ethnicity and gambling treatment · 2018-09-18 · 1 problem gambling project, camh ethnicity and...
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1Problem Gambling Project, CAMH
www.ProblemGambling.ca
Ethnicity and Gambling Treatment
Facilitated by:
Negar Sadeghi, MA. & Chantal Dubois, BA, CPCG
Problem Gambling Project,
Centre for Addiction and Mental Health (CAMH)
June 5 & 6, 2008
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2Problem Gambling Project, CAMH
www.ProblemGambling.ca
Overview of TrainingWhat to expect for this training
Introductions
Participant goals
Overview of agenda
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3Problem Gambling Project, CAMH
www.ProblemGambling.ca
Why Ethnicity and P. Gambling?You asked
There is great need in the province
We have local expertise
Regional resources sharing
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4Problem Gambling Project, CAMH
www.ProblemGambling.ca
But First, Let’s Look InwardWhy?
Explore issues of power and marginalization
Look at complexity of social relationships
Discuss how these may affect clinical encounter
Expand our awareness and clinical skills
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5Problem Gambling Project, CAMH
www.ProblemGambling.ca
DIVERSITY
DIVERSITY
The Diversity Flower has been adopted from the Power Flower (Source: Arnold, R., Burke, B., James, C. & Martin, D. (1991) Educating for a Change, Toronto, ON: Between The Lines)
Marginalization Privilege
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6Problem Gambling Project, CAMH
www.ProblemGambling.ca
The Story of
Rosemary
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7Problem Gambling Project, CAMH
www.ProblemGambling.ca
Worldview/Cultural OrientationsFamily IndividualOrientation
Orientation(extended, clan, tribe)
(nuclear family)
Hierarchy Equality(levels of power)
(equal power)
Values/Beliefs Values/BeliefsUnquestioned
Questioned
Oral
Written Communication
Communication
Gender GenderSegregation
Integration
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8Problem Gambling Project, CAMH
www.ProblemGambling.ca
Cultural & Religious values “Gambling”
Different or
the Same?
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9Problem Gambling Project, CAMH
www.ProblemGambling.ca
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10Problem Gambling Project, CAMH
www.ProblemGambling.ca
Culture is like an iceberg..Most of an iceberg is out of sight, most of culture is out of awareness…Visible aspects of culture are above theiceberg’s surface…Travel sections and tourism brochures celebrate this aspect of culture…
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11Problem Gambling Project, CAMH
www.ProblemGambling.ca
Below the iceberg surface is…
BeliefsValues
AttitudesUnconscious rules
Assumptions How problems are solved
How emotions are handledWhat else……….
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12Problem Gambling Project, CAMH
www.ProblemGambling.ca
Influence of Culture?
‘Gambling’ ‘Problem Gambling’
‘Seeking Help’ ‘Clinical Care’
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13Problem Gambling Project, CAMH
www.ProblemGambling.ca
Influence of Culture in Clinical Care & Gambling
Attitudes, beliefs
Forms, where, when, with who
Expressions: Metaphors, Idioms
Seeking help
Therapeutic Relationship
Positive Outcome
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14Problem Gambling Project, CAMH
www.ProblemGambling.ca
Why Talk About Ethno- Cultural Groups and Problem Gambling?
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15Problem Gambling Project, CAMH
www.ProblemGambling.ca
Because………
Diverse country
Increase availability- rise in the prevalence
Ethno-Cultural communities are affected
Programs designed for the mainstream
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16Problem Gambling Project, CAMH
www.ProblemGambling.ca
What makes the ethno-cultural communities vulnerable to develop gambling-related
problems?
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17Problem Gambling Project, CAMH
www.ProblemGambling.ca
Vulnerable Population
Systemic,cultural & language barriers
Settlement issues
Generally lack needed knowledge
Less likely to take part in health promotion, prevention and treatment programs
Focus on Western, bio-medical approach
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18Problem Gambling Project, CAMH
www.ProblemGambling.ca
Culturally Competent Care
What does it mean?
How would you work with someone culturally different than you?
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19Problem Gambling Project, CAMH
www.ProblemGambling.ca
Cultural Competence
Capacity of an organization or individual to appreciate diversity, and to adapt to and work with people of different cultures, while ensuring everyone is treated equally.
Culture Counts, 2004
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20Problem Gambling Project, CAMH
www.ProblemGambling.ca
Systems to Consider in Cultural Competence
Culture of Clinician
Personal Culture
Client’s Culture
Organizational Culture
Therapeutic Encounter
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21Problem Gambling Project, CAMH
www.ProblemGambling.ca
Culturally Competent Care: Frameworks
A) Quadripartite Framework
B) Culture Care Framework
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22Problem Gambling Project, CAMH
www.ProblemGambling.ca
Knowledge
Skills
Awareness
Power
EQUITY
Quadripartite Framework
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23Problem Gambling Project, CAMH
www.ProblemGambling.ca
Quadripartite FrameworkAwareness Own Cultural Values/Beliefs
Client’s Worldview
KnowledgeCulture-Specific
Culture-Generic
SkillsKnowing “HOW”
Power Issues/RelationshipClient-Therapist dyad (micro level)
Client-System (macro level)
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24Problem Gambling Project, CAMH
www.ProblemGambling.ca
Dimensions of Culture Care
Culture Culture
Sensitivity Knowledge
Culture
Resources
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25Problem Gambling Project, CAMH
www.ProblemGambling.ca
Culture SensitivityUnderstandingof Professional, OrganizationalCulture
Understanding OWN Culture
biases/prejudices Culture KnowledgeCulture sensitivity
values/beliefs
CULTURE Cultureresources
Understanding of Issues
POWERTRUSTEQUITY
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26Problem Gambling Project, CAMH
www.ProblemGambling.ca
Culture Knowledge
Culture sensitivity
Culture resources
Culture knowledge
Meaning of illness
Ways of healing
Values related to care, care providers, illness
Impact of Life Events - immigration / settlement / racismFamily involvement
Generic or Specific Cultural Knowledge
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27Problem Gambling Project, CAMH
www.ProblemGambling.ca
Culture Resources
Culture Resources
Internal / ExternalNetworking
Organizational Resources
e.g., develop partnership
Interpreters / Community Services
Access to information
Culture Sensitivity
Culture Knowledge
Learn From the Other, not just about the other
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28Problem Gambling Project, CAMH
www.ProblemGambling.ca
Culturally Congruent Care
Preserves / ValidatesKEY values & beliefs
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29Problem Gambling Project, CAMH
www.ProblemGambling.ca
“What Works” in Therapy: Scott D. Miller, Ph.D. (1997)
40%
30%
15%
Extratherapeutic FactorsRelationship FactorsHope & ExpectancyModel and Technique
15%
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30Problem Gambling Project, CAMH
www.ProblemGambling.ca
Therapeutic Alliance
How Do You Establish Rapport?
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31Problem Gambling Project, CAMH
www.ProblemGambling.ca
Role of the Family in Care
Involve the family or anyone else? Family values? How problems are handled? Are there hierarchical structures?Stigma?
Generational or intergenerational conflicts?Anything else?
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32Problem Gambling Project, CAMH
www.ProblemGambling.ca
Counsellor and Agency Roles & Guidelines
Explain what counselling is, what to expect
Agency’s role and responsibilities including your limitations
Explain therapeutic approaches
Negotiate agreements and how power is shared
Discuss anonymity and confidentiality
Reassurance
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33Problem Gambling Project, CAMH
www.ProblemGambling.ca
L-E-A-R-N MODEL of Cross- CULTURAL ENCOUNTERS
(Handout)
Listen & AskExchange InformationAcknowledge Reword/Reframe Negotiate
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34Problem Gambling Project, CAMH
www.ProblemGambling.ca
Communication Tips
Different Styles
No Assumptions
Ask Questions
Clarify
Listen Carefully
Nothing Fancy
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35Problem Gambling Project, CAMH
www.ProblemGambling.ca
Communication Tips more…..
Note non-verbal communication styles. Watch the person’s face and body language.
Do not make assumptions, ask if you don’t understand. For example, in some Middle Eastern and African cultures, making direct eye contact is considered being disrespectful, so they don’t make direct eye contact as sign of respect. But not making direct eye contact in Western countries might be interpreted differently.
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36Problem Gambling Project, CAMH
www.ProblemGambling.ca
Communication Tips more…Ask if they understand what you are saying, talk slowly, ask if they need clarification: might be needed due to language barrier. Repeat if necessary just make sure the other person has understood what you said.Speak slowly & be very respectful, patient and courteous especially with the older generation.
Use simple language, nothing fancy.
Make the session as interactive as possible. Allow them to talk and tell their story.
Show respect. Be aware of power dynamics and differentials between you.
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37Problem Gambling Project, CAMH
www.ProblemGambling.ca
Communication Tips more…
Do not worry about correctness of English usage-conversation is not an English lesson.
Listen carefully to what the client is saying. Try to avoid interrupting by completing sentencing.
Be humble-remember that the client probably has the ability to speak about four languages and has significant exposure to other cultures. Do not place any value of superiority because you speak “Canadian”English.
Provide interpretation free of charge if possible and necessary.
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38Problem Gambling Project, CAMH
www.ProblemGambling.ca
Cultural Assessment Guidelines (Handout)
Section IModel Questions
Cultural Identiy & Social Context
Treatment Relationship
Section IIGuidelines for working with
Cultural Interpreters and Clients
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39Problem Gambling Project, CAMH
www.ProblemGambling.ca
Ethnicity/Culture and GamblingGoals
Actively explore connections
Enhance awareness of relapse risks
Enhance knowledge of culturally-appropriate supports for RP
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40Problem Gambling Project, CAMH
www.ProblemGambling.ca
Thank YouFeel free to contact us for any follow-up:
416-535-8501, ext. 3921
416-535-8501, ext. 3923