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Assessing Culturally Competent Chemical Dependence Treatment Services for Mexican Americans

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Abstract

Mexican Americans struggling with chemical dependence are greatly underserved. Barriers to treatment include language, lack of culturally relevant services, lack of trust in programs, uninviting environments, and limited use and linkage with cultural resources in the community. This project aimed to develop a tool for assessing and planning culturally competent/relevant chemical dependence treatment services for Mexican Americans. Focus groups were conducted with experts in Mexican-American culture and chemical dependence from six substance abuse programs serving adult and adolescent Mexican Americans and their families. Sixty-two statements were developed describing characteristics of culturally competent/relevant organizations. Concept mapping was used to produce a conceptual map displaying dimensions of culturally competent/relevant organizations and Cronbach’s alpha was calculated to assess the internal consistency of each dimension. Analysis resulted in seven reliable subscales: Spanish language (α = 0.84), counselor characteristics (α = 0.82), environment (α = 0.88), family (α = 0.84), linkage (α = 0.92), community (α = 0.86), and culture (α = 0.89). The resulting instrument based on these items and dimensions enable agencies to evaluate culturally competent/relevant services, set goals, and identify resources needed to implement desired services for both individual organizations and networks of regional services.

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Acknowledgements

This research was funded by the Gulf Coast Addiction Technology Transfer Center. The authors would like to thank Emmitt Hayes, Director of Probation Service, Travis County Juvenile Probation Department, for contributing the concept of cultural relevance. This research was administered through the Center for Social Work Research, The University of Texas at Austin.

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Correspondence to Clayton Shorkey PhD, LCSW.

Appendix 1

Appendix 1

Instrument for Assessing Culturally Competent/Relevant Chemical Dependence Services for Mexican-American Clients and their Families (Items Grouped by Dimension with Average Ratings Identified by Original Randomly Assigned Number)

Dimension: Environment

  1. 14

    The agency provides an environment that is colorful rather than institutional in appearance when working with Mexican-American clients and their families (3.66).

  2. 28

    The agency provides Mexican cultural activities and celebrations (e.g., Dia de los Muertos and Cinco de Mayo) when working with Mexican-American clients and their families (3.40).

  3. 37

    The agency displays books, literature, art, posters, and newspapers that reflect the diversity of Mexican-American culture when working with Mexican-American clients and their families (3.37).

  4. 22

    The agency provides a play space for children that has culturally relevant bilingual videos, reading, and play material for families when working with Mexican-American clients and their families (3.34).

  5. 61

    The agency provides an atmosphere conveying Mexican-American culture through attention to the arts (e.g., dance, poetry, and music) when working with Mexican-American clients and their families (3.20).

  6. 53

    The agency provides an environment that contains living things (e.g., plants and birds) when working with Mexican-American clients and their families (2.91).

  7. 44

    The agency incorporates the use of religious and folk healing beliefs and traditions or rituals as part of the recovery process when working with Mexican-American clients and their families (2.66).

  8. 6

    The agency provides traditional Mexican foods and drinks (e.g., agua fresca, pan dulce) when working with Mexican-American clients and their families (2.23).

Average: 3.10

___

Dimension: Community

  1. 27

    The agency has developed linkages with community-based culture groups (e.g., Nosotras and Comadres) when working with Mexican-American clients and their families (3.71).

  2. 23

    The agency teaches classes in social and language skills needed for clients’ success in the broader cultural environment when working with Mexican-American clients and their families (3.66).

  3. 45

    The agency distributes culturally and linguistically relevant materials to the community, through placement in Spanish-language papers and periodicals when working with Mexican-American clients and their families (3.17).

  4. 51

    The agency has linkages with Spanish-speaking churches when working with Mexican-American clients and their families (3.06).

Average: 3.40

____

Dimension: Culture

  1. 17

    Staff receives training on culturally appropriate terminology to explain chemical dependence to Mexican-American clients and their families (4.43).

  2. 20

    Agency staff understands traditional Mexican-American cultural views related to addiction and its treatment when working with Mexican-American clients and their families (4.11).

  3. 21

    The agency incorporates an understanding of Mexican-American cultural views of drug use and the problems associated with it when working with Mexican-American clients and their families (4.06).

  4. 36

    The agency provides staff training related to the diversity of Mexican-American culture when working with Mexican-American clients and their families (3.94).

  5. 5

    The agency incorporates the use of culturally specific treatment techniques (e.g., dichos and platicas) in the treatment of Mexican-American clients and their families (3.83).

  6. 2

    Staff pays attention to the pronunciation and significance of their clients’ names when working with Mexican-American clients and their families (3.74).

  7. 52

    The agency incorporates an understanding of the role of machismo when working with Mexican-American clients and their families (3.66).

  8. 12

    The agency offers specialized family activities for clients and alumni as part of the recovery process when working with Mexican-American clients and their families (3.57).

  9. 15

    The agency uses families in recovery as mentors when working with Mexican-American clients and their families (3.54).

  10. 49

    The agency provides opportunities for staff to take courses on Mexican-American culture when working with Mexican-American clients and their families (3.31).

  11. 13

    The agency incorporates an understanding of differences related to ancestry when working with Mexican-American clients and their families (3.11).

Average: 3.76

____

Dimension: Spanish Language

  1. 1

    The agency has Spanish-speaking staff at all levels, including counselors, administrators, and support staff when serving Mexican-American clients and their families (4.34).

  2. 9

    The agency has Spanish-speaking staff available in person and by phone when serving Mexican-American clients and their families (4.34).

  3. 25

    The agency has interpreters to work with Mexican-American clients and families and help in all phases of the treatment process (4.26).

  4. 62

    The agency provides opportunities for staff to take Spanish language courses when working with Mexican-American clients and their families (3.83).

  5. 57

    The agency is committed to facilitating Mexican-American staff to work toward their LBSWs, LMSWs, LCDCs, or LPCs (3.74).

  6. 33

    The agency provides Spanish interpreters training in basic social work and chemical dependence concepts (3.69).

  7. 10

    The agency employs staff with similar geographic/cultural background as clients’ to foster rapport when working with Mexican-American clients and their families (3.54).

  8. 41

    The agency offers Spanish-speaking only groups for Mexican-American clients and their families who prefer this option (3.54).

Average: 3.91

____

Dimension: Family

  1. 4

    The agency uses motivational techniques to encourage Mexican-American families to participate in the treatment process (4.29).

  2. 7

    The agency emphasizes the importance of intergenerational family patterns of substance abuse when working with Mexican-American clients and their families (4.03).

  3. 60

    The agency incorporates an understanding of the significance of gender roles when working with Mexican-American clients and their families (4.03).

  4. 30

    The agency assesses the acculturation level of its clients and families as part of treatment planning when working with Mexican-American clients and their families (3.91).

  5. 59

    The agency includes both immediate and extended family members in the treatment of Mexican-American clients and their families (3.86).

  6. 38

    The agency assesses the level of acculturation stress and acculturative stress experienced by Mexican-American clients and their families (3.60).

Average: 3.95

____

Dimension: Linkage

  1. 26

    The agency links Mexican-American clients and their families with programs that provide classes in English as a Second Language (ESL) (4.17).

  2. 35

    The agency has developed linkages with health care programs when serving Mexican-American clients and their families (4.09).

  3. 42

    The agency has developed linkages to Spanish-speaking detox services when working with Mexican-American clients and their families (4.06).

  4. 3

    The agency has developed linkages with Spanish-speaking 12-step support groups (e.g., AA, NA, CA, Al Anon) when serving Mexican-American clients and their families (4.00).

  5. 58

    The agency provides linkages with programs for financial assistance for needy families when serving Mexican-American clients and their families (3.83).

  6. 18

    The agency offers a schedule of times when wage earners can access services when working with Mexican-American clients and their families (3.80).

  7. 19

    The agency has developed linkages with vocational training programs when serving Mexican-American clients and their families (3.77).

  8. 34

    The agency has developed linkages with programs that provide legal assistance to undocumented immigrants without threat of report to la migra when serving Mexican-American clients and their families (3.69).

  9. 11

    The agency has developed a community speakers program to provide clients with positive recovery models when serving Mexican-American clients and their families (3.66).

  10. 43

    The agency developed linkages with legal services to assist immigrants with citizenship, residency, or political asylum when serving Mexican-American clients and their families (3.60).

  11. 50

    The agency provides linkages with child care resources when serving Mexican-American clients and their families (3.46).

  12. 32

    Counselors seek the support and involvement of faith groups for developing prevention programs in the Mexican-American community (3.40).

Average: 3.95

___

Dimension: Counselor Characteristics

  1. 40

    Counselors understand the importance of privacy in the counseling relationship when serving Mexican-American clients and their families (4.57).

  2. 39

    The agency provides individually focused treatment plans when serving Mexican-American clients and their families (4.49).

  3. 46

    Counselors emphasize listening skills in communication when serving Mexican-American clients and their families (4.49).

  4. 56

    Counselors emphasize a person-to-person relationship when serving Mexican-American clients and their families (4.43).

  5. 55

    Counselors focus on developing trust and respect as the primary focus of the treatment relationship when serving Mexican-American clients and their families (4.43).

  6. 31

    Counselors build on the strengths of clients and their families when serving Mexican-American clients and their families (4.29).

  7. 29

    Demonstrates sensitivity to the shame associated with admitting to addiction problems for some Mexican-American clients and their families (4.20).

  8. 47

    Counselors “listen” to the body language of their Mexican-American clients and their families (4.17).

  9. 54

    Counselors demonstrate the difference between treatment and punishment for court-mandated clients when serving Mexican-American clients and their families (4.14).

  10. 48

    Counselors understand the significance of the impact of environment (rural, urban, street) when serving Mexican-American clients and their families (4.09).

  11. 16

    Uses gender matching of clients and counselors for Mexican-American clients and their families who have difficulty working with counselors of the opposite sex (3.83).

  12. 24

    Counselors use appropriate self-disclosure/sharing when serving Mexican-American clients and their families (3.74).

  13. 8

    Counselors are flexible in their decision making related to clients’ participation in the treatment program when serving Mexican-American clients and their families (3.71).

Average: 4.20

____

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Shorkey, C., Windsor, L.C. & Spence, R. Assessing Culturally Competent Chemical Dependence Treatment Services for Mexican Americans. J Behav Health Serv Res 36, 61–74 (2009). https://doi.org/10.1007/s11414-008-9110-x

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