Raquel Andres-Hyman

Culture and Clinical Practice: Recommendations for Working With Puerto Ricans and Other Latinas(os) in the United States

Much has been written concerning ethno– cultural constructs and their application to the behavioral health treatment of Latinas(os). Perhaps because of the inherent complexity of attempting to describe ethno– cultural beliefs and treatment implications while avoiding stereotyping and overgeneralizing, writings in this area often begin with brief descriptions of select cultural values. Often what follow are treatment implications and recommendations, embedded in a broader theoretical discussion. This article builds upon this work by placing cultural concepts in ecological perspective and offering practice recommendations that follow from specific cultural beliefs. Although not exhaustive, these recommendations are intended to offer concrete approaches to care that are consistent with a contextual understanding of individuals of Hispanic heritage, particularly of individuals of Puerto Rican ethnicity living in an urban setting.

Oil and Water or Oil and Vinegar? Evidence-Based Medicine Meets Recovery

With the increasing prominence of the notions of “recovery” and “recovery-oriented practice,” practitioners, program managers, and system leaders are increasingly asking about the relationship between “evidence-based practices” and recovery. After reviewing the concepts of recovery from mental illness, being in recovery with a mental illness, recovery-oriented care, and evidence-based medicine, the authors argue for a complementary relationship between recovery and evidence-based practices. This relationship is neither simple nor straightforward, but results in a whole that is greater than the sum of its parts through which each element benefits from the influence of the other.

From “Double Trouble” to “Dual Recovery”: Integrating Models of Recovery in Addiction and Mental Health

ABSTRACT Conceptualizations and approaches to the treatment of co-occurring psychiatric and substance use disorders are currently in transition. With the dawning of the contemporary “recovery movement,” both the mental health and addictions fields are increasingly moving toward acknowledging that people with mental illnesses and addictions are first and foremost people rather than their diagnoses or disorders, subsequently replacing such phrases as “mentally ill chemical abusers” with person-first language. To follow this basic principle in practice rather than merely in rhetoric, we need to accept that it is the people with these experiences who know best what is entailed both in living through and in recovering from these disorders. As one step in this direction, this article reviews two models of recovery, one in mental health and one in addictions, which were developed in collaboration with advocacy communities in each of these fields. These models are then integrated to allow for one model of dual recovery for people with co-occurring disorders as a step in moving practice toward the recovery orientation being called for in both fields by the federal government and by people in recovery themselves.

A clinical trial of peer-based culturally responsive person-centered care for psychosis for African Americans and Latinos.

Background Providing culturally competent and person-centered care is at the forefront of changing practices in behavioral health. Significant health disparities remain between people of color and whites in terms of care received in the mental health system. Peer services, or support provided by others who have experience in the behavioral health system, is a promising new avenue for helping those with behavioral health concerns move forward in their lives. Purpose We describe a model of peer-based culturally competent person-centered care and treatment planning, informed by longstanding research on recovery from serious mental illness used in a randomized clinical trial conducted at two community mental health centers. Methods Participants all were Latino or African American with a current or past diagnosis within the psychotic disorders spectrum as this population is often underserved with limited access to culturally responsive, person-centered services. Study interventions were carried out in both an English-speaking and a Spanish-speaking outpatient program at each study center. Interventions included connecting individuals to their communities of choice and providing assistance in preparing for treatment planning meetings, all delivered by peer-service providers. Three points of evaluation, at baseline, 6 and 18 months, explored the impact of the interventions on areas such as community engagement, satisfaction with treatment, symptom distress, ethnic identity, personal empowerment, and quality of life. Conclusions Lessons learned from implementation include making cultural modifications, the need for a longer engagement period with participants, and the tension between maintaining strict interventions while addressing the individual needs of participants in line with person-centered principles. The study is one of the first to rigorously test peer-supported interventions in implementing person-centered care within the context of public mental health systems. Clinical Trials 2010; 7: 368—379. http://ctj.sagepub.com

WHAT PSYCHOTHERAPISTS CAN BEGIN TO LEARN FROM NEUROSCIENCE: SEVEN PRINCIPLES OF A BRAIN-BASED PSYCHOTHERAPY

Advances in neuroscience provide guidance for the development of psychological conceptualizations of mental illness and treatment that go beyond a reductionistic biological etiology. The authors propose that these advances can be translated into practical clinical applications. Through the elaboration of 7 principles that can be helpful in using neuroscience to enhance clinical practice, this article describes areas of neuroscientific knowledge with particular relevance to psychotherapy.

Beyond parallel play: Science befriending the art of method acting to advance healing relationships.

Research underscores the central role of factors in healing that appear to relate to the therapeutic relationship. These nonspecific or common factors and placebo effects are often overshadowed by an emphasis in the field on particular empirically supported therapies. Yet relationship variables account for a greater proportion of the variance in treatment outcomes than the technical intervention employed, representing a notable blind spot in our science and, by extension, our practice. As a consequence, clinical instruction in psychology and in the health professions more broadly generally lacks adequate specificity with respect to how to cultivate a healing relationship. Through the elaboration of several techniques derived from theatrical traditions, the authors propose that method acting and similar schools of drama provide a method for honing clinical skills in these areas that is amenable to empirical scrutiny. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Racial-ethnic differences in access, diagnosis, and outcomes in public-sector inpatient mental health treatment.

This study investigated inequities in access, diagnosis, and treatment for African Americans and Hispanic Americans receiving treatment in northeast, public sector, inpatient mental health settings as part of a Department of Mental Health and Addiction Services Health Disparities Initiative. Data from 1,484 adults were obtained through a random extract of patients admitted to state inpatient facilities between 2002 and 2005. After controlling for demographic variables and symptom severity, logistic and linear regression showed that Hispanic Americans were significantly more likely to enter inpatient care through crisis/emergency sources and were significantly less likely to self-refer or come to inpatient care through other sources (e.g., family, outpatient). After admission, Hispanic Americans were more likely to be diagnosed with other psychotic disorders (e.g., schizoaffective disorder, delusional disorder), were less likely to receive an Axis II diagnosis at discharge, and had a shorter length of stay than non-Hispanic White Americans. African Americans were more likely than other groups to be diagnosed with schizophrenia, drug-related, and Cluster B diagnoses (discharge only), and they were less likely to be diagnosed with mood disorders and other nonpsychotic disorders. Although African Americans were more likely than other groups to come to inpatient units from numerous routes, including self-referral and referral from other sources (e.g., family, outpatient), they were more likely to terminate treatment against medical advice and displayed shorter length of stay despite receiving ratings of greater symptom severity at discharge. These findings highlight the need for policies, programs, and system interventions designed to eliminate disparities and improve the quality and cultural responsiveness of behavioral health services.

Seven Essential Strategies for Promoting and Sustaining Systemic Cultural Competence

Racial and ethnic disparities are disturbing facets of the American healthcare system that document the reality of unequal treatment. Research consistently shows that patients of color experience poorer quality of care and health outcomes contributing to increased risks and accelerated mortality rates relative to their white counterparts. While initially conceptualized as an approach for increasing the responsiveness of children’s behavioral health care, cultural competence has been adopted as a key strategy for eliminating racial and ethnic health disparities across the healthcare system. However, cultural competence research and practices largely focus on improving provider competencies, while agency and system level approaches for meeting the service needs of diverse populations are given less attention. In this article we offer seven essential strategies for promoting and sustaining organizational and systemic cultural competence. These strategies are to: (1) Provide executive level support and accountability, (2) Foster patient, community and stakeholder participation and partnerships, (3) Conduct organizational cultural competence assessments, (4) Develop incremental and realistic cultural competence action plans, (5) Ensure linguistic competence, (6) Diversify, develop, and retain a culturally competent workforce, and (7) Develop an agency or system strategy for managing staff and patient grievances. For each strategy we offer several recommendations for implementation.

Racial-Ethnic Differences in Referral Source, Diagnosis, and Length of Stay in Inpatient Substance Abuse Treatment

OBJECTIVE Racial-ethnic differences in referral source, diagnosis, and length of stay in substance abuse treatment were examined. METHODS Data from 495 African Americans, 492 Hispanics, and 497 non-Hispanic whites were analyzed. RESULTS Hispanics were less likely than whites to be referred by crisis services; African Americans were more likely than other groups to be referred from criminal justice settings. At admission Hispanics and African Americans were more likely to have a drug use disorder, and whites were more likely to have an alcohol use disorder. Both African Americans and Hispanics were more likely than whites to have a cluster B personality disorder diagnosis at discharge. African Americans had longer stays than other groups. CONCLUSIONS The findings could be used to design interventions to reduce disparities in inpatient substance abuse treatment.

Contexts and Narratives of Recovery

ABSTRACT Expanding on the introduction to the multinational study described in the first article, this article briefly reviews informants’ contexts of treatment across Italy, Norway, Sweden, and the United States, and provides a cursory description of each informant, organized according to her or his respective country. The informant descriptions are followed by illustrative third-person narratives drawn from interviews with two informants from Sweden. As a counterpoint to themes derived across informant narratives, such as the roles of home, significant others, and coping strategies, this article attempts to illustrate how such themes are interwoven within the context of individuals’ lives and personal journeys toward recovery.