Culture” by Donald B. Kraybill

Gelassenheit/ModernityGelassenheit/Modernity

Moderns value personal fulfillment Moderns value personal fulfillment and individual achievementand individual achievement

The way of Gelassenheit discovers The way of Gelassenheit discovers fulfillment in community…and fulfillment in community…and receives in return a durable and receives in return a durable and visible ethnic identityvisible ethnic identity

Gelassenheit/ModernityGelassenheit/Modernity

Amish work just as hard at losing Amish work just as hard at losing themselves as moderns work at finding themselves as moderns work at finding themselvesthemselves

There is an ordered sense of doing There is an ordered sense of doing things “right” and well…God watches all things “right” and well…God watches all we do…we do…

if it is worth doing , it is worth doing it if it is worth doing , it is worth doing it rightright

““The Shrinking Edges of The Shrinking Edges of Gelassenheit”Gelassenheit”

Toward individualismToward individualism Public recognition … signing namePublic recognition … signing name Business CardsBusiness Cards

The Shrinking Edges of The Shrinking Edges of GelassenheitGelassenheit

However,However,

Obedience, humility, plainness, and Obedience, humility, plainness, and simplicity remain powerful engines of simplicity remain powerful engines of resistance to dominant cultureresistance to dominant culture

The Amish, Don KrabillThe Amish, Don Krabill

"Upside-Down Values""Upside-Down Values"

The individual is not the supreme The individual is not the supreme

realityreality

Communal goals transcend personal Communal goals transcend personal onesones

"Upside-Down Values""Upside-Down Values"

The past is as important as the The past is as important as the

future (persecution history)future (persecution history)

Tradition is valued equally with Tradition is valued equally with changechange

Upside Down ValuesUpside Down Values

Personal sacrifice is esteemed (and Personal sacrifice is esteemed (and rewarded) over pleasure:rewarded) over pleasure:

.. Local involvement outweighs Local involvement outweighs

national national acclaimacclaim

"Upside-Down Values""Upside-Down Values" Work is more satisfying than Work is more satisfying than

consumption: utilitarian cultureconsumption: utilitarian culture

Obeying, waiting, and yielding Obeying, waiting, and yielding

are embracedare embraced

Newer, bigger, and faster are Newer, bigger, and faster are

not better:not better:

"Upside-Down Values""Upside-Down Values"

Preservation eclipses progressPreservation eclipses progress

Staying together is the supreme Staying together is the supreme valuevalue

ValuesValues

Larger family and extensive church tiesLarger family and extensive church ties

Accustomed to caring for their ownAccustomed to caring for their own

Defer to leadership/authorityDefer to leadership/authority

Difficulty verbalizing if disagreeing with Difficulty verbalizing if disagreeing with authority figureauthority figure

ValuesValues

Stoic with emotional and physical Stoic with emotional and physical pain pain

Concrete, detail orientationConcrete, detail orientation

Value face to face communicationValue face to face communication

Our CommunityOur Community

What is the impact of this population What is the impact of this population on our community???on our community???

How has the community been How has the community been shaped by this people???shaped by this people???

How does understanding this How does understanding this community impact the delivery of community impact the delivery of mental health care??? mental health care???

Our CommunityOur Community

Communication… language barriersCommunication… language barriers

Service delivery…cultural competencyService delivery…cultural competency

Service access…transportation issuesService access…transportation issues

Values conflicts…cultural competencyValues conflicts…cultural competency

Our CommunityOur Community

Dealing with a significant sub-culture Dealing with a significant sub-culture while at the same time providing while at the same time providing services for a larger culture.services for a larger culture.

Requires understanding of both the Requires understanding of both the broader culture and the sub culturebroader culture and the sub culture

(Interest in sub culture can trump the need for (Interest in sub culture can trump the need for understanding of the larger culture)understanding of the larger culture)

Our CommunityOur Community

The dynamics of our community with The dynamics of our community with the Amish positions us uniquely for the Amish positions us uniquely for significant cultural training, and for significant cultural training, and for contribution to the field of contribution to the field of Transcultural Counseling. Transcultural Counseling.