Development of Culturally Competent Mental Health Care

描述(由申请人提供)：最近的国家报告呼吁实施具有文化能力的精神卫生保健。然而，文化能力的概念和经验基础是薄弱的，因此限制了我们的护理系统可以做的事情来响应这一呼吁。本申请的总体目标是通过以下方式解决这些已注意到的局限性：(A)将现有的文化能力模式转化为治疗方法，(B)制定与该模式配套的培训方案，(C)与一组公共精神卫生从业者一起进行培训，以及(D)评估临床医生的文化能力技能是否随着培训的结果而增加，以及患者的满意度、治疗保留率和功能是否因临床医生的培训而提高。题为“改变文化镜头”的文化能力概念模型(洛佩兹，1997)将转化为一套系统的程序。此外，文化理论的最新进展将被纳入这本治疗手册。将制定一项培训方案，以促进治疗方法的实施。作为发展这一模式的第一步，培训的重点将是与拉美裔美国人合作，拉美裔是美国最大的少数民族/种族群体。将与加州圣克鲁斯县公共部门的30名心理健康从业人员(非精神科医生)一起对治疗手册/培训方案进行初步评估。将采用受试者内设计，在培训前与一名新入院患者和培训后另一名新入院患者进行录像临床互动，以评估临床医生和患者的结果。我们期望临床医生的文化能力技能，他们的治疗联盟，以及他们的热情表达将在培训后增加。此外，我们预计培训后患者的满意度、治疗保留率和临床功能将会提高。定性(叙述)措施也将被用来评估临床遭遇。

DESCRIPTION (provided by applicant): Recent national reports have called for the implementation of culturally competent mental health care. However the conceptual and empirical base of cultural competence is weak, thus limiting what our systems of care can do to respond to this call. The overall objective of this application is to address these noted limitations by (a) operationalizing an existing cultural competence model into a treatment approach, (b) producing a training protocol to accompany this model, (c) carrying out the training with a group of public mental health practitioners, and (d) assessing whether clinicians' cultural competence skills increase as a function of the training and whether patients' satisfaction, treatment retention, and functioning improve as a result of the clinicians' training. A conceptual model of cultural competence entitled "Shifting Cultural Lenses" (Lopez, 1997) will be translated into a systematic set of procedures. In addition, recent advances in culture theory will be integrated into this treatment manual. A training protocol will be produced to facilitate the implementation of the treatment approach. As a first step in developing this model, the focus of training will be in working with Latinos, the largest ethnic/racial minority group in the United States. A preliminary evaluation of the treatment manual/training protocol will be carried out with 30 mental health practitioners (nonpsychiatrists) who serve the public sector in Santa Cruz County California. A within subjects design will be applied such that both clinician and patient outcomes will be evaluated with Latino consumers in videotaped clinical interactions with a newly admitted patient prior to the training and another newly admitted patient after the training. We expect that clinicians' cultural competence skills, their therapeutic alliance, and their expression of warmth will increase after training. In addition, we expect that patients' satisfaction, treatment retention, and clinical functioning will increase after training. Qualitative (narratives) measures will also be used to assess the clinical encounter.