1. 4th International Symposium on Substance Abuse Treatment and Special Target Groups 1 Cultural responsiveness in substance abuse treatment A qualitative study using professionals’ and clients’perspectives Stijn Vandevelde, Ma. Educ. Wouter Vanderplasschen, Ma. Educ. Eric Broekaert, Ph.D. Ghent University, Department of Orthopedagogics

2. 4th International Symposium on Substance Abuse Treatment and Special Target Groups 2 Introduction (1) Impact of substance abuse treatment facilities on ethnic & cultural minority groups Impact of substance abuse treatment facilities on ethnic & cultural minority groups Increasing number of ethnic minority clients Increasing number of ethnic minority clients Both researchers and treatment services report on the importance of implementing culturally responsive treatment Both researchers and treatment services report on the importance of implementing culturally responsive treatment

3. 4th International Symposium on Substance Abuse Treatment and Special Target Groups 3 Introduction (2) Treatment services insist on specification Treatment services insist on specification 1.substance abuse treatment system not equally distributed 2.differences amongst culturally diverse persons seeking help Researchers emphasize specification as well Researchers emphasize specification as well (individuality / differences concerning alcohol & substance abuse)

4. 4th International Symposium on Substance Abuse Treatment and Special Target Groups 4 Aims To investigate if and to what degree substance abuse treatment services are currently working in a culturally responsive way To investigate if and to what degree substance abuse treatment services are currently working in a culturally responsive way To gain information on bottlenecks of cultural responsiveness and suggested improvements To gain information on bottlenecks of cultural responsiveness and suggested improvements To investigate professionals’ as well as clients’ perspectives To investigate professionals’ as well as clients’ perspectives

5. 4th International Symposium on Substance Abuse Treatment and Special Target Groups 5 Terminology Cultural responsiveness is the « need for program staff to play an active role in integrating the client’s cultural background into the treatment process » (Finn, 1996) Cultural responsiveness is the « need for program staff to play an active role in integrating the client’s cultural background into the treatment process » (Finn, 1996) Ethnicity vs. Nationality Ethnicity vs. Nationality No official numbers of ethnic minorities and substance abuse (exclusion criterion / under- estimation of number) No official numbers of ethnic minorities and substance abuse (exclusion criterion / under- estimation of number)

6. 4th International Symposium on Substance Abuse Treatment and Special Target Groups 6 Method (1) Methodological background Methodological background Qualitative research Social interactionism Grounded theory

7. 4th International Symposium on Substance Abuse Treatment and Special Target Groups 7 Method (2) Sample Sample Clear-cut region of Ghent (225.000 inhabitants, 17.000 not Belgian nationality, 10.000 Turkey/Maghreb-countries) Specialised treatment (diversity/comprehensiveness) Four types ( 1. outpatient psycho-social care & 2. medical-psycho- social care / 3. residential short-/ 4. long-term) At least 2 experts/1 client from one of these types

8. 4th International Symposium on Substance Abuse Treatment and Special Target Groups 8 Method (3) Procedure Procedure Semi-structured interview with professionals (n=11) and clients (n=11) Three parallel focus groups for professionals Analysis Analysis Transcribed interviews analysed by means of WinMAX98

9. 4th International Symposium on Substance Abuse Treatment and Special Target Groups 9 Method (4) Grounded in the codification of the written material, a scheme was constructed. What are the most important pitfalls and pathways ? Three levels : 1. Perception 2. Actual treatment 3. Policy

10. 4th International Symposium on Substance Abuse Treatment and Special Target Groups 10 Method (5)

11. 4th International Symposium on Substance Abuse Treatment and Special Target Groups 11 Results General overview General overview Most expressions focus on difficulties and pathways concerning actual treatment, both for clients as well as for professionals Perception-issues and policy are less commented on

12. 4th International Symposium on Substance Abuse Treatment and Special Target Groups 12 Results (2) Difficulties according to professionals Difficulties according to professionals Communication problems (26 %) Problems involving the social network (25 %) Cultural background (25 %) Accessibility and distribution of information (15 %) Difficulties according to clients Difficulties according to clients Influence of cultural and religious background (57 %), especially status and honour Accessibility and distribution of information (19 %) Communication problems (12 %) Lack of ethno-cultural peers (8 %)

13. 4th International Symposium on Substance Abuse Treatment and Special Target Groups 13 Results (3) Pathways according to professionals Pathways according to professionals Communication problems – interpreters, (using family members, peers) Problems involving the social network – formal, respecting pace Cultural background – medial dimension, culturally, short-term treatment Accessibility and distribution of information – case studies, leaflets Pathways according to clients Pathways according to clients Influence of cultural and religious background – cultural responsiveness Accessibility and distribution of information – importance of peers Communication problems – using ‘own’ language Lack of ethno-cultural peers – ‘good’ example

14. 4th International Symposium on Substance Abuse Treatment and Special Target Groups 14 Discussion Presented results reveal the impact of ethnicity and culture on treatment Presented results reveal the impact of ethnicity and culture on treatment (identity, impact, reason to abuse (Finn, 1996)) Clients and professionals agree on an integrative paradigm (not separating ethnic minority clients), taking specific aspects into account (see table) Clients and professionals agree on an integrative paradigm (not separating ethnic minority clients), taking specific aspects into account (see table)

15. 4th International Symposium on Substance Abuse Treatment and Special Target Groups 15 Discussion (2)

16. 4th International Symposium on Substance Abuse Treatment and Special Target Groups 16 Discussion (3) Generalization ? Generalization ? Social network Social network Lenght of time Lenght of time Further research : Further research : Test the presented suggestions Implementing feedback Needs of minority groups Unequivocal registration protocol