TREATMENT AND CARE
As a comprehensive health center, we often work with people from different cultural backgrounds. These cultural backgrounds include areas of heritage, community, spirituality, family and individual identity, and geography. We work with these individuals to develop a cultural assessment for the purposes of improving their healing from addiction, mental health struggles, and overall healthcare.
Recovery is highly contingent on the presence of good therapeutic relationships, and many people of different cultural backgrounds often struggle with feeling supported and understood in healthcare. There may be language barriers or cultural insensitivity involved, leading to limited treatment compliance, awareness and trust. Taking the time to do a good cultural assessment can help build the foundation for good care. It also can give clinicians highly useful information such that we can make better recommendations.
What are some of the important factors present in this cultural assessment? This article describes some of the themes we have noticed in treatment and the importance of attending to such cultural health dimensions.
A cultural assessment is fundamentally open-ended in that it encourages the patient to express his or her views about heritage and lifestyle. We have many people who are part of a specific ethnic group who may or may not participate in common cultural practices of that group. Our job is to help the person describe their beliefs and lifestyle such that we can effectively blend themes of recovery and health with that person.
A good example of this involves immigrants, especially those who grew up in a primarily non-English speaking family. Our healing path fundamentally involves communication, hence paying particular attention to language is a good place to start in our cultural assessment. Some of the useful questions we might ask include:
- What language do you currently speak at home? Do you speak more than one language at home? How strongly do you feel with each language you speak?
- What language was spoken when you were growing up?
- If you have children or parents living with you, what languages do they speak?
- How have you experienced the healthcare system in the areas of language and communication? Have there been times in which an interpreter was involved in your healthcare? How did it go?
- Do you know of any local peer support groups, such as Alcoholic’s Anonymous, where your primary language is spoken?
Country of Origin and Citizenship
For immigrants, we may ask more detailed questions about their country of origin and citizenship. This is important for us to understand the person’s network of peers, potential anxiety and access to healthcare. This is also important for us in the screening of trauma, as refugee immigrants may have been victims of highly severe trauma prior to entering the United States. Cultural questions in this topic area may include:
- Where are you a citizen? Are you currently working through a citizenship process in the United States? Are there special actions you need to take regarding your immigrant status in the United States? Do you have any strong emotions or anxiety around this process?
- Do you associate with a community of people who have also immigrated from your homeland?
- How often (if ever) do you travel back and forth to your country of origin?
- Are there other people in your community of heritage who are in recovery from drugs or alcohol? Can you tell us what peer support means to you in this area?
- Did you enter the United States as a refugee? Were there traumatic or other threatening experiences you’d like to talk about as part of your treatment at CeDAR?
Healthcare Patterns and Beliefs
Additional general cultural questions are necessary for all people, regardless of being an immigrant or born in the United States. These address some very basic lifestyle themes including areas of dietary preferences, living situation within the home, family bonds and spiritual/faith beliefs. We also focus closely on beliefs and possibly negative experiences working with people in healthcare. Specific examples of questions might include:
- Do you have a primary care doctor or specialist doctor you see for your healthcare needs?
- Have you felt that healthcare providers have been sensitive to your cultural background in the past?
- Do you feel that taking medications would be an option for you in terms of your recovery?
- Do you take any other herbal remedies, vitamins or supplements for areas of your wellness?
- Are there certain cultural beliefs used to describe the cause of your illness or health problem?
Regional Factors and Geography
As we have reviewed in other articles, one of our most important goals of clinical work at CeDAR is to help someone embrace a continuum of care so they can maintain stable recovery over upcoming years. This trajectory is very much based on access to services. For patients who come from different cultural backgrounds, sometimes there are unique avenues for available care.
We have treated many patients over the years from American Indian heritage, including those who live on reservations in the State of Colorado or surrounding states. Just as with any patient, we need to understand what is available in terms of healthcare and peer support for these individuals. This is especially true for patients who receive advanced medication protocols like buprenorphine maintenance. The scarcity of physicians licensed to prescribed these meds across the state can influence how we might make medical choices for someone in treatment at CeDAR. An intervention that is highly difficult to follow once someone discharges from care will not be a sustainable, nor worthwhile approach.
The same applies for access to such services as Intensive Outpatient (IOP). Because an IOP approach lasts 3 months, a good referral would be something within reasonable proximity for the patient. If we link a patient to an IOP that may be a 60-minute drive for that individual, what are the chances the person drops out of the program? All of these factors are important in our continuing care recommendations process.
Finally, there are many people who fall into more than one cultural group. A person could be both an immigrant and part of the LGBT community. For these people, we seek to understand how they identify and to what core communities they belong. They may more actively embrace cultural themes from part of their background instead of other areas, or they may concurrently identify with all areas of their heritage.
It is also important for us to acknowledge that some people may be from a cultural background and not necessarily practice its beliefs and patterns. Someone could be of an American Indian heritage and be highly active in tribal practices or somewhat removed from such events. We learn through asking and showing curiosity in the diversity of those we treat at CeDAR.
Our efforts in conducting a cultural assessment are part of our greater healthcare initiative of delivering patient-centered care. What are the unique layers of someone’s life? We need to know how best to help anyone under our care, and this includes an awareness of cultural factors. The above examples illustrate some of the key areas we might consider in this process.