Cultural Competence in an MST and related programs for African American Males in the Juvenile Justice System
David G. Stewart, Ph.D., C.D.P. December 6, 2005
Prime Time/ FIT Team
Eric Trupin, Ph.D. David Stewart, Ph.D., C.D.P. Ann Vander Stoep, Ph.D. Terry Lee, M.D. Leonard Irving, C.D.P. Greg Terry Anthony Houston, M.S.W,C.D.P. My Banh, Psychology Resident Tracy Jones, Psychology Resident
Disproportionality
State of Washington White (non Hispanic) African American Youth of Color King County JRA JRA from Statewide King County 54% 18% 46% 30% 44% 70%
79% 3% 21%
73% 5% 27%
Prime Time Project
Youth in King County Detention
2 or more admissions Serious and/or violent offence Evidence of psychiatric disorder Evidence of substance use disorder Reside in Seattle or near suburbs Live with a caregiver Age 12-17.5 Priority Population African American males
Family Integrated Transitions (FIT)
Ages 11 to 17 at intake Substance abuse or dependence disorder AND Axis 1 Disorder OR currently prescribed psychotropic medication OR demonstrated suicidal behavior in past 6 months At least 4 months left on sentence Residing in service area
Demographics of Prime Time Youth 1995-2003 (n=195)
Race African American White American Indian Hispanic Asian Male Median Age
69% 21% 4% 3% 3% 62% 15
FIT vs. Comparison Groups
FIT Number 53 WSIPP 105
MH Transition Study
44
Age (years)
Percent Male Percent White Pct Black Pct American Indian Security Classification Score Criminal History score
16.2
77% 62% 28% 4% 44.3 15.3
16.3
88% 70% 10% 5% 44 15.6
16.9
79% 52% 27% 9%
Elements of MST programs
Small caseloads (4-6) Intensive training, supervision and consultation 24/7 availability of MST therapist Services provided in home and community
Social-Ecological Model
Neighborhood School Peers Caregivers Teen Siblings
School
Attached to school Achieving-moving toward graduation
Peers
Positive Peers Peers are involved in + activities
Caregivers
High Monitoring Consistent Discipline Low Conflict Expressed Warmth
Teen Positive Behavior
Neighborhood
Multiple adult(+) models - Recreational Activities Jobs/ training - Religious/Spiritual Guidance
Engagement, Accountability and Cultural Competence in the MST Model
Keys to Engagement
Treatment team responsible for engagement and provide services unconditionally Therapists are strength-focused Family members full collaborators; therapists align with parents Services individualized and comprehensive
Services provided in natural ecology (i.e., family home)
Creating an Environment of Alignment and Engagement
“My family and the therapist were honest and straightforward with each other.” “The sessions were lively and energetic.” “Family members were not engaged in power struggles with the therapist.”
Alignment and Engagement
“My family and the therapist worked together effectively.”
“My family and the therapist had similar ideas about ways to solve problems.”
“Family members and the therapist agreed upon the goals of the sessions.”
“A lot was accomplished during the therapy sessions.”
Cultural Competence
1. Interventions are designed to empower families to intervene in multiple systems, including ones that may be perceived as coercive or punitive 2. Interventions are provided by therapists who are : Culturally Competent and often Culturally Matched 3. Interventions are designed that are respectful of and consistent with the cultural values of the family and community.
4. Cultural strengths are recognized and developed as keys to change
Case Presentation
H., a 15 y.o., Eritrean-American male Marijuana Dependence, Ecstacy & Alcohol Use Oppositional Defiant Disorder Hx of thefts, domestic violence, truancy and noncompliance with probation Attending alternative school due to disruptive behavior and truancy At Risk Youth Petition
Ethnic Identity Development Hypothesis: Client is developing an identity and lacks/disregards positive role models
•Discuss with family in session •Discuss with cultural consultant •Confirmed: Youth is struggling with issues of identity development and acculturation
•Disassociated from negative peers •Successful enrollment in public school •More integrated identity development
•Provide positive African American role models •Exit alternative school and enroll in public school with diverse African American peer group •Enroll in activities to foster positive identity development- Martial arts, African language course, African American History group •MST-PLUS Relapse Prevention
Engagement and Completion (n=80)
Engagement
(>1 month of treatment)
African American White
c2(80,2)=6.00, p=.05
88% 64%
Treatment Completion
African American White
c2(80,2)=1.20, p=ns
72% 60%
Performance Indicators for FIT teams
Engagement and Treatment Dose (n=94) Total % Engaged in Services Post-Release 80 Avg. Days of Service Prior to Release Avg. Hours of Pre-release Service Avg. Number of Weeks of Service Post-Release Avg. Hours per Week of Face to Face Services with youth* 52 35 Team 1 Team 2 79 80 59 30 33 39
16
16
17
2.0
1.8
2.1
*note: an additional 2-3 hours per week are provided in family and community/ case management interventions
Adherence Ratings
Attempts to Change Interactions Non Productive Sessions Adherence Prime Time FIT 1 FIT 2 MST Standard
-0.4
-0.2
0
0.2
0.4
0.6
Prime Time Project Clinical Outcomes 1997-2002
The results of our clinical outcome evaluation of 80 youth enrolled in Prime Time and followed for one year demonstrate: In the COMMUNITY, Prime Time youth are less likely to be incarcerated, committing violent offences or engaging in criminal activity at 6 months and one year after entering treatment. At HOME, Prime Time youth are more likely to live at home and less likely to cause family conflict and violence after participating in the program. Prime Time youth are more often enrolled in SCHOOL and attend more regularly after completing the treatment program. Prime Time youth dramatically reduce SUBSTANCE USE after participating in the integrated mental health/chemical dependency interventions. The MENTAL HEALTH status of Prime Time youth at 6 mon ths and one year is much improved, including fewer behavioral problems and improved mood.
12 Month Recidivism
50% 40% 30% 20% 10% 0% FIT
* c2 (1,97)=5.68,
*
*
WSIPP Control
p<.05
MH Transition Study
Conclusions
MST as an ecological model of intervention lends itself to culturally competent adaptation Culture is a strength that can be leveraged by the culturally competent therapist Cultural specificity and matching are helpful but not sufficient to ensure positive outcomes Supervision, consultation and therapist/client collaboration are important elements of culturally competent practice Structured techniques like Cultural Hypothesis Testing enhance cultural competence, especially in a CBT oriented model