|
Health Disparities and Cultural Competence
-
Trigger Video
We encourage the use of these suggestions for using the trigger video in a small group format.
Click to view streaming trigger video (requires Real Player)
Right click (save target as) to download trigger video (Windows Media Player)
Working with small groups:
Every group has its own dynamic depending upon the size and composition of the group. In the best groups, members balance each other, assist each other and participate appropriately and proportionately in the learning activity.
The same is true when teaching a cultural competence curriculum that involves topics covering the diverse issues of race, ethnicity, socioeconomic status and which may include discussions regarding gender and sexual identity. Many of the barriers to communication regarding these issues exist in the general society and those barriers can and do extend into the medical dialogue. Examples to such barriers to communication include but are not limited to perceptions based on personal, family and historical experience, the setting in which the dialogue takes place (the sociocultural context of the dialogue ie. the difference between a living room and an exam room), language, etc.
Establishing the teaching environment as a safe place to discuss these issues is particularly important. Set ground rules: respect each other’s views, assure confidentiality, one’s experience is neither right nor wrong- it is his/her experience.
Effective facilitators will allow the small group to serve as not only the venue for teaching but as a resource for teaching as well. Each individual brings expertise regarding his/her personal perspectives that should be respected.
Role and use of trigger videos in small group teaching:
Our trigger video presents an example of a cross-cultural clinician/patient encounter, which happens to model as well the potential role of the clinician in relapse prevention.
Some of the important aspects of relapse prevention the facilitator can remain aware of include the acknowledgement that the individual dependent on alcohol who is trying to achieve sobriety and recovery and those with at-risk levels of drinking who seek to cut down will need to:
- Develop new coping skills for high-risk situations and relapse triggers
- Make lifestyle changes to decrease the need for alcohol
- Increase healthy activities
- Prepare to effectively handle “slips” to avoid a full-blown relapse
Depending on the group, video cases may trigger immediate relevant discussion, may trigger irrelevant discussions, or may yield silence. Before using this video trigger video, be sure to review it ahead of time and prepare a series of questions to prompt discussion should your group be the quiet type. Be sure to steer the group back on track should the discussion be off topic. If discussion is on-topic, be aware of the key points that you may want to reinforce and use the Socratic method to draw these points from the learners. The facilitator can do this informally or collect the points on a board or flip chart as the discussion progresses.
The video presented can be used to teach the elements of the RESPECT model, which is a helpful framework to remain mindful of to assure effective cross-cultural communication between clinician and patient.
Respect-a demonstrable attitude that can help mitigate power differentials. Shameful feelings can be minimized in a non-judgmental environment.
Explanatory Model- the clinician should remain sensitive to the patient’s point of view regarding his/her alcohol use.
Sociocultural context- the clinician should seek to understand and recognize how drinking influences or is influenced by class, race, education, ethnicity, family and gender roles (among others). It is also helpful for providers to become familiar with the culture of recovering communities. Some familiarity with 12 step programs (the language, expectations and experiences of those who participate) is invaluable.
Power- there is an inherent power differential within the clinician/patient encounter; experiences of those of a racial, socioeconomic, etc., background different from the provider can add to a perceived additional difference in power
Empathy- the clinician should try to assure the patient feels understood with attention to their concerns…”I believe I heard you say…is that right?”
Concerns and Fears- often a patient who is abusing alcohol has hidden fears about his/her drinking but is afraid to acknowledge them due to concern about the provider’s ill judgment of them. Further, these fears may be exacerbated if the patient believes the provider is judging them or treating them differently due to race or other difference.
Therapeutic Alliance/Trust- clinicians will enhance adherence and compliance with treatment and health promotion if they negotiate these with a patient who feels valued and understood. The primary care clinician has a wonderful opportunity to acknowledge the unique aspects of their patient’s alcohol use, become aware of their triggers to drinking and encourage their ongoing support and utilization of healthy lifestyle modifications that can diminish relapse to drinking.
Video summary - A cross-cultural interview/Relapse Prevention
Goals and Objectives
We suggest the facilitator review the elements of the RESPECT model and observe on the trigger video the demonstration of elements of the model. The comments can be positive or negative; that is, elements of the model that were demonstrated well or those that might have been handled in an alternate manner. It is fine to generate “what if?” scenarios for both the clinician and patient.
Ask your learners prior to starting the video to observe the behavior of both clinician and patient and feel free to explore the experience from each of their perspectives.
View streaming trigger video (requires Real Player)
Download trigger video (Windows Media Player)
The following table offers some suggestions regarding observations based on the individual aspects of the RESPECT framework.
|
Patient |
Clinician |
Respect |
|
- Begins with a complement, such as “great blood pressure.”
- Normalizes obtaining alcohol history, “something I ask everyone”
- When patient reports he’s an alcoholic and sober the clinician gives a warm smile and a congratulatory “good for you.”
|
Explanatory Model |
“I’m an alcoholic” |
- The clinician skillfully asks why the patient doesn’t drink and what’s helped him stay sober.
- They seem to have the same understanding of alcoholism as a disease process.
|
Sociocultural Context |
The patient easily uses the language of AA, such as “avoid triggers- people, places and things.” |
- The provider asks specifically which people, places and things.
- Acknowledges he’s figured out what causes problems and how to get support
|
Power |
|
- The provider empowers the patient when she puts him in the role as teacher- for example, teaching her about his disease by saying, “what has helped you stay sober?”
- Although the provider has good knowledge about alcoholism, she doesn’t make assumptions.
|
Empathy |
|
- The clinician states she is aware that people can relapse and asks if he ever has had a relapse.
- Empathetic response: “sounds like you learned something.”
|
Concerns and Fears |
Patient reports relapse 4 years ago-“I can’t be doing this” |
- The provider could explore his specific concerns or past experience.
|
Trust/ Therapeutic Alliance |
|
- Provider clearly states she’s not expecting problems but extends her ongoing support if needed.
|
Debrief
The comments above are just offered as examples of some of the observations that can be made. You can brainstorm with the group about encounters that might not have gone as well and if recalling elements of the RESPECT model might have helped get the encounter back on track.
Also remember that non-verbal observations are important as well. Eye contact, body posture, hand gestures are important as well.
It is also OK to acknowledge any feelings participants might want to share as they watched the video: were they comfortable, uncomfortable, did the video bring up any past experience they would like to share?
|
Return to Related Curricula
|
