Multicultural Training with System, Community, and

One Community’s Experience
Implementing the California Brief
Multicultural Competence Scale
Multicultural Training with System,
Community, and Family Partners
Building Culturally Competent and Diverse Organizations and
Systems of Care Conference, 9/26/2013, Lansing, MI
Saginaw Max System of Care
Lula Haynes, Parent Support Partner (ACMH)
Yalonda Freeman, Secretary of the Empowered to Reach and Teach Families Team
Wardene Talley, Director
Dalia Smith, Cultural and Linguistics Competency Coordinator
Today’s Objectives
 Describe 4 indicators within a system that
would identify a need for Multicultural
Identify 8 key partners to assist with
developing a community wide cultural
competence training plan.
List 6 biases that impact clinical practice.
Richard Dana, Portland State University
Glen Gamst, University of La Verne
Aghop Der-Karabetian, University of La Verne
With Contributions From:
Leticia Arellano-Morales, University of La Verne
Marya Endriga, California State University, Sacramento
Robbin Huff-Musgrove, Patton State Hospital
Gloria Morrow, Private Practice
With Generous Support From:
California Department of Mental Health
Office of Multicultural Services
Eli Lilly Foundation
California Mental Health Directors Association
California Institute of Mental Health
University of La Verne, La Verne, CA
Conocimiento Activity
(knowledge through sharing)
 Select a partner and ask the following questions over
the next five minutes. Be prepared to introduce your
partner based on the information shared after seeking
your partners permission:
 What is you name? Is there a story to your name?
Are you named after someone?
 Where do you work and how does the work you do
fit with your personal philosophy of life?
 Name one cultural fact about yourself that we
would not be able to tell by looking at you.
The Danger of the Single Story
Chimamanda Ngozi Adichie
 Community Demographics:
Saginaw County pop. 198,353
Saginaw City pop. 50,790
2nd highest rate of poverty in MI:
Saginaw County 18.6%
Saginaw City 36.9%
 3rd Most Violent City in Nation
Saginaw County:
Hispanic/Latino/a 19.4%
Black/African American 7.9%
Saginaw City:
Hispanic/Latino/a 46.1%
Black/African American 14.3%
2013 FBI ranking (per capita)
 2013 Statistics:
Saginaw County – 25 confirmed homicides as of 9/13/13
Saginaw City - 23
 Milton Hall
Saginaw is a traumatized community!
(U.S. Census QuickFacts, 2010 and 2012)
Milton Hall
Another Story
Collaborative Decision Making Process
 Convened Saginaw Max Evaluation Advisory Team (January 2011)
Made up of multiple system, community and family partners.
 Completed a Strengths and Needs Assessment (Spring 2011)
Identified a need for multicultural training for system partners.
 Created a Logic Model (June 2011)
Approved by the Coordinating Council (Saginaw Max’s decision making body).
 Took advantage of a training opportunity offered by the Technical
Assistance Partnership (August 2011)
CBMCS Multicultural Training
 Began work on Saginaw Max Strategic Plan (September 2011)
The strategic plan outlines the action steps to achieve Saginaw Max objectives
including cultural and linguistic competency.
Data Informed
Saginaw County Youth Data
Why We Need a System of Care
Between May 2004 and January 2013, 5,739 MAYSI-2 mental health screens were completed by
juveniles under the jurisdiction of the Saginaw County Circuit Court - Family Division. In 1,974 of
these screens (34.4%), youth admitted that they have personally witnessed someone get severely
injured or killed.
Juveniles complete a MAYSI-2 screen every time they are adjudicated or every three months during a
lengthy sentence. As of January 2013, MAYSI-2 screens were completed by 3,004 individual youth of
which 40.3% (1,212) admitted at least once that they personally witnessed someone get severely
injured or killed.
Of the 5,739 MAYSI-2 screens completed by juveniles under the jurisdiction of the Saginaw County
Circuit Court - Family Division between May 2004 and January 2013, 4,213 screens (73.4%) indicated
that the youth appears to have a mental health concern in one or more areas.
In 2008, Saginaw County Community Mental Health Authority and the Saginaw Department of Human
Services collaborated to determine the extent of mental health needs of youth in foster care. Based
on assessments conducted with a representative sample of all Saginaw County youth in foster care at
the time, results revealed that as many as sixty-nine percent (68.75%) of children in foster care in
Saginaw County had moderate to critical mental health needs.
Between January 2004 and June 2009, 41% of youth who were originally involved with the court due to
neglect and abuse were eventually charged with crimes
Saginaw County System of Care
 Saginaw Max has provided CBMCS Multicultural Training to 77
individuals in Saginaw County (2013)
Saginaw Public Health Department (April 2013)
Saginaw Department of Human Services (June 2013)
Disproportionate Minority Contact Initiative (September 2013)
 Disproportionate Minority Contact (DMC) Initiative
There is disproportionality in our juvenile court and child welfare systems.
Gearing up to implement a countywide multicultural training program.
 Health and Social Equity Advisory Group sponsored by Project LAUNCH
Ties into our PHD Community Health Improvement Plan (CHIP).
Priority 1 of 3 - Infant Mortality:
Saginaw County (3.7)
Saginaw City (4.4)
 Saginaw Max System of Care (SAMHSA funded site)
Cultural and Linguistic Competency (CLC) Team
 Alignment Saginaw
California Brief Multicultural Competence
Scale (CBMCS) Development
 The CBMCS was developed as a response to the Surgeon General’s
Report and Supplement Report on mental health.
 Goal: Develop a Multicultural Competence Scale easily
administered and scored.
 1999 Scale Developed
 2000 lengthy Questionnaire 5-Scale (137 questions)
 2000-01 #1,244 CA practitioners participated
 2001 Client/Family members reviewed
 2001-02 Training manual – Richard Dana, PhD
 2002-03 From manual to training.
Development of CBMCS Training
 Summer 2004, 40 MH cultural competence experts
participate in review of CBMCS Training, representing
14 counties and state DMH
 CBMCS 4 Modules were revised
 Summer 2005/06 15 experts revised the CBMCS training
from MH provider input
 Fall 2006 Pilot of CBMCS begins
 The CBMCS represents a true partnership between State
and Local Mental Health and University evidence based
research and development.
Selected CBMCS Pilot Sites
 5 Counties selected from original 14 counties that
participated in early review
 Kern County – training completed Oct. 2006
 San Bernardino
 Sacramento
 Santa Clara
 San Francisco
 All pilots to be completed by February 2007
CBMCS Training for Trainers and
Staff Training Nationwide
 Between 2006 – present:
Yreka County, CA
Imperial County, CA
Ventura County, CA
Forth Worth, Texas
Alameda County, CA
Solano County, CA (CIMH)
Pittsburg, PA
Hartford, CT
Ontario, CA (hosted by Dr.
Morrow where trainers came
from all across the United
Plainview, Texas
Merced County, CA (CIMH)
Stanislaus County, CA (CIMH)
Commissioned by Ken
Martinez to provide CBMCS
training in Denver, CO and
Atlanta, GA
Egyptian Health
Department, IL
Reviewed Existing Literature
 The development group identified 5 self-report cultural
competence instruments:
La Fromboise, et al.
 MAKSS D’Andrea, et al.
 MCAS-B Ponterotto, et al.
Sodowsky, et al.
 Most of these instruments were 45-60 items long and developed on
university student populations.
The California Brief Multicultural
Competence Scale and
Multicultural Training Program
 This scale consists of 4 subscales:
 Multicultural Knowledge
 Awareness of Cultural Barriers
 Sensitivity and Responsiveness to Consumers
 Sociocultural Diversities
 An 8-hour training program is available for each subscale.
 32 multicultural training CEUs offered
 The CBMCS is a 21-item self-assessment of cultural competence.
The CBMCS can be used by an agency to
identify the training needs of the agency staff.
The unique aspect of this scale is that it has its
own Training Program that “flows” from the
Agencies can use the CBMCS scale to target
which staff should receive a particular module.
Agencies could run staff through all 4 modules.
The CBMCS scale could be used as a pre-post
measure of training effectiveness, along with
client outcome or satisfaction measures.
Current Status
The CBMCS instrument is being used across the
country in over 20 sites.
The CBMCS Training Program and the Train the
Trainer Program have gone national.
Setting the Tone
 It’s very important that participants commit to the entire length of
the training.
 This is an intensive multicultural training.
 Consistency is needed to create a “safe” learning environment.
 Ground Rules and a “Parking Lot” are important tools.
 Review of the Transitional Stages of Change is important.
 Denial (of differences), defense (against differences),
minimization (bury differences under cultural similarities),
acceptance (of cultural differences), adaptation (of behavior and
thinking to that difference)
U.S. Surgeon General’s Report
 1999 U.S. Surgeon General developed a report on
mental health, Mental Health: A Report of the
Surgeon General.
 2001 U.S. Surgeon General created a supplemental
report to the one on mental health focusing on the
four major minority groups, A Supplement to Mental
Health: A Report of the Surgeon General.
African American
Latino American
Asian American
Native American Indian
Challenges to the Mental Health
System: U.S. Surgeon General’s Report
 U.S. mental health system maybe ill prepared to meet
the mental health needs of racial/ethnic groups due to
deficiencies in level of cultural competence among
service providers of all types (e.g. psychiatrists,
therapists, case managers).
 Unique cultural differences exist among racial/ethnic
groups with regard to coping styles, utilization of
services, help-seeking attitudes and behaviors, and the
use of family and community as resources.
(U.S. Department of Health and Human Services, 2001)
Another Story
Mental Health Disparities:
African Americans
 May be at higher risk of mental disorders than the White
population due to socioeconomic differences (Reiger,
Narrow, Rae, Manderscheid, Locke & Goodwin, 1993a).
 Tend to be underrepresented in outpatient treatment, yet
overrepresented (by twice as many) in inpatient treatment
(Snowden & Cheung, 1990; Snowden, 2001).
 More likely to use emergency room for mental health
problems than the White population (Snowden, 2001).
 Higher rates of misdiagnosis as compared to the White
population and consequently, mistakes lead to the use of
inappropriate medications.
 Disproportionately represented in homeless, incarcerated,
and child welfare populations, and as victims of trauma – all
risk factors for mental illness.
(Surgeon General, 2001)
Mental Health Disparities:
American Indian/Alaskan Native
 Few epidemiological surveys of mental health and
mental disorders.
 Depression is a significant problem for many
American Indians/Alaskan Natives.
 Higher risk of alcohol abuse and dependence.
 High rates of suicide (50% higher than national
 U.S. veterans have higher prevalence rates of PTSD
than the White population.
(Surgeon General, 2001)
Mental Health Disparities:
Asian Americans/Pacific Islanders
Model Minority Myth and other subgroup
Under utilization due to stigma and shame.
Delay seeking services until problems
become very serious.
Access barriers due to lack of language
proficiency of service providers.
(Surgeon General, 2001)
Mental Health Disparities:
Hispanic/Latino/a Americans
 Prevalence rates of mental disorders in Mexican-born Mexican
Americans similar to general population, however,
 Prevalence rates for depression and phobias are higher in U.S.
born Mexican Americans relative to European Americans.
 Limited data is available for some Latino/a groups (e.g. Cuban,
Puerto Rican, Guatemalan, etc.).
 Latino/a immigrants have very limited access to mental health
 Latino/a youth are at high risk for poor mental health
 Historical and sociocultural factors suggest Latinos/as are in
great need of mental health services.
 As many as 40% of Hispanic Americans report limited English
language proficiency.
(Surgeon General, 2001)
Mental Health Disparities:
U.S. Surgeon General Report
 Minority communities have disproportionately high burden of
disability from untreated or inadequately treated mental
health problems.
 Additionally, we must also understand that other groups have
experienced oppression throughout the United States and
the world. Some of these groups are immigrants from
Europe, people who are Jewish, people who are Middle
Eastern, women, the LGBTQ community, the disabled, and
those who live in poverty.
(Surgeon General, 2001)
Training Goals
 To be introduced to a historical overview of the CBMCS;
 To gain a better understanding of what cultural
competence/responsiveness means, and its relevance;
 A review of the mental health disparities and historical oppression
among children, youth, and parents who are members of the four
major ethnic/racial groups;
 To become aware of empirical knowledge concerning the mental
health status of ethnic/racial groups;
Training Goals (cont.)
 To recognize deficiencies in related research.
To critique traditional theories and consider new ones.
 To examine how cultural responsiveness is reflected in our system
of care;
 To explore the cultural responsiveness needs system-wide;
Improve sensitivity to experiences and worldview of consumers.
Improve sensitivity and responsiveness to the effects of racism, oppression,
and discrimination on consumers mental health services.
Improve sensitivity to the impact of provider and consumer social values and
communication styles.
Improve sensitivity to the importance of consumer advocacy.
Service delivery implications (ex. bad practices = malpractice).
Another Story
Training Goals (cont.)
 To discuss the barriers to cultural responsiveness;
Self-awareness of personal values, beliefs, and ethnic/racial/cultural
Self-awareness of privilege, bias, and stereotypes.
 To discuss the benefits of increasing cultural responsiveness using
the CBMCS curriculum.
To extend the parameters of diversity beyond the limits of ethnic/racial
To explore the interactions of multiple human identity components
Another Story
Creates change in the heart
(not just the “head”).
Lessons Learned
 8 hours per day may be too much.
 The best format for training may be 4 consecutive days or 2-2
consecutive days over 2 weeks.
 Participants may be better able to engage with training content when
the audience is a mixture of system, community, family and youth
 Participants are better able to integrate culturally responsive behavior
when they do not see it as something that has to be added onto an
already heavy workload.
 Some materials had to be modified and/or deleted.
 The addition of more experiential opportunities with more process
time given is necessary.
 Trainers must be sufficiently skilled in facilitating this type of training.
 Individuals inevitable find the training experience as emotionally
charged. However, many of the same individuals say the curriculum
has changed their lives in positive ways, both personally and
Preparation for Countywide
Multicultural Training:
 It takes patience to build urgency and gain buy in at all levels.
 The community needs to have dialogue around 3 questions:
Is cultural and linguistic competency important?
If it is important, are we a culturally and linguistically competent community?
If we aren’t there yet, what do we need to do to be a culturally and linguistically
competent community?
 The community needs to be engaged in a data informed,
collaborative, decision making process.
 Families, youth, community and system partners need to agree on
an objective and strategy that everyone can get behind.
 Key leaders need to be engaged (champions).
Planning for Countywide
Multicultural Training:
 Secure funding resources.
Blended and braided funding.
Build into Strategic Plans.
Leverage Federal and/or State monies dedicated to CLC issues (DMC, violence, trauma,
health disparities, etc.).
 Use an application (and interview) process to identify potential
Publically acknowledge those who have been chosen to be trainers.
 Collect and use local vignettes, data, and current events to make
the training meaningful to participants.
 Trainings may benefit from being off site.
 Engage faith based community (needs a different approach).
Implementing Countywide
Multicultural Training:
 Commitment from system leadership to address barriers.
Ex. Encourage and allow staff to attend a 4-day (32 hour) training.
 Trainers must be sufficiently skilled in facilitating this type of
Quality coaching, consultation, and mentoring is essential.
 Measure, track, and monitor outcomes.
 Think ahead for sustainability.
Build a core group of trainers from multiple disciplines (teams of 2).
Integrate into core training requirements.
Coaching, Consulting and Mentoring
Dr. Gloria Morrow is one of the nation's leading clinical psychologists, who
devoted her early career to teaching students in undergraduate and graduate
psychology programs. As an academician, clinician and author, her teaching,
counseling and books have helped thousands of people find true inner healing.
As an academician and researcher, Dr. Gloria has presented the results of her
research at professional conferences all over the world, including the University
of Cape Town, in Cape Town, South Africa.
As a top-rated professional with profound insight in her trade, she has been
featured in a host of newspapers, (such as the award-winning Inland Valley News,
an African American weekly). In addition to her published work in scholarly
journals and books, she has been cited in critically acclaimed national
publications such as “Psychology Today,” “Jet,” “Heart and Soul,” “Essence,”
“Woman’s Day,” and “Black Enterprise.”
Dr. Gloria is a Master Trainer for the CBMCS (California Brief Multicultural
Competency Scale) Training Program, and she helped to develop the training
curriculum. This program focuses on the four major ethnic groups: African
American, Asian/Pacific Islanders, Hispanic/Latino/Mexican American, and
American Indian/Native American. However, includes other diverse communities,
such as the Muslim and Middle Eastern cultures in her training. In addition, she
has facilitated several workshops and seminars focusing on cultural competency
issues, such as the role of Spirituality in recovery. She was commissioned to
develop a Spirituality Toolkit for the California Institute of Mental Health.
Dr. Gloria holds an earned PhD in Clinical Psychology from Fielding Graduate
University, Santa Barbara, CA; a Master of Science degree in Marriage and Family
Therapy from Azusa Pacific University, Azusa, CA; and a Bachelors of Science
degree in Psychology from the University of La Verne, La Verne, CA.
In Closing
Contact Information
Yalonda Freeman
Secretary (2013-2014)
Saginaw Max Empowered to Reach and Teach Families (ERTFT) Team
[email protected]
Lula Haynes
Parent Support Partner
Association for Children’s Mental Health (ACMH)
[email protected]
Contact Information
 Wardene Talley
Project Director
[email protected]
 Keva Clark
Lead Family Representative
[email protected]
 Dalia Smith
Cultural and Linguistics
Competency Coordinator
[email protected]
 Kelley Blanck
Technical Assistance Coordinator
[email protected]
 Willie Hillman
Youth Involvement Coordinator
[email protected]
 Melissa Lee
Social Marketing Coordinator
[email protected]
 Ashley Wilcox
Administrative Coordinator
[email protected]

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