EBP and Multicultural Rehabilitation

Transcription

1 EBP and Multicultural Rehabilitation Julie Smart, Ph.D., CRC, LVRC, NCC, LPC, ABDA, CCFC Professor Rehabilitation Counseling Program Utah State University Overview v Recent research findings v Diagnosis v Informed Choice v Use of foreign language translators v Ethics 1

2 Recent Research Findings v Most VR research on racial/ethnic minorities has been outcome research v Almost all of this research is of questionable value Recent Research Findings (cont.) v Most research has used dichotomous independent variables (African Americans and European Americans) v Only a handful of studies have included Native Americans, Pacific Islanders, and Hispanics 2

3 Recent Research Findings (cont.) v Resources at time of entry v Acceptance for services rate v Types of services provided v Reasons for unsuccessful closure v Wages and benefits earned at closure Research Results v Most pointed toward inferior services for minorities v Greatest contribution: Raised awareness that probably resulted in Section 21 of the Rehab Act 3

4 After 25 years, there have been few, if any, EBPs suggested. LeBlanc, S., & Smart, J.F. (2007). Outcome discrepancies among racially/ethnically diverse consumers of vocational rehabilitation services: Summary and critique of the literature. Journal of Applied Rehabilitation Counseling, 38, Solution v Use EBPs from general counseling research v Problem: General counseling never includes disabilities 4

5 Diagnosis v To most of us, our culture/religion/nationality is one of our most important possessions. v Furthermore, because most of us are in the majority, we don t have to think of our culture/religion/ nationality very often. Diagnosis v For some disabilities, especially severe, physical disabilities, there is high cross cultural uniformity in defining symptoms and rendered diagnoses. v However, severity of disability is also culturally defined. 5

6 Diagnosis Generally, the following types of disabilities are more culturally defined and diagnosed: v Insidious onset disabilities v Hidden disabilities v Fluctuating disabilities v Cognitive and behavioral disabilities v Psychiatric disabilities Diagnosis v Mild disabilities, of any type, are very difficult to diagnose, especially when the individual is from another culture. v Subtle, small changes are difficult to diagnose when the clinician and client are from different cultures. 6

7 Diagnosis v Screening devices will be easier to use than diagnostic devices. v Differential diagnoses are more difficult when the individual is from another culture. Differential diagnoses look for fine, small differences. Diagnosis v If diagnosis does not include culture, it is doubtful if the treatment plan will include culture. v Level of frustration is culturally determined. (Remember, some diagnoses use level of frustration as a diagnostic criterion.) 7

8 Diagnosis It is easier to be yourself in your first language (regardless of how well you speak your second language). An individual s first language is the language of emotion. Smart, D.W., & Smart, J.F. (2007). DSM-IV-TR and culturally sensitive diagnosis: Some observations for counselors. Journal of Counseling and Development, 75, Barriers to Informed Choice v A history of discrimination v A mindset of limited choice v Perceived threat of public disclosure v Lack of appropriate assertiveness v Customs of compliance with perceived experts/authorities v The value of self-sacrifice 8

9 Recommendations for Culturally Sensitive Informed Choice v Do not deny the power differential. The larger it is, the more careful the provider should be. v Teach decision-making skills v Look for motivators behind actions v Clearly define (and re-define) roles and responsibilities. More Recommendations for Culturally Sensitive Informed Choice v Remember, compensating and coping strategies are very culturally determined v Ask questions about client s perceptions v After every session, ask: What was most helpful to you today? 9

10 Recommendations for Culturally Sensitive Informed Choice v Describe each phase of treatment, including the rationale. v Remember, some cultures do not equate competence with formal education v Some cultures avoid blame and shame and highly value honor and dignity. Avoid highly confrontive therapies. Smart, J.F., & Smart, D.W. (1997). Culturally sensitive informed choice in rehabilitation counseling. Journal of Applied Rehabilitation Counseling, 28,

11 The Use of Foreign Language Translators v Avoid using family and friends as translators v The translator should avoid correcting or interpreting what the client said. The translator should state exactly what has been said. v The relationship is between the client and the counselor. The Use of Foreign Language Translators v Translators should be trained in ethical issues, such as confidentiality v Translators should be trained in the VR process v Translators should be supervised 11

12 Smart, J.F., & Smart, D. W. (1995). The use of translators/interpreters in rehabilitation. The Journal of Rehabilitation, 61, Ethics v Most professional codes of ethics emphasize cultural competence v All codes are designed to protect (and represent) the weaker party v Designed to contain the power of the professional v The counselor is held to higher standards than the client. 12

13 Boundaries v Professional boundaries separate therapeutic behavior from any behavior which WELL-INTENTIONED or not, could decrease the benefit of care. The Purposes of Boundaries 1. Keep the counselor-client relationship safe, predictable, and consistent. 2. Keep the counselor/client relationship based on the client s needs. 13

14 Problem v The client and the counselor may perceive boundaries differently. Solution v Define roles and responsibilities clearly. 14