Practice Modification to Embrace Multiculturalism: Balancing the Individual and the Evidence Samantha Pelican Monson, PsyD, Clinical Psychologist KC Lomonaco, PsyD, Clinical Psychologist Collaborative Family Healthcare Association 16 th Annual Conference October 16-18, 2014 Washington, DC U.S.A. Session #G3c Friday, October 17, 2014

We have not had any relevant financial relationships during the past 12 months. Faculty Disclosure

#1 Describe the impact of multicultural patient presentations on current integrated primary care models. #2 Identify viable solutions to preserve efficiency and population-based care while embracing patient diversity. #3 Cite relevant evidence to support practice innovation to incorporate multiculturalism. Learning Objectives At the conclusion of this session, the participant will be able to:

Bibliography / References 1.Manoleas, P. (2008). Integrated primary care and behavioral health services for Latinos: A blueprint and research agenda. Social Work in Health Care, 47, Kleinman, A., Eisenberg, L., & Good, B. (1978). Culture, illness, and care: Clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine, 88, Bass, J.K., Annan, J., Murray, S.M., Kaysen, D., Griffiths, S., Cetinoglu, T., … Bolton, P.A. (2013). Controlled trial of psychotherapy for Congolese survivors of sexual violence. The New England Journal of Medicine, 368, Crosby, S.S. Primary care management of non-English-speaking refugees who have experienced trauma. The Journal of the American Medical Association, 310,

Bibliography / References 5.Bridges, A.J., Andrews, A.R., Villalobos, et.al. (2014). Does integrated behavioral health care reduce mental health disparities for Latinos? Initial findings. Journal of Latina/o Psychology, 2, Kirmayer, L.J., Narasiah, L., Munoz, M., Rashid, M., Ryder, A.G., Guzder, J., … Pottie, K. (2011). Common mental health problems in immigrants and refugees: General approach in primary care. The Canadian Medical Association Journal, 183, E959-E Sue, D.W., & Sue, D. (2007). Counseling the culturally diverse: Theory and practice (5 th ed.). New York, NY: John Wiley & Sons, Inc. 8.Hays, P. (2013). Connecting across cultures: The helpers toolkit. Thousand Oaks, CA: Sage Publications, Inc.

 A learning assessment is required for CE credit.  Questions and answers will be conducted throughout this presentation. Learning Assessment

 Linguistic, cultural, acculturation, and age diversity FQHC with Refugee Patients

 Linguistic, cultural, acculturation, and age diversity FQHC with Refugee Patients

 Linguistic, cultural, acculturation, and age diversity FQHC with Refugee Patients

 Linguistic, cultural, acculturation, and age diversity FQHC with Refugee Patients

 Linguistic, cultural, acculturation, and age diversity—messy! FQHC with Refugee Patients

 Some staff and providers are bilingual in English/Spanish, and some are not  Our organization is retrofitted to provide care to Latino patients, not built explicitly for this purpose FQHC with Latino Patients

 Issues that arise in clinic:  Beliefs about heath and illness differ from culture to culture  Acculturation – Families that straddle two (or more) different worlds  Disparities in care increase stressors, health issues FQHC with Latino Patients

How do we look outside our Western frame of reference to offer culturally sensitive care while maintaining model fidelity? 1

 What do you think caused the problem?  What kind of treatment do you think you should receive?  What are the most important results you hope to get from treatment?  Acknowledge the differences in the room Is there a place for these questions in your model of integrated primary care? Clinical Pearl #1: Add culture-based questions to standard practice. 2

 Validated modifications of evidence-based treatments often:  Bring patients together in groups  Utilize a trusted community leader  Host at a non-clinical site Is your model of integrated primary care flexible enough to incorporate alternative modalities? Clinical Pearl #2: De-individualize assessments and interventions. 3

 Micro—within the care team:  Promote cultural competence through education  Mutual feedback among colleagues about stereotyping or prejudice  Macro—outside the care team:  Encourage flexibility of policies (e.g., inclusion of non-Western approaches) to align with multicultural patient populations Is there “space” for this in your model of integrated primary care? Clinical Pearl #3: Advocate for social justice to decrease biases in care. 4,5

 Prevalence of common mental health problems is lower immediately after migration and increases over time  Patients may not be prepared for the racism and discrimination they will face Does your model of integrated primary care accommodate this? Clinical Pearl #4: Acculturation may bring new or increased symptoms. 1,6

 How do ethical principles adapt to be culturally responsive?  Dual relationships/conflict of interest  Touch  Self disclosure How have you changed/challenged your ethical practice to work in a culturally sensitive manner within your model of integrated primary care? Clinical Pearl #5: When ethics are unclear, consult! 7

Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you! Session Evaluation