Using Cultural Mindfulness & Intersectionality to Inform ... · 3. Over-reliance on diagnosis/nosology, negating human and cultural experiences 4. Disregard for the social and moral

Using Cultural Mindfulness

& Intersectionality to

Inform Ethical and

Universally Designed

Services Nicole J. Pashka, MS, CRC, CPRP, LCPC

6th Annual HIV Outreach & HEI

Case Management Conference

Austin, TX

August 13-16, 2017

Acknowledgments

The Center for Mental Health Services, Substance Abuse & Mental Health Services Administration

Thresholds, Chicago, IL

UIC Center on Mental Health Services Research & Policy

The views and ideas expressed herein do not reflect the policy or position of any Federal Agency or private corporation.

Pashka (2017) Using Cultural Mindfulness & Intersectionality to Inform Ethical and Universally Designed Services

Learning Objectives

Explain the importance of one’s self awareness about ethno-history, attitudes and values about diversity;

Discuss the importance of recognizing discrimination and privilege within their service delivery program;

Learn concrete steps to remove or overcome institutional barriers to diversity, inclusion & intersectionality in their own institutions;

Understand and apply the learning from current pressing and relevant issues of stigma and discrimination that are in the national and international media;

Identify ways to use mindfulness as medium to promote universally designed services and conversations.



Healthy People 2020: Population Disparities

…Health disparities adversely affect groups of people who have

systematically experienced greater obstacles to health based on their

racial or ethnic group; religion; socioeconomic status; gender; age;

mental health; cognitive, sensory, or physical disability; sexual

orientation or gender identity; geographic location; or other

characteristics historically linked to discrimination or exclusion.”

U.S. Department of Health and Human Services. The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for

2020. Phase I report: Recommendations for the framework and format of Healthy People 2020. Section IV. Advisory Committee findings and

recommendations. Available at: http://www.healthypeople.gov/hp2020/advisory/PhaseI/sec4.htm#_Toc211942917. Accessed 1/6/10.


Social Determinants of Health

Availability of resources to meet daily needs, such

as educational and job opportunities, living wages

Public safety & Exposure to crime, violence

Social disorder, such as the presence of trash

Lack of access to mass media, emerging

technologies, such as the Internet or cell phones

Quality schools

Transportation options

Residential segregation

Access to healthful foods, food deserts



HIV Care Continuum


Mental Health & Culture:

7 Sins of Traditional Psychiatry

1. Underestimate the evolutionary nature of mental health

experiences and how this is symbolized in culture

2. Reductionist, medicinal approaches to treatment that ignore

cultural components and traditional practices

3. Over-reliance on diagnosis/nosology, negating human and

cultural experiences

4. Disregard for the social and moral influences and commitment

to aid in wellness of underserved and marginalized


5. Devaluing of cultural, religious, and spiritual meaning

6. Undue reliance on an atmosphere for pharmaceutical

treatment

7. Endorsing forms of psychotherapy that bypass important

cultural components – founded more in economics and

objectivity.

Mental Health & Culture:

7 Sins of Traditional Psychiatry

Fabrega, H. (2000). Culture, spirituality and psychiatry. Current Opinion in Psychiatry, 13, 525-530.



Do services & treatment follow theory?

Empirical Example from the WIHS

National Multisite Study: HIV+ women

Even when MEDICALLY INDICATED by CD4 and vRNA

indicators, those still NOT prescribed HAART were:

African American

Less then High School Education

Lower SES (poverty or 200% below poverty)

Past/Current Treatment for Depression

Cook et al. (2004)


What can we do? Make the invisible visible!

Learn from constant vigilance of your own biases and fears.

Engage in experiential reality: interact with people who are different from you in social identities

Don’t be defensive.

Be open to discussing your own attitudes and biases and how they might have hurt others or may have revealed biases on your part

Be an ally – Stand personally against all forms of bias and discrimination

(D. W. Sue, 2010; Weaver, B., 2014)


What is mindfulness?

Definitions commonly

emphasize being…

Attentive

Non-judgmental

Intentional


Core Actions of the Culturally

Mindful

Is aware

Plugs in

Affirms

Self-evaluates


But HOW do I do this? Notice the behaviors of others.

Be open to novel, unfamiliar behavior without evaluation.

Fully use your senses to take in details, nuances and

stay attuned to them.

Allow yourself to be curious, especially with regard to the

cultural context of the other.

Try to connect with the other inside their framework - is

there some aspect of their culture that also exists within

you.

Be humble

This seems complicated…


Step IN Activity!



Intersectionality

Intersectionality is a concept often used in critical theories to describe the ways in which oppressive institutions (racism, sexism, homophobia, transphobia, ableism, xenophobia, classism, etc.) are interconnected and cannot be examined separately from one another.

The concept first came from legal scholar Kimberlé Crenshaw in 1989 and is largely used in critical theories, especially Feminist theory, when discussing systematic oppression.

…system of

oppression that

reflects the

"intersection" of

multiple forms of

discrimination


Micro-aggressions

…brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative slights and insults…

Derald Wing Sue, PhD

Chester Pierce, MD

"Microaggressions hold their power because they are invisible, and therefore they don't allow us to see that our actions and attitudes may be discriminatory. My

hope is to make the invisible visible”

Sue, 2009


How did you decide which one of you would

wear the dress?


Every U.S. State Perfectly Captured By One Photograph www.historylocker.com Pashka (2017) Using Cultural Mindfulness & Intersectionality to Inform Ethical and Universally Designed Services

Every U.S. State Perfectly Captured By One Photograph www.historylocker.com Pashka (2017) Using Cultural Mindfulness & Intersectionality to Inform Ethical and Universally Designed Services

I am female computer tech. Our

departments gets phone calls; the caller

has to select the computer techs. A

couple of times a week, I answer the

phone and am immediately asked to be

transferred to the tech department. My

male coworkers never have to assure

callers that yes, indeed, they are techs.

Just me. Better than the one guy who

said he didn’t want me to work on his

computer; he wanted a REAL (male)

computer tech.

I am an Asian woman. It’s

Halloween today and I walked

by a white woman dressed as a

geisha, with her face painted

and hair darkened. We made

and held eye contact for a few

seconds, and I think she looked

embarrassed. It made me feel

me angrier somehow. If it was so

easy for her to recognize that

this was an embarrassing thing

to do, why did she still do it?

When a doctor dismissed my

abdominal pain as period

pain. Turns out I had a severe

kidney infection.

Can I touch your hair?

“Hold-on Grandpa, let me

show you how that works.”

A coworker complained to my

supervisor after I referred to myself as a

dyke (my language of choice for my

orientation) in the lunch room. I was told

that this is unprofessional language by

my supervisor.



30+ Examples of Class Privilege

http://itspronouncedmetrosexual.com








What is Motivational

Interviewing? Conversation about change

Collaborative

Evocative

Person-Centered

Choice

Ambivalence: noun \am-ˈbi-və-lən(t)s\

simultaneous and contradictory attitudes or

feelings (as attraction and repulsion) toward an

object, person, or action…


Where did it come

from?

First cited by William R. Miller

in 1983

But first, in 1973, during a

graduate internship in

Milwaukee…―Working with

some of the most despised

and rejected members of

our society…‖

Substance Use, Mental

Health, Health Care, PLWHA


Motivational Interviewing (MI)

Over the past 25 years, MI has been evaluated in comparative effectiveness

research (CER) trials, systematic reviews,

and outcome studies published in

hundreds of peer-reviewed publications.

MI is included in several evidence-based

program registries and recognized as an

effective model for the treatment of

behavioral and addiction disorders.

Research supports its effectiveness with

results that are generalizable to different

populations, communities, and settings.


Brainiacs Suggest NREPP – over 1,500 publications world wide

A randomized, control group study (Martino et al., 2000) of people with co-occurring disorders admitted to a partial

hospital program found that participants who received a

single session of motivational interviewing as part of the

admission process were more likely to participate in

treatment and to stay in the program longer than those who

only received the standard preadmission interview.

In a review of treatments for people with co-occurring

disorders, Drake and colleagues (2004) found that

motivational interviewing and related techniques were

employed principally as short-term approaches. In general,

the studies found improvements in treatment engagement,

substance use, symptoms, and other measures


Brainiacs Suggest MI was more effective than the comparison intervention in

38 of the 72 studies.

MI treatment effects can emerge quickly—within a few

weeks.

The strongest evidence was found for substance abuse, with

effects persisting over time when MI is used as an additive to another treatment.

Significant effect sizes were also found for HIV risk, alcohol

use, diet and exercise programs, and treatment adherence.

Provider type did not predict effectiveness in MI.

MI increases treatment adherence and treatment retention.

Adamian et al., 2004


Empathy An empathetic style:

Communicates respect for and

acceptance of clients and their feelings

Encourages a nonjudgmental,

collaborative relationship

Allows you to be a supportive and knowledgeable consultant

Sincerely compliments rather than

denigrates

Listens rather than tells

Gently persuades, with the understanding

that the decision to change is the client’s

Provides support throughout the recovery

process


Nobody Likes Change. Not Even Babies.

―You would think . . . ‖

You would think that hangovers, damaged relationships, an auto

crash, and memory blackouts

would be enough to convince a

person to stop drinking…

Even with all that modern

medicine has to tell us regarding

medication adherence (diabetes, HIV/AIDS)…

Sometimes things change - we

make changes in our lives - but - WHY?


Mount Ambivalence Ambivalence is natural

When people get stuck in

ambivalence; avalanche is

the problem

Like LA (NYC; Jersey; Florida)

- it is nice but you wouldn't

want to live there


Factors for Providers & Organizations • Burnout affects many counselors

• Get adequate support from

peers, supervisors

• Maintain healthy boundaries

• Healthy lifestyle

• Exercise, Nutrition, Rest and

Relaxation

• Work with Clients with a variety

of issues, not just abuse

• On-going training



Contact Us! Nicole J. Pashka, MS, CRC, CPRP, LCPC

Assistant Director, Research

[email protected]


mailto:[email protected]

Documents

Using Cultural Mindfulness & Intersectionality to Inform ... · 3. Over-reliance on diagnosis/nosology, negating human and cultural experiences 4. Disregard for the social and moral