From the Margins to the Core : A Case Example of a Cultural Community Leading Innovative Practice in Ontario

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1 Mutta,B., Nelson, G., & Ochocka, J. (2009). From the Margins to the Core: A case example of a cultural community leading innovative practice in Ontario. Presented at the Making Gains Conference, Toronto, ON, November From the Margins to the Core : A Case Example of a Cultural Community Leading Innovative Practice in Ontario Presented by: Geoff Nelson, Wilfrid Laurier University Baldev Mutta, Punjabi CHS Joanna Ochocka, Centre for Community Based Research Making Gains in Mental Health and Addictions Toronto, November 4, 2009

2 Taking Culture Seriously In Community Mental Health Five-year ( ) research and community mobilization initiative bringing together university and community partners in Toronto and Waterloo Region To explore, develop, pilot and evaluate mental health services and supports that are culturally effective for the multicultural Canada Modeling reciprocal collaboration among communities, academics, service providers and policymakers

3 Three Phases Phase I: Exploring Ways of Thinking about Mental Health Problems and Practice with Cultural Communities ( ) Product: A framework and strategies for culturally effective mental practice. Phase II: Developing Culturally Effective Practice (2007) Product: Funding proposals for demonstration projects Phase III: Evaluating Demonstration Projects ( ) Product: Evaluation results and final conference Taking Culture Seriously in Community Mental Health -

4 Innovative Demonstration Projects Acknowledge the disconnections between the mental health system and Canada s cultural diversity Engage multi-disciplinary researchers, a range of practitioners and diverse cultural communities in reciprocal collaboration Consider both issues of power and culture Give priority to the voices of people from culturallinguistic communities

5 Utilization-focused, Participatory Evaluation Designed to be of use to: Punjabi CHS The Punjabi community in Brampton and Mississauga Other mental health practitioners Funders and policy-makers The research community Evaluation designed in close collaboration between CURA researchers and Punjabi CHS staff

6 A C T I V I T Y INPUTS: Director & Staff of PCHS; Case manager Services of a Registered Nurse; CW-LHIN Funds; TV program slot Food for Participants; Prenatal Support Support for women with mood disorders Punjabi Community Health Services Demonstration Project Logic Model A C T I V I T Y A C T I V I T Y Mental health promotion Van for home visits; Link with 4 South Asian Psychiatrists; Network with WHO & peel Public Health; CURA evaluation services PCHC office space A C Diversity training for MH providers T I V I T Y Outputs: Ten sessions of 4 hour each in partnership with Peel Public Health to educate families about pregnancy related issues; Referral to family physicians and MH workers PCHS has plans for a curriculum on mood disorders in partnership with Peel public health; A booklet in Punjabi, Hindi, & Urdu with basic info on mental health issues will be distributed to all South Asians in Brampton Weekly ½ hour telecast to raise awareness About mental health issues (going since four years); PCHS director and co. host shows with guest health care professionals on mental health topics PCHC conducts 4 full day seminars for service providers at CMHA, York Region, and Credit Valley MH organizations about working with South Asian clients; Family stops blaming the mother; More knowledge about medical, biological, and family dynamics impacting on pregnant women Wife-in laws-husband triad of conflict reduces and support increases; Mothers are linked to mental health system leading to less depression More knowledge about mental health issues and available services; Insight into the manner in which culture and family dynamics contributes to mental illness or health Practitioners acquire knowledge and skills about culturally sensitive practice More collaboration between MH system and cultural community orgs. Reciprocal capacity building

7 INPUTS (Resources) PCHS director, Staff, & Case Manager; CW-LHIN Funds; Food for Participants Community support; CURA Evaluation Services TREATMENT INPUTS: Van for home visits; Link with 4 South Asian Psychiatrists; Network with WHO & Peel Public Health; Space at PCHS Individual Counseling ACTIVITIES Family Education Output 1 1 on1 sessions for clients with depression anxiety, OCD, addictions Output 2 Case management Output 3 Home visits Output 4 Assessment & Referral Services Output 5 1/month mental health education Sessions for families Outcomes for Health System Linkage with mainstream mental health and addiction services Outcomes for individuals & families More knowledge; More support to loved ones; Fewer symptoms; Less family conflicts Outcomes for Communities Culturally & linguistically appropriate services to the South Asian Community

8 Evaluation Part 1: Mental Health Promotion: Community Connection & Complicated Issues Community Connection and Complicated Issues Community Connection is a half an hour program dedicated to raise awareness of the community Complicated Issues is a hour long talk show on television which also discusses health and social issues

9 Evaluation Part 1: Mental Health Promotion: Community Connection & Complicated Issues Online survey of South Asian community asking about: Perceived quality of programs Frequency of viewing or listening to the programs Knowledge of mental health issues and services Insight into how culture and family dynamics contribute to mental health issues Stigma We want to see if the people who watch or listen to the programs are more knowledgeable and have more insight into mental health issues and their community

10 Evaluation Part 2: Cultural Competency Training Brief description of cultural competency training workshops Trainings for Board, Staff and Volunteers on cultural competency Brief description of cultural competency consultations with organizations How would an organizations undertake a change? Three aspects to change: Change with no costs Change with minimal costs No change possible without money

11 Evaluation Part 2: Cultural Competency Training Paper and pencil survey given out to participants at the end of the training sessions asking about: Knowledge and skills in culturally sensitive mental health service practice Collaboration between mental health services and Punjabi CHS We want to see if the people who attend training are more knowledgeable and have more insight into mental health issues and culturally diverse communities

12 Evaluation Part 2: Cultural Competency Consultation Case study of a mental health organization that is working closely with Baldev to become more culturally competent in its services We want to document the major elements of change a mental health organization goes through when becoming more culturally competent

13 Evaluation Part 3: Prenatal Support Program Prenatal support program Punjabi women recruited for six sessions programs 6 evenings or 6 Saturdays 3 hours each Curriculum to discuss Medical aspects Cultural aspects

14 Evaluation Part 3: Prenatal Support Program Paper survey given out to participants at the beginning and at the end of the program asking about: Marital and family conflict, social rejection, family and social support Knowledge about cultural and mental health issues and pregnancy Satisfaction with the program Focus groups about program outcomes We want to see if the people who attend the program have more positive interactions within the family and social support, and are more knowledgeable about mental health after the program

15 Evaluation Part 4: Treatment Services Mental health case management Assessment Treatment plan Follow up Engage family Link with other resources Psychiatrist available Alcoholism and addictions treatment Assessment Treatment plan Follow up Engage family Link with other resources Case management and day program

16 Evaluation Part 4: Treatment Services Paper survey given out to those in treatment and, with their permission, one close family member, while on the waiting list, just before starting treatment, and after 3 months of being in treatment asking about: Social rejection, family and social support, symptom distress (for clients only), and family burden (for family members - family burden) Knowledge about cultural and mental health issues and use of and satisfaction with mental health services Focus groups about program outcomes Four case studies (2 with mental health issues, 2 with addictions), with input from those in treatment, close family members, and treatment staff We want to see if the people who attend services have more positive interactions within their family and social systems, have less symptom distress, and are more knowledgeable about mental health and mental health services

17 Conclusion It is important to develop and support culturally responsive mental health services These services should include not just treatment, but education and prevention It is important to rigorously evaluate the implementation and outcomes of culturally responsive services, so that we can better learn how to develop the most effective practices Mental health researchers need to work collaboratively with practitioners to develop useful evaluations of culturally responsive mental health services

18 Questions??? Comments??? Taking Culture Seriously in Community Mental Health -

19 ( Contact Information Centre for Community Based Research, 73 King Street West, Suite 300 Kitchener, ON, N2G 1A7 Phone: (519) Website: Punjabi Community Health Services Airport Road Brampton, On, L6R 0C7 Phone: (905) Website:

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