Transcript Slide 1

THE ROLE OF CULTURE IN
INTEGRATING SCHOOLS AND
MENTAL HEALTH
Mario Hernandez, Ph.D. and
Teresa Nesman, Ph.D.
Department of Child and Family Studies
Louis de la Parte Florida Mental Health Studies
School of Mental Health Studies
Presented to the Department of Student Support Services, Hillsborough County Public Schools
Paul R. Wharton High School, 20150 Bruce B Downs Boulevard, Tampa, FL. 33647
October 17, 2008
Purpose

Why is culture important?

Identify issues/challenges faced in serving
diverse children and their families

Increase awareness of how recommendations
made by school personnel might be perceived
by diverse families
Assumption Underlying

Culture plays a pivotal role in child development,
parenting, learning approaches as well as in
mental health and mental illness
What Is Culture?

Culture has been defined in various ways by
different disciplines and for numerous purposes
(Kao, Hsu, & Clark, 2004)

It is often invisible to people until they find
themselves in a cross-cultural situation
Maslow’s Hierarchy Of Needs:
Humanistic Theory
Self
Actualization
Esteem and Identity
Love and Belonging
Safety and Security
Physiologic (e.g., Food, Water)
(Cross, Bazron, Dennis, & Isaacs, 1989)
Why Is Culture Important
To Mental Health?

Life trajectories of diverse children and youth
are impacted when disproportionate numbers
end up in systems such as child welfare,
juvenile justice, and alternative education, etc.

Sadly, relatively high levels of severity of a
mental health problem are required in order for
culturally-diverse individuals to overcome their
reluctance to seek help from a professional

This is likely true for all people
In The US….

Emergency rooms are swamped with people with mental
health problems with nowhere to go; and the failure to
treat those with serious mental health problems has
resulted in incalculable cost, in terms of real dollars and
human suffering, to the community and individuals
(Gruskin & Dickens, 2006, p. 1904).

Schools have born the burden of unmet mental health
needs of both children and their families.
Gaul, C. E, & Farkas, C. (2007). Public Health and Mental Health: A model for Success. Perspectives in Psychiatric Care. Oct.
Global Conditions Experienced By Many Of
Our Children And Their Familes

Unfortunately, in most parts of
the world, mental health and
mental disorders are not
regarded with anything like the
same importance as physical
health, instead, they have been
largely ignored or neglected.
World Health Organization. (2001). The World Health Report 2001. Mental Health: New Understanding, New Hope. France.
Global Conditions Experienced By Many Of Our
Children And Their Familes

Most individuals with severe mental disorders
and their families are left to cope as best they
can with their private burdens such as
depression, dementia, schizophrenia, and
substance dependence.

Many are victimized for their illness and become
the targets of stigma and discrimination.
World Health Organization. (2001). The World Health Report 2001. Mental Health: New Understanding, New Hope. France.
Examples Of Disparities In Mental Health
African Americans

Less likely to seek treatment and when
they do seek treatment, they are more
likely to use the emergency room for
mental health care, and they are more
likely than whites to receive inpatient
care.
For More Information please refer to SAMHSA Surgeon General's Report: Mental Health Fact Sheet for African Americans.
Available Online at: http://www.mentalhealth.samhsa.gov/cre/fact1.asp
Examples Of Disparities In Mental Health
Latinos/Hispanic Americans

In a national survey of high school
students, Hispanic adolescents
reported more suicidal ideation and
attempts than whites and blacks.
For More Information please refer to SAMHSA Surgeon General's Report: Mental Health Fact Sheet for Latinos/Hispanic Americans.
Available Online at: http://www.mentalhealth.samhsa.gov/cre/fact3.asp
Examples Of Disparities In Mental Health
Asian American/Pacific Islanders

When they do seek care, they are
more likely to be misdiagnosed as
"problem-free“.
For More Information please refer to SAMHSA Surgeon General's Report: Mental Health Fact Sheet for Asian American/Pacific Islanders.
Available Online at: http://www.mentalhealth.samhsa.gov/cre/fact2.asp
The Challenges We Face Integrating Mental
Health And The Schools

Stigma

Lack of trust

System bias (managed care, Medicaid, etc.) and
institutional racism

Navigating unfamiliar systems
Hernandez, M. Nesman, T., Isaacs, M., Callejas, L. M., & Mowery, D. (Eds.). (2006).
Examining the research base supporting culturally competent children’s mental health services. Tampa, FL: USF, Louis de la Parte
Florida Mental Health Institute, Research & Training Center for Children’s Mental Health.
Online at: http://rtckids.fmhi.usf.edu/rtcpubs/CulturalCompetence/services/CultCompServices.pdf
Cultural Competence
Definition Of Cultural Competence



“Cultural Competence” is a set of behaviors and
attitudes that come together in a person that enable him
or her to work effectively in cross-cultural situations.
The word “cultural” is used because it implies an
integrated pattern of human behavior that includes
thoughts, language, actions, customs, beliefs, and
values shared by a social group, including service
providers or school personnel.
The word “competence” is used because it implies
having the capacity to learn and function effectively in
cross-cultural interactions.
(Cross, Bazron, Dennis, & Isaacs, 1989)
Essential Elements Of Cultural
Competence

Value diversity;

Have the capacity for cultural self-assessment;

Institutionalize cultural knowledge;
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Develop adaptations to diversity; and
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Be conscious of the dynamics inherent when
cultures interact
(Cross, Bazron, Dennis, & Isaacs, 1989)
Summary Of Cultural
Competence Continuum
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Cultural Destructiveness

Cultural Incapacity

Cultural Blindness

Cultural Pre-Competence

Cultural Competence

Advanced Cultural Competence
(Cross, Bazron, Dennis, & Isaacs, 1989)
Consequence Of Well-Meaning
Cultural Blindness
Compatibility With Our Community
Populations
Compatibility with
Community Populations
Cultural/Linguistic
characteristics of a
community’s population

Cultural
populations
Competence
means developing
Between schools and

Compatibility
compatibility
Between mental
health providers and
populations
An organization’s combined
policies, structures and
processes that support
compatibility
Hernandez, M., & Nesman, T. (2006)
Understanding The Racial, Ethnic And
Cultural History Of Your School’s Community

Who lives in the community?

What are population characteristics
such as:


Cultural view of mental health

History

Language

Resources

Strengths

Needs
What are the accepted racial and
ethnic stereotypes in the
community?
Creating a Front Porch: Strategies for
Improving Access to Mental Health Services

Responsive to both child & family

Supportive family focus

Simplified intake process

Address stigma & adapt mental health
terminology

Outreach to community organizations &
providers

Broad network of services and supports

System navigation

Flexible, individualized, culturally specific interventions
Consequences Of
Untreated Mental Health Issues….


"While mental disorders may touch all Americans
either directly or indirectly, all do not have equal
access to treatment and services. The failure to
address these inequities is being played out in
human and economic terms across the nation –
on our streets, in homeless shelters, public health
institutions, prisons and jails.“
For our country’s children and youth, the schools
are front lines for connecting to, and at times,
providing formal mental health services
United States Surgeon General Press Release: Sunday, August 26, 2001 http://mentalhealth.samhsa.gov/cre/release.asp
Additional Resources
http://rtckids.fmhi.usf.edu/rtcpu
bs/CulturalCompetence/porch/
default.cfm
http://rtckids.fmhi.usf.edu/rtcpu
bs/CulturalCompetence/servic
es/default.cfm
http://rtckids.fmhi.usf.edu/rtcp
ubs/CulturalCompetence/prot
ocol/default.cfm
References
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Cross, T., Bazron, B., Dennis, K., & Isaacs, M. (1989).
Toward a culturally competent system of care: A
monograph on effective services for minority children who
are severely emotionally disturbed. Washington, DC:
National Technical Assistance Center for Children’s Mental
Health.
Gaul, C. E, & Farkas, C. (2007). Public Health and Mental
Health: A model for Success. Perspectives in Psychiatric
Care. Oct.
Hernandez, M. Nesman, T., Isaacs, M., Callejas, L. M., &
Mowery, D. (Eds.). (2006). Examining the research base
supporting culturally competent children’s mental health
services. Tampa, FL: USF, Louis de la Parte Florida
Mental Health Institute, Research & Training Center for
Children’s Mental Health.
Kao, H. S., Hsu, M. T., & Clark, L. (2004). Conceptualizing
and critiquing culture in health research. Journal of
Transcultural Nursing, 15, 269-277.
Masi, R., & Cooper, J. (2006, November). Children’s
Mental Health Facts for Policymakers.
http://nccp.org/publications/pub_687.html#10
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Martinez, K., Garay, L. (2008, July). Community Outreach
and Engagement. Cultural and Linguistic Competence
Pre-Institute. Symposium presented at the Training
Institutes 2008, Nashville, TN
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Takaki, R. (1993). A different mirror: A history of
multicultural America. Boston, MA: Little, Brown and
Company.
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United States Surgeon General Press Release: Sunday,
August 26, 2001.
http://mentalhealth.samhsa.gov/cre/release.asp
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U.S. Department of Health and Human Services [DHHS].
(1999). Mental health: A report of the Surgeon General.
Rockville, MD: Author.
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World Health Organization. (2001). The World Health
Report 2001. Mental Health: New Understanding, New
Hope. France.
http://www.who.int/entity/whr/2001/en/whr01_en.pdf