1. Evidence-Based Practices and Effective Services to Multicultural Populations: Are They the Same? Vivian H. Jackson, Ph.D. Senior Policy Associate National Center for Cultural Competence Georgetown University Center for Child and Human Development Washington, DC June 16, 2008 2008 NAMI Convention Orlando, FL

2. Service Request  Seeking relief from physical signs and symptoms  Resolution with troubles in interpersonal relationships  Difficulty with functioning in social roles effectively  Difficulty with functioning in in culturally defined roles effectively  Searching for opportunity to flourish – living your life’s purpose V. Jackson, Ph.D., NCCC, 2008

3. Organizational responsibility  Facilitate environment to achieve resolution of issue as quickly and thoroughly as possible with minimum burden on client and family  EBPs the answer?  But…. Context and external validity Transportability Adoption –fidelity and consistency Diffusion – impact on organize culture and climate – tension between fidelity and modifications V. Jackson, Ph.D., NCCC, 2008

4. Slide Source: National Center for Cultural Competence,2008 Cultural Competence behaviors attitudes policies structures practices requires that organizations have a clearly defined, congruent set of values and principles, and demonstrate behaviors, attitudes, policies, structures, and practices that enable them to work effectively cross-culturally (adapted from from Cross, Bazron, Dennis and Isaacs, 1989)

5. Practices What does culture have to do with it? V. Jackson, Ph.D., NCCC, 2008

6. CULTURE Culture is an integrated pattern of human behavior which includes but is not limited to: thought languages values beliefs customs practices courtesies rituals communication roles relationships expected behaviors … of a racial, ethnic, religious, social, or political group; the ability to transmit the above to succeeding generations; dynamic in nature. manners of interacting Slide Source: The National Center for Cultural Competence, 2008

7. An Iceberg Concept of Culture dress age race/ethnicity gender language eye behavior facial expressions body language sense of self concept of justice value individual vs. group notions of modesty concept of cleanliness emotional response patterns rules for social interaction child rearing practices © decision-making processes © approaches to problem solving perceptions of mental health, health, illness, disability patterns of superior and subordinate roles in relation to status by age, gender class and much more… Adapted by the NCCC

8. Improved Outcomes and Satisfaction ? Africentric Practice? Africentric Perspective? Intervention Africentric Practice? Issue of Concern Engagement Culture Specific Element Culture Specific Intervention Culture Specific Outcome Participation Fundamental Question: Does the use of Africentric Practice Make a difference for African Americans? Africentric Practice? Vivian Jackson, 2007

9. EBP Considerations  Therapeutic alliance (EBP theory of change) Concordance of issue to be addressed  What does a symptom mean?  Therapeutic goal – what are you trying to change Role of helper  Expert? Guide? Helper?... Strategy to receive help  therapeutic procedures – how you facilitate change V. Jackson, Ph.D., NCCC, 2008

10. EBP Considerations  Population of study Cultural representation within sample Analysis of findings for the cultural subset V. Jackson, Ph.D., NCCC, 2008

11. EBP Considerations  Structured Well defined entry criteria Focal problems Structured assessment Sequence of defined intervention procedures Scripts Forms Charts Fidelity  Strategic Broad/problem entry criteria Complex presentations Systemic assessment Sequence of therapeutic goals/treatment phases Menu of therapeutic procedures with guidance Prototypical cases Variation in therapeutic procedures Therapeutic competence V. Jackson, Ph.D., NCCC, 2008

12. EBP Considerations  Administrative implementation (mandate/choice) Program level implementation (NIRN perspective)  Resources  Training  Coaching  Time  CQI loop  EBP Choice? # of people with minimal fidelity/ Number of people who NEED that intervention …problem agency embarks upon use of measure sufficient number of people who meet the eligibility criteria V. Jackson, Ph.D., NCCC, 2008

13. EBP Considerations  Interpretation of static or negative outcomes Modification of intervention?  (but what about fidelity?) Blame practitioner?  (did the practitioner do it correctly?) Blame client?  (is it the client, the theory or the implementation?) V. Jackson, Ph.D., NCCC, 2008

14. EBP Considerations  Organizational Context Organizational Culture Organizational Climate V. Jackson, Ph.D., NCCC, 2008

15. Community Based Practice  Portability not necessary for effectiveness  Context matters V. Jackson, Ph.D., NCCC, 2008

16. Clinician decision  How can I best help?  What’s offered  Training  Cost  Career advancement  Financial rewards V. Jackson, Ph. D, NCCC, 2008

17. Administrator Decision  Good service  Stay in business  Costs  Better than what we are already doing?  Advance the agency  (respond to mandate) V. Jackson, Ph.D., NCCC, 2008

18. Client Decision  Feel better?  Perform better  Time required  Money? Can I afford it?  Worth it..how much work? V. Jackson, Ph.D., NCCC, 2008

19. Recommendations for Advocacy  Is there an EBP that addresses my distress as I interpret my distress (faith question vs compliance question)  Is the organization attempting to use cultural adaptation as a substitute for becoming organizationally culturally competent  Does the EBP address my world view – in domains of theory of change, who provides the service, strategies for intervention, etc.  Has the EBP been analyzed for my cultural group?  What about the value of community based evidence  For those practices that work? Can people who need it access it? V. Jackson, Ph.D., NCCC, 2008

20. It’s all about the children, youth, consumers, peers and their families!