Cultural Competency in Mental Health Peer-run Programs and Self-help Groups

The Cultural Competency in Mental Health: Peer-run Programs and Self-help Groups is a resource by the National Alliance on Mental Illness (NAMI) STAR Center and the University of Illinois at Chicago was created to help mental health, consumer operated programs and self-help groups assess their own cultural competency. By using it, you’ll identify the ways in which your activities are already responsive to culturally diverse peers and areas where you could use some improvement. You’ll also create specific action plans to enhance your cultural competency in five important areas. This tool is structured around five focus areas - Administration, Policies and Guidelines, Peer Providers and Group Leaders, Services and Supports, Program or Group Environment, Communication and Language Capacity. For each of the five focus areas, you will:

• Review why the area is an important part of cultural competency in peer programs and self-help groups
• Learn about where to look when conducting your assessment in that area
• Rate your program on how well it meets the given criteria
• Consider and act on ways to improve your competency in that area

Download the tool (pdf). Learn more about the NAMI STAR Center.

Addiction Discriminates? What That Means in Today’s Troubled Economy

For decades now, addiction has been branded “an equal opportunity disease.” And judging from the largely white, middle-class people who populate most AA meetings and rehabs, it is. But while no sector of society is immune from substance abuse, addiction does discriminate. Examples abound: "drug problems" among college grads is nearly a third lower than those for high school dropouts, according to the National Household Survey on Drug Abuse and Health. Unemployed people are twice as likely to be addicts as people with jobs. With America facing the greatest income gap since the Great Depression, the largely unpublicized link between financial inequality and drug addiction suggests big trouble ahead.

Of course, the causal connection between poverty and substance use runs both ways. People who are suffering from alcohol or drug problems are obviously more likely to drop out of school or lose their jobs, while those who don't have the education and skills to find a job in this fast-changing, increasingly high-tech economy not only increase face increased odds of addiction but also dramatically lower odds of recovery.

Americans earning less than $20,000 a year are half as likely to successfully quit smoking—and nearly one third less likely to end a cocaine addiction—than those making $70,000 a year or more. Addiction is disproportionately concentrated among the poor, and, consequently, among blacks and Hispanics. If we continue to ignore the special role that the lack of education and employment play in fermenting the growing drug problem, we are likely to leave them out of the solution when it comes to crafting treatment and prevention.

Read more on the AlterNet website.

Can Electronic Health Records Erase Disparities?

Switching to electronic health records might help close health gaps between black and white Americans, researchers suggest in a new study. Using government data on primary care visits from 2007 to 2008, they found a racial gap in well-controlled blood pressure among doctors who didn't use digital records, but not among those who did. That could be important, because African Americans are more likely to have high blood pressure than whites, which might in turn explain why they also have more heart attacks, strokes and kidney disease, said Dr. Lipika Samal, who worked on the new study. "If we really do find the tools help to reduce disparity," she told Reuters Health, "then as a society we should incentivize people to use these tools." But that's still a big 'if,' according to Samal, of Brigham and Women's Hospital in Boston. Her findings are just an association, she said, and can't prove that electronic health records by themselves get rid of health disparities.

The study is based on a survey of doctors across the U.S. It includes more than 17,000 primary care visits, during which doctors recorded patients' blood pressure. Fifteen percent of the doctors said they used electronic health records, with another 27 percent using special pop-up messages in addition to the digital records to help them make medical decisions. When offices used traditional records, 69 percent of blacks were estimated to have their blood pressure relatively under control (less than 140/90) after accounting for age, insurance and who owned the office, among other factors. That number was 75 percent for whites. At offices that had embraced the new technology, the numbers were similar for blacks and whites at 75 percent and 78 percent, respectively. And Hispanics had an even higher rate of good blood pressure control.

Samal said more research is needed to tease out why the gap between whites and blacks disappears at offices that use digital tools, but said it could be that the systems help doctors make better decisions -- such as suggesting cheaper medicines for poor patients.

Read more on the Medline Plus website. Read the full study (requires login).

Navajo Nation confronts HIV and AIDS

Five years ago, the man Elsie Smith loved told her calmly from his hospital bed that it was time for him to go. He died with a hushed goodbye and a squeeze of her hand. Smith herself had been feeling ill for a while. Her bones ached and she vomited often. She soon mourned him from her own hospital bed. A doctor explained to the Navajo woman that her lover had died of AIDS. It was important that they check her blood, he said. She agreed. Two days later, the doctor told her that she had HIV. Her tired mind became flustered with questions, but she asked only one. "What is HIV?"

Smith learned of her diagnosis at the Indian Medical Center in Gallup, where Western medicine and traditional healing converge to treat members of the Navajo Nation and where a ceremonial hogan — or sacred structure — sits on hospital grounds. It is where Jerry Archuleta and Emerson Scott, partners who are both HIV-positive, go for their monthly checkup and where Danny Morris nearly died from AIDS before receiving care from both doctors and medicine men.

The hospital has become a leading force in the effort to quell a rise of HIV transmission among Navajo, a troubling development at a time when HIV infections are holding steady or declining in other groups across the country. Most of the infections are occurring in the Navajo Nation, a vast expanse in the Four Corners region where poverty, poor education, alcohol abuse and the hardships of reservation life cultivate an environment in which the virus can spread.

Larry Foster, the Navajo Nation's sexually transmitted disease coordinator, said health professionals had encountered resistance when giving presentations on the disease. "They didn't want to listen because they thought we were bringing a curse, bringing death into their communities," Foster said. "Nobody cares until they have seen an AIDS death in their family." In sheer numbers, the amount of infections is small among the 173,600 people who live in the Navajo Nation. The Indian Medical Center and its clinics scattered across the reservation log about 35 new cases a year. But that's about three times the number recorded a decade ago.

Read more on the Los Angeles Times website.

Racial Respect and Racial Socialization as Protective Factors for African American Male Youth

African American adolescents must negotiate the transition to adulthood in a society that makes the achievement of positive cultural identity and self-respect difficult. Frequently, young men turn to violence in an attempt to achieve respect in their communities. This study published in the Journal of Black Psychology explores factors that predict the use of violence among African American male youth. Adolescents from 14 through 18 years of age who completed a written survey in group settings in Oregon included 100 youth who were detained in the juvenile justice system and 100 who were members of a community youth development program. A history of witnessing violence strongly predicted the intensity of violent behavior of study youth; however, endorsing positive attitudes toward racial respect significantly moderated the effects of chronic exposure to violence. Additionally, racial socialization was negatively correlated to violence intensity and was marginally significant in moderating the effects of witnessing violence. Implications for practice with male African American youth are highlighted.

Read the abstract of the study. Read the full study (pdf).

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