Multicultural Approach in Geriatric Mental Health Services for Refugees and Immigrants Agnes Hajek, ACSW Dr. Dixie Galapon Salwa Yalda
Dec 15, 2015
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