General data 10/10/2017. Healing the Liver: Effective and Culturally Responsive Strategies for treating Hmong Clients

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1 Healing the Liver: Effective and Culturally Responsive Strategies for treating Hmong Clients Alyssa Kaying Vang, PsyD, LP 13 th Annual Mental Health and Substance Use Recovery Conference October 24, 2017 Common problems in the Hmong community, anecdotally: Broken families Increase in excessive drinking Drug use (meth, cocaine, heroine) Homicide/suicide Suicide among our youth 3 rd leading cause of death for youth 2 nd leading cause of death for ages Continued domestic violence General data Mental health disorders are higher in Hmong- Americans compared to general US population (33.5% vs. 18.2%) 1

2 Common mental health problems in a clinical Hmong population: 80% depression Hmong had higher prevalence than other Asian groups (80.4% Hmong, 70.7% Cambodian, 59.2% Laotian, 54.1% Vietnamese) 11.8% Posttraumatic Stress Disorder 3.5% Anxiety/Somatoform 2.7% Psychoactive Substance use.8% Schizophrenia.4% Personality Disorder 11.8% Non-clinical Help-seeking patterns Hmong are the least likely to seek Western treatments compared to other ethnic groups Access barriers System Transportation Child care Language barriers Stigma Trust Lack of understanding of Western mental health services More apt to seek traditional healing practices Rapport and trust building 2

3 Rapport and trust building Basic and fundamental elements Humility, empathy, compassion Know the Hmong history Understand the Hmong social structure and cultural practices Rapport and trust building Specific approaches to help with motivation and compliance The expert stance Instilling hope Honest and direct approach about their situation Transparency about what therapy is Language and Semantics Group activity 3

4 What are feelings? Emotions and personalities are expressed through the liver - siab [pronounced shia ] Reflects and, at times, govern our emotions Play a significant role in overall health, mental stability, and personality I am someone who has liver and lungs Role play demonstration Mental illness As conceptualized by most Hmong: Nyuab siab Xiam Hlwb Vwm What it really is from a cultural interpretation: Tus mob puas siab puas ntsws What it is from a direct translation: tus mob rau txoj kev xav 4

5 Metaphors and idioms Stress, depression, sadness Nyuab siab, txhawj Ua lub neej tsaus ntuj nti Lubsiablubntswslwjtag Zoo li lub pob ntoo qhuav tag Worthlessness Tsis muaj nuj nqi Zoo li lub khob ntsoog tag es muab puab rov qab los tsis zoo lawm Zoo li daim ntaub dawb es tsuas ib qhov lawm. Metaphors and idioms Hopelessness Tag kev cia siab Zoo li tus dej ntws mus lawm xwb, tsis muaj ntws los lawm Zoo li khob dej nchuav lawm, muab daus tsis tau rov qab Zoo li tus neeg tuag tabsi tsis muaj ntxa Hope Muaj kev cia siab Mloog txoj sia rov qab loj zog tuaj lawm, txoj sia tuaj zog lawm Zoo li tauv huab kaj ib pliag ib pliag es lub hnub tawm tuaj ib pliag ib pliag lawm Qaim Qaim hli lawm, tsis tsaus ntuj ntais lawm Culturally-sensitive and culturally- responsive treatments 5

6 Psychoeducation Lime exercise Lion analogy Western: Connection is between the mind and the body The way I think affects the way I feel If I change the way I think about something, it might change how I feel about it Internal locus of control The behaviors and choices I engage in can influence the outcome Hmong: Connection is between the body and the soul, the mind and the soul Shut down the brain, don t think about it External locus of control The outcome is based on luck, fate, VISA, timing, other people, mandate Treatment approaches Every treatment I provide as a Western trained psychologist is complementary to other treatments they are already receiving. Adapted treatments Controlled breathing Psychoeducation about fight and flight (trauma) the physiology of stress and depression increased heart rate physical health complications over time Benefits of controlled breathing Smelling flower, blowing candles or wood Smelling bowl of pho and blowing to cool it down 6

7 Adapted treatments Visual Imagery Guided imagery in an open area Guided steps, suggesting sights, sounds, scent Repeating this multiple times References: Bliatout, B. (1991). Hmong Health Practitioners. Hmong Forum, 2, Cha, D. (2003). Hmong American Concepts of Health, Healing, and Conventional Medicine. Routledge. Culhane-Pera, K. et.al. (2003). Healing by Heart: Clinical and Ethical Case Stories of Hmong Families and Western Providers. Nashville: Vanderbilt University Press. Hmong Mental Health: An assessment of mental health needs and services for the Hmong community in Ramsey County, Wilder Foundation, 2010 Lee, S. (2013). Mental Health of Hmong Americans: A metasynthesis of Academic Journal Article Findings. Hmong Studies Journal, Vol. 14, 31 pages. Ly, Pajtshiab, Barriers to accessing mental health services by the Hmong, Master of Social Work Clinical Research Papers, St. Catherine University, Epidemiological Profile of Substance Use + Related Factors among Minnesota s Hmong Youth, April 2015, Developed by EpiMachine, LLC on behalf of the Minnesota State Epidemiological Outcomes Workgroup Alyssa K. Vang, PsyD, LP (651) akvpsych@gmail.com 7