CRDP API SPW Strategies Working with API Older Adults

Transcription

1 CRDP API SPW Strategies Working with API Older Adults Dixie Galapon, Ph.D. Union of Pan Asian Communities Director, Mental Health Services CRDP API Statewide Conference February 1, 2012 (Los Angeles, CA)

2 UPAC Info Established in 1974 Mission of UPAC: To provide for social service needs of San Diego s Asian, Pacific Islander and other ethnic groups

3 Union of Pan Asian Communities (UPAC) PROGRAMS Fiscal Year Mental Health Services Addiction Treatment & Recovery Services Health Promotion & Disease Prevention Children & Youth Development Economic Development Senior Services Community Development Adult Mental Health Counseling & Treatment Center Parolees Peer Support East Wind Clubhouse BPSR LIHP Latino Supported employment Family Education Positive Solutions EMASS: Elder Multicultural Access & Support Services HEART Program (OVW) HOPE Connection Verizon/HEART MOSAIC: Multicultural Outreach & Safety Advocates for Improved Communities (OVW) Child & Adolescent Mental Health MediCal Early Periodic Screening Detection & Treatment Rainbow Central Region Schools North County Schools Clinic- Central Region Non MediCal Rainbow Central Region Schools North County Schools Clinic- Central Region ACE: Alliance for Community Empowerment Alcohol & Drug Adult Treatment, Recovery & Education Pan Asian Treatment & Recovery Mental Health Counselors Alcohol & Drug Adolescent Treatment Adolescent Intervention & Recovery Problem Gambling Prevention, Technical Assistance & Training Cancer Awareness and Research CEED: Center of Excellence to Eliminate Disparities Breast education, patient screening, treatment and social support. WINCART: Weaving an Islander Network for Cancer Awareness, Research and Training Leadership Development Youth Volunteer Community Service Youth Financial Literacy After School Primetime- Academic, Social & Cultural Enrichment Mentorship API High Risk Mentorship Program Employment Family Self-Sufficiency (FSS) Central Region Entrepreneurship Multicultural Economic Development Family Day Care Technical Assistance & Training Small Business Enhancement Micro entrepreneurs PRIME (SBA) Ethnic Community Self- Help Program (ORR) Housing Foreclosure Prevention and Home Retention HUD NOFA Education Fist Home Buyer HUD NOFA Education on Mortgage Modification and Mortgage Scam Assistance Telecommunication Telecommunication Education Assistance in Multiple-languages Energy Outreach & Education, Dispute Resolution and Assistance Nutrition Pan Asian Senior Nutrition-Congregate Meal Sites Outreach & Education Chinese Outreach Project Translation & Interpretation Culturally Competent Material Development Cultural Competency Training & Consultation 2012 Union of Pan Asian Communities. All Rights Reserved.

4 Who are our API Older Adults? Major groups: Filipino, Vietnamese, Chinese, Korean Refugees and immigrants Many isolated because of language, culture, financial situation, illness, etc

5 Two Older Adult Programs EMASS (Elder Multicultural Access and Support Services) Funded by MHSA Prevention & Early Intervention Funds; 2009 Positive Solutions Funded by MHSA Prevention & Early Intervention Funds; 2009

6 Program Criteria 60 & older African American, Filipinos, Latinos, Somali Refugees North, South, Central San Diego Counties EMASS 60 & older Any ethnic background North and Central San Diego Counties POSITIVE SOLUTIONS

7 Who have we served - APIs EMASS Positive Solutions Filipino Older Adults Korean Older Adults Vietnamese Older Adults Chinese Older Adults

8 UPAC-EMASS PROGRAM FRAMEWORK MISSION Promote Health & Wellness VISION Healthy Aging and Reduce Stigma of Mental Health Community Outreach Strategies through Promotora Model Individual Interventions Translation Advocacy Peer education & support Referrals to basic social services Depression Screening Transportation Assistance Group Interventions Healthier Living Self-Management Workshop Good Mental Health Seminar Aging Well Seminar Weekly Social and Recreational Support Group GOALS Access to care Reduce disparity to Care Maintain selfsufficiency Reduce ER visits & Specialty care Increase knowledge of healthcare system Prevent hospitalization and institutionalization Unserved & Underserved Communities

9 Social & Recreational Day Program Spectrum

10 EMASS Goals and Outcomes 315 Filipinos served (35%) out of targeted 800 older adults (Filipino, Latino, African American, African refugee). Overall, 906 older adults served in last fiscal year.

11 OUTREACH OUTCOMES FY JUL AU G SEP OCT NO V DE JA C FE N B MA R APR MAY JU N TOTAL AFRICAN AM FILIPINOS LATINOS SOMALI TOTAL

12 MHSA OUTCOMES OA-02 Increase timely access to care 369 OA-03 Reduce disparities in care 466 OA-04 OA-05 OA-06 Increase and maintain individual self-sufficiency Increase knowledge of healthcare system Reduce utilization of specialty and emergency room services

13 Challenges and Strategies CHALLENGE: API Adults usually deny problems with mental health, and can be manifested in physical health => STRATEGY: Adapted Healthier Living workshops on chronic disease self management workshop where emotional problems and depression were one of the topics and introduce the self-management tools.

14 CHALLENGE: Cultural barriers of hiding their own feelings and showing what is acceptable to society => STRATEGY: Use Filipino Soap Operas as a way to generate discussion

15 What is different about EMASS? Use of promotoras model for multi-ethnic communities Good Mental Health is ageless curriculum Healthier Living curriculum Laughter Yoga Congregate Meals for Seniors Filipino/Latino menu Mobile outreach to senior apartments, ADHCs and other places where seniors live

16 What have we learned? It is important to build rapport and begin where they are ready to address MH issues We provide educational opportunities. Use stressful situation instead of mental health issues Filipinos tend to be more responsive to prevention rather than going to treatment

17 Suicide Most of our participants have a passive death wish. We address it by tapping their faith and beliefs, and provide opportunities to explore meaningful activities.

18 Positive Solutions Developed as a collaborative partnership model utilizing gatekeepers Meal delivery drivers Firefighters Ethnic community leaders Use of evidence-based treatment model PEARLS (Program to Enhance Active and Rewarding Lives for Seniors)

19 Positive Solutions Program Framework Refer to other treatments Outreach Screening & Assessment Brief Intervention Refer to other resources & Discharge Education Stigma Reduction Increase mental health awareness Determine appropriate services Assessing clients needs 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 Continuum of Care Discharge plan

20 PEARLS Key Components Problem Goal Problem Solving Treatment Pleasant Activity Planning Physical Activity Planning Solutions Pros and Cons to each solution Action plan Confidence Level Social Activity Planning

21 Implementation Innovative ideas Working with illiterate population Integrating Motivational Interviewing in PEARLS Working closely with gatekeepers/ promotoras (training gatekeepers, joint visits, etc.) Culturally appropriate implementation Addressing basic needs Establishing relationships Addressing physical health issues Incorporating Case Management Working with caregivers

22 PSP Outcome (Continued) PHQ % 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% 50% Cognitive Behavioral Therapy 77.78% PSP PEARLS Sx Reduction (Note) Risk and Symptoms Reduction for PSP PEARLS is 88.03%

23 Challenges and Strategies CHALLENGE: Difficult to motivate homebound/socially isolated seniors => STRATEGY: Engage caregivers CHALLENGE: Multiple medical issues = > STRATEGY: Provide case management services first

24 Challenges and Strategies, cont d CHALLENGE: Cultural barriers of hiding their own feelings and showing what is acceptable to society => STRATEGY: Do home visit first to engage, then follow up multiple times. Encourage alternative healing practices. CHALLENGE: Some participants are illiterate when reading psycho-ed materials =>STRATEGY: Use visual aids or pictures to convey an idea

25 Outreach Vietnamese Federation of San Diego Senior apartments where APIs tend to live Partnership with these organizations Korean seniors living in Escondido area Meals-on-Wheels, and other meal delivery drivers Librarians Pharmacists Fire Department Chinese and Korean churches

26 Lessons Learned Address each individual need differently, based on their cultural background and individual differences Work closely with family members and friends who are supportive of the recovery Use words that are not stigmatizing at first Start to address the medical issues and other obstacles first

27 Successes 87% of participants have maintained or increased their self-sufficiency 91% of participants feel more comfortable in seeking help

28 Suicide Passive and active suicidal ideation Past attempts Staff continually assess for SI, and also activate social/physical/pleasant activities as soon as possible; Also establish social support network, and find the meaning of life.

29 One last item Another success Integration between EMASS Program and Positive Solutions

30 Integration of Promotoras from both programs and PEARLS clinical intervention

31 Thank you! Dixie Galapon, Ph.D. Union of Pan Asian Communities (UPAC) Director, Mental Health Services (619)