Hello and welcome. I'm Shereen Khan, Vice President of Operations and Strategy at Thresholds, Chicago's oldest and largest provider of community mental health services and social work expert for SMI Advisor. I'm very pleased that you are joining us for today's SMI Advisor webinar, health treatment, understanding and addressing diverse cultural backgrounds. SMI Advisor, also known as the Clinical Support System for Serious Mental Illness, is an APA and SAMHSA initiative devoted to helping clinicians implement evidence-based care for those living with serious mental illness. Working with experts from across the SMI clinician community, our interdisciplinary effort has been designed to help you get the answers you need to care for your patient. Today's webinar has been designated for one AMA PRA category one credit for physicians, one continuing education credit for psychologists, and one continuing education credit for social workers. Credit for participating in today's webinar will be available until August 15th, 2023. Next slide. Sorry about that. I just got to wake up a little bit. All right. Slides from the presentation today are available to download in the webinar chat. Select the link to view. And next slide. Please feel free to submit your questions throughout the presentation by typing them into the question area found in the lower portion of your control panel. We will reserve 10 to 15 minutes at the end of the presentation for Q&A. And next slide. Now I would like to introduce to you today the faculty for our webinar, Jason Phillips. Jason is a trusted licensed clinical social worker that provides evidence-based treatment to foster success for your mental health and wellness. He has extensive experience in various settings, including community mental health, grief and loss, college counseling, psychiatric inpatient units, veterans, and active duty soldiers. And his areas of expertise include trauma, anxiety, depression, grief, loss, and life transition. Jason, thank you so much for leading today's webinar. And I'll turn it over to you. Yeah, thank you, Sheree. I'm very excited to be here and talk with you all today about our topic. So before I jump in, I would like this to be a very engaging, informative, and educational presentation, but I'll go through the learning objectives for this afternoon. So upon completion of this activity, we would like you to be able to examine the definition of culture and cultural identity, exploring how these impact mental health treatment and assessment. Secondly, we're going to discuss how to utilize evidence-based cultural assessment tools to provide culturally sensitive assessments and diagnoses. And last, how do you employ strategies to enhance the therapeutic relationship and overcome challenges and barriers to implementing culturally competent treatment? So just so you can expect or you know what to expect throughout this presentation, we're going to break down the definition of culture and culture identity. We'll discuss the role of cultural factors in mental health treatment and assessment. We'll go through the cultural formulation interview and cultural assessment tools. We'll talk about evidence-based practices for culturally competent treatment. And of course, we're going to wrap up with strategies for overcoming challenges and barriers to providing culturally competent care. All right, so I hope you all are very excited. I know it's Friday, so everybody's probably ready for the weekend. So let's go ahead and dive right in. So what is culture? So the definition we have here is the values, beliefs, and practices of a group of people shared through symbols and passed down from generation to generation. So if you don't mind, in the chat, when you think of culture, just jot in or type in, what does culture mean to you? And I'll say when I think of culture, I think about who I am as an individual, who are you, and what is my makeup? So even when I'm working with my clients and I think about their culture, I think about the language that they use, the dress, their backgrounds, where they're from. All of these things play a role in our culture. And it's not something that we can assume. And this is why this conversation is necessary, because often when we think about someone's culture, we can lump them into a certain category. And we know that it's just not one thing that is part of your culture. Also, if you all don't mind, what is one thing that is a part of your culture that you are very proud of, that you really embrace? All right, that's just something to go ahead. People are putting things into the Q&A. So I see religion, traditions, customs, food, beliefs, values, family, your way of life. Oh, it's still coming, lots of them. Traditions and belief systems is the main theme. Yeah, thanks, Serene. Thank you. Thank you all for engaging. I think religion is one that definitely stands out. And I'm going to highlight that because it's a part of our culture that I often see in practice that can change over time. One of the parts of the assessment that I ask people is, you know, is religion or spirituality very important to you? Is it important to you now? And was it important to you growing up? And I often get a number of different answers because, just because someone may have grown up in a certain religious or practicing a certain way, it doesn't mean that they always follow those same beliefs later in adulthood. So thank you. And what is cultural identity? Cultural identity encompasses specific identities of people or groups in cultural, subcultural, or social groups. Categories can include gender, race, ethnicity, social class, religion, or sexual orientation. So a lot of the things that you all were mentioning in the chat can be makeups of our cultural identity. And when you think about it in certain groups, cultural identity can look very different. A lot of my time as a clinician has been spent working with the military population, whether active duty or veteran populations. And you all know there are some things about that culture that are different from those who have not served. So when you think of military, what do you think of for their culture? And as you all are putting things in and out, one thing that stands out to me is acronyms. Because in the military, they have a much different way of communicating just the everyday things. Also, there's a lot of dry humor. Rank is important in the military. So there's different nuances just based on the military culture. And that makes up their identity. Let's see, we're seeing stoicism, people who have experienced traumatic events, formal, formality, structure, brotherhood. Yeah, yeah, brotherhood is big. It's key. And trauma too, unfortunately. And also, when we think about the culture identity, a different example is I'm from Detroit. And Detroit has a culture identity of being blue collar, hardworking. It's an urban area. But now, that was when I was growing up, 30, 40 years, it's changing. Where now, there's more younger people coming in, things are changing. So again, it's important to know what our culture is, what the identity is, and how these things are changing because it does impact treatment and how we provide care. All right. So let's get into culture and mental health. So we're going to break it down in three different categories. First, cultural syndromes. So mental disorders distinguished by unique clusters of symptoms that only occur in specific cultures. So just like we talked about the military having a specific way of doing things, there are certain mental health issues and challenges that come up in cultures, and it looks a certain way. Also, cultural idioms of distress. So how are people really expressing their psychological or behavioral distress? That's going to look different from culture to culture, and also how the culture explains it. And we have to be aware of how we're asking questions, our own bias when we're interviewing and providing treatment, because we don't want our perception of psychological distress to interfere with what our clients or the groups that we're serving are sharing with us. And that's very, very important. So we don't want to diminish what someone's experiencing, and we also don't want to gloss over it either. There's been a couple of times, and most recently, probably a few weeks ago, where I met with a young man, Black male, probably age 28 to 30, and he was sharing with me that he had a really poor experience in the ER system because when he presented for care and was expressing his symptoms, he felt like because he was a man in the military that all of his issues were being dismissed. Just tough it up. Just suck it up. You can get through this. And so he said, you know, I was really thinking about not showing back up. It was just that bad. But he was in a lot of distress. So just because someone identifies with a certain culture or a certain group, we want to make sure that we don't think that they can handle any and everything because of their background and their culture. All right. Culture and mental health treatment. Also, we want to look at the underutilization of mental health services, often because of culture. There are certain groups and populations that won't seek care because it's not part of the cultural norm. Are there any groups that you all can think of that probably won't seek out care because they may be frowned upon in that specific culture? And as you all are chatting, we'll look at the barriers to treatment. So culture-bound values, class-bound values, language variables, experience with microaggressions, which the microaggressions, they can really stick with us because that's another form of trauma. So when we think about seeking help again, we may say, you know, I really had a bad experience before, so I don't want to go back. So, Jason, we have African-Americans, Asian culture, Latinx veterans, female veterans in particular, men, people who are lower income I'm seeing, non-English speakers. So there's immigrants. That's a pretty good list. It is. It is. And when you think about non-English speakers or immigrants, just starting with some of the last items you put down, there can be a disconnect or someone's feeling like they're inferior because English is not their first language. So as they're explaining things, maybe they're feeling some kind of transference or that they're being judged or dismissed, and that's preventing them from not either seeking the help in the first place or they don't want to stay in the help or, you know, stick with the help. I was talking with a good colleague of mine, he's a therapist too, and he has a speech impediment. But he said, you know, I don't harp on it if he stutters. He said, I don't think about this anymore because English is my fourth language. And I was really taken aback because I didn't know that. We're not that close. But where I'm going is there's a lot of work when you are sharing what you're experiencing and trying to communicate it in a way that people can hear you and you feel like you're expressing everything accurately. But then if English is your second, third, or fourth language, now you're really having to overcome a lot of hurdles. So I can only imagine what that person has been through over years trying to communicate to their provider or to their physician or even just to their loved ones without feeling like, you know, without being traumatized again in the process. So I guess that coincides directly with trauma-informed care, not causing more harm while you're trying to administer a specific intervention or just provide support. So what can help? One, having competence, multicultural competence, cultural matching. There's oftentimes where I'm working with men or women and they'll say, you know, you're great, but I would like to work with a female provider. And it's nothing against you, but, you know, things that I've been through or maybe just what I'm presenting with, it'd be better if I'm working with a female provider. And also there's culture-specific therapies. Are there some that you all are familiar with? I'll throw out a few. Narrative therapy can be very helpful as opposed to some other therapeutic modalities. That person is really telling their story from their own lens. And then from there, we're looking at different symbols, different language, different issues that continue to come up and they're really driving that treatment. Another therapy is art therapy, where this person can illustrate what they're experiencing. Now, this doesn't always have to be the norm, but we want to give our clients different options so they don't feel pigeonholed to have to conform to whatever practices we're most comfortable with. The other thing, somebody also mentioned narrative therapy before you said that. Music therapy, possibly psychodynamic. And then somebody mentioned how, you know, a lot of the research for evidence-based practices, such as cognitive behavioral therapy, which is probably the most commonly used therapy, is done on white people in particular. There's not a lot of research and evidence-based practices towards other groups. That's so true. Thanks, Shireen. And also, our younger folks too, we need to have treatment modalities that work with them and their culture because, you know, they may be experiencing things that are different or they're expressing it in a different way. All right. So, cultural competence. I feel like it's almost, I won't say a buzzword, but we're hearing it more and more often now. Would you all agree? So, cultural competence, the definition is the ability to interact effectively with people of different cultures. And I think all of us strive to have a high level of cultural competence but then sometimes we don't know what that means. What does it look like? How do we achieve that level of cultural competence? So, we're going to talk about how do we interact effectively with people of different cultures and again, without causing more harm. So, there's a couple of things that we can do. We're probably familiar with the KS here, awareness, knowledge, skills. So, having awareness of your own assumptions, your own values and biases, also having the knowledge. So, understanding the worldview of culturally diverse individuals and then skills, developing culturally appropriate intervention strategies and techniques. So, if you are, I'm going to put you on the spot a little bit. If you could rate your cultural competence on a scale of one to 10, where would you say you are at? And as you all are doing that, I'm going to also throw out a couple of other things that can help enhance our cultural competence. So, we talked about self-awareness, meaning how can I be aware of the things that I present with that could highly impact the treatment with other individuals and other groups of people. Also, being empathetic. So, when I'm talking with someone, I'm actually listening to understand, listening to be informed and not listening to pose any judgments. Also, having effective communication. This means I have to ask if I don't know something or if I'm not so sure of what the person is expressing, be humble enough to ask for clarification. I don't want to assume because now we're starting off already on the wrong foot. So, just we're seeing mainly between four to six, but we do have a couple sevens and eights and then a couple on the lower end, but I would say most people are between, yeah, right in the middle. Yeah, and I appreciate you all for, you know, for being vulnerable and put dropping that in the chat because it gives us at least a benchmark of where do I go from here? How can I go from a four to a seven or from a six to an eight? And these are some very tangible things. So, again, having more awareness, having knowledge, having skills, some things that are not on the slide, but having respect for diversity and looking at our own perceptions of diversity. And then lastly, being flexible and adaptable. There are certain practices and certain ways that cultures do things that are going to be different from how we've grown up, what we've been taught. And in treatment, we may have to be very flexible with our communication styles, our listening, our mannerisms, because there are some cultures where it may be more appropriate to, you know, speak more or speak less, speak louder. So we have to be just aware of all of those things. And I think the more comfortable that we can make our clients so they can educate us so that we can be more competent on their background and their culture, the more success that we'll have or they'll have in treatment. So assessing cultural factors for providing mental health treatment for SMI. So how do we assess for these factors? We've talked about what culture is, what culture identity is. But how do we assess for it? So one, being aware of the stigma amongst certain communities. So cultures may believe that mental health or mental illness equals weakness. And I'll be the first to say in the black community, there's still a lot of hesitation to seek out support, especially from people who you don't know. And who sometimes don't look like you. So we have to be aware of those factors. What are some of the cultural beliefs? Again, relying on community support. Placing emphasis on spiritual practices. So a lot of the research as I was preparing for this presentation looked at how certain cultures are really driven more to pastors, ministers, chaplains for spiritual support over some more of the formalized treatment. And I found this to be even true in, you know, working with military population. There are some times where people say, I was hesitant to come in, but, you know, my chaplain or my pastor really kind of encouraged me. Also, lack of knowledge of treatment options and outcomes. People don't always know that we're available, or they think that if I'm talking about my mental health, then that means I'm automatically going to be hospitalized, or I'm going to be prescribed medication, or I'm going to have a major diagnosis. So there's all of these assumptions that come along, and then it gets passed along. So now, one person doesn't seek care, so then their friends or family members, now it becomes a cultural thing. So we have to be aware of that. And also people aren't aware of the outcomes, like the benefits. I'll never forget, I was working with a young man, he was around 25 years old, maybe 26, and we were working on some depressive symptoms. We were on about session four or five, and he was making some progress, but not the progress that, really, with the work that he was putting in, he was doing the homework exercises, and looking at his PHQ-9 or his different measures for depression, it wasn't really increasing it in a way that I thought would be most beneficial for him. So I suggested medication. Initially, he was opposed. We met a couple of more times, he's still in some distress. He said, you know what, I'll talk to the psychiatrist, I'll talk to her. He was prescribed, I believe Zoloft. We met again, he was feeling so much better. By the time it was time for us to discharge, I said, well, you can talk to your provider about, you know, whenever you guys are going to wean off medication or whatever that looks like. And he said, I don't ever want to go back to feeling like how I felt before. But if he wouldn't have been open to the medication, he wouldn't have achieved the level of success that he did. So that's just something that I keep in the back of my mind, that sometimes people don't know just what options are out there, and what the benefits and not just the ramifications can be of engaging in different levels of support. There's also limited access to resources. Not everybody can afford mental health services, can have transportation, or childcare. What else do you all find will be some of the limited access or some of the barriers to receiving support? But those are a few that I've seen just firsthand that really can prohibit people from getting the support that they want, or can benefit from. I've seen a few so far, so just people's schedule, like busyness, language, transportation, rural areas, not having family support, mobility issues, not being able to afford it, don't know how to access it. There's a lot, not having insurance. Let's see, some of these are, yeah, hours of service maybe don't work. Yeah, the travel time, wait lists, social stigma, so a pretty comprehensive list. It is, and again, doing some of this research, sometimes providers are, we're not really being empathetic about those barriers. So if someone is missing appointments, we may be thinking they don't care. They're not prioritizing their health. So we're discharging them, or we're quick to say they're not following medical advice. But oftentimes, there are some real legitimate barriers, so like childcare or transportation. Maybe they can't afford the co-pay. And again, five, 10 years ago, telehealth was not as popular. It was around, I remember when I first started at the VA, they were rolling out prolonged exposure therapy through virtual telehealth means, and I remember thinking, who's going to do that? But now, you know, treatments like EMDR and other therapies are, you know, they're always practiced, you know, quite often in a telehealth setting. So things can really, once we look at what are some of the barriers, then we can start to provide solutions and not penalize the clients or the participants, but we can be more inclusive and think, well, how can I best support them? You know, should I, do they need more reminders? Do we need to schedule at a different time where the children are not going to be present? Those are real life issues that people are dealing with. And then lastly, the co-occurring medical conditions. So prioritizing our physical health issues over our mental health signs and symptoms. So we're not always putting two and two together that, you know, my back pain or my physical health declining, it's starting to impact how I'm feeling, my irritability, my depressive levels, my mood. So we'll prioritize, hey, I know I need to get this checkup, or I know I need to get this surgery, but I probably need to talk to a mental health provider so I can have some support on that end too. So these are some of the things that we have to be just more aware of. Other cultural factors in mental health treatment and assessment, the language barriers. We've discussed that. So that can result in miscommunication or misunderstanding. This always does not have to be just from a, you know, the language. It could also be somebody's communicating something and just using other terms that we're not familiar with. So we have to ask, what does that mean to you? Because there are some terms that may mean something for me, whereas you have a totally different interpretation on it. Behavior patterns misinterpreted due to provider bias. That happens too. I remember vividly four or five years ago, a young man came into the clinic, and as he was talking to the walk-in provider, she felt like he was in a manic episode. And she hospitalized him against his will, diagnosed him with bipolar. And when he got with his regular provider, they were able to converse, and he felt like, you know, she didn't listen to me. And she found out, the provider, that these were some of this other mannerisms that she wasn't aware of, but she didn't know him. So there was a lot of judgment in place, and honestly, it was a big mess, and I felt really bad just for the young man. I think he was around 18 or 19, because he went through a lot trying to seek help. So we're misinterpreting someone being maybe a little elevated or just them describing their behaviors or their practices, and often it can lead to adverse outcomes. Also, lack of cultural competence leading to clients feeling judged. So we have to be more competent. Understanding the impact of past trauma. I want to highlight this, because there are certain things that people experience in certain cultures that if we don't understand the magnitude of it, then that can, again, cause further harm. I was talking to someone who is from a Nigerian background and was given different names by different family members. And that is part of that person's culture. But she said her therapist said, well, it sounds like you have a lot of aliases. And I don't know about you, but alias oftentimes has a negative connotation to it. So this person who is already managing anxiety, depression, for other issues is now feeling like, well, wait, my provider is telling me I have all these aliases, and I'm feeling like, do I know myself? Or now identity issues are starting to arise. So we have to be careful of how we're, you know, how we're exploring someone's background to not cause further trauma. And lastly, involvement of family for collateral information. This one can't be more true, especially when I'm working with men. A lot of times they'll say I'm here, but I'm not sure what's going on. I'm here because my wife told me or my doctor said I should be here. And when the family gets involved, it's very helpful to provide more clarification and a different explanation of what the presenting issues are. So the cultural formulation interview, this is one of the techniques or assessment tools that we can use. And I want to go over what, you know, how it's helpful. So one, cultural identity. We've explored the definition of it, but we know that is important when we're providing care. Also, the cultural explanation of illness. So what are the norms? How are you expressing your distress? Cultural levels of psychosocial support and functioning. Is it more of the norm for you to seek support from a colleague, a friend, a coworker, a mentor? Cultural elements of the client-provided relationship. And then being aware of information that influences the diagnosis and treatment. Here's a list of other cultural assessment tools that you can use to tailor treatment. And I would definitely screenshot this if you can or take note of it, because I feel like the more different tools and variety of tools that we have, the better off we can be. And even if you're not using these tools in every single assessment or every session, being aware of some of the language and some of the questions that they're asking. So the aftermath, now we're going to move towards the aftermath of the lack of culturally competent treatment. So I have here listed some negative outcomes that may occur, but if you all, can you all share, what do you think could happen as a result of not providing culturally competent treatment? And I'll read the list as you all put some things in the chat. So we talked about misdiagnosis, reinforced stigma, so further pushing people away, mistrust in the medical system, worsening of symptoms, ineffective treatment, confusion, so not knowing, okay, what do I do? How do I get support? And it also could lead to legal consequences, particularly when you're thinking about the SMI population. So there's lots of, similar to the list, but definitely lack of engagement, mistrust, also the dropout rate or lack of treatment, even if they get in the door, more additional trauma, causing harm, confusion. Oh, somebody said you have them all listed. Substance use, worsening of symptoms, yeah, a lot about the disengagement or not following through with treatment. Yeah, so, and I want to highlight that one. So if we think about disengaging a treatment or dropping out, a lot of us, when we consume something, whether this is like food or we're buying some things, we're looking at the reviews. We're looking at, you know, when we take a trip, you pick out your hotel, you want to see what did other people say about this place? Was it something that's worth my time? Is it going to be worth my resources and energy? In the same fashion, this can apply to mental health services as well. Because if people have a negative experience, they're going to tell somebody else, hey, don't, I tried therapy, it didn't work, I tried medication, they didn't listen, all they did was force this on me, blah, and the list goes on. So now that experience, that negative experience from one person, they're telling everybody. So now it's reinforcing, I should not seek help, or you should not seek that type of help. So it's going to lead more to drinking your problems away, could result in legal issues. But I think we really have to understand just the magnitude of not seeking support or providing poor care, because people will talk about it. Or another thing that can happen is someone who's not receiving the best care, but maybe they say, yeah, I'm in therapy, and now others are looking like, well, you're telling me you're seeking help, but I don't see anything working, it's not changing. So that can really spread throughout the community, and it can become generational at that point. So now that we talked about some of the things that can happen if we don't have good care, let's talk about some of the evidence-based practices for culturally competent treatment. So what do you all think are some of the EBPs that we can use for culturally competent treatment? Or some that you are already using? Now, as you all are putting things in the chat, I'll go over some. We have to be aware of how to make this effective and impactful for that person and their culture. Also, motivational interviewing. So this is a technique where we're engaging people or patients in a non-confrontational manner to assist with changing behavior, utilizing a collaborative approach. So, Jason, this was the one most mentioned in the chat was motivational interviewing. And then there's also EMDR, and I don't know what this is, HEAT slash HER curriculum, so is that maybe a specific EBP? PET? It's H-E-A-T slash H-E-R. Oh, I'm not familiar with that. I'm not familiar with that. Yeah, I have to look that one up. But again, we can all enlighten each other, so thank you for sharing that one. Yeah, MI, I think it's definitely a great tool. It's a skill that takes practice, it takes effort, and the emphasis is on the collaborative approach. So you can know the skills, how to engage with resistance, how to ask the open-ended questions, but being aware of that person's culture and how they view things is going to be really critical to implementing MI effectively. Same with CPT, knowing what are the cultural norms. So for instance, you don't want to work with someone on the control because of past trauma, and you're using an example where they're sharing practices that are pretty much the norm and widely acceptable in their culture. So you may think something that they're doing is causing more trauma or is a result of trauma, and they can say, no, that's how we do things, and I'm okay with that. Other forms are DBT, used to effectively teach distress tolerance and emotion regulation, and ACT, so an EBT that provides comprehensive support, including case management, medication management, psychotherapy, and vocational support, assertive community treatment. So there's lots of EBPs that can be utilized for culturally competent treatment and definitely EMDR is one. I think that's probably being more widely practiced now and studied because of its effectiveness. So now how do we address the cultural factors in the therapeutic relationship? Being aware of the role of family, spiritual practices, provider bias, we talked about those things and how they can impact the therapeutic relationship. Also being aware of different risk factors. So gender, race, family history of anxiety, experiences of stressful life events or traumatic experiences in childhood. I shared earlier when I was working with the young lady who preferred a female provider and when I had looked at her chart and record review, I was already aware that because of things that she had experienced, I may not be the best person for her. And I remember playing this day when you know she advocated for herself as we were checking in. I was more than happy to help facilitate a transfer so she could get the care that she wanted and desire it will be most effective with. So just being aware of some of those factors of gender, race, and other things that could impact the treatment. Race-based traumatic stress. So as we think about culturally competent treatment, we also want to be, we have to be aware that traumatic stress in response to race-based incidents can cause psychological pain and distress. And if we're not aware of that, we could easily not, well, ignore or downplay different incidents that our clients have been through or traumatic events while they're expressing their trauma, while they're sharing their story. So we want to be really aware, really patient, ask questions, listen, and make it a very safe space for them to emote in care. Trauma-informed crisis response. So traumatic events do not exist in a vacuum like other social phenomena. They should be understood within the social and cultural context in which they occur. So essentially we're saying that when something happens, it's not just this isolated event often. It's, we want to look at the wider frame so that we can provide the best care and support. So how do we overcome these challenges and barriers? It's another slide that really hits at some of the principles. So we want to make sure we're providing safety. When we're thinking about trauma-informed care or trauma-informed approach, safety is going to be at the top of the list. We can have all of the evidence-based practices in the world. We can have great skills in EMDR or CBT, DBT, but if we're not implementing this with safety, to make sure that our clients are safe, we're not going to be effective. Another principle is trustworthiness and transparency. So as clinicians, if we need to know something or if we know something that can be beneficial for our client, share it. Don't keep that to yourself. That's going to help build the therapeutic relationship. Also peer support. Advocating for good solid peer support because we're not going to always be there and we want to encourage our clients to have good outside resources. Collaboration and mutuality. So working together and not against each other. You don't want to be bumping heads constantly with the person you're trying to help. Making sure that you empower them so they can make their own choices in their care. Going back to the example of the young man who was experiencing depression, I did not force him to meet with psychiatry or psychiatrists. I empowered him when he was ready to make that choice. And then lastly, being aware of cultural, historical, and gender issues. The more we can be aware of these things, the better. So now culturally sensitive care. We've talked about cultural competence and how skills, knowledge, attitudes, information, that is going to be imperative to work with diverse populations and cultural humility. That's been sprinkled in throughout this conversation where we have to humble ourselves. We have to be open to learn. And not feel like we're the expert. We may have the credentials and the years of experience, but they're the expert when it comes to their own life. And when you start to ask questions in a way that positions them to be the expert, now they're going to feel empowered to be the expert. And they're going to feel now they're going to feel empowered to ask more questions or to share more about their traumatic experiences or what they're feeling, what their mood fluctuations are. Because now there's a level of trust that can only come with providing and making that safe space. So today we've discussed quite a few things. We broke down the definition of culture and cultural identity. The role of cultural identity in mental health treatment. The importance of culturally competent assessment in mental health treatment. The different evidence-based tools that we can use. The role of trauma and culturally competent care. And the specific strategies to overcome the barriers. So I think this is the bibliography, and then we'll open it up after Shireen. You have some things before we go into Q&A. Yeah, just to thank you for such an interesting presentation. And right before we shift into Q&A, I just want to take a moment and let you know that SMI Advisor is accessible from your mobile device. So you can use the SMI Advisor app to access resources, education, and upcoming events, complete mental health rating scales, and even submit questions directly to our team of SMI experts. You can download the app at smiadvisor.org. Okay, so we'll move into our Q&A. And if you have some as we start going, please go ahead and add them to the chat. So the first question, if somebody doesn't bring up their culture, should we bring it up as the clinician? And if so, do you have any recommendations on how to approach that? That's a good question. Yeah, I think we should. I do think we should. And if they don't bring it up, because we know it's there, this may be a time where you can use appropriate self-disclosure for parts of your own culture so that person can get a sense of where you're going. Because I think that at times, the word culture can feel very vague. And that person, depending on their background and what they've experienced, they may not be really comfortable or confident enough to share parts of their culture or what their culture means to them. So this is a great time, particularly maybe earlier on in care where you're building rapport, excuse me, for you to share some things about your own culture so they get a sense of what you're asking and more comfortable answering the question. So it's definitely something we should bring up and provide space for them to elaborate on. Great, thank you. So there's a general, there's not as many people of color who are providers available. So we talked about cultural matching, but that's not always possible. So what advice do you have when people are working with people of different cultural backgrounds? Should you acknowledge it? And if so, yeah, how would you, how do you go about bringing that up? Yeah, I think it is, it's great to acknowledge because if you acknowledge it, the more open that you can be as a provider, then you let that person who you're providing care for know, okay, I see you, I see that maybe I'm a younger or an older white female who's providing services to a young black male. So our worlds look totally different and that's okay. Or they can be, you know, the things that my interests are probably different from yours. And when you do that, now that person, it could even be, one is probably fair and honest and it gives them a chance to say, well, you know what, I do relate in some of these ways. Or they can say, well, as a provider, you can ask them, what are some things that I may not be aware of that you experience? Or what are some of the apprehensions that you have about talking with someone with my background? So now you're letting them know, I understand that this can already be a challenging situation for you. And again, you're just making it very, you're putting it out there, you're making it known. And if you're open to listening to what that person says, you're going to strengthen their trust in you as their provider. But if you kind of come as the expert that you know everything because you, you know, you have the experience, you have the age, especially when you're working with someone young, no matter what the race, there's already a dynamic that, oh, you think because you're older, you know everything and I know nothing. So you want to balance that out as early as possible too. Great. So we'll move into a little bit about the assessments that you shared. So, you know, they're, people have standardized intake and assessments, right, at agencies typically. So how do you recommend incorporating the cultural frameworks and assessment that you shared into that process? Yeah, so what I would do is, because we do have these probably standard templates that we use, I would develop a separate subset of questions for yourself. So it doesn't have to totally derail the assessment or add another 30 to 40 minutes to the assessment, but pick out some that you feel like would be really helpful for you to provide the care. And I would add that either at the, you know, the end, the beginning, somewhere in your intake flow or process so that it can become the standard. Another thing that you can do, so there's a couple ways to tackle it. You could also just utilize that assessment tool in the next follow-up session. If you feel like you really want to dive deeper or this is, you're working with a culture or a person that you really feel like I need to know a lot more and this is going to be beneficial for them staying in treatment, then I would just kind of allocate time during the next follow-up. If, another suggestion, if this is a pervasive problem where you're feeling like, hey, as an agency we're working with populations that our team is not fully equipped to provide the best level of cultural competent care, then I would bring it up to more of the, like the higher-ups, your leadership, about how can we incorporate this into our standard practice. You can just use that language and say, you know, our team cannot really service X population at the highest level, so is there a way that we can have more time? Is there a way that this can be, you know, maybe some of the information can be provided to the clients beforehand, but you want to do something so that now you can be more inclusive with that information. That's a great question too. Great, so we talked about individual, we'll open it up a little bit to others. So somebody has the question, how do you talk with colleagues who are not, maybe not displaying cultural competence or not interested in it, so how would you approach that? So you have to be, now I'm pausing because the colleague has to be receptive. I had a conversation with a colleague about a month or so ago where she was working with a young Black male and she said, hey, I don't know how to work with this, well, I don't know, she said, I don't know, but she said, I'm an older white woman, I'm working with the young Black male and he's been through a lot of trauma, so she was coming to me for support, consultation, and as soon as I started to talk to her about some things, you know, with trauma, I don't know if I went into CBT or EMDR, but whatever I said, she immediately kind of shut me down and said, no, no, no, I got the trauma stuff, I need to know how to relate. So I wasn't able to really provide the best support for her because she wasn't, she said she was, she asked me, but she wasn't receptive. So if you're talking to a colleague, so if you're seeking out the support, make sure that you actually want to learn and you, you're open to what they're, you know, the information or suggestions that that person is going to give you. If you notice that your colleague needs more support, then I would ask them, you know, again, stating some of the, the obvious, I noticed maybe on your case load, you have mostly teenagers from, you know, Hispanic background, is, did you have specific training? I wonder how do you, how do you measure success or what's been your, your out, your treatment outcomes with them? And you can let them know because maybe that's something that you've struggled with, or you may have more expertise or training, so you could lend them, or they could lend an ear to some things that you could help them with. So that person has to be open. And then if you do have some tools, I would just let them know that you're not coming from a place of trying to, to critique their clinical experience because you're probably not in a room with them, but you see where there could be a gap and then providing the best care. And then lastly, I know I'm a long winded on this one, if you do have more expertise for your colleagues at home, maybe you do a lunch and learn or ask to do some type of presentation where you're giving information to everybody and not just singling one person out. Great. We have one final question and it's a big picture question. So how can we work to reduce stigma and barriers for people of color to access care? When you have people of color in your office, particularly, but even if it's the first session or the last session, so it doesn't matter the timeframe, ask them for feedback on how you're doing. If, if this person is going to be open and honest, great. You can incorporate that feedback so that they can, again, tell other people. You could also solicit feedback through one of those, like a non, like an anonymous drop box or something, but you want to get the feedback from them so that you know, or the agency knows what are, where are we missing the mark? You know, this information is great, but we really need the information from the people that we're servicing so that we can better improve our services. If you think about anything that we do now, there's always a survey at the end. No matter if you're going to a restaurant, again, if you're taking a test, I mean, even here, there's, there's going to be a survey after this presentation because you all want the data so that you can make sure that the next person who presents to your, your group does an even better job. So we have to take that same consideration into the care that we provide. I was talking with someone the other day and I asked them, like, what stands out from our session or do you have feedback for me? And this person had been in care for years, you know, a couple of years. And she said, nobody's ever asked me that. And I'm like, well, get used to it because I do ask because I need to know if I'm saying something wrong, if I'm doing something wrong. So we can, we can break the stigma by asking the questions and then again, being more inclusive with our approach too. So we may have to be out of the box. We may have to not just think about one-on-one services. We may have to get people in the door in a more creative way. Thank you so much. So that ends our Q&A. I just have a few more things to cover before we end for today. So if there are any topics that were not covered in this webinar that you would like to discuss with colleagues in the mental health field, you can post a question or comment and SMI advisors webinar round table topics discussion board. So this is an easy way to network and share ideas with other clinicians who participated in this webinar. And if you have questions about this webinar or any other topics related to evidence-based care for people living with serious mental health conditions, you can get an answer within one business day from one of our SMI advisor national experts. This service is available to all mental health clinicians, peer support specialists, administrators, and anyone else in the mental health field who works with individuals who have SMI. It's completely free and confidential. SMI advisor offers more evidence-based guidance on culturally competent mental health care, such as the fact sheet, culturally competent care for black American adults living with a serious mental illness. This guide addresses common barriers to accessing mental health services and provides practical strategies to overcome them. You can access the fact sheet by clicking on the link in the chat or by downloading the slide. To claim credit for participating in today's webinar, you'll need to have met the requisite attendance threshold for your profession. After the webinar ends, please click next to complete the program evaluation. The system will then verify your attendance for you to claim credit. This could take up to one hour. And lastly, please join us next week on June 23rd as Marcus Smith and Kelly Winbush Fairley present Racism and Black Mental Health, Unpacking Implicit Bias in Counseling. Again, this free webinar will be on June 23rd at 12 p.m. Eastern. Thank you so much for joining us and thank you so much to Jason. Until next time, take care.

diverse cultural backgrounds

mental health treatment

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cultural factors

culturally competent assessment

barriers to accessing mental health services

evidence-based practices

cultural competence

trauma-informed care

reducing stigma