DMH Office of Communications and Community Engagement

Commonweath Conversations

Department of Public Health Blog

From "Culturally and Linguistically Competence" to "Culturally Comfortable" Care

By Ed K.S Wang, Psy.D.

Director

DMH Office of Multicultural Affairs

In the recent blog Hold On, It's Not Over, Lisa Lambert, Executive Director of Parent/Professional Advocacy League (PAL), brought forward the concept of "culturally comfortable" care for discussion. "When programs strive to be culturally competent, the result should be that families are 'culturally comfortable.' Most parents and youth can tell you whether it is easy and comfortable for them to be connected to and involved with a program. Feeling culturally comfortable helps families decide how they view a program, a worker or a service."

The goal of the Department's Consumer and Family Satisfaction Survey is to evaluate service satisfaction. It also includes a sampling of multicultural and linguistically diverse clients and their families. The survey result has provided a glimpse of the youth, young adults and families' experiences of the Department's services. What better way to come up with additional measures of satisfaction based on the concept of "culturally comfortable" care than from those receiving the services? 

The PAL blog discusses increasing cultural competence in the delivery of mental health services for children can help reduce disparities and increase access. "Changing a setting, practice or dialogue so that it becomes more 'culturally comfortable' is something that families can notice and determine for themselves."

Recovery Through Partnership is the Department's guiding principle that supports recovery, consumer empowerment and choice. We have committed to the integration and transformation of cultural knowledge, information and data about diverse individuals and groups into specific clinical standards, skills, service approaches and techniques that match the individual's culture. This has been the Department's operational definition of cultural and linguistic competence to increase access, quality and appropriateness of mental health care and outcomes. How do we know our commitment is working? As the PAL blog stated, "parents and youth can tell you whether it is easy and comfortable for them to be connected to and involved with a program."

The "culturally comfortable" care relates to the feeling of being comfortable as recipients of services. It extends beyond cultural awareness and cultural sensitivity.  Feeling comfortable also provides families, children, adolescents and young adults the security to comment on services planned and received. It also enables us as partners to participate in service planning and changing any negatively perceived or experienced services that are often highlighted in health disparities research as one of the key barriers towards health equity. A culturally and linguistically comfortable service environment is the gold standard of care of shared respect, shared knowledge and shared learning together to achieve wellness and recovery.

As the PAL blog said, "When programs strive to be culturally competent, the result should be that families are "culturally comfortable."  We welcome Lisa's invitation to join PAL for further discussions on the relation of cultural and linguistic competency strategies and the result of "culturally comfortable" care and practice. "Nihil de nobis, sine nobis" or "nothing about us without us" is the key to further understand and define what works for our youths, young adults and their families to improve the Department's goal of culturally and linguistically competent care.

A group of Tewksbury State Hospital staff and individuals receiving services recently attended the 10^th Annual Massachusetts Psychosocial Rehabilitation Association (MassPRA) Conference, "Putting Our Collective Vision Into Action: Enriching Lives in the Community," held at the College of the Holy Cross in Worcester.

The Recovery Model is alive and well at Tewksbury Hospital and staff are committed to support transition to the community for consumers, finding that participation in an event such as a conference promotes sharing, collaboration and growth and can act as a catalyst for individual progress.

Individual choice and assuming personal responsibility and directing one's own life were key components of the conference and were fostered by many aspects of the day, from choosing what session to attend to selecting lunch from a great buffet.

The keynote speaker, Judith Cook, Ph.D., from the University of Illinois at Chicago, spoke about the "tools" available to promote self-determination as well as support person-driven services. Dr. Cook focused on being in charge of one's own life and choosing how one would want to live it. The conference also offered 27 interesting sessions throughout the day, ranging from peer roles and skill building to understanding trauma, employment and support services, transition, CBFS, Clubhouses, health and wellness, current research and how to become a Certified Psychiatric Rehabilitation Practitioner.

One individual described his conference experience this way: "It was great, I learned a lot of information. I was encouraged to apply to go to college there and it gave me a chance to see the college." He also voiced interest in becoming a Certified Peer Specialist. Participating in conferences and available community events exemplify the true nature of recovery from mental illness.

Tewksbury Hospital is also proud that Ann Roy, Director of Rehabilitation for the Northeast-Suburban Area, was co-chair for the conference. All are now looking forward to the USPRA conference, which will be held in Boston this coming spring on June 13 through 16.

Tuesday March 1, 2011
Bullying and Young People Webinar
Featuring the new Words Can Work® DVD
Bullying: True Stories

3:00 to 4:30 p.m.

 Please join us ONLINE for a free Webinar offered by
McLean Hospital and Blake Works.

This Webinar is offered to personnel from Massachusetts public and private schools, colleges/universities, and school-affiliated programs. When you register, we'll send you a complimentary DVD Bullying: True Stories and booklet Words Can Work: When Talking About Bullying.  Please review these resources prior to the Webinar.

Register Online   Click here to register    If registration has closed, please contact info@wordscanwork.com  to be put on the waiting list.

After registering you will receive a confirmation email containing information about joining the Webinar.

Please contact us at info@wordscanwork.com
or 978.282.1663 with any questions

_______________

NEW DATE

Thursday April 28, 2011

Postponed from the January 27 snow storm

Screening of the DVD

Bullying: True Stories

and

Educational Forum on Bullying

9:30 to noon

Massachusetts State House

Gardner Auditorium

Presented by

Partners Healthcare: Massachusetts General Hospital and Brigham and Woman's Hospital

Co-Sponsored by

Massachusetts Department of Public Health

Massachusetts Department of Mental Health

The DVD is produced by BlakeWorks. Organizations attending the event will receive a DVD and companion booklet to use as educational tools.

Please RSVP

info@wordscanwork.com

Community First and our Future is the theme as DMH holds its annual series of citizens legislative breakfasts, an opportunity for members of the mental health community to meet with their legislators, thank them for their support and discuss how DMH helps people with mental illnesses recover and live satisfying lives in communities of their choice.  It is also an opportunity for consumers and family members to share good news and success stories about their life experiences. 

 The Great Hall was filled to capacity as the Northeast portion of the Northeast-Suburban Area kicked off the series on February 8. Local Boston Singer/Songwriter and Recording Artist Dan Martin (pictured at left) entertained attendees during the social time before the presentations began. Dan is a regular performer for the Chelsea Soldiers Home and known as "The Official Folksinger" of "The Steve LeVeille Broadcast" on WBZ News Radio1030. He is also a traveling troubadour with the musical group, "Tunefoolery."

Senator Patricia Jehlen and Representative Paul Donato were the legislative sponsors for the event. "Their leadership and support are vital to the individuals we serve, and we are delighted that they stand with DMH in our efforts to make mental health a priority," said Commissioner Leadholm.  

Individuals with lived experience shared their personal stories of recovery, providing heartwarming and encouraging words for the gathering. Grace Kristyna told her story of her recovery from PTSD and depression that she first noticed when she was nine years old. "I was connected with a kind DMH worker for 10 years who helped me get the services and benefits I needed," she said. "She helped as I transitioned from hospitals, to group homes, then my own place for the last seven years. In that time I completed my associate degree with high honors despite my illness." Grace also credited peers in her recovery, a model that gives hope in a healing way for all involved.

Jeanne Hussey (pictured here) spoke passionately about her son Matt's experience with mental illness, through anxiety, depression, auditory hallucinations and suicide attempts. She shared how she is particularly grateful that Matt was able to attend the Solstice School in Rowley where he was able to live and get the supports that he needed.

"DMH attended every meeting, they were my eyes and ears when I was at the end of my rope and couldn't listen anymore," she said. Jeanne says she now pays it forward as a family partner which allows her to look at parents and be able to say I know just how you feel, I have been there and there is light at the end of the tunnel.

The final speaker was Robert "Bob" Boisvert who was introduced by his mother Jenn. Jenn shared some background on Bob and his difficulties with depression and hallucinations which began when he was in the fifth grade.  Now a student at Bridgewater State University, Bob is an English major and a confident writer, poet and speaker.

Upcoming DMH Citizen Legislative Breakfast events:

Commissioner Leadholm and Senator Patricia D. Jehlen  Click here to view more photos from this event

Tuesday, March 8

Metro-Southeast Area

Great Hall, State House

Tuesday, March 15

Northeast-Suburban Area

Great Hall, State House

Friday, March 18

Central-West Area

Worcester Technical High School, adjacent to Worcester State Hospital

Friday, April 8

Central-West Area

Springfield Technical Community College 

For the past two years, a unique cross-agency group has been working on the issue of self-injury. The group's diverse membership includes Joy Connell, Dr. Mary Ellen Foti, Sian Mason, Brenda Peterson, Ellie Shea-Delaney and Lucille Traina from DMH; Deborah Delman, Amanda Morley and Emily Russel from The Transformation Center; Douglas Kozlowski from Mass Behavioral Health Partnership (MBHP);  Laurie Markoff from the Institute of Health and Recovery; and Beth Filson from the National Association of State Mental Health Program Directors (NSMHPD).

Three forums held last spring elicited feedback on the issue of self-injury which has informed a set of draft guidelines for providing trauma-informed care for individuals who use self-injury.

It is estimated that 90 percent of public mental health clients have a history of trauma, and that most have experienced multiple trauma. Of the many responses to trauma, one of the most challenging for providers and for family and friends is the use of self-injury.  Also referred to as "self-inflicted violence," "self-harm," and many other terms, self-injury is the intentional physical harm to one's own body. This may take many forms such as cutting, burning, punching or swallowing objects.

Unfortunately, the many myths surrounding self-injury pose barriers to effective treatment. A common response to people who use self-injury focuses on risk management and containment.  Providers often confuse the person's attempt to manage their underlying emotional pain by using self-injury. It is often confused with suicidal intent or symptoms of borderline personality disorders.  In fact, hospitalization and restraint, often the treatment offered, may result in further traumatization of the individual.   

This cross-agency self-injury work group is now offering to mental health providers an opportunity to enhance their experience and expertise through training and technical assistance. This opportunity is available for a consortium of programs that choose to apply to be trained together in the delivery of trauma-informed care. At the end of this project, the hope is to increase the use of healing responses to people who use self-injury in Massachusetts. Rather than asking the person "What's wrong with you?" the question will become "What happened to you?" It is a significant shift.

For a copy of the application or any other information regarding the project, please contact Fariha Quadir at Fariha.Quadir@MassMail.state.ma.us  or leave her a message at 617-626-8067.  She will direct the question to an appropriate person on the workgroup who will respond to questions and requests.

By Caryl Beth Thomas, MA, ACMT, LMHC

Music Therapist, MBMHU Rehabilitation Department

For the past several months, the sound of live music is all around the halls of the Metro Boston Mental Health Units (MBMHU) programs at the Lemuel Shattuck Hospital. It is the sound of music therapy, which is now a full-time treatment modality within the rehabilitation program at MBMHU. Since music is something that people from all corners of the earth and all walks life can relate to and have experience with, it can serve as a valuable and effective type of treatment for almost anyone.

Sometimes music can help someone make a connection and provide an opportunity for engagement when nothing else has been successful. Those who have been withdrawn and isolated often will respond to music, either actively and passively, and are offered a path to reconnect with others through musical expression, exploration of sensory experiences and tapping into strengths that had been dormant. It is striking to observe an environment that is tense and loud one moment and that with the introduction of a drum, a guitar or a song suddenly transforms to a community with respect and smiles. This is the experience that we see over and over again with the presence of a skilled music therapist.

Music therapy provides opportunities for a sense of camaraderie and relatedness in a unique and positive manner. Musical experiences can help build community. People have come together in music in every culture and civilization for eons, and now they come together in music therapy in the MBMHU programs. Sometimes it is one individual who connect to his caregivers. Other times it is a larger group that refocuses to listening and participation in a song. This can make the difference between a stressful atmosphere to an environment of cooperation and engagement. Music can be calming and soothing and therefore used as a mode of relaxation and much needed respite. It can also bring energy and vitality to those that it touches, and so can also be used as a means of grounding and focusing in the here and now. There is potentially something for everyone in shared music experiences facilitated in the process of music therapy.

Recently one individual awaiting discharge was feeling anxious about the prospects of taking care of his infant daughter that he had barely ever been around. He was able to use his individual music therapy sessions to process his fears and worries. He eventually transferred those feelings into words that became a song that he then wrote for her. This process helped him deal with his own fears and feelings and also provided him with something he could take with him. The hope is that he could use this song to help him as he transitioned into an unfamiliar role of being a parent.

Music therapy is a clinical intervention firmly anchored in research and evidence based practice.  It can be applied individually, in groups and in community settings. Our goal is to continue to strengthen our expressive therapy programs including music therapy and offer these opportunities to patients to help promote hope, effective communication, increased safety and engagement in treatment. Music therapy sessions are now an integral part of the MBMHU inpatient units, with sessions on the units and in the various daily rehab programs and a community- based weekly drum and song circle held in the evenings off of the units.

The drum and song circle began as an evening dedicated to "Songs of Peace" to commemorate 9/11 this year. The patients enjoyed this event and it now is a regularly scheduled group in the evening rehab program that focuses on simple songs of peace, hope and good will and the coming together of people with unity of purpose. One can hear the group most any Tuesday evening singing "we gather round this circle today, we gather round to sing and play,together."

By Sabrina L. Davis

Center Club Member

In 1986 I was diagnosed with Type 2 Diabetes. When the doctor informed me of this I became emotionally deregulated. I did not know that I had diabetes. I had what is called a diabetic thirst. One day I drank a quart of eggnog and a half gallon of orange juice. I was rushed to the Cambridge Hospital and my blood sugar was 608. I could have died.

I had to follow the ADA diet which meant limiting starches and avoiding concentrated sugars. Twice a day I injected myself with two types of insulin and I performed at least four finger sticks every day to monitor my blood sugar throughout the day.

My doctor told me two things: follow the ADA guidelines and walk 20 minutes everyday. Soon those 20 minutes turned into five miles on weekends and some form of exercise every day. I lost some weight, so my doctor discontinued the daily insulin injections and started me on diabetic pills.

A few years ago I lived at a local YMCA. Employees and residents have access to the gym. I lived there for three years and I lost about 40 pounds, so my doctor reduced my diabetic medication in half--WOW!

When I moved from the YMCA, I no longer had my free membership to the gym. I did not want to stop exercising so I returned to Center Club. I was directed to Leonard Campbell who told me about the Wellness Project and the gym facilities at the Lindemann Mental Health Center which are free for club members to use. I went to the gym three times a week and earned a Center Club T-shirt.  Leonard and I became gym buddies. We shot baskets at the gym to vary my exercise regimen. My workouts were not boring!

A little over a year ago, I learned about the InSHAPE Program run by Vinfen and I became involved in that. The National Institute of Mental Health is doing a study on people who have mental illness and are overweight. In the study, there are two groups of participants who receive a free one-year membership at the YMCA, a physical therapist and a nutritionist. One group works with a health mentor/personal trainer, the other group does not. Fortunately I was part of the group that gets a mentor/trainer. Everyone participates in a series of interview sessions to gather the research data. For example, they might record your blood pressure, weight and a fitness test. The study is measuring to find out if those participants who receive a personal mentor achieve better results. My trainer was tough on me. She encouraged me to do more than I thought I could. When my workouts became routine, my trainer introduced me to new exercises. She kept me motivated!

On my next trip to see my doctor, my dosage of the diabetic pills was cut in half again and she said, "You're on your way to going off your diabetic pills." Eating healthy has always been a battle and sometimes I thought about giving up. Sometimes I stopped focusing at my gym sessions, but I committed myself to exercise no matter what.

In spring 2010 my doctor left me with the idea that if the next test was as good as the others, the pills for my diabetes would be discontinued. Last fall I finally got a letter from my doctor telling me to stop taking the pills. One of my fitness goals was to stop taking the diabetes medication and I've succeeded!

Since its expansion last spring, the North East Recovery Learning Community (NERLC) and Metro Boston Recovery Learning Community warm lines have been open Tuesday through Sunday from 4 to 8 p.m. The peer-run and entirely peer-staffed compassionate listening and information and referral line is open to callers in the North East and Metro Boston Areas. 

In less than a year, the peer warm line has gained national recognition. The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) also featured the peer warm line in their Recovery to Practice (RTP) Weekly Highlights.  The article gives readers some background on the warm line as well as Boston Emergency Services Team (BEST). BEST provides 24-hour services for adults and youth in need of immediate psychiatric intervention. Individuals who contact BEST are treated by experienced master's level clinicians, physicians, peer specialists and family partners who specialize in rapid community response to those in psychiatric crisis. The warm line and BEST are located across the hall from each other and they have created a great partnership. The peer warm line has been useful in alleviating calls that are not emergency situations but are from individuals simply need of a compassionate listener. The New York Association of Psychiatric Rehabilitation Services featured the article Warm Lines: Peers Helping Peers Featuring The Metro Boston Recovery Learning Community in their newsletter also.

Sheila K. (pictured) and Sam A. are the co-coordinators of the peer warm line. "Each human being has the basic need and right to be heard. Even with the multitudes of human beings surrounding us each day, finding a compassionate ear to simply listen as we express ourselves is a difficult task. The peer warm line seeks to make this task more attainable. We are here to listen compassionately and respond thoughtfully.  

"Those who call are offered a forum to be sincerely heard and validated by caring operators who have had personal lived experience with mental health diagnoses. Our goal is to facilitate a caller's exploration of their own inner wisdom rather than give advice. We encourage and empower folks to take an active role in their own recovery process. We desire and strive to see this type of support become available to more people who are seeking an open ear," said Sam.

The peer warm line is accessible by calling 877-733-7563, a toll-free number that can be easily remembered, as it spells 877-PEER-LNE on a standard phone. All are encouraged to refer anyone in need of support and a listening ear.

MBRLC additionally hosts the site http://www.warmline.org. This site contains links to warm lines by state, offers a link to mental health peer-operated crisis respite programs and provides access to warm line electronic mailing subscriptions as well as peer-run respite electronic mailing subscriptions.

For information on the Peer Warm Line, contact Chuck Weinstein, LMHC, NCC, at 617-305-9989 or info@bostonresourcecenter.org. 

Celebrates the Opening of the Brown Community Wellness Center

The Western Mass Recovery Learning Community (RLC) said goodbye to Co-director, Oryx Cohen (pictured here) by celebrating the opening of its new Bowen Community Wellness Center this month in Springfield. The celebration included food, music and community speaking time. 

The RLC's Bowen Community Wellness Center is now open at 340 Main St. in Springfield. The center hours are Wednesday through Friday from noon to 6 p.m. There are a variety of treadmills, ellipticals, bikes, hand weights and weight machines available. On days when the Wellness Center is not open for drop-ins, the center hosts such activities as Reiki, yoga, hip hop dance and women's self defense. The Wellness Center is free and open to the public.

The Bowen Community Wellness Center is named after the late Shelley Bowen, a Springfield native who was active with the RLC's advisory council and much loved within our community. The Wellness Center is now down the hall from the existing Bowen Resource Center.

At the celebration, the RLC said good-bye to one of its co-directors, Oryx Cohen. Oryx was a founding member of the RLC and co-director since its inception in 2007. During his tenure, the RLC has opened centers in Holyoke, Greenfield, Pittsfield and Springfield. 

Oryx's next endeavor will be with the National Empowerment Center (NEC) as the Director of NEC's Technical Assistance Center, one of five federally funded Technical Assistance Centers in the United States. Oryx will be doing similar work helping transform mental health systems to more recovery-oriented, peer-run approaches, except now at a national level.

The Western Mass RLC is entirely peer-run and supports individuals in finding their own path to recovery within communities of their choice by offering trauma-informed peer supports and through the development of a regional peer network. They were honored at the Commissioner's Distinguished Service Award ceremony held last spring

at the State House. The main center of the RLC, the Holyoke Resource Connection Center (RCC), is located in downtown Holyoke, 187 High St., Suite 303. For more information about the Western Mass RLC please call toll-free 866-641-2853, e-mail info@westernmassrlc.org  or visit the Western Mass RLC website at www.westernmassrlc.org.

Commissioner Leadholm presents Oryx Cohen and Sera Davidow with the Western Mass. RLC Commissioner's Distinguished Service Award at a State House ceremony held last spring.

Lynne Musto, Northeast-Suburban Site Director for the Arlington Site Office, was recently presented with a Shining Star Award from The Edinburg Center, a DMH CBFS provider. Lynn was honored for her continual support, guidance and dedication to The Edinburg Center's DMH contracts for more than 20 years.   

"A Night of Shining Stars" is an annual recognition event that formally acknowledges the exceptional accomplishments of people served, staff and community friends of The Edinburg Center. This presentation marked the 10th anniversary of this event.

Lynne's nomination was made by The Edinburg Center senior management staff. Award selection was made by Edinburg Center Associate Director Holly Baab and CBFS Director Vicki Fredrickson. PACT Team Leader Mark Koenig presented the award to Lynn. Along with a plaque and brass Shining Star paperweight, Lynne received legislative citations from Senator Kenneth J. Donnelly and Representative Jay R. Kaufman. 

Pictured right to left: Holly Baab, Associate Director, The Edinburg Center; Lynne Musto, East Suburban Site Director, DMH Northeast Suburban Area; Vicki Fredrickson, Director of CBFS & ICS Services, The Edinburg Center; and Mark Koenig, PACT Team Leader, The Edinburg Center.

 

About the New Header for DMH Connections

1. Commissioner Leadholm joins the Central MAss drumming performance at the May 2010 Commissioner's Performance Recognition Awards Honoring the RLC's.

2. The Award Winning Express Yourself Performers at their 2010 show.

3. Commissioner Leadholm and the Recovery is Real team at the 2010 NAMI Walk

4. Governor Deval Patrick speaks at the Topping Off Ceremony of the New Hospital in August 2010.