GARDNER CORPORATIONS The Gardner Corporations provide comprehensive - - PDF document

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Dayrn Reicherter, MD Yeon Soo Lee, LCSW

March 18, 2014

The contents are partially contributed by Meekyung Han, Ph. D. and Bophal Phen, LCSW

Mind Mindful fulness Meditation for Cambodians Cambodians

GARDNER CORPORATIONS

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The Gardner Corporations provide comprehensive health care services dedicated to improving the health status of the low and moderate-income communities in Santa Clara County, especially the disenfranchised, poor and most vulnerable members.

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Our mission is to provide high quality behavioral, social and primary care to include education, prevention, treatment, intervention, early intervention, treatment and advocacy services which are affordable, respectful, culturally, linguistically and age appropriate.

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GFCC - GFCC - Mental Health Depar ental Health Department ment Ce Centr ntro De Biene De Bienestar – Center of Well Being

Service programs

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Early Intervention Family Services

Expanded Differential Response Program Family Strength Base Program Intensive-Up -Front Family Enrichment Program /FIRST 5 Interns Program (School Based) FIRST 5 Superior Court Initiative

Dual Diagnosis Services

CalWORKs Program Criminal Justice -Prop. 63 Program Ryan White/H.I.V Program AfterCare/Probation Programs Parolee Re-entry Program (PRC) Supportive & Therapeutic Options

Program (S.T.O.P .)

Ranch Victims/Offenders Program

OA/Adult/F&C Services

 Adult Service Program  Asian Youth Service Program  Adult – Prop. 63 Service Program  Cambodian Culturally Specific

Family Services

 Council on Aging Service  Learning Together Initiative  Family & Children Services  Older Adult Service  Story Telling Program  System of Care Service  Juvenile Probation Department

(JPD)

 Therapeutic Behavioral Services

Cambodia in Cambodia in the the Hist Histor

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y

 Khmer Kingdom (AD 802)  French Colonial Period (1863)  Administration of Sihanouk Khmer Republic and War (1953)  Pol Pot Regime (1975)  Killing Field (1975- 1979)

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Cambodians Cambodians in the in the Unit United Stat ed States es

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 Cambodians are the most traumatized population with well-

documented mental health problems.

 After two decades after resettlement in U.S.A., study showed high

rates of mental health problems such as PTSD (62%) and Depression (51%) (Marshall et al., 2005).

 Potential impact of Cambodians’ trauma on their current life

functioning.  Low level of acculturation

 Poor English proficiency – 53% categorized as limited English proficient (APIAHF,

2005).

 Poverty/Income – approximately 54% live below the 200% poverty level line (U.S.

Census, 2000).

 Education Attainment- only 9% have a bachelor’s degree and 53% have less than a

high school education (APIAHF, 2005).

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Gar Gardner’s CCFS Pr ner’s CCFS Program

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 Gardener Family Care Corporation has been providing culturally

competent mental health services to Cambodian community through Cambodian Culturally Specific Family Services (CCFS) since 1999.

 CCFS has been offering family-focused mental health services to

low-income Cambodians in Santa Clara County.

 Cambodian program staff provides linguistically and culturally

sensitive counseling, case management, medication services to individual and families with emotional and psychiatric problem

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CCFS program provides :

 Comprehensive system of care to Cambodian clients.

 The spectrum of services: crisis intervention, individual counseling, group counseling,

family counseling, medication support and case management.  Family focused services: family assessment, linkage, referral, family, marital

counseling, child-rearing training, and self-help group.

 Places of Services: clinic, home, school, community agencies including faith-

based organization.

 Individualized service : to meet the specific cultural and treatment needs of

the clients and the families.

 Culturally specific mental health services: unique cultural strengths,

traditions, and communication methods and styles are used.

 “Mindfulness Meditation Group”:

 Culturally competent mental health services within the context of Cambodian cultural

traditions and religious (Buddhist) philosophy.

 Developed based on Buddhist philosophy to assist participants to reduce PTSD symptoms

• f clients and improve daily functioning.

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 2006 visiting Cambodia and local Buddhist temple  Cultural factors in Cambodian and Cambodians in U.S.  Roles of Buddhist monks in Cambodian culture  Meditation and mental health treatment  Collaboration with Buddhist monks.

De Development of the lopment of the Meditation Gr Meditation Group

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Buddhism and the concept of Buddhism and the concept of Ka Karma

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 The main concept of Buddhism is Karma (Kam in the Cambodian language),

which is defined as “the individual’s actions or thoughts (often of an evil nature) in a prior existence that affects life in the present” (Hsu, Davies, & Hansen, 2004, p.198).

 Some Cambodians believe that personal hardship in the current life (e.g., war-

related trauma) was predestined as a form of Karma (from the past life).

 Feeling of shame about the trauma and/or refuse to talk about the experience, or

some might accept sufferings as being ‘righteous’. And, the concept of Karma in Buddhism teaches the importance of the “here and now” and “future-oriented” approach.

 One can create a positive Karma for the future in the present life: An approach

cultivating mindful awareness of Karma in a sense of “here and now” should be implemented.

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Serv rvice D Delivery ry:

Working with a ing with a Buddhist Buddhist Monk Monk as a as a para- para- pr prof

• fessional

essional

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 Professional help is sought after all personal/familial resources are

exhausted.

 Cambodian clients are known to have a high rate of premature

termination of treatment (Chung, 2001).

 The healing process in Cambodian culture occurs through a

system of rituals facilitated by healers (e.g., Buddhist monks) - helping professions (Musser-Granski and Carrillo, 1997).

 Having the Buddhist monk as a para-professional may promote the

efficacy of treatment as embracing Cambodians’ cultural belief system.

Mindfulness Meditation Mindfulness Meditation

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 Use of the concept of Karma, as well as the somatization of

emotional distresses, mindfulness meditation (MM) based on Buddhist concepts needs to be one of the treatment components.

 MM has shown substantial benefits for individuals suffering from

chronic pain, depression, and anxiety disorders including PTSD (Astin, 1997; Grossman et al., 2004).

 The focus is on the progressive acquisition of mindful awareness

about self and the world as comprehending Karma and creating a new positive Karma in every moment.

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Mindfulness Meditation at Gardner

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 12 sessions, 80 minutes per session  Facilitators: a Buddhist monk and two mental health

clinicians

 Topics :

Mindfulness Meditation - 1 session Metta ( Loving- Kindness) -2 sessions Karuna (Compassion) - 2 sessions Mudita (Sympathetic Joy)- 2 sessions Upekka (Equanimity) - 2 sessions Purification from Mental Defilements -2 sessions Peaceful mind in daily life- 1 session  Schedule: lecture, meditation, discussion

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STUDY

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 Addressing compounded trauma - war (pre-migration) and acculturation

related stress (post-migration) and disruption of cognition based on the theoretical framework (shattered assumption theory and acculturation theory);

 Addressing somatization as the characteristics of PTSD Cambodians

experience;

 Addressing the perception of trauma and the adaptation process within a

cultural value system, such as the Buddhist concept of Karma;

 Addressing para-professional’s (Buddhist monk in this case) effectiveness

in mental health settings as promoting service delivery outcomes

 Addressing the empirical evidence of the effectiveness of the PSCTG

program and its applicability to other agencies.

Pilo Pilot t PSCT PSCTG Pr G Program

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Overview of the Current Pilot PSCTG program

Compounded trauma & disruption of cognition: pre/during/post migration Reduced PTSD symptoms: Trauma related & Family stress related Cognitive Psychology Treatment and Modified Family Therapy Clinical components based on theoretical foundation Culturally competent PSCTG program: Treatment Approach & Service Delivery Hypothesized

• utcomes

Collaboration with a surrounding Cambodian Community

Mindfulness Meditation within a Buddhism context

Cambodian Buddhist monk as a para-professional Bilingual/bicultural clinician

Somatization of trauma : The characteristics of PTSD among Cambodians Cultural Belief: Buddhism/Concept of Karma

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Findings: Findings: Potential ntial Usefulness of the Pr Usefulness of the Program

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References rences

Astin, 1997; Grossman et al., 2004 Chung, R. (2001). Psychosocial adjustment of Cambodian refugee women: Implications for mental health counseling. Journal of Mental Health Counseling, 23, 115-126. D'Avanzo, C. E., Frye, B., & Froman, R. (1994). Culture, stress and substance use in Cambodian refugee women. Journal of Studies on Alcohol, 55(4), 420- 426. Hein, J. (1995). From Vietnam, Laos, and Cambodia: A refugee experience in the United States. New York: Twayne Publishers. Hinton, D. E., Um, K., & Ba, P. (2001). A unique panic-disorder presentation among Khmer refugees: The sore-neck syndrome. Culture Medicine and Psychiatry, 25,297-316. Hinton, D. E., Chhean, D., Pich, V., Pollack, M. H., Orr, S. P., & Pitman, R. K. (2006a). Assessment of posttraumatic stress disorder in Cambodian refugees using the Clinician-Administered PTSD Scale: Psychometric properties and symptom

• severity. Journal of Traumatic Stress, 19, 405–411.

Hinton, E., Pich, V., Chhean, D., Safren, S., & Pollack, M. (2006b). Somatic-focused therapy for traumatized refugees: Treating posttraumatic stress disorder and comorbid neck-focused panic attacks among Cambodian refugees. Psychotherapy: Theory, Research, Practice, Training, 43(4), 491-505. Hsu, E., Davies, C. A., & Hansen, D.J. (2004). Understanding mental health needs of Southeast Asian refugees: Historical, cultural, and contextual challenges. University of Nebraska, Lincoln. Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology of trauma. New York: The Free Press. Kwak, K. (2003). Adolescents and their parents: A review of intergenerational family relations for immigrant and non-immigrant families. Human Development, 46, 115-136. Koenig, H. G. (2003). Chronic pain: Biomedical and spiritual approaches. Binghamton, NY: Haworth Press. Mollica, R. F., Wyshak, G., & Lavelle, J. (1987). The psychosocial impact of war trauma and torture on Southeast Asian refugees. American Journal of Psychiatry, 144, 1567- 1577. Nicholl, C., & Thompson, A. (2004). The psychological treatment of post traumatic stress disorder (PTSD) in adult refugees: A review of the current state of psychological therapies. Journal of Mental Health, 13(4), 351-362. Ying, Y. & Han, M. (2007). Parental Contributions to Southeast Asian American adolescents’ well-being. Youth & Society. 40 (2), 289-306.

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