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

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

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 NKI is one of two State funded mental health research facilities in the state of New York This gives you some context as to the development of our Toolkit

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 There are many other registries of EBPs out there also, but there is often a large overlap between them and SAMHSA’s registry Modifications are being done, but they are often haphazard which means that there seems to be no comprehensive manner for thinking about these cultural modifications

An Overview of the Process There is an underlying assumption that the agency or system has already identified a problem or a need for a specific cultural group. The following describes the basic flow of the Toolkit. As you can see working with communities is an umbrella over the entire process and is critical throughout the cultural modification process. In the next group of slides, I will give you an overview of each section described here.

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 The overall goal is to create an equal and reciprocal relationship between the agency or system and the community. We have been seeing this notion increasingly promoted in larger systems-of-care with consumer groups being increasingly empowered through things like involvement in professional conferences.

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 Not every agency or system will need this guidance as some are already using evidence-based practices or they have selected one to use

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 This chapter describes HOW to actually go about doing a cultural modification.

A Framework for Identifying Components Engagement Work Termination/Discharge When we did a study of existing EBPs we found that there were additional components besides those traditionally identified as engagement, work, and termination. These frequently entail factors that dictate whether or not consumers can access services. Influencing each of these are specific cultural factors, which we categorize, that are unique to cultural groups in the environment in which they live and work. Specific cultural factors Access

Toolkit Tables To help you with a cultural modification project, the Toolkit has numerous tables with multiple examples to help you work through your own unique situation.

Implementation Issues Evaluating organizational readiness for change Evaluating the organization’s current level of cultural competence Final implementation While this is currently at the end of the process, we have found that some of these implementation issues can be evaluated and addressed early on.

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

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 Now we’re going to shift to see how the Toolkit has been used in practice. This has been easier said than done. Because the Toolkit itself was developed with public funds and is available for free, we know that organizations download it and use it, but it is hard for us to determine who is using it and how. Has been used successfully in federal grants to show how cultural competence will be addressed. To study how the Toolkit has been used in practice, we found 2 agencies in NY that planned on using it, and they agreed to let us follow them through the process.

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.

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 2) While we participated in the initial training, it was driven by the agency who provided an overview of the project, why it was being undertaken, and what they hoped to achieve.

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

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.

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