Providing Cultural Competency Training in a Psychology Training - - PowerPoint PPT Presentation
Providing Cultural Competency Training in a Psychology Training Program: A Paradigm Shift Orlando S nchez, PhD Ren S tinson, PhD Thad S trom, PhD, ABPP Minneapolis VA Health Care S ystem Acknowledgments u Wayne S iegel, PhD, ABPP
Orlando S ánchez, PhD Ren S tinson, PhD Thad S trom, PhD, ABPP Minneapolis VA Health Care S ystem
u
Wayne S iegel, PhD, ABPP
u
Workgroup members
u J. Irene Harris, PhD u Rebecca S
tinson, PhD
u Kelly Moore, PhD u Julia Perry, PhD u S
hani Ofrat, PhD
u Kelly Moore, PhD
u
Bill Robiner, PhD, ABPP
This workshop is designed to help you:
u Explain to others the multicultural sensitivity,
awareness, and knowledge skills-based philosophy that has been adopted at the Minneapolis VA Psychology Training Program.
u Describe at least one challenge faced and one strategy
used to create a new diversity program philosophy for a psychology training program.
u Design at least one multicultural skills-based diversity
training activity to implement into your own training programs.
u Describe to others the preliminary outcome data
gathered from Minneapolis VA trainees in the Diversity S eminar.
u For internship and residency, a program must
demonstrate adherence to the S tandards of Accreditation (S
diversity, which can be broadly thought to fall within the following areas:
u Program Climate u Recruitment and Retention of Diverse S
taff and Trainees
u Attainment of Profession-wide competencies pertaining
to Individual Culture and Diversity
u Educational Activities that Promote the acquisition of
profession-wide competencies
u Historically, this has been a value of the program.
Prior efforts to meet S
u S
ervice line and facility diversity committees
u On average 6-8 diversity related didactics yearly u Full day diversity seminar with other local accredited
programs
u Efforts to infuse diversity discussions within all didactics
and within the supervision context
u Less than positive feedback from trainees
u Not skills focused u For some, approach is redundant to prior content
learning
u Focus on cultural group presentations feels ‘ siloed’
and doesn’ t generalize
u S
taff hesitations to “ say the wrong thing” often lead to little to no discussions
u Discussions with other Training Directors
and local diversity experts
u Goals:
u Move beyond knowledge-based approach to
diversity training, and focus on skill acquisition and enhancement
u Foster discussions within supervision contexts u Continue demonstrated value toward diversity
and adherence to S
Cult ural Knowledge Cult ural Awareness Cult ural S ensit ivit y
Cultural Competency
Parochial S tage “ My way is t he only way” S ynergistic S tage “ There are benefit s t o my way and ot her ways” No awareness Awareness but No S ensitivity
ee weaknesses in our ability to provide services to diverse patients
remedies)
culture/ diversity in high esteem
examination
cultural sensitivity
Cultural Awareness: change in attitude; reflects openness
and flexibility – Connerley & Pedersen, 2005; Quappe & Cant at ore, 2005; Pope &
Reynolds, 1997
Cultural Sensitivity (cultural humility): recognize
differences and similarities without making value j udgments
– Connerley & Pedersen, 2005; Lindsey, Robins, & Terrell, 2003; Pope & Reynolds, 1997
Ethnocentric S tage “ I know t heir way, but mine is bet t er” Participatory Third Culture S tage “ Our way”
Cultural Awareness: change in attitude; reflects openness and
flexibility – Connerley & Pedersen, 2005; Quappe & Cant atore, 2005, Pope & Reynolds, 1997
S
upervision (ADDRES S ING Model)
Reflection exercises Cultural immersion
Cultural Sensitivity (cultural humility): recognize differences
and similarities without making value j udgments – Connerley & Pedersen,
2005; Lindsey, Robins, & Terrell, 2003; Pope & Reynolds, 1997
The skill of effective cross-cultural communication The skill of effectively generating a cultural formulation
Cultural Knowledge: cultural characteristics, history, values,
belief systems – Connerley & Pedersen, 2005; Lindsey, Robins, & Terrell, 2003; Pope &
Reynolds, 1997
ht t p:/ / www.cult urecareconnect ion.org/ navigating/ mncountyprofiles.ht ml
Consult at ion
From t he pat ient
Theoret ical and empirical knowledge-base (Accult uration Theory & Ident it y Theory)
Recently showered. CK One.
about my breath (good or bad) while I’m talking with them. No perfumes since some clients may be sensitive to those things.
loud. Depends on the situation. More compassionate tone with clients. A bit more assertive tone in consultation with clients. Generally, I’m less loud than I am in my personal life. Talk less listen more at work. I like hugs and hugging. High fives are great! I don’t really do kisses on the cheek much – they make me uncomfortable. I was taught not to touch clients – boundary crossing. Though in some hospital settings I have seen providers touch patients during therapy (e.g., bedside in a medical unit). Personally, I don’t mind hugging clients, but because of how I was taught I don’t do it. I have to give this one more thought. I like dressing stylish and comfortable. Usually Nike sport pants, white sneakers, hoodie, and a flat-brim baseball cap. Some call it “urban” style and it helps me identify with my cultural group. I don’t wear much make-up. I don’t care much about my hair. I don’t care much about what gender people perceive me in my personal life. I actually prefer that my appearance is more gender neutral. I also have tattoos and like showing them off if I can – gotta let them breathe! I feel much more pressure in professional settings to adhere to specific clothing and grooming norms, which seem to be set by the dominant culture, and have more distinction between genders. I look more traditionally female at work – make-up, women’s dress pants and blouse. This isn’t how I would dress personally, but I feel like I need to adhere to set norms. I want to feel authentic at work and I think I will do my job better as a psychologist if colleagues and clients notice that I am comfortable in my own clothes (make-up, hair, shoes, etc.). I can’t hide my race (multi-racial), but I actually think it is less apparent at work since I adhere to dominant culture norms for dress, hair, make-up – which accentuate the white parts of my identity.
change? Why? How will this impact your professional identity?
professional identity?
with patients?
ideas and preferences for what are “appropriate” smells, sounds, touch, and sight in personal and professional life come from?
this activity, what areas of stimulus value would you change (or experiment with changing) for your professional role?
Y
limit ed informat ion in t he chart you learn t hat t he pat ient ident ifies as a 28-year-
A services t wo mont hs ago, and t here is only one visit document ed; from t he emergency depart ment . The ED not e st at es t hat t he vet eran’s first language is S panish, t hough it is not ed t hat t he pat ient is proficient in English. The vet eran present ed t o t he ED for a “ flare-up” of a chronic back pain problem and also not ed t rouble wit h memory at work. The ED doct or document ed t hat t he vet eran appeared anxious in t heir encount er. ED doct or suggest ed t hat vet eran would benefit from ment al healt h services, t hus t he referral t o your clinic for int ake.
u
CULTURAL PROFILE. Look up a cultural profile (or profiles) for this patient. What sections of the cultural profile seem most useful to you for this intake? Why?
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http:/ / www.culturecareconnection.org/ navigating/ mncountyprofiles.html
u
Look at the list of Culturally Relevant Intake questions. List five questions you may not typically ask for an intake, but believe would be helpful to understand the role
with this task. (e.g., Do you have a preferred gender pronoun? What t hings do you do t o maint ain connect ion wit h your family’s cult ure? What is your experience wit h ment al healt h care? )
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Before meeting the patient, who would you choose to consult with about this case? List five questions you would have prepared for this consultation meeting we a colleague.
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Any other considerations or approaches?
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Program evaluations include assessment of diversity related competencies consistent with program wide competencies
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Diversity seminar assessment
u Baseline, midyear, end of year u Mix of satisfaction, didactic feedback, skill-based
questions
u Cross-cultural Counseling Inventory- Revised (LaFromboise,
Coleman & Hernandez, 1991)
u 20 items on 6 point Likert scale (1- st rongly disagree t o 6-
st rongly agree)
u
Trainees hopes for the seminar:
u Improved S
elf-Awareness
u Improved S
kills
u Improved Knowledge of Regional Groups u Advocacy/ S
u
To what extent did you feel the diversity coursework in your graduate program provided you with the skills necessary to provide psychological services to diverse clients? (0-100)
u Mean- 39.0
Item Baseline Mean Midyear Mean
Ability to identify what cultural information is missing/needed.
3.92 5.00
Knowledge of where to find cultural reference information.
4.08 5.11
Ability to take a meaningful cultural history when interviewing a client
3.33 4.78
Ability to generate a cultural conceptualization/formulation
3.58 4.67
Ability to generate a culturally informed treatment plan.
3.25 4.56 CCI-R Total S core 90.17 (range 80-108) 98.22 (range 89-112)
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Changes reflect an overall plan to improve all aspects of diversity training within the training programs.
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Beyond the diversity seminar, other areas that were addressed as a part of the philosophy shift have included:
u Using seminar assignments to facilitate discussions within
supervision
u Updating public materials with overall program philosophy u Improving the identification of diverse applications through
revised selection and recruitment interactions
u Continued ongoing didactics that focus on relevant local
cultural groups (e.g., Veterans, S
u Revised rotation evaluation forms consistent with S
u
Pros
u S
kills-focused
u Continuity of presenters across the year u Aids in all diversity-related accreditation areas u Initial outcomes are positive
u
Cons
u Two hour seminar can be long u Requires having qualified staff to teach segments u Preliminary data is positive, but need full year, and supervisor
ratings to be sure of impact
u Changes to recruitment and retention remains to be seen
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If you have additional questions, please feel free to contact us:
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Orlando.S anchez@ va.gov
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Ren.S tinson@ va.gov
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Thad.S trom@ va.gov