 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. Welcome everybody and I really appreciate you being here the day after Christmas. I know we're all kind of sluggish today. We're going to be covering culturally responsive services with African-American clients in today's webinar. We're going to explore the culture values and traditions of African-Americans kind of briefly just to kind of give you an overview and I've given you a lot of written resources. If you want to know more about some of those things there's just so much that we can cover in an hour. We'll identify issues and barriers which need to be considered to provide culturally responsive treatment and we'll learn about how to provide culturally responsive group psychoeducation. So a lot of the stuff we're going to talk about is going to sound familiar from the webinars for the last week. But we're going to have this additional concept today of culturally responsive psychoeducation and I chose to put that in here because it's not something we talk about a lot and this plays off of obviously culturally responsive education services. But a lot of us when we do do groups we have a multicultural group and making sure that we are providing those services in a way that meets the needs of everybody in there can feel really daunting if you're thinking about it like we typically do. So we're going to talk about that. An additional resource that's also in your class is the Mental Health Care for African-Americans document by the Surgeon General. It talks a lot about historical issues, barriers, etc. that may be facing African-Americans and causing some of the health disparities. So that's in there for you too. You don't have to know it for today's quiz. I just wanted to make sure you had a little bit more rounded information than we can cover in an hour. Alrighty, so African-Americans or blacks are people who are whose origins are in any of the black racial groups of Africa. And this is according to the SAMHSA tip on improving cultural responsiveness. This term includes descendants of African slaves brought to this country against their will. More recent immigrants from Africa, the Caribbean or South Central America. Many individuals from these latter regions, if they come from Spanish-speaking cultural groups will identify primarily as Latino. So we don't want to assume just because of biological characteristics that someone ascribes to a certain culture. In most African-American communities, significant alcohol or drug use may be socially unacceptable or seen as a sign of weakness. Even in communities where the sale of such substances may be more acceptable. So that may be something if you work with clients who have co-occurring disorders or who have substance use disorders. That may be an issue to pay attention to. Overall, African-Americans are more likely to believe that drinking and drug use are activities for which one is personally responsible. Well, that's a good thing. We can use a lot of that in our motivational interviewing and motivational enhancement strategies. Thus, they may have difficulty accepting alcohol abuse and dependence as a disease. So a lot of times when we're looking at working with the with people who are African-American, they may not ascribe to the whole disease model of addiction, which is what a lot if not 90% of treatment centers are based on and it's what 12 steps is based on. So treatment issues. African-Americans are less likely than white Americans to receive treatment for anxiety and mood disorders, but they're more likely to receive treatment for drug use disorders. And you know, just to kind of sum up all the stuff that I read basically a lot of the instruments that we use to identify mood and anxiety disorders in African-Americans don't capture the symptom not symptomatology correctly. And a lot of times they are put in for drug use disorders and the mental health disorder is not recognized or not attended to. So even if they do have an addictive disorder, it's an important to screen for the co-occurring disorder. In one study evaluating PTSD among African-Americans in an outpatient mental health clinic, only 11% of clients had documentation referring to PTSD, even though 43% of the clients showed symptoms of it. My first thought is, okay, that's just one clinic. So maybe their training was really bad. But my second thought is how pervasive is that under diagnosis throughout other clinics? And if we're not diagnosing it as PTSD, what are we diagnosing it as if it is a presenting issue that's problematic for that person? African-Americans are more likely to be diagnosed with schizophrenia and less likely to be diagnosed with affective disorders than white Americans, even though multiple studies have found that the rates of both disorders among these populations are comparable. Again, highlighting the fact that our assessment instruments and our assessment techniques for whatever reason, and they really didn't delve into that in the research that I went through. For whatever reason, we are not hitting the mark on assessment when working with African-American clients. African-Americans are about twice as likely to be diagnosed with a psychotic disorder as white Americans, and more than three times as likely to be hospitalized for such disorders. What would cause that? And I don't have the answers. It is something that I pondered for a while after I came across that statistic, and you know, we really want to look and see if we're missing culture-bound syndromes. And why would we hospitalize more frequently? Maybe because people, some of the African-Americans who present with psychotic-like symptoms don't have a supportive enough environment. You know, if you think back to the ASAM or your patient placement criteria, whatever instrument you use, if they don't have a supportive recovery environment, hospitalization may be a better option because they don't have a safe place. I'm not sure. For an overview of mental health across populations referred to the mental health in the United States 2010, which is a publication by SAMHSA, another one of those free publications you can get online. Blacks were much more likely to receive mental health services from general practitioners than mental health specialists. This is another key point for us to recognize if we are trying to reduce disparities, then we need to increase utilization, which means we need to reach out to those general practitioners and we'll find out in a few minutes also religious leaders and help them understand what we do, how we do it, how it's beneficial, and get that outreach going so we can get referrals from those practitioners who may not really know what options there are or may similarly feel that the mental health system similar to African-Americans may feel that the mental health system just doesn't meet their needs. So we want to talk with doctors about how can we work together, not how can I take your patient, but how can we work together so we can help this person have the highest quality of life. Same thing with the pastors. How can we work together in order to enhance this person's recovery? African-Americans were significantly more likely than white Americans to have an undetected co-occurring mental disorder. And if detected, they were significantly less than likely than white Americans or Latinos to receive treatment for the disorder. So even if they've got a problem, they may not be reaching out. One of the things, one of the possible reasons is that they're not aware of the breadth or types of services available or they can't afford them or there are other barriers that are getting in their way. So we need to evaluate our own communities in a community that has really good public transportation that has, you know, clinics that are walking distances that has affordable healthcare, you know, all kinds of stuff that may be serving as barriers. Some communities have that some communities don't and you know, I'll tell you the more rural you get the less additional services, the less wraparound care you've got to connect the dots between all the different providers. So doing a assessment of your community is going to help you reduce those disparities and increase, you know, our ability to provide early intervention and prevention services. 74% of African Americans who had a past year major depressive episode were identified as also having both alcohol and marijuana use disorders. So if you're working with somebody who has a major depressive episode in African American with major depression, be cognizant of this fact and assess for alcohol and marijuana use there. They may not bring it up and a lot of clinicians and you know, I'm just using this speaking in general terms from my experience working with other clinics. If they're a mental health clinic, a lot of times they don't do a full substance abuse assessment unless that's what the person is presenting for. So, you know, ask about, you know, the big five, you know, alcohol, marijuana, cocaine, opiates and you know, any of your hallucinogens like LSD. It doesn't take long and it gives you an idea of where that person may be with substance use. African Americans are overrepresented among people who are incarcerated and a substantial number of those who are incarcerated have mental health problems and I can attest to this. Unfortunately, in many jails and prisons are a little bit different, but my experience with prisons in three different states is that they're not much better. When clients come, when people come into the jail, if they are on psychotropic medication for whatever reason, depression, bipolar, yes, even bipolar, or even some of your atypical anti psychotics, a lot of times the jail will withdraw that medication and dry out the person if you will or get them off of that medication and only provide it back to them. If they are a behavior management problem. So the medical team evaluates the person says now I don't think this person really needs to be on this medication and they pull them off of it. It just kills me that they do this because they destabilize the person. They don't put them back on the medication before they release them and what do you think is going to happen? Okay, end of that soapbox, but if you're working with someone who has recently gotten out of incarceration, be aware that they may not have had access to their mental health meds. If you are working with someone who is incarcerated, you know, you want to ask about whether they are on mental health meds. If they're not while they're incarcerated, ask them if they were when they came in. So you kind of have an idea and you can possibly advocate for them. African-Americans are more likely to be referred to treatment from criminal justice settings rather than self-referred or referred by other sources and I'm not sure how much of that is just because they're overrepresented in criminal justice settings. They're referred more often versus there are more barriers and I think both things probably are true, but we do want to be aware that a lot of African-Americans will not self-refer. So where can we reach out? Where can we provide these connections? Where can we provide education? Lack of familiarity with the value and use of specialized behavioral self-services may limit service use. So how can we help them know about the value? And this is true for a lot of our clients. A lot of people say, you know, if if it's not falling off, I probably don't need to see a doctor for it. If I am not just desperately depressed or can't deal with my anxiety, then I don't need to go see a therapist. It's too expensive. I don't have the time. Yada, yada, yada. We need to understand what's preventing them from reaching out. Is it cost? Is it accessibility? Is it lack of knowledge? Is it lack of culturally responsive care? And then start addressing those things so we can put out prevention and early intervention activities or whatever you want to call it to help improve the health of the community. Now you think, well, why would I want to do that because I need clients? There's always clients out there. So if we can establish ourselves as a credible resource in the community, if we can provide people with useful tools, tips to manage their life, then when something gets, you know, amiss when they start feeling poorly, then they may come to us and go, hey, can you help me out? Because it doesn't feel so scary. If they've already interfaced with us in some way, even if it's through a web video, if it's through handouts that their pastor gives them, if you feel personable and approachable and it doesn't seem scary to go into counseling, a lot of people think what we do is magic in some sort of way, then they're going to be more likely to come. An essential step in decreasing disparity in behavioral health services among African Americans involves using culturally sensitive instruments and evaluation tools. African Americans were next to Asian Americans, the least likely of all major ethnic and racial groups to state a need for specialized treatment. A lot of times they don't see the depression. Maybe they've been depressed for so long. They don't know any different. So why is it? And these are systemic questions. I'm just kind of proposing for you to ponder. Why is it that they are least likely to see a need for treatment, even though they may have a presenting issue? African Americans were more than like were more likely than members of other major ethnic and racial groups to state that they lack transportation to the program or that their insurance did not cover the cost of such treatment. Now this is was document was updated in 2000 and 11. So affordable care was around, but it wasn't as prevalent. I'm hoping that this disparity is starting to shake out a little bit. Longstanding suspicions regarding established health care institutions can also affect African Americans participation in attitudes toward and outcomes after treatment. A lot of the clients I worked with were African American when I worked at the clinic in Florida and we were perceived as part of the system, the larger system, which it included jails, courts, child welfare and mental health. We were all kind of lumped in together. Medical professionals kind of were on their own. They weren't lumped in together as much, but they saw coming to us as potentially threatening and potentially triggering a referral or a call to child welfare or something else like that. So making sure that your clinic or your facility has a good reputation for being you know, supportive of people not you know, always making calls to DCF, etc. Obviously there are sometimes we have to make those calls, but just being aware of that can be a preventing factor. Attitudes towards psychological services appear to become more negative as distress increases, which is yet another reason we need to get out there and talk to the people who interface with the African American community and who have status. The religious leaders can be one and and help them understand what we can do talking to the physicians and helping them realize that we're a resource and reducing our waitlists. If somebody realizes that they need help and they call and you're like, well, I can get you in six weeks from Tuesday. They're going to be so distressed by that point. That their attitude may be more negative or they may just never seek treatment. So those are two things outreach and reduce waitlists. In many African American communities, there's a persistent belief that social and treatment services try to impose white American values. Audit your own facility and see and you know, I can tell you places that I've worked fall more into that category than being culturally responsive. So increasing the organization and the executives level of knowledge about what we need to do to be culturally responsive is really important. African Americans, even when receiving the same amount of services as white Americans are less likely to be satisfied with those services. Again, probably because they're culturally unresponsive. If you went to a restaurant and you ordered food and your friend ordered food and you both got the same amount of food, but your food was cold and theirs was nice and hot. Would you be as happy? You know, you're not getting food that served to meet your needs. Once engaged, African American clients are at least as likely to continue participation as members of other racial or ethnic groups. So if we can get them hooked, if we can establish that rapport, if we can get the engagement, we're golden. But getting that trust built and developing that rapport is really tough. If you're not culturally responsive, providers also need to craft culturally responsive health related messages for African Americans to improve treatment, engagement and effectiveness. So brochures about depression, brochures about anxiety, brochures about health and wellness that address the issues and needs that are present for the African American people in your community. What might they need to know? What resources are out there? You know, trying to help do that outreach and establish that connection. African American clients generally respond better to an egalitarian and authentic relationship with counselors. So they don't want us to be the expert, which is cool because that's what we're taught is to try to develop more of an egalitarian relationship. Request personal information gradually rather than attempting to gain information as quickly as possible. That just feels like an interrogation. If they sit down and you're like, alrighty name, date of birth, you know, they feel like they're at an intake for jail or something. So we want to be sensitive and this isn't just true for African Americans either. Go slow with that personal information initially. Take that first five minutes, establish rapport that develops trust. And you know, as we've seen for the other cultures, it works and it's useful for all of the other cultures. Avoid information gathering methods that clients could perceive as an interrogation. So trying not to gather additional data by getting reports from DCF or reports from the criminal justice system or if you can avoid it. Sometimes you can't be willing to address the issue of race and to validate African American clients experiences with racism and its reality in their lives, even if it differs from their own experiences. So thinking about working with African American clients, you know, maybe you have one who says, you know, I really haven't experienced a lot of racism or oppression in my life. And okay, that's cool. If that's your perception, I'm far be it from me to contradict you. Does racism in general impact your life? Does it impact your family's life? How do these things impact you? Those are things we need to be willing to talk about. It doesn't need to take a focus of treatment if the client doesn't want to go there, but it could be something they want to explore. Racism and discrimination can lead to feelings of anger, anxiety or depression. They're often really pervasive. It's not just situationally dependent. So counselors should explore with clients the psychological effects and help them develop approaches to challenge internal negative messages that have been received or generated based on their race. Six core principles when working with African-Americans. Discussion of clients, substance abuse or presenting issues should be framed in a context that recognizes the totality of life experiences faced by clients as African-American as African-Americans. So if you're talking about depression, let's frame it in terms of what is it like to be a depressed African-American? What is what is it like to struggle with this? What do you think caused it for you? A quality is sought in the therapeutic counselor-client relationship and counselors are less distant and more disclosing in these relationships helps establish trust and obviously not over the top, but being a little bit more genuine and in the moment. Emphasis is placed on the importance of changing one's environment not only for the good of clients themselves but also for the good of their communities. So African-Americans tend to have a communal approach to things. So recognizing that sometimes the motivation isn't so much for the client but for their family or for their community. Focus is placed on coping strategies and solutions that underscore personal rituals, cultural traditions and spiritual well-being. And as I've said in each presentation before this, remember this is a starting point for understanding people from a particular culture. You need to assess your client's level of acculturation before you start applying these principles. Figure out where they are, what they're embracing and how to develop culturally responsive services which can really help develop that engagement and rapport in the beginning. If you ask questions to try to understand how to best serve that particular client. Recovery is a process that involves gaining power in the forms of knowledge, spiritual insight and community health. So asking them what types of things do you think might help you feel better? What types of things do you do that help you feel better? And what knowledge, insight or health do you need or what sorts of things do you need in your community to help you be healthier and happier? Recovery is framed within a broader context of how recovery contributes to the overall healing and advancement of the African-American community. Interventions. Interventions should make use of the core African-American value of Communalism by addressing the ways in which the individual substance of use affects his or her whole community. African-American artwork and food can help programs create a welcoming and familiar atmosphere. One intervention that tends to work better for African-Americans and Latino clients is what we talked about last week with node mapping. Where you use visual representations such as diagrams fill in the blank graphic tools in order to help clients generate mind maps or visual maps of what's going on and how what they're doing connects to recovery or how what they're doing right now may connect to keeping them stuck in their in their unhappiness. Cognitive behavioral therapy has distinct advantages. It fosters a collaborative relationship. So score for that. It recognizes that clients are the experts on their own problems. So that gives them more power. You've got the power by having the license and being the medical professional. But recognizing them as experts gives them the power to say this works for me. This doesn't. When comparing CBT and 12 steps for a group of mostly African-Americans who were homeless, it found that CBT achieved significantly better abstinence outcomes. So if you're working with somebody and you want to get them in mutual support, remember there are 12 step groups for schizophrenia and mood disorders. There's emotions anonymous is great for people with emotional dysregulation. But if they don't embrace that philosophy then CBT may may work a little bit better. They may work well together too. You can use CBT in addition to 12 steps in treatment and make it work. The living in the balanced intervention uses psychoeducation and CBT and it's also been shown to improve treatment retention and reduce substance use. So that's great. There's a review of cultural adaptations of evidence-based practices by Bernal and Dominic Rodriguez in 2012 that you can look up if you want to see adaptations of things that you may already use like motivational interviewing. So some of the strengths of African-American family life can be used to support recovery, including strong bonds and extensive kinship. So there's potentially people out there that they consider family that are willing to help and able to help. The adaptability of family roles, a strong family hierarchy, strong work orientation, high achievement orientation and a strong religious orientation. Again, not all of your clients are going to ascribe to all of these or necessarily any of these, but in general, when we're talking about African-American family life, we can look for these types of characteristics. African-American clients appear more likely to stay connected with their families throughout the course of their illness. So when they're depressed, they're more likely to still stay connected with their family instead of withdrawal completely. African-American families are embedded in a complex kinship network of biologically related and unrelated persons. Hence, we need to be willing to expand the definition of family to a more extended kinship system. So who do you think of as family? And one of the questions I ask a lot of my clients is, you know, when we're talking about family and supports, I want to know who you could call at two in the morning if you were having a bad time. So we want to ask them how they define family, who they identify as family, who lives with them and who they rely on for help. To build a support network, we need to ask clients to identify the people that would be willing and able to support them and then ask if we can include them in treatment. A lot of insurance, well, all insurance providers pretty much mandate as part of their level of care guidelines, involvement of the family in the recovery process. So we need to be kind of broad and how we define family and we do need to try to incorporate that because we want them to have social support on the outside, regardless of whether what their problem is, depression, anxiety, substance abuse. We want them to have people who get it, who know the tools that we're teaching them, who are involved in the process and can be supportive. Engaging Moms is a family-oriented program and intervention developed specifically for African-American mothers that's been shown to significantly improve treatment engagement and there are a lot of issues that it works on and it can be used and when you look at it, there are a lot of pieces that you can pull. You're not going to be using the evidence-based practice to fidelity, but there's a lot of good information for working with African-American mothers with small children and helping them develop bonding and all that other stuff that they just don't give us a manual for. Multisystem family is appropriate and incorporates extended networks of relationships that play a part in clients' lives. Using this model, social service and other community agencies can be considered a significant part of the family system. So we can bring in, you know, other people and other resources instead of having to do everything ourselves. You know, we want to look at what do we do and what do we do well and then where are extensions, you know, feel kind of like an octopus where you've got eight arms, but at the end of each arm is a wrap-around service that can help support the client. So you're not having to do it all. The family team conference model can be a useful approach given that it also engages both families and communities in the helping process by attempting to stimulate extensive mobilization of activity in the formal and informal relationships in and around clients' families. So we want to get out there into the community and let them know that we're there. The family team conference brings in the people who are important and says, okay, what can we do to create the most conducive recovery environment and help everybody, not just the identified patient, be happier and healthier? Because of the communal cooperative values held by many African Americans, group therapy can be a particularly valuable component of the treatment process. Speaking in groups is generally acceptable to African American clients. So little caveat, again, remember that there are different subcultures and depending on their age, they may not feel comfortable self-disclosing because they were raised, you know, a lot of people who are older, 70s, 80s were raised in a time where you didn't put your stuff out there. So be cognizant of that. Don't assume that everybody's going to just fit right into group therapy. Note that black Caribbean Americans can be less comfortable with these group process, particularly the requirement that they self-disclose personal problems to people who are pretty much strangers. And African Americans may be less likely to self-disclose about their past in group settings that include non-Hispanic whites. So if you've got a multicultural therapy group, be aware that you may have some hurdles to overcome there. Homogenous African American groups can be good venues for clients to deal with, with systems of problems such as racism, a lack of economic opportunities in the African American community. If you have a homogenous group, that might be something to consider. The black community has changed the mutual help model for substance use and mental health to make it more empowering and relevant to American, African American participants. If you go to this link, they've redone a lot of the handouts that the 12 step program provides and have provided more culturally connected. What's the word? I'm looking for stories and vignettes. That's what I'm looking for that can help African Americans connect with do I have a problem is a for me yada yada. So that's a resource that you can go and you can download that PDF African American culture and history is steeped in healing traditions passed down through generations, including herbal remedies, root medicines and so forth. Acceptance of these practices by the clients in their families doesn't necessarily indicate that they oppose or reject modern therapeutic approaches or other alternative approaches. You, I can tell you the clients that I've worked with for 20 years, very few of them have ever told me that they've tried herbal remedies or root medicines or anything first. So, you know, you don't want to assume that they don't embrace sort of the Western concept of medicine. They can accept and use all forms of treatment selectively depending on the perceived nature of their health problems. Psychological and substance abuse problems can be seen as having spiritual causes that need to be addressed by traditional healers or religious practices. African Americans are much more likely to use religion or spirituality as a response to physical or psychological problems. They're more likely to go to their pastor before they are to make an appointment. And my question would be, is that because of the spiritual component, which, you know, there's probably an element of that, is that because their pastors tend to be available 24-7? Is that because they don't have insurance to cover counseling? What are the reasons that they choose pastoral counseling over traditional counseling? African American cultural and religious institutions play an important role in treatment and recovery, education, politics, recreation and social welfare in African American communities. I very much saw this. My old boss was the vice president of the facility I worked for. He was also a pastor. He was always out doing stuff. He never got home before 10 or 11 at night because they always had some sort of recreational activity going on or something that was going on at the church or with the church. So there was a lot of activity and communalism within that particular congregation. A growing number of African Americans are converts to Islam and many recent immigrants from Africa to the United States are also Muslims. Again, don't assume that just because somebody is African American that they are Christian. You know, they may be Catholic. They may be Muslim being sensitive to that. It's not uncommon for African American to approach clergy first with mental health or substance abuse problems, but many clergy members believe they're not well prepared to address those problems. So this is another opportunity like I've already said a couple of times for us to reach out and connect with clergy and go, hey, can we provide you some continuing education? Clergy actually do need to get continuing education in a lot of cases. We can do seminars and workshops when they have get a bunch of pastors together and do a brief workshop for them. It doesn't have to be super in depth, but it can give them some tools for screening. It can let them know what we do and explain some of the techniques like cognitive behavioral to them so they can better, you know, help clients understand when they may need to reach out for professional help. Consider involving African American clergy and treatment programs to better engage clients and their families. If you've got a pastor available, they may get used. Another means of engagement within the church can lead to recovery. So participation in religious services, even if it's not dealing with their depression or their anxiety, participation in those services often helps people feel better and the use of peer mentors. It can also be helpful in the African American churches, peer mentors who've gone through similar things may be available to say, Hey, I walked this road. I'll walk it with you treatment issue. African American clients tend to us to underestimate the difficulties they're going to face after treatment. They report a greater need for resources and greater exposure to high risk situations, but have a greater belief in their ability to maintain recovery. So they are super confident. Although an individual's belief in coping can have positive effects on initially managing high risk situations. It can also lead to a failure to recognize the level of risk in a given situation and failure to anticipate consequences, failure to secure resources and appropriate support when needed and failure to engage in coping behaviors conducive to maintaining recovery. So we want them, you know, if they're going to the family reunion and they know that there are people there that may trigger their anger and they've got anger management issue, you know, we want to make sure that they don't think, Well, I got this covered. So we need to role play coping skills. What are you going to do if Uncle Bob comes up to you and is being rude or whatever the case may be making sure that while they think they're confident and they think they're ready, making sure that they're ready by walking through it and anticipating some things that could happen. Counselors can help clients practice coping skills by role playing, even if clients are confident they can manage difficult situations. So onto culturally responsive group education. A common misconception about culturally responsive instruction or group education is that this is that facilitators must teach the Asian way or the black way. That's not it. When we're teaching to a group, now this is different than therapy. This is psycho ed. We have a bunch of different people and they're creating, they all come from a similar community. So they do have some similarities. They do have some similar beliefs and experiences. People often get intimidated by the worst culturally responsive because of the incredible number of cultures and mixes of cultures in today's treatment groups. Too often clinicians subscribe to the misguided idea that clients of different races need to be taught differently and waste an enormous enormous amount of effort in the process. We've talked about different cultures and there are cultures who are more visual. There are cultures that are more auditory. There are cultures that are more kinesthetic or doing well. Try to present the material and this is just good adult learning theory. Present the material in all three ways. Give them something to look at. Do some node mapping on the on the whiteboard while you're talking to them. Present it, you know, you're talking so that's oral and then have them do role plays or have them teach a part of it or have them will get to this on gamification. Have them create some sort of activity to teach the concept back to the group or to the next group, incorporate hip hop music or some other kind of music into sessions because many participants may relate to this style of music. So pay attention in your community. What kind of music do people listen to and then try to figure out how to incorporate some of that if it's appropriate. When you reach complicated concepts make analogies or use metaphors about cars, animals, sports or other topics that will peak student interest. Like when I talk about the stages of recovery, I talk about getting into a cold pool from a hot sunbathing chair. A lot of people can relate to that and they're like, okay, that makes sense and it makes it easier to remember. When I talk about, you know, not managing time effectively and holding on to grudges and getting worn down and not preventing vulnerabilities. And I talk about that as if you're carrying around 250 pound bags of dog food in your trunk what it does to your gas mileage does the same to your energy. So make analogies that people can relate to use metaphors that work for them. Teach the entire concept in a way that all of your participants can relate to and understand using aspects of their cultures with which you are comfortable. So if you're teaching mindfulness, how can you help people understand what being mindful is from different cultures? What does that mean in different cultures? What would you be aware of? How would you teach meditation in a way that is culturally responsive? And how can people relate? What metaphors can you use? And you can ask clients. You may present a topic and go, can you relate this to anything? What is this like and help them or have them help you develop metaphors? That empowers them. They feel good about it. If you find one that's really awesome and you're like, Oh, I'm going to steal that. A lot of times people's faces light right up. So teach to their collective culture. What you've got in the room in a group has its own little micro culture and you're going to find that they like I said, they share similar interests like around here. You know, we might talk about football because football is really big in Tennessee. Know the learner. Group facilitators need to know as much as possible about their participants to teach them well, not just their racer culture, but their learning style and pace. Some people are reflective learners. Some people are active learners. Active learners think and process as they go and they just keep putting pieces together. Reflective learners. Not so much. We take everything together and then we say, okay. So putting it like a puzzle and active learner dumps all the pieces out flips them all over so you can see them and then just starts putting pieces together and they're figuring out as they go. A reflective learner would sort the pieces into piles. First hear the frame pieces and then hear all the blue pieces that are probably the flower and hear all the brown pieces that are probably the deer. We sort them and then we sit back and we make the frame and we say, okay. Now let's strategize. How does all this work and go together? They need a little bit more time to reflect. It's not that they're not smart. We just think a little bit differently and things that tend to be more difficult for people. They may need a little bit more reflection time like for me. Math I always I just sat there and uh-huh uh-huh through the class and I thought it was making sense and I get home and do my first problem and realize I didn't absorb anything. So we need to have those aha moments give people time to absorb it and realize whether they got the concept or the light bulb just didn't go off and they need to ask some questions. Quality facilitators believe all participants can learn and we have the desire and capacity to differentiate curriculum and instruction understanding diversity and thinking about participants developmentally. You're not going to teach the same to an eight year old as you are to a 16 year old as you are to a 24 year old. They have way different life experiences and way different cognitive abilities. So we want to keep that in mind in in addition to all the other things we're considering about the person. Generally when you're doing a group some of those characteristics are going to be similar like when I had the adolescent boys facility. You know they were all adolescent boys that were from you know within a 60 mile radius of where we were which was kind of kind of rural. So I knew that they had certain traits and you know characteristics and those sorts of things that I could then I could start building off of so I knew where I would start. You wouldn't want to start with an introductory something if you were leading a group of physicians necessarily quality curriculum. Curriculum needs to be interesting and relevant. This is another adult learning thing just for everybody. But we want to provide appropriately challenging complex and thought provoking questions not just you know do you understand. We want to say how would you apply it or if you would have had this tool last week. How might you have used it and things have gone differently or how do you think you could modify this in order to make it work for you or make it work for your child you know I like doing the whole child thing is it makes them think about well how could I teach this to my kid which makes them figure out how they could use it to. Teaching needs to be focused on concepts and principles not just facts. We can teach facts all day long but unless we take it home and say OK now what do I do with it. It's not going to hit the mark we can teach that. Poor sleep contributes to depression and anxiety. Well that's great. What do I do with that. How do I fix the problem. And we want to be focused on quality not quantity. We don't want to just rush through and go OK we've covered these 15 topics which is kind of what I feel like when I'm doing some of these webinars doing the overviews. When you're doing group counseling when you're doing psychoeducation if you're getting into a topic for example if we were learning motivational interviewing as a skill. We wouldn't want to rush through everything and just see how much we could get done in an hour. We would want to go through and figure out how much we could get done and actually take and use and apply in an hour. So we're emphasizing the depth of knowledge making sure people actually have a usable skill instead of just an overview of the top 40. Flexible teaching and learning time resources includes team facilitation. Want to have people work together. One of the things that I used to do with final exams when I taught stress management was I'd have I'd give out the exams and then I'd have everybody get together in groups of six. There were about 150 people in the class. So we had a bunch of groups and I would have them go through the test together and then they would talk about what they thought the correct answer was they all had their own test and they obviously could either choose to go with the group or not. But then it gave them a little bit more feedback and interest and it didn't feel near as daunting if they were working on it kind of in a group. Likewise, if I would give an exam and everybody completed it independently then I would give them the right answers and I would have them get into a group and discuss why that answer would be might be right instead of what they chose. Instructional delivery and best practices include flexible grouping cooperative learning learning stations and centers and individual treatment plans that are tied to what you're doing. So they can see on their individual plan. Okay, I'm learning about cognitive techniques today. Well, you go into group or I need to learn about cognitive techniques to address my thoughts that are helping me maintain my anger. You go into group and it's a group on cognitive behavioral or cognitive interventions. The person can see the connection and then you have learning stations. I love learning stations where you put either dry erase boards if you're lucky enough to have a bunch of those or flip chart paper up on the wall with different concepts and people go around in groups and answer the questions that are on the wall and they talk about it. Assessment and evaluation needs to include observations skills checklists. So if you're assessing their their coping skills their communication skills. Have people demonstrate it role play whether they've got a skill or not. Semi structured interviews you can ask your clients how do you think things are going what progress do you think you've made and your standardized or objective tests like the Beck Depression inventory but you don't want to rely on just one thing. We want to communicate high expectations and have consistent messages from both us and the whole agency the participants are going to succeed and have a genuine respect for participants and belief in their capabilities. Instruction needs to be designed to promote student engagement by requiring participants play an active role in crafting the curriculum and developing learning activities. So if you're teaching a group on self-esteem you could go in and just start teaching whatever this is how I teach self-esteem or you could go in and say what do you think self-esteem is how do you think it's developed what do you think causes low self-esteem figure out where they're coming from what their knowledge they're starting with and then say okay you know how do you think we could best figure out how to develop this skill over here or help people be less critical of themselves and help them try to develop or have them help try to develop the curriculum. We want to be more of a facilitator than you know the person who's the know it all we want to guide mediate and serve as a consultant not just the one teaching everything so we can provide some overarching concepts but then we want to encourage people to explore it a little bit more and come up with questions we want to have positive perspectives on families of of culturally diverse participants and have an ongoing participation and dialogue with participants and their community in what issues are important to you and how can we incorporate that in our lobby you know if you notice that diabetes in African-Americans is going up in your community having education about that having books and materials that are culturally sensitive and culturally responsive all the different cultures you serve in the lobby or waiting room there are a lot of things that we can do that present a positive perspective we want to maximize learning opportunities gain knowledge of the cultures represented in our classrooms in our groups and translate this knowledge into instructional practice reshape the curriculum into a culturally responsive one in which the background of the participants informs how we utilize different strategies such as cooperative learning and diverse learning styles we talked about other cultures last week that don't respond as well to auditory or oral traditions so they're sitting in group they're probably flailing they're not getting as much out of it so how can we incorporate them in group if we're talking about the african-american culture tends to be more of an oral tradition so if we're having most of it be reading material they may not be getting as much out of it so we want to talk about what do you need in the curriculum student-controlled classroom discourse allows participants the opportunity to control some portion of the lesson providing facilitators insight into the way that speech and negotiation are used in the home and community we used to do that when we did family ed it was actually awesome we would put people together and in groups and we would have them do a role-play to explain a particular concept whether it be codependency or the roles in the addicted family or whatever it is and it gave us an idea insight into how they perceived it what what they were getting out of the lesson and watching them negotiate and put this together helped us understand better how they interact with others outside of the group learning environment gamification most games employ a lot of the cultural tools you'd find in oral traditions such as repetition solving a puzzle making connections between things that don't seem to be related a lot of gamification centers around a token economy you know if divide the group into different teams and whichever team gets the most points wins and then gets so many tokens you can use those tokens to choose your reward based on you know the list so token economies can be really good but they can also be really hard to implement in psychoeducational groups because you don't have a lot of rewards you can give people consider what you might want to do if it's a closed group it may go a little bit easier other things you can do to gamify Jeopardy we used to make Jeopardy games so clients could learn basic concepts and be able to articulate them and it was a little more fun we did the same thing with the the game of taboo and you can also have them create a game whatever they want give them a poster board and you know little marker type things and color markers and have them figure out how to create a game like monopoly or shoots and ladders or sorry or trivial pursuit whatever the the case is that relates to the topic that you're talking about by doing that by figuring out how to present this information in a game situation they really solidify it in their mind and it's a lot more fun than just sitting in lecture you can also give them a game format to start out with so you say I want you to make a Jeopardy game or a Wheel of Fortune game based on these 15 concepts so if you do it a little bit narrower than that or narrower like that they can usually get it done in an hour and a half instead of you know if they're creating a game from scratch you could take a week make it social organize learning so that participants rely on each other and will build on their communal orientation so have them interview each other have them ask each other have you ever been depressed you know what did you do when you were depressed or have you ever gone to a party and had to make small talk how did you get over your anxiety or what did you do or what was it like encouraging them to explore the topics you're talking about and ask each other for solutions for insight for you know examples can really build participation communal orientation can be summed up in the African proverb proverb I am because we are even making learning slightly competitive in a good-natured way of course increases participants level of action and engagement so you don't want to make it too competitive so it it gets cut throat but having them challenge their themselves and get really excited about the possibility of winning and even if it doesn't result in much whenever I've done games in in my groups even if there was no prize the teams really got into it and they wanted to be the winning team so it helped them you know work together Oh what's that other one Richard Dawson used to do that game family feud that's another game that you can do and it can be really fun in class another thing you can do to have them work together is say how can we work together to solve this problem you know lack of resources in our community or suicide in children or or whatever it is whatever problem the group is addressing low self-esteem for example how can you how what could we do to prevent it in our children what types of interventions might we use you know and have them get together and sort of focus groups and brainstorm talk about what their families did that helped or their community did that helped you know maybe staying away from the stuff that hurt focus on the positive but that can make learning again more social story thigh story thigh it the brain is wired to remember stories and use the story structure to make sense of the world diverse participants learn content more effectively if they can create a coherent narrative about the topic or process presented it's the brain's way of weaving it all together think about your Bible stories you know you may not remember some of the stuff from Jose or Amos but you probably remember Genesis you know in the beginning because it's more of a story and so being aware of the fact that people can relate to those have them create skits or role plays to drug refusal skills but you can also story thigh social skills and have people have a skit that demonstrates a particular social skill in outreach if you're working with pastors and parents and stuff who are in a prevention early intervention interested in helping the community you may break them into smaller groups so as parents what can you do to help youth with this problem as pastors and community leaders what can you do to help people with this problem or have them related to something they already know such as a story in the Bible the Quran a piece of literature or a current event you know what does this remind you of can you see any parallels between this and something else that you've you know so we've explored the culture values and traditions of African Americans kind of briefly to include Communalism and the importance of spirituality for many clients not all identify issues and barriers which need to be considered to provide culturally responsive treatment including the use of ineffective assessment tools lack of insurance or transportation and lack of awareness of the types and benefits of counseling services so those are all things that we can do in terms of removing barriers and outreach is addressing those issues and we've learned about how to provide culturally responsive group psycho education including how to teach to the collective cultural and how to be a more effective group facilitator how to make it more fun instead of just sitting there and talking or lecturing how can you get a group in engaged and stuff I love when I teach face-to-face because I'm able to do the small group activities in the breakout sessions and really get to know my students a little bit more and really get to drill down more into okay what concepts are more important to you and you know what may I have missed or not explained well and we learned about a variety of evidence-based practices demonstrated to be effective with African Americans if you enjoy this podcast please like and subscribe either in your podcast player or on YouTube you can attend and participate in our live webinars with Dr. Snipes by subscribing at all c e u s .com slash counselor toolbox this episode has been brought to you in part by all c e u s .com providing 24 7 multimedia continuing to counselors, therapists and nurses since 2006. Use coupon code counselor toolbox to get a 20% discount off your order this month.