Hold On, It's Not Over

A Blog about Children's Mental Health in Massachusetts

Getting to “culturally comfortable”

When programs strive to be culturally competent, the result should be that families are “culturally comfortable.” Most parents and youth can tell you whether it is easy and comfortable for them to be connected to and involved with a program. Feeling culturally comfortable helps families decide how they view a program, a worker or a service.

I first encountered the term “culturally comfortable” in the guide, Working with Families of Children in the Juvenile Justice and Corrections Systems. As Trina Osher and Barbara Huff note, some families may require a boost to become involved with their child’s services or program. They list some key strategies to provide that boost and providing culturally comfortable settings is a priority.

The term “culturally comfortable” has been cropping up in health and education settings for a number of years now. Many urban health centers have changed how they practice, finding new ways to share health information and deliver care. Some ask patients how they think a condition should be treated before offering their own recommendations. One pediatric practice in Virginia explored creating a “culturally comfortble” medical home. Some preschool educators have also been strong proponents of ensuring that their classrooms are culturally comfortable. Beverly Gulley and Nillofur Zobairi write that educators need to “know and understand the family’s cultural orientation to make a child feel comfortable and secure, and provide a sense of continuity.”

While cultural competence is a core value for both wraparound and creating a systems of care in children’s mental health, the notion of “culturally comfortable” settings or practice has yet to show up. I think it’s about time. Cultural competence is a rich, complex yet formal standard and most parents and youth would be hard pressed to say how close a setting or practice is to getting there. Yet they would be able to judge whether it was culturally comfortable. Feeling comfortable or uncomfortable is something we are all familiar with. Culturally comfortable settings, dialogues and practice make families feel welcome and respected.

Increasing cultural competence in the delivery of mental health services for children can help reduce disparities and increase access. But these results are frequently unknown to families, especially if the changes are gradual. Changing a setting, practice or dialogue so that it becomes more “culturally comfortable” is something that families can notice and determine for themselves. Determining whether that change is happening can empower parents and youth. Early in the family movement, parents often judged whether materials, programs or approaches were family friendly and later family dirven. So, too, can parents and youth figure out if materials or programs today are culturally comfortable.

Building an approach that is “culturally comfortable” starts with communication and awareness. Find out what the family values, who its members are, what the concerns and goals for its children may be. Ask families what matters to them. Find out what is private in a family and what is easily shared. Culture influences parenting and family behaviors, including meals, sleep, how to dress, interaction with both adults and other children, health care, how to show affection and respect, ways of celebrating and what occasions to celebrate. Many different family configurations are out there. Celebrate moms, dads, grandparents, extended family members, siblings, and others important to children. Model respect and show that customs, languages, cultures, and physical attributes different from your own are important and to be honored. Diversity in our society should be valued and enjoyed, not considered a threat to the values or lifestyle of any group.

Catherine Stakeman, Maine NASW, said that “becoming culturally comfortable between all cultures is a journey, and there is always room for improvement.” To make it happen, it must be everyone’s responsibility.

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January 16, 2011 Posted by | children's mental health | , , , , , , , , , , , , , , , , , | 3 Comments

Family engagement is a two way street

Change can be hard. On the other hand, if we don’t change, we don’t grow. What I observe growing here in Massachusetts, sometimes slowly and other times in leaps and bounds, is an understanding that partnering with parents is pivotal to the success of children and youth with mental health needs.

Seems like a no-brainer, right? Children live in families and their families know them better than anyone else. They invest in them emotionally, financially and give them truckloads of time and energy. They worry about them, cheer their successes and feel their failures. In the words of Jane D. Hull, “At the end of the day, the most overwhelming key to a child’s success is the positive involvement of parents.”

While involvement is a start, it anchors the beginning of a continuum. At one end is family involvement which builds to family engagement which in turn leads to a full partnership with families. The kind of relationship where you share information, communicate regularly, hold each other accountable and respect each other’s expertise. If all we aspire to is involvement, then a school, a program or a clinician can ask a parent in for a meeting and check off the box labeled “involvement.” After all, that parent showed up, listened and maybe signed off on some forms. The criteria for involvement has been met.

Family involvement is often unilateral. A program might develop family-program activities without parent input in order to help the program achieve its own goals. A school summons parents to hear their information, not to contribute their own information. A clinical team has recommendations for parents on how to improve family involvement. In each of these instances, the program assumes they are the experts about the child and the parents are the learners. There is a single approach for all families.

Family engagement, on the other hand, is a two-way street. A program works together with families to develop activities that promote goals that they share. They always seek family input when developing plans to increase family involvement. A school listens to and includes the input of families. A clinical team believes that each person, including the parent and youth, has expertise and information to share. All of them assume that parents care about their child’s progress and well being when planning interventions and treatments. They respect the differences of each family and understand that one strategy is unlikely to work for everyone.

Family engagement and its impact on the success of children and youth with mental health needs is also being studied and reported on. In Occupational Therapy in Mental Health, Claudia Fette and Rebecca Estes define family engagement this way: “Family engagement is an active and ongoing process that facilitates opportunities for all family members to meaningfully participate and contribute in all decision making for their children, and in meaningful involvement with specific programs and with each other.” Note that the definition uses the term “ongoing process” and includes the involvement of families not only with their child’s program, but with other families as well.

The bar is set higher to get to family engagement. It means more work than giving parents information and having them sign forms. But the odds for successful outcomes for children and youth go way up too. Change is hard, but it is rewarding. As we are moving in that direction, always remember that the future comes one day at a time.

July 7, 2010 Posted by | children's mental health | , , , , , , | 4 Comments