Lowell Interview
Lowell Community Health Center Interview
Promising Practice: Multicultural Connections for Health
Interviewed
Nancy Colburn, psychologist; Sun Ly Lao, bi-cultural mental health specialist; Pat Lathrop, Director of Patient Care Services
What is the name of your care model?
Co-counseling —by a licensed therapist and a bi-cultural paraprofessional, working within an integrated primary care setting. There are 3 clinicians, 2 bicultural mental health specialists, a psychiatrist and a psychiatric nurse practitioner with prescribing authority, and a bicultural case manager. We started in 2000, when the Metta Health Center started, as part of Lowell Community Health Center to serve the large Cambodian Community in Lowell.
What problems does it address in serving refugee clients?
Strong stigma against using mental health services for both the individual and their family (e.g. medications are called “crazy meds”) despite known psychological problems; cultural bridge for differing views of the causes of symptoms (e.g. a “spell” is causing the symptoms) and for psychoeducation about trauma; clients able to come for behavioral health services to the newly created Cambodia culture-specific health center (Metta Health Center) because behavioral health is co-located with primary care, thus reducing the stigma,; very low education level of most older Cambodia refugees.
Do you see torture survivors using this model?
Yes, many.
Is there any special training for the bicultural mental health specialist role?
No formal training. They attend Lowell’s customized interpreter training, on the job and outside training in mental health issues and treatment.
How is it different than having a therapist and an interpreter who is allowed to act as a cultural bridge for the provider and client?
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. In some ways, 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 social 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 psychicatrist 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.
Have you evaluated this model yet?
We use the Hopkins checklist and the Harvard Trauma Questionnaire, after 6 and 12 months. Our client enrollment has gone from 50-60 when the project started to over 160 clients now. These are, by and large, older long term clients on SSI, due to chronic depression or PTSD.
Is your model only used for individual therapy or for group therapy as well?
Mostly individual therapy, but we also operate two Cambodian women’s support groups.
Do these pertain to torture survivors? Yes, they do.
We operate self-management groups for depression or PTSD, based on the Stanford model: Chronic Disease Self-Management Program. Our model has been modified from 2.5 hours a week for 6 weeks to 1.5 hours for 10 weeks. These run parallel to psychological treatment and are not a substitute for. We also are part of the Massachusetts Depression Collaborative.
Is there anything else you want to say about how the model works?
Since the sessions are all in Khmer (Cambodian language), it is the bi-lingual mental health therapist who is always hearing the torture story. They have their own trauma history, so it is important for the therapist to provide support for the co-counselor. For more information, contact Nancy Colburn at nancyco@lchealth.org or Pat Lathrop at patla@lchealth.org.
