1. Practice Modification to Embrace Multiculturalism: Balancing the Individual and the Evidence Samantha Pelican Monson, PsyD, Clinical Psychologist KC Lomonaco, PsyD, Clinical Psychologist Collaborative Family Healthcare Association 16 th Annual Conference October 16-18, 2014 Washington, DC U.S.A. Session #G3c Friday, October 17, 2014

2. We have not had any relevant financial relationships during the past 12 months. Faculty Disclosure

3. #1 Describe the impact of multicultural patient presentations on current integrated primary care models. #2 Identify viable solutions to preserve efficiency and population-based care while embracing patient diversity. #3 Cite relevant evidence to support practice innovation to incorporate multiculturalism. Learning Objectives At the conclusion of this session, the participant will be able to:

4. Bibliography / References 1.Manoleas, P. (2008). Integrated primary care and behavioral health services for Latinos: A blueprint and research agenda. Social Work in Health Care, 47, 438-454. 2.Kleinman, A., Eisenberg, L., & Good, B. (1978). Culture, illness, and care: Clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine, 88, 251-258. 3.Bass, J.K., Annan, J., Murray, S.M., Kaysen, D., Griffiths, S., Cetinoglu, T., … Bolton, P.A. (2013). Controlled trial of psychotherapy for Congolese survivors of sexual violence. The New England Journal of Medicine, 368, 2182-2191. 4.Crosby, S.S. Primary care management of non-English-speaking refugees who have experienced trauma. The Journal of the American Medical Association, 310, 519-528.

5. Bibliography / References 5.Bridges, A.J., Andrews, A.R., Villalobos, et.al. (2014). Does integrated behavioral health care reduce mental health disparities for Latinos? Initial findings. Journal of Latina/o Psychology, 2, 37-53. 6.Kirmayer, L.J., Narasiah, L., Munoz, M., Rashid, M., Ryder, A.G., Guzder, J., … Pottie, K. (2011). Common mental health problems in immigrants and refugees: General approach in primary care. The Canadian Medical Association Journal, 183, E959-E967. 7.Sue, D.W., & Sue, D. (2007). Counseling the culturally diverse: Theory and practice (5 th ed.). New York, NY: John Wiley & Sons, Inc. 8.Hays, P. (2013). Connecting across cultures: The helpers toolkit. Thousand Oaks, CA: Sage Publications, Inc.

6.  A learning assessment is required for CE credit.  Questions and answers will be conducted throughout this presentation. Learning Assessment

7.  Linguistic, cultural, acculturation, and age diversity FQHC with Refugee Patients

8.  Linguistic, cultural, acculturation, and age diversity FQHC with Refugee Patients

9.  Linguistic, cultural, acculturation, and age diversity FQHC with Refugee Patients

10.  Linguistic, cultural, acculturation, and age diversity FQHC with Refugee Patients

11.  Linguistic, cultural, acculturation, and age diversity—messy! FQHC with Refugee Patients

12.  Some staff and providers are bilingual in English/Spanish, and some are not  Our organization is retrofitted to provide care to Latino patients, not built explicitly for this purpose FQHC with Latino Patients

13.  Issues that arise in clinic:  Beliefs about heath and illness differ from culture to culture  Acculturation – Families that straddle two (or more) different worlds  Disparities in care increase stressors, health issues FQHC with Latino Patients

14. How do we look outside our Western frame of reference to offer culturally sensitive care while maintaining model fidelity? 1

15.  What do you think caused the problem?  What kind of treatment do you think you should receive?  What are the most important results you hope to get from treatment?  Acknowledge the differences in the room Is there a place for these questions in your model of integrated primary care? Clinical Pearl #1: Add culture-based questions to standard practice. 2

16.  Validated modifications of evidence-based treatments often:  Bring patients together in groups  Utilize a trusted community leader  Host at a non-clinical site Is your model of integrated primary care flexible enough to incorporate alternative modalities? Clinical Pearl #2: De-individualize assessments and interventions. 3

17.  Micro—within the care team:  Promote cultural competence through education  Mutual feedback among colleagues about stereotyping or prejudice  Macro—outside the care team:  Encourage flexibility of policies (e.g., inclusion of non-Western approaches) to align with multicultural patient populations Is there “space” for this in your model of integrated primary care? Clinical Pearl #3: Advocate for social justice to decrease biases in care. 4,5

18.  Prevalence of common mental health problems is lower immediately after migration and increases over time  Patients may not be prepared for the racism and discrimination they will face Does your model of integrated primary care accommodate this? Clinical Pearl #4: Acculturation may bring new or increased symptoms. 1,6

19.  How do ethical principles adapt to be culturally responsive?  Dual relationships/conflict of interest  Touch  Self disclosure How have you changed/challenged your ethical practice to work in a culturally sensitive manner within your model of integrated primary care? Clinical Pearl #5: When ethics are unclear, consult! 7

20. Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you! Session Evaluation