4th international symposium on substance abuse treatment and special target groups 1 cultural...

4th International Symposium on Substance Abuse Treatment and Special Target Groups

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Cultural responsiveness in Cultural responsiveness in substance abuse treatmentsubstance abuse treatment

A qualitative study using professionals’ and A qualitative study using professionals’ and clients’perspectivesclients’perspectives

Stijn Vandevelde, Ma. Educ.Stijn Vandevelde, Ma. Educ.

Wouter Vanderplasschen, Ma. Educ.Wouter Vanderplasschen, Ma. Educ.

Eric Broekaert, Ph.D.Eric Broekaert, Ph.D.

Ghent University, Department of OrthopedagogicsGhent University, Department of Orthopedagogics


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Introduction (1)Introduction (1) Impact of substance abuse treatment facilities Impact of substance abuse treatment facilities

on ethnic & cultural minority groupson ethnic & cultural minority groups

Increasing number of ethnic minority clientsIncreasing number of ethnic minority clients Both researchers and treatment services Both researchers and treatment services

report on the importance of implementing report on the importance of implementing culturally responsive treatmentculturally responsive treatment


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Introduction (2)Introduction (2)

Treatment services insist on specificationTreatment services insist on specification

1.1. substance abuse treatment system not equally substance abuse treatment system not equally distributeddistributed2.2. differences amongst culturally diverse persons seeking differences amongst culturally diverse persons seeking helphelp

Researchers emphasize specification as wellResearchers emphasize specification as well(individuality / differences concerning alcohol & (individuality / differences concerning alcohol & substance abuse)substance abuse)


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AimsAims

To investigate if and to what degree substance To investigate if and to what degree substance abuse treatment services are currently working in abuse treatment services are currently working in a culturally responsive waya culturally responsive way

To gain information on bottlenecks of cultural To gain information on bottlenecks of cultural responsiveness and suggested improvementsresponsiveness and suggested improvements

To investigate professionals’ as well as clients’ To investigate professionals’ as well as clients’ perspectivesperspectives


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TerminologyTerminology

Cultural responsiveness is the « need for program Cultural responsiveness is the « need for program staff to play an active role in integrating the staff to play an active role in integrating the client’s cultural background into the treatment client’s cultural background into the treatment process » (Finn, 1996)process » (Finn, 1996)

Ethnicity vs. NationalityEthnicity vs. Nationality

No official numbers of ethnic minorities and No official numbers of ethnic minorities and substance abuse (exclusion criterion / under-substance abuse (exclusion criterion / under-estimation of number)estimation of number)


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Method (1)Method (1)

Methodological backgroundMethodological background

Qualitative researchQualitative research

Social interactionismSocial interactionism

Grounded theoryGrounded theory


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Method (2)Method (2) SampleSample

Clear-cut region of GhentClear-cut region of Ghent(225.000 inhabitants, 17.000 not Belgian nationality, 10.000 (225.000 inhabitants, 17.000 not Belgian nationality, 10.000 Turkey/Maghreb-countries)Turkey/Maghreb-countries)

Specialised treatment (diversity/comprehensiveness)Specialised treatment (diversity/comprehensiveness)

Four types Four types ( 1. outpatient psycho-social care & 2. medical-psycho-social ( 1. outpatient psycho-social care & 2. medical-psycho-social care / 3. residential short-/ 4. long-term)care / 3. residential short-/ 4. long-term)

At least 2 experts/1 client from one of these typesAt least 2 experts/1 client from one of these types


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ProcedureProcedureSemi-structured interview with professionals (n=11) Semi-structured interview with professionals (n=11)

and clients (n=11)and clients (n=11)

Three parallel focus groups for professionalsThree parallel focus groups for professionals

AnalysisAnalysisTranscribed interviews analysed by means of WinMAX98Transcribed interviews analysed by means of WinMAX98


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Grounded in the codification of the written material, Grounded in the codification of the written material, a scheme was constructed. What are the most a scheme was constructed. What are the most important pitfalls and pathways ?important pitfalls and pathways ?

Three levels :Three levels :

1. Perception1. Perception

2. Actual treatment2. Actual treatment

3. Policy3. Policy


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DIFFICULTIES

PATHWAYS

PERSPECTIVE

n

Percentages

n

Percentages

PROFESSIONALS

Perception / knowledge Actual treatment

Policy

Total number of expressions

11 329 30

370

2.9 88.9 8.1

100

26 273 3

302

8.6 90.3 0.9

100

CLIENTS

Perception / knowledge Actual treatment

Policy

Total number of expressions

7 191 38

236

2.9 80.9 16.1

100

3 375 35

413

0.7 90.7 8.5

100


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ResultsResults

General overviewGeneral overview

Most expressions focus on difficulties and Most expressions focus on difficulties and pathways concerning actual treatment, both pathways concerning actual treatment, both for clients as well as for professionalsfor clients as well as for professionals

Perception-issues and policy are less Perception-issues and policy are less commented oncommented on


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Results (2)Results (2) Difficulties according to professionalsDifficulties according to professionalsCommunication problems (26 %)Communication problems (26 %)

Problems involving the social network (25 %)Problems involving the social network (25 %)

Cultural background (25 %)Cultural background (25 %)

Accessibility and distribution of information (15 %)Accessibility and distribution of information (15 %)

Difficulties according to clientsDifficulties according to clientsInfluence of cultural and religious background (57 %), especially status Influence of cultural and religious background (57 %), especially status

and honourand honour

Accessibility and distribution of information (19 %)Accessibility and distribution of information (19 %)

Communication problems (12 %)Communication problems (12 %)

Lack of ethno-cultural peers (8 %)Lack of ethno-cultural peers (8 %)


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Results (3)Results (3)

Pathways according to professionalsPathways according to professionalsCommunication problems – interpreters, (using family members, peers)Communication problems – interpreters, (using family members, peers)

Problems involving the social network – formal, respecting paceProblems involving the social network – formal, respecting pace

Cultural background – medial dimension, culturally, short-term treatmentCultural background – medial dimension, culturally, short-term treatment

Accessibility and distribution of information – case studies, leafletsAccessibility and distribution of information – case studies, leaflets

Pathways according to clientsPathways according to clientsInfluence of cultural and religious background – cultural responsivenessInfluence of cultural and religious background – cultural responsiveness

Accessibility and distribution of information – importance of peersAccessibility and distribution of information – importance of peers

Communication problems – using ‘own’ languageCommunication problems – using ‘own’ language

Lack of ethno-cultural peers – ‘good’ exampleLack of ethno-cultural peers – ‘good’ example


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DiscussionDiscussion

Presented results reveal the impact of Presented results reveal the impact of ethnicity and culture on treatment ethnicity and culture on treatment

(identity, impact, reason to abuse (Finn, 1996))(identity, impact, reason to abuse (Finn, 1996))

Clients and professionals agree on an Clients and professionals agree on an integrative paradigm (not separating ethnic integrative paradigm (not separating ethnic minority clients), taking specific aspects minority clients), taking specific aspects into account (see table)into account (see table)


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Discussion (2)Discussion (2) Making use of the medical dimension as an ‘entrance’ into treatment instead of

forcing clients - from the outset - into disclosing emotions, feelings and beliefs.

Short-term treatment, taking continuity of care into account.

Making use of formal signs of professionalism (e.g. the use of medical argot) without

being rude or authoritarian.

Respecting the pace at which clients feel comfortable during treatment.

Showing respect for the status and honour of clients (especially male).

Treatment approaches based on ‘activity’ rather than on verbalizing.

The importance of taking apparently ‘small’ details into account

Trying to have ethno-cultural peers in the treatment facility.

The necessity of explicitly enabling clients to act according to cultural and religious

norms.


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Discussion (3)Discussion (3)

Generalization ?Generalization ? Social networkSocial network Lenght of time Lenght of time Further research :Further research :

Test the presented suggestionsTest the presented suggestionsImplementing feedbackImplementing feedbackNeeds of minority groupsNeeds of minority groupsUnequivocal registration protocolUnequivocal registration protocol

4th international symposium on substance abuse treatment and special target groups 1 cultural...

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