Multicultural Approach in Geriatric Mental Health

Services for Refugees and Immigrants

Agnes Hajek, ACSWDr. Dixie Galapon

Salwa Yalda

Session Objectives & Agenda

Culture Self-Assessment

EMASS Diversity Framework

Multicultural Management Approach

Sharing of community experience with Arabic speaking Refugees & Filipino Immigrants

By the end of the 2-

hour session,

the participants will be able to:

Identify the

helpful strategie

s to reach out to

refugees and

immigrants

seniors

Describe the cost-efficiency and cost

effectiveness of

partnership and

collaboration with other

stakeholders

Share the insights

gained in working with the community where the CHW is also a member

Culture self assessment• Have I been able to separate what is important to

me, and what is important to my client?• What do I know about the client’s cultural

heritage?• What is the client’s relationship with his/her

culture from his/her perspective?• What are my stereotypes, beliefs and biases

about this culture?• Have I appropriately consulted with other mental

health professionals, members from this culture, and/or members of the client’s family or extended family?

• Have I incorporated culturally appropriate strategies/techniques with this client?

Adapted from the presentation of Dr. Erwin, Chika Asai, Jenny Durham, Amy Halvorson & Sarah Holte “Benefiting Multicultural Clients by Considering Acculturation”Counseling and Student Affairs Minnesota State University Moorhead North Dacota Counseling Conference Bismark, North Dakota February 6, 2006

Acculturation

• The process by which two cultures in constant contact engage in an exchange of ideas, traditions, and characteristics that ultimately alter both cultures

• The process can be emotionally and psychologically taxing, leading to mental distress and self-identity issues in individuals

Assessing Acculturation

• Language• Religious

beliefs• Educational

status• Employment• Societal

norms

• Social status• Media usage• Social

relations• Gender roles

Adapted from the presentation of Dr. Erwin, Chika Asai, Jenny Durham, Amy Halvorson & Sarah Holte “Benefiting Multicultural Clients by Considering Acculturation” Counseling and Student Affairs Minnesota State University Moorhead North Dacota Counseling Conference Bismark, North Dakota February 6, 2006

Individualism vs. Collectivism

• Individualism– World view that

respects personal goals and individual uniqueness more than communal goals and social unity

– Personal needs have priority over in-group needs

• Collectivism– A worldview that

group members are connected with and interdependent between each other

– In-group needs are placed before personal needs

Self-Concept

• Individualism–The self is independent from a group

• Collectivism–The self is a part of a group

Relationships

• Individualism

– Autonomous in interpersonal relationships

– Higher social skills in a starting new relationships

– May give up unproductive social relationships easily

• Collectivism– Interpersonal

harmony is the primal concern

– Take time in forming new relationships

– Relationships tend to be intimate and long-lasting

– Make efforts to maintain relationships

Communication Style

• Individualism –Direct

communication style

–Focuses on content

–Verbal communication is stressed

• Collectivism – Indirect

communication style

–Focuses on context

–Non-verbal communication is important

Coping Strategies

• Individualism–Assertiveness

–Expressing emotions

–Confrontation

• Collectivism–Social support

–Avoidance–Forbearance

Berry’s Model of Acculturation

Cultural Maintenance YES

Cultural MaintenanceNO

Cultural ParticipationYES

Integration Assimilation

Cultural ParticipationNO

Separation/ Segregation

Marginalization

Berry’s Acculturation Principles

• Cultural Maintenance – The extent individuals value and wish to

maintain their cultural identity

• Contact Participation– The extent individuals value and seek

out contact with those outside their own group, and wish to participate in the daily life of the larger society

Characteristics of Acculturation

• Integrated individuals– Individuals want to maintain their identity with home

culture, but also wants to take on some characteristics of the new culture

• Assimilated individuals– These people do not want to keep their identity from

their home culture, but would rather take on all of the characteristics of the new culture

• Separated individuals– They want to separate themselves from the dominant

culture– Can be called segregation if it forced separation

• Marginalized individuals– These individuals don’t want anything to do with either

the new culture or the old culture

Factors Influential in Successful Coping with the

impact of acculturation

• Amount of Exposure to the Culture

• Intercultural Competency• Ethnic Self-Identity• Social Support

Maslow's Hierarchy of Basic Human Needs

Higher -level needs

Self-actualization

Self-esteem

Love and belonging

Lower-level needs

Safety and security

Physiologic

Chart illustrating the theory of Maslow's hierarchy of basic human needs.LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD

Management Team

Bilingual Community Health Workers

Monolingual/Bilingual Community Members

Multicultural Management Approach

Formulate thePersonal Goal

Plan(PGP)

SocialServices/care

needsassessment

Signifywillingness to

engage?Outreach

Intake Form Assessment tool

Service ProvidedForm

Facilitate theimplementation

of the PGP

Personal GoalPlan

Follow up every6th month

Task/Servicecompletion

SatisfactionSurveyProgress Report

START/END ofthe Process

Outreach and Engagement Process

PEI Intervention Chart

CHW'sCare

ManagementPEI

Interventions

INPATIENT OROUTPATIENT

CLINICS

MEDICAL/MEDICARE

EXTRA HELPINSURANCE

IHSS , SSI/ SSA ,CALFRESH ETC

SKILLS ORCAREER

DEVELOPMENT

JOB REFERRALS

ADA Cert, NCTD ,Transportation

Assistance

LEGALASSISTANCE

HEALTH

WELFARE

EDUCATION

EMPLOYMENT

TRANSPORTATION

JUDICIAL

MONOLINGUAL; MULTICULTURALUNSERVED & UNDERSERVED ETHNIC COMMUNITIES

MASS BASED

ORGANIZED ETHNIC GROUPS MOBILIZING THE ETHNICCOMMUNITIES FOR HEALTH EDUCATION; PEER SUPPORT; SERVICE

PROVISIONSAMAKA

LATINO GROUPWOMEN'S HEALTH(SOMALI OR ARABIC) GROUP

MEN'S (SOMALI OR ARABIC) HEALTH GROUPAFRICAN AMERICAN GROUPS

MAY BE BILINGUAL OR MONOLINGUAL

BILINGUAL COMMUNITY HEALTH WORKERS PROVIDING CAPABILITYBUILDING TRAINING TO GROUP LEADERS AND VOLUNTEERS

PAID OR VOLUNTEERS OR INTERNS

EVIDENCED BASED PRACTICESPROMOTORAS MODEL

DIALECTIC BEHAVIOR THERAPYCOGNITIVE BEHAVIOR THERAPY

ACCEPTANCE & COMMITMENT THERAPYCHRONIC DISEASE SELF-MANAGEMENT

CARDIO VASCULAR HEALTH

Community Building Pyramid

Social & Recreational Day Program Spectrum

SKILLEDNURSING

HOMEASSISTED

LIVINGADC/ADHCCEMASSPROGRAM

SENIORCENTERS

Center-basedonly

FREE WILLINGSOCIAL AND

RECREATIONALACTIVITIES

CENTER-BASEDMOBILE/FIELDBASEDINTEREST-BASEDCOACHING &ENCOURAGEMENTFROM Promotoras

GUIDED SOCIALAND

RECREATIONALACTIVITIES

Center-basedonly

SUPERVISED/RESTRICTED SOCIAL

RECREATIONALACTIVITIES

Residentialbased only

RESIDENTIAL/IN-HOUSE SOCIAL& RECREATIONAL

ACTIVITIES

Residentialbased only

RESIDENTIAL1:1/SMALL GROUP

SOCIAL ANDRECREATIONAL

ACTIVITIES

For more information, please contact:UPAC-EMASS Escondido office: 760-233-1984 UPAC-EMASS El Cajon Site: 619-749-5560

Dr. Dixie GalaponMental Health Director 619-229-2999

Agnes Hajek, ASW, MSW 619-208-4349EMASS Program Manager

Salwa Yalda 619-206-6661CHW & Site Coordinator African American CHWStephanie Wilson 619-208-3016 Hispanic/Latina CHWGina Osuna & Rosa Lopez  Somali CHWsFadumo Jama 619-208-6444 Lolita Gatmaitan 619-208-6669Filipino CHW