Funded by County of San Diego, Mental Health Services Act, Prevention and Early Intervention

1. Evidence-based Prevention and Early Intervention Services for African American, Latino, and Vietnamese Older Adults Pei-Chen Emily Wu, Psy.D. Positive Solutions Program Manager Evelyn Parada, MSW Positive Solutions Program Lead Clinician Funded by County of San Diego, Mental Health Services Act, Prevention and Early Intervention

2. Objectives of the workshop • To learn how to tailor the prevention and early intervention services to meet the client's needs base on their unique cultural backgrounds • To learn how prevention and early intervention services are delivered in a culturally relevant way • To learn how to increase clients' knowledge about community resources to increase the access to behavioral health services. • To learn about cultural adaptation of an EBP for African American, Latino and Vietnamese culture

3. Positive Solutions Program Criteria

4. Positive Solutions Program Framework (adopted from SBIRT) Outreach Screening & Assessment Refer to other treatments Brief Intervention Refer to other resources & Discharge

5. Outreach • Education • Stigma Reduction • Increase mental health awareness

6. Screening & Assessment • Determine appropriate services • Assessing clients’ needs

7. Brief Interventions • Empower • Skills building • Reduce depressive symptoms and risks • Develop action plan • Increase social support • Reduce feeling of isolation • Increase or maintain self-sufficiency • Increase ability to access to appropriate care • Reduce early mortality in seniors • Reduce Suicidal Ideation

8. Discharge • Continuum of Care • Discharge plan

9. Positive Solutions Program Framework • Education • Stigma Reduction • Increase mental health awareness Outreach • Determine appropriate services • Assessing clients’ needs Screening & Assessment • Empower • Skills building • Reduce depressive symptoms and risks • Develop action plan • Increase social support • Reduce feeling of isolation • Increase or maintain self-sufficiency • Increase ability to access to appropriate care • Reduce early mortality in seniors • Reduce Suicidal Ideation Brief Intervention Refer to other treatments Refer to other resources & Discharge • Continuum of Care • Discharge plan

11. Program to Encourage Active and Rewarding LiveS (PEARLS)

12. PEARLS Key Components

13. Exercise • Pair up with someone next to you • Share cultural beliefs and how it makes you who you are • Ask questions that you think will help you to understand one’s cultural background and how it shapes him/her to who he/she is • Strengths • Values • Views/perspectives in Mental Health • 15 minutes

14. Did you ask Questions regarding to… • Family • Work • Social Support Network • Religious and Spirituality Beliefs ………etc.

15. Culture is …… • Values, beliefs, and practices • Dynamic and ever-changing • Culture resides in the social world as much as it resides within individuals • There is considerable heterogeneity within ethnic and racial groups • We often …… • Fail to recognize the dynamic nature of culture • Assume that people are passive recipients of culture

16. African American • Family • Extended family • Older generation is more conservative • Institutionalization of elders has historically been avoided, with sons and daughters taking on the family caretaker role • Religion • Christianity • Maintaining good health is often correlated with good religious practice.

17. African American (Continued) • Distrust in the health care system due to the experiences of past generations of African Americans with health care. (e.g. Tuskegee experiments on African Americans) • History of enslavement and discrimination

18. Implementation – African American • Connection with family • Utilizing strong religion belief as a strength • “partnership with religious belief” • Build the trust • warm hand off • Explaining services in details and how things work • Framing accepting help is a strength & opportunity to allow others to serve • When providing resources/access to other care • Tapping into what client’s desires are

19. African American Client Case Presentation • Baseline PHQ9: 15 • Final PHQ9: 2

20. Hispanic • Family and child rearing are important • Hierarchical Relationships: • The elderly, parents, and males are given special authority. • Expressions of anger toward family members in authority are discouraged Potocky-Tripod, Miriam (2002) Best Practices for Social Work with Refugees & Immigrants Sue & Sue (2003) Counseling the Culturally Diverse – Theory and Practice

21. Hispanic (Continued) • Men are expected to be strong, dominant, and the provider for the family (machismo). • Women are expected to be nurturant, submissive to the male, and self-sacrificing (Marianismo). • Religious Belief: • Sacrifice in this world is helpful to salvation • Being charitable to others is a virtue • One should endure wrongs done against him/her. Sue & Sue (2003) Counseling the Culturally Diverse – Theory and Practice

22. Implementation – Hispanic • Using bilingual staff • Using culture references / metaphors • Accepting food as a way of building rapport • Utilizing religion as a strength

23. Hispanic Client Case Presentation • Baseline PHQ9: 11 • Final PHQ9: 6

24. Vietnamese • Vietnamese Immigrants • First Wave • 1975 • “the fall of Saigon” ended the Vietnam War • About 125,000 highly educated professionals • Four refugee center in the U.S. • Second Wave • 1977 – 1980s • New Communist government’s implementation of economic, political, and agricultural policies based on Communist ideology • About 2 millions “boat people” • 531,310 were accepted in the U.S. between 1981 and 2000 • Third Wave • Children fathered by American soldiers and their Vietnamese mothers The History of Vietnamese Immigration: http://www.ailf.org/awards/benefit2005/vietnamese_essay.shtml

25. Vietnamese(Continue) • World View • Great respect for the emperor, the teacher, and the father • Religion • Approximately 90% Buddhist; 5-10% Catholic • Acceptance of one’s fate • Endure suffering: Suffering and perseverance are seen as virtues • Karma Molina HealthCare: Vietnamese Culture: Influences and Implications for Health Care Sue & Sue (2003) Counseling the Culturally Diverse – Theory and Practice

26. Vietnamese(Continue) • Family • Health Decision is greatly influenced by the family • Collectivistic Orientation: Asian families tend to have a family and group orientation instead of promoting individual needs and personal identity • “Loss of face” of a family member behaves inappropriately • Language • 83% of Vietnamese American households, Vietnamese is the dominant language. Molina HealthCare: Vietnamese Culture: Influences and Implications for Health Care Sue & Sue (2003) Counseling the Culturally Diverse – Theory and Practice

27. Vietnamese(Continue) • Social Structure • Polite & Delicate • Frank honesty & speaking up are often considered rude • Hierarchical Relationships: Males and elderly usually occupy higher statuses • Importance of harmony in relationships • Strong emotional displays are considered to be signs of immaturity or a lack of control. • Food and hospitality are related Molina HealthCare: Vietnamese Culture: Influences and Implications for Health Care Sue & Sue (2003) Counseling the Culturally Diverse – Theory and Practice

28. Vietnamese(Continue) • Health Beliefs • The concept of mental illness does not exist in Vietnamese culture. • Spiritual remedies • Illness is considered to be an imbalance of “vital forces”, which can be influenced by changing in diet. Molina HealthCare: Vietnamese Culture: Influences and Implications for Health Care Sue & Sue (2003) Counseling the Culturally Diverse – Theory and Practice

29. Implementation – Vietnamese • Using Visual aid • Creating tangible goals • Providing verbal instructions • Food offering • Prompting • Clinicians take initiation to facilitate the action plan • Allowing the client to talk about their accomplishments and use them as strengths for problem solving

30. Vietnamese Client Case Presentation • Baseline PHQ9: 12 • Final PHQ9: 8

31. Demographic Data • African American: 4% • Hispanic: 12% • Vietnamese: 20.02%

32. Positive Solutions Program OutcomeFY 11-12 (07/01/11 to 06/30/12) • Measurement • PHQ 9 • Satisfaction Survey • Fiscal Year 11-12 • Central Region: 463 • North County: 382 Total of 845 seniors were served. 179 were provided with brief interventions

33. PSP Outcome (Continued) • PHQ9 (Depression Measurement)

34. PSP Outcome(Continued) • Satisfaction Survey • Overall, I am satisfied with the services I received here. Strongly Agree & Agree Neither Agree nor Disagree Disagree

35. Key Take Home Points • Transference • Countertransference • Assumptions • Respect

36. Contact Information Pei-Chen Emily Wu, Psy.D. (619) 238-1783 Ext.300 ewu@upacsd.com Evelyn Parada, MSW (619) 238-1783 Ext.303 eparada@upacsd.com UPAC Website: www.upacsd.com Thank you!!