Building Relationships with Campus Partners: A Necessity to Providing Culturally Competent

Services

Mona Ghosheh, PhD

Objective and Outline• Discuss reasons for underutilization of traditional services

by students of color.

• Describe concept of organizational cultural competence and its significance to outreach for racial and ethnic minorities.

• Identify indicators of OCC in counseling center setting.

• Utilize methods to increasing the visibility of counseling

center OCC by developing relationships campus partners.

Problem: Underutilization • A general problem across the US

– Especially for racial and ethnic minorities

• Concerning because:– minority groups tend to experience similar community rates of

mental disorders – Utilize services at lower rates– And receive poorer quality of care

• Results in higher proportion of unmet mental health needs in minority communities

U.S. Department of Health and Human Services, 2001

Racial & Ethnic Minorities

• Race– the category to which others assign individuals on the basis of

physical characteristics and the generalizations and stereotypes made as a result (APA, 2003)

• Ethnicity– Shared practices, customs, and heritages of particular groups

(Phinney, 1996)

• + Minority – Individuals or groups other than those of the dominant

European or Caucasian-American cultural group

Racial and Ethnic Minority• Experience of minority groups (Vacc, DeVaney, & Brendal,

2003):– Experience a pattern of disadvantage or inequality – Share a sense of self-consciousness or physiological awareness

that is associated with their group membership and its status– Experience the identification with and internalization of

stereotypes

• Further differentiation (USDHHS, 2001):– Underrepresentation and underutilization experienced by these

populations across a variety of sectors such as education and employment

– Disproportion exists despite increasing population sizes

Problem: Underutilization

University campuses are not exempt from this disparity

Possible Reasons

• Help-seeking attitudes and behaviors

• Cultural mistrust– “mental health services as a microcosm of the larger White

society” (Whaley, 2001)

• Stigma – Confounded for minority groups: “double stigma” (Gray, 2005)

• Worldview– Collectivistic worldview = help seeking within family & cultural

group – Definition of problem= external vs. internal

Reason: Incongruence

• Traditional Psychotherapy – Individualism, autonomy, and individual

responsibility vs. collectivism, group harmony, and societal responsibility (Sue & Sue, 1999)

– Treatments originally developed for European Americans (Hall, 2001; Vera & Speight, 2007)

• Accessibility – “the probability of use, given the need of services”

(USDHHS, 2001)

The Disparity

Increasing enrollment rates of minority students + Underutilization + lower accessibility = culturally relevant

treatments

Recommendation: Outreach• Proactive, Preventative, and Strength/empowerment based

– Reduces stigma (directly/indirectly)

• Consistent with collectivistic worldview– Outreach tends to be group-oriented – Accessible: occurring in the context of students’ communities – Allows for the social experience necessary for this developmental age

• Reduces cultural mistrust– Outreach providers become weaved into the fabric of acceptable sources of

help– Consistent with the educational context of the university

• Flexible formats – Allow for modification based on groups’ needs & norms

Unanswered Questions

• Are UCCs providing outreach services specific to racial and ethnic minorities? If so…– How much outreach? – What types of outreach? – What specific groups are being served?

• If not, could there be factors influencing whether a UCC provides outreach services specific to the these populations?

History of UCCs and Outreach• 1940s-50s: beginning of UCCs• 1960s-70s: beginning of outreach

– Increase of student population– Greater emphasis on prevention– Transition from individual/vocational to a overall group/overall well-being

focus

• 1980s: greater enrollment of diverse students– Increased variety of presenting concerns– Budget cuts– Restricted resources– Increased use of outreach

• Today: – Great majority of UCCs are providing outreach– 92% of 302 schools surveyed provide outreach (Gallagher, 2009)

Possible Factors• Staff size

– Larger size = more outreach • (Whitely et al., 1987)• Professional staff, pre-professionals, and support staff

• Accreditation– Accreditation = more outreach

• (Whitely et al., 1987) • IACS, APA, other accreditation

• Institution size– # of enrolled students

• Student diversity

Other Factors?• The factors identified influence the availability of

outreach in general

• What about specific to racial and ethnic minorities? – Outreach services for racial and ethnic minorities classify as

“culturally adapted mental health interventions” (Griner & Smith, 2006)

– This means that they would require some cultural competency: knowledge, awareness, and skills of cultural factors (Sue, et. al., 1992).

BUT cultural competency of individual clinicians is limited

Cultural Competency

Organizational Cultural Competency

• “the capacity of an organization to support culturally appropriate responsive care” (Geron, 2002)

• Cross et al.’s (1989) model of mental health organizational cultural competency – “a set of congruent attitudes, practices, policies,

and structures that come together in a system or agency, or among professionals that enable effective interactions in cross-cultural situations”

OCC Development

• Occurring across attitudes, policies, and practices • Occurring across the practitioner, agency, and

system level (Sue, 2001).

How Do You Measure OCC?

• Greiger’s (1996) Student Affairs Multicultural Organizational Development Checklist

• Reynolds and Pope’s (2003) Template for a Multicultural Counseling Center

OCC Markers– Mission Statement

• Explicitly use the term “diversity” and/or mulitculturalism• States that these concepts are significant to all UCC funtions• How often incorporated in publications/flyers/advertisements, etc

– Staff diversity • Percentage

– Hiring and retention practices • How often? • How often are bi-mulit-lingual staff recruited?• Retention of racial and ethnic minority staff (3yrs)

– Diversity committee • Frequency of meetings?• Client population in committee?

– Translation• How often?

– Physical environment • How often?

– Cultural competency training • How often? • For whom?

Research Questions• Are UCCs providing outreach services specific to racial and ethnic

minorities? If so…– How much outreach? – What types of outreach? – What specific groups are being served?

• Is there a relationship between the availability of outreach services to racial and ethnic minorities and institutional factors?

• How about a relationship to OCC?

• If a relationship exists between OCC and outreach, does it more significantly explain the variance in outreach to minorities as compared to institutional factors?

Participants • University Counseling Centers (151/641)-26.8%

response rate– Completed by center directors– Location

• 41 different states

– Institution type• 55% private, 45 % public

– Institution size• 187-52,000; mean 10,000 (SD-11,000)

– Student diversity • Ranged from 2% to 100%

– Staff size:• Total: 1 to 73• Senior staff professionals: 1 to 39• Pre-professionals: 1 to 50• Support staff: 1 to 8

Results: Research Q1

Results: Research Q2

Results: Research Q3

Results: Research Q4 • As expected: the group of institutional variables resulted in a

significant, strong, and positive, predictive relationship of outreach availability

• (R=.651, p<.001)

• Significant Predictors:– Staff size t(141) = 2.85, p < .01 – APA and IACS accreditation t(141) = 2.15, p < .05– Other accreditation t(141) = 2.06, p < .05– Student diversity t(141) = 3.33, p < .01

• Insignificant Predictors:– Institution type– Institution size

Results: Research Q4 • OCC explained additional 6.3% of variability in the

availability of outreach services for racial and ethnic minorities (R=.697, p<.001)

• Significant Predictors:– Staff size t(141) = 2.85, p < .01 – APA and IACS accreditation t(141) = 2.15, p < .05– Other accreditation t(141) = 2.06, p < .05– Student diversity t(141) = 3.33, p < .01– CCCC measure t(141) = 4.15, p < .001

What Does this Mean?• Consistent with OCC theory and this study provides initial

support for the relationship between services to minorities and the OCC of a mental health agency.

• Institutional factors helped explain importance of :– resources – supply & demand– professional standards

• BUT an additional component is vital when servicing racial and ethnic minorities:

The multicultural competence of the organization

Implications • UCCCs not providing outreach to racial and ethnic minorities (40%).

– Self-assessment tools to improve OCC of counseling center

– The study and CCCC instrument may provide support for markers and their expression on an OCC continuum

• Diversity mission statement• Diverse staff • Hiring and retention practices• Diversity committee• Translation • Physical environment• Cultural competency training

– OCC is developmental process; so having a high availability of outreach does not eliminate the need for continuous improvement of OCC

– Approaching limited resources from the angle of OCC might help substantiate argument for need of resources

Anecdotal Experiences, Discussion, and Questions

• What about relationships with campus partners (overall community)?– How effective is OCC if the campus is not aware of or

perceiving of the UCC as a competent entity?

• How do we communicate, develop, and demonstrate cultural competency on our campuses and with campus partners? – Maybe partners need to be involved in developing services for

racial and ethnic minority students? – Maybe UCCs need to be more vocal and involved in diversity

affairs on campus? • Take a clear stance on SJ issues

• Cross, T. L., Bazron, B. J., Dennis, K. W., & Isaacs, M. R. (1989). Towards a culturally competent system of care: Volume 1. Monograph produced by the CASSP Technical Assistance Centre, Georgetown University Child Development Centre

• Gallagher, R. P. (2009). National survey of counseling center directors 2009. Washington, D.C. International Association of Counseling Services. Available at http://www.iacsinc.org/

• Gary, F. A. (2005). Stigma: Barrier to mental health care among ethnic minorities. Issues in Mental Health Nursing, 26, 979-999. • Geron, S. M. (2002). Cultural competency: How is it measured? Does it make a difference? Generations, 26, 39-45. • Griner, D., & Smith, T. B. (2006). Culturally adapted mental health intervention: A metaanalytic review. Psychotherapy: Theory, Research,

Practice, Training, 43, 531- 548. • Hall, G. C. N. (2001). Psychotherapy research with ethnic minorities: Empirical, ethical, and conceptual issues. Journal of Consulting and

Clinical Psychology, 69, 502- 510. • Hernandez, M., & Nesman, T. (2006). Conceptual model for accessibility of mental health services to culturally/linguistically diverse

populations. Presented during the grantee communities workshop entitled Operationalizing cultural competence for implementation in systems of care at the 19th Annual Research Conference: A System of Care for Children’s Mental Health: Expanding the Research Base, Tampa, Florida.

• Reynolds, A. L., & Pope, R. L. (2003). Multicultural competence in counseling centers. In D. B. Pope-Davis, R. L Toporek, & W. M. Lui (Eds.) Handbook of Multicultural Competencies in Counseling and Psychology. (pp. 365-382). Thousand Oaks, CA: Sage.

• Sue, D. W. (2001). Multidimensional facets of cultural competence. The Counseling Psychologist, 29, 790-821. • Sue, D. W., Arredondo, P., & McDavis, R. J. (1992). Multicultural counseling competencies and standards: A call to the profession.

Journal of Counseling and Development, 70, 477-486. • Sue, D. W., & Sue, D. (1999). Counseling the culturally different (3rd ed.). New York: John Wiley. • U.S. Department of Health and Human Services [USDHHS]. (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.

• Vacc, N. A., DeVaney, S. B., & Brendal, J. M. (2003). Counseling multicultural and diverse populations: Strategies for practitioners (4th ed.). New York: Brunner Routledge.

• Vera, E. M, Buhin, L., Montgomery, G., & Shin, R. (2005). Enhancing therapeutic interventions with people of color: Integrating outreach, advocacy, and prevention. In R. T. Carter (Ed.), Handbook of Racial-Cultural Psychology and Counseling: Training and Practice (pp. 477-491). Hoboken, N.J.: John Wiley.

• Vera, E. M., & Speight, S. L. (2007). Advocacy, outreach, and prevention: Integrating social action roles in professional training. In E. Aldarondo (Ed.), Advancing social justice through clinical practice (pp. 373-389). New York: Routledge.

• Whaley, A. L. (2001). Cultural mistrust and mental health services for African Americans: A review and meta-analysis. The Counseling Psychologist, 29, 513- 531.

• Whiteley, S. M., Mahaffey, P. J., & Geer, C. A. (1987). The campus counseling center: A profile of staffing patterns and services. Journal of College Student Personnel, 28, 71-81.