Transcript Slide 1

LIFE IS PRECIOUS:
A PROMISING COMMUNITY DEFINED EVIDENCE
PRACTICE-BASED MODEL
ROSA M. GIL, DSW
FOUNDER, PRESIDENT & CEO
ROUND TABLE DISCUSSION – LATINA TEEN SUICIDE SPONSORED BY NEW YORK STATE
COALTION FOR CHILDREN’S MENTAL HEALTH SERVICES. FEBRUARY 7, 2011, ALBANY,
NEW YORK
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COMUNILIFE, INC.
WHO WE ARE

Comunilife is a Latino multi-service, not-for-profit organization
created in 1989 to expand access to the continuum of housing,
behavioral health and social services for Latinos and other
diverse communities in New York City.
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Comunilife Pioneered the Multicultural Relational Approach for
Diverse Populations™ that is based on a community-centered
practice that incorporates the worldview, cultural values, beliefs
and endemic knowledge in the definition, assessment, treatment
interventions of behavioral health problems with Latinos. (Gil &
Genijovich, 1994)
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COMUNILIFE, INC. (CONTINUED)
WHO WE ARE

Comunilife developed the Multicultural Relational
Assessment Instrument™ to enable clinicians to incorporate
clients’ cultural knowledge and concerns into treatment
interventions, treatment plans that includes goals, objectives
and outcomes. (Gil & Genijovich, 1994)
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Life is Precious, a suicide prevention program for Latina
adolescents was developed based on the principles of the
Multicultural Relational Approach for Divers Populations™.
It is a promising community-defined evidence based practice
to be discussed later in this presentation. (Gil, Rendon &
Cifre, 2007)
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Hispanic Disparities in Mental Health Care and
Research
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Disparities in mental health care for Latinos and other multicultural
populations are greater in comparison to white populations. The
inequalities are more prevalent in the areas of access, availability, quality
and outcome of care. (Callejas and Martinez, 2009)
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Collectively, ethnically/racially diverse populations experience a greater
disability burden from emotional and behavioral disorders than do white
populations (Huang, 2002: Department of Health and Human Services,
2001)
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Between 1986 and 2001, nearly 10,000 participants were included in
randomized controlled trials evaluating the efficacy of interventions for four
mental health conditions (bipolar disorder, schizophrenia, depression and
ADHD) and included only:
■ 561 African Americans (5.6%)
■ 99 Latinos (.01%)
■ 11 Asian American and Pacific Islanders (.001%)
■ No single study analyzed the efficacy of the treatment by
ethnicity or race. (Miranda et al, 2003)
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Current Evidence-Based Practice (EBP)
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In an attempt to provide the best treatment available, policymakers,
researchers and funders have promoted the
use of evidence-based practice (EBP)
But, is the EBP “Gold Standard” culturally appropriate?
■ Most EBP trials are conducted with White, educated, verbal and
middle class individuals and may not generalize to ethnic/racial
groups and third world communities (Bernal & Sharon-del-Rio, 2001)
■ Empiricism (upon which randomized-controlled trials are
based) is a western epistemological model–does not support
other knowledge bases. (Callejas and Martinez, 2009).
■ Frequently don’t take the following aspects into consideration:
◆ Historical trauma
◆ Cultural values, beliefs, traditions and preferences
◆ Contextual, transactional and societal variables relating to the
environment in which the individuals lives.
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Current Evidence-Based Practice (EBP) (Continued)
“The central problem is that treatments that have been validated in
efficacy studies cannot be assumed to be effective when
implemented under routine practice conditions” (Hoagwood et al.,
2001).
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An Alternative Community-Defined Evidence (CDE)
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The Community Defined Evidence Project CDEP, a partnership between the
National Latino Behavioral Health Association (NLBHA) and the National
Network to Eliminate Disparities (NNED) in Behavioral Health. (NNED,
2007)
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Community-defined evidence (CDE) is a set of practices that communities
have used and determined to yield positive results as determined by
community consensus over time and which may or may not have been
measured empirically but have reached a level of acceptance by the
community (Martinez, 2008)
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CDE includes worldview, historical and contextual aspects, and transactions
processes that are culturally rooted and do not limit to one manualized
treatment
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Emphasize the importance of community input in development,
implementation and evaluation of practices.
An Alternative Community-Defined Evidence (CDE)
(Continued)
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The central goal of the CDEP is to discover and develop a model for
establishing an evidence based using cultural and/or community indices that
identify community-defined and based practices that work.
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CDEP was designed to identify “successful” community defined-based
practices to support overall good health and well-being among Latinos.
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With the support of SAMSHA the University of South Florida in
partnership with NLBHA and NNED has conducted research of community
defined-based practices in 16 Hispanic agencies throughout the country.
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Comunilife’s Life Is Precious program, grounded on our Multicultural
Relational Approach for Diverse Populations™ has been selected as one of
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the CDE practice in the University of South Florida’s research study.
DEFINITION OF THE PROBLEM
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Latina adolescents are much more likely than black and white adolescents
to report attempt suicide (CDC YRBS, 2009) in the nation.
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New York City Latina adolescents have suicide attempt rates that are higher
than the national average (11% versus 14.7%).
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Latina teens generally attempt suicide at a rates far greater than their nonHispanic counterparts –more than twice the rate of white youth in New
York City (14.7% versus 6.2%) and 44% more frequently than teenage
African-American girls (14.7% versus (10.2%).
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More than one Latina teenager out of every five living in Brooklyn
attempted suicide during 2009 –a rate that was almost twice the level just
two years earlier. Brooklyn has the highest rate of attempts suicide by
Latina teen than any other locality in the country.
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The levels of suicide attempts by Latina teenagers were also shockingly
high in the City’s other boroughs: 16.5% in Staten Island, 15.3% in the
Bronx, 12.2% in Queens and 11.7% in Manhattan.
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This mental health disparities have been neglected by policy makers and
researchers since 1995 “CDC RBS, 1995”.
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Central and South American and Caribbean countries had some of the
lowest suicide rates in the world (Carpinello, 2006)
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Lack of research on efficacy of Latino community defined practice based
models of care.
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Most current clinical practices not normed on Latino populations.
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Failure of traditional treatment programs due to a poor fit with Latino
community.
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LIFE IS PRECIOUS
DEVELOPMENT OF A COMMUNITY DEFINED
PRACTICE-BASED MODEL
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Mobilized the following sectors to create awareness, education and actions to
address the problem:
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Latino and English Speaking media
Latino business community
Latino and non elected officials
Latino Grass root organizations
Government Agencies
Latino and Non-Latino mental health providers
Community at large
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Conducted a qualitative marketing research focused on Latino parents and
teens in the Bronx with the following research objectives:
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to assess awareness and attitudes towards teen suicide and prevention
to determine awareness of existing resources and programs
to better understand the target population’s lifestyles and preferences
to seek suggestions for program design to address Latina teen suicide
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QUALITATIVE MARKETING RESEARCH FINDINGS
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Huge communication gap between Latina adolescents and parents driven by
acculturation stress and immigration
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Adolescents believe that their worries and problems could lead to suicide;
parents do not believe so.
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Cultural differences increase stress and can play a role in suicide ideation
and attempts.
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Daughters’ increased independence is perceived as “falta de respeto”.
Respect is a major Latino cultural value (Gil & Vazquez, 1996)
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Adolescents identify family members as role models but do not seek their
help due to lack of confidentiality in the family.
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Parents usually turn to family for help and to mental health services only as
a last resort.
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Parents and adolescents shared a strong anti-medication bias for treating
emotional distress.
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QUALITATIVE MARKETING RESEARCH
FINDINGS
(CONTINUED)
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Parents and adolescents do not believe that traditional mental health
services and schools are responsive to their needs.
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Parents and adolescents are UNAWARE of suicide prevention
programs or suicide hotlines in English or Spanish.
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Adolescents communicate through “My Space.”
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Adolescents suggest programmatic activities; peer counselors;
academic tutoring and internet café “fun” activities such as
discovering their talents.
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Mothers suggest activities to foster socialization to decrease their
sense of isolation.
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Mother suggested family oriented activities.
LIFE IS PRECIOUS
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GOALS AND OBJECTIVES:
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Decrease suicidal behavior
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Improve communication between parents and adolescents
Improve academic performance
Increase self-esteem
Improve social relationships
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CRETERIA FOR ADMISSION:
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Latina teens between 12 and 16 years old
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In treatment in a mental health clinic
Diagnosis of mood disorder with hx of suicidal ideation or
attempts
Must be in school
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PROGRAM HOURS
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Monday through Friday 3:30 PM to 7:30 PM
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Saturdays 10 AM to 2 PM
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Locations
Bronx Program open in 2008 (6 days a week)
Brooklyn Program open in 2009 (3 days a week)
PROGRAM ACTIVITIES
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Tertulias for mothers and Dominos for fathers
Saturday’s family day
Creative art therapy
Tutoring
Youth ambassadors (peer mentors) - (Promotores de Salud Mental)
Internet café
School advocacy
Case management to help families with socio economic stressors
Indigenous volunteers, “madrinas”, “padrinos” and youth
ambassadors (Promotores de Salud Mental)
Community coalition to reduce suicide among Latina adolescents
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PROGRAM OUTCOMES
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More than 100 Latina adolescents have participated in the program
in the last two years.
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Decreased suicidality only 5 teens were readmitted during the two
years of the program in the Bronx. .
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Strengthened family communications and relationships with
mothers, friends and others.
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Sixty six percent (66%) of the girls improved academic performance
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Forty four percent (44%) of parents agreed teens had better coping
skills; and 86% of girls felt they handled their daily lives better
than they used to
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PROGRAM OUTCOMES (CONTINUE)
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Adolescents discovered personal talents, improved self-esteem and
increased optimism about life.
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Level of satisfaction by participants indicates this model is culturally
appropriate for parents and adolescents
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Twenty eight (28) “padrinos”, “madrinas” and youth ambassadors
participated in the program (Promotores de Salud Mental)
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Lack of research resources to analyze all the data collected in the
Life Is Precious program.
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Program is funded by New York Community Trust; Van Ameringen
Foundation and New York State Office of Mental Health
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References Cited
Bernal, G. & Sharon-del-Rio, M.R. (2001). Are empirically supported
treatments valid for ethnic minorities? Toward an alternative approach for
treatment research. Cultural Diversity and Ethnic Minority Psychology, 7:
328-342.
Carpinello, S. (2006). Suicide in 2 Ethnic Groups is Topic at Assembly Hearing.
New York Times, December 8, 2006
Gil, R. & Genijovich, E. (1994). The Multicultural Relational Approach for
Diverse Populations™. Comunilife, Inc.
Gil, R. & Genijovich, E. (1994). The Multicultural Assessment Form.
Comunilife, Inc.
Gil, R. M. & Vazquez, C. (1996). The Maria Paradox. G.P. Putnam’s Sons, New
York, NY
Gil, R., Rendon, M. & Cifre, R. (2007). Life is Precious. Comunilife, Inc.
Hoagwood, K., et al. (2001). Evidence-based practice in child and adolescent
mental health services. Psychiatric Services, 52:1179-1189.
Huang, L. (2002). Reflecting on cultural competence: A need for renewed
urgency. Focal Point, 16 , 4-7.
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References Cited (Continued)
Miranda, J., Nakamura, R., & Bernal, G. (2003). Including ethnic minorities
in mental health intervention research: A practical approach to a longstanding problem, Culture, Medicine & Psychiatry, 27 , 467-486.
U.S. Department of Health and Human Services .(2001). Mental health:
Culture, race, and ethnicity – A supplement to mental health: A report of
the Surgeon General. Rockville, MD: U.S. Department of Health and
Human Services, Substance Abuse and Mental Health Services
Administration, Center for Mental Health Services.
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