This program is being implemented by the Lowell Community Health Center in Lowell Massachusetts. It is a program that was set in place to help the growing Cambodian community that they serve heal from the psychological trauma and memories of torture that they have. This program employs a method called Co-counselling that allows clients to feel more comfortable by having bi-cultural mental health specialists work hand-in-hand with the western specialists.
Multi-cultural Connections for Health
Groups Served by Program
The Cambodian community in Lowell, many of whom are torture survivors
Program Objective and the Needs Addressed
This program aims to overcome the stigma attached to using mental health services for both individuals and families. Despite the existence of known psychological problems, there is a cultural bridge that has to be crossed when it comes to the differing views of the causes of symptoms. The program provides psychoeducation about trauma, which enables clients to come in for behavioral health services at the Cambodia culture-specific health center and due to the fact that behavioral health is co-located with primary care, the stigma towards mental health care is reduced for older Cambodian refugees.
The program uses a care model called Co-counseling, whereby a licensed therapist and a bicultural paraprofessional work within an integrated primary care setting. The bi-cultural mental health specialist is always the same person with a client and acts as a co-counselor. This means that the specialist is free to ask follow-up questions on her own and to explain some of the concepts that the Western therapist may be trying to convey in her own words, in a way that is consistent with the culture and language. It could be understood this way: The bicultural specialist conducts the therapy in conjunction with and under the direct guidance of the Western therapist. So there is a certain amount of independence in the role, with a lot of coordination between the two providers. The specialist attends the team meeting to discuss client’s needs and progress. Some special service needs are handled by the specialist. The therapist “endorses” the expertise of the specialist with the client and vice versa. Sometimes only the specialist meets with a client. The bicultural worker also partners with the psychiatrist and psychiatric nurse practitioner for medication evaluation and management. Their role is critical in helping to overcome the stigma associated with psychiatric medication. The majority of the patients in this program do require medication.
This model is used mostly for individual therapy. The program also operates two Cambodian women’s support groups, which includes torture survivors. They operate self-management groups for depression and PTSD, based on the Stanford model: Chronic Disease Self-Management Program http://patienteducation.stanford.edu/programs/cdsmp.html. The model has been modified from 2.5 hours a week for 6 weeks to 1.5 hours for 10 weeks. These run parallel to and are not a substitute for psychological treatment.
Program Staffing and Required Staff Training
There are 3 clinicians, 2 bicultural mental health specialists, a psychiatrist and a psychiatric nurse practitioner with prescribing authority, and a bicultural case manager. The bicultural mental health specialist need not have formal training, they attend Lowell’s customized interpreter training OTJ and outside training in mental health issues and treatment.
They use the Hopkins checklist and the Harvard Trauma Questionnaire after 6 months and then 12 months. Their client enrollment has gone up from about 50-60 at the start of the project, to over 160 clients now. These are, by and large, older long term clients on SSI, due to chronic depression or PTSD.
Since the sessions are all in Khmer (a Cambodian language), it is the bilingual mental health therapist who is also hearing the torture story. They have their own trauma history, so it is important for the therapist to provide support for the co-counselor.
You can read the full interview with Lowell staff here.