A Systematic Review of Cultural Competence Trainings for Mental Health Providers

Providing antiracist cognitive-behavioral therapy: Guidelines, tools, and tips

This article addresses gaps in cognitive-behavioral therapy (CBT) when it comes to integrating racial issues that affect racialized patients' mental health. Traditional adaptations of CBT focused on social, religious, and linguistic challenges but neglected the critical aspects of interpersonal, institutional and systemic racism, internalized racism and complex racial trauma. This oversight has resulted in less effective outcomes for racialized individuals. The article proposes clear, applicable guidelines for clinicians to provide anti-racist CBT interventions. They cover clinical self-development, re-design the CBT triangular (thoughts, feelings, behaviors) theoretical framework, provide practical tools and tips to facilitate antiracist CBT interventions. Clinicians are encouraged to engage in self-assessment to understand their own racial biases and develop competencies to address racial issues and dynamics in therapy. CBT theoretical framework is re-envisioned to include environmental factors that impact the lives of racialized people, acknowledging the pervasive effects of racism on mental and physical health. The article also highlights the importance of creating a culturally safe therapeutic environment for racialized children, adolescents, and families, and emphasizes the need for specialized training to effectively serve these groups. The proposed guidelines aim to transform CBT practice, increase confidence of racialized individuals in mental health care, and ultimately decolonize CBT interventions.

Trauma focused-cognitive behavioral therapy training effectiveness in promoting professional development of psychotherapists working with unaccompanied minors in Greece: a non-blinded randomized control trial

The need to develop psychotherapists' skills to respond to current treatment challenges, such as addressing trauma due to the refugee crisis, is increasing. However, there is a dearth of evidencebased training for psychotherapists who work with refugees, especially in frontline countries. A randomly selected sample of 80 clinicians working with unaccompanied minors (UAMs) in Greek accommodation centers nationwide participated in an intensive trauma-focused cognitive behavioral therapy (TF-CBT) training (n=44) or a control-group (n=36) and completed the Professional Quality of Life Scale, the Work and Meaning Inventory and a questionnaire to assess knowledge and therapeutic skills, in pre-andpost measurements. Clinicians with 1-3 years of experience with refugees reported higher burnout (p=0.012, M=25.78 vs M=22.04) and secondary traumatic stress than those with less than a year (p=0.014, M=22.03 vs M=18.04). Positive meaning at work increased in both groups at post-test (TF-CBT group: p=0.019, M=15 vs M=13.6, and control group: p<0.001, M=15.17 vs M=13.42). The TF-CBT training group outperformed the control group in knowledge and skills (p=0.021, M=10.15 vs M=8.75) and identified a lower number of children with post-traumatic stress disorder symptoms (p=0.009, M=6.94 vs M=4.33) post-training. This study provides preliminary evidence on TF-CBT training effectiveness in equipping psychotherapists to work with UAMs, while their professional quality of life warrants further research.

Designing a Novel Digitally Delivered Antiracism Intervention for Mental Health Clinicians: Exploratory Analysis of Acceptability

BACKGROUND

There is a great need for evidence-based antiracism interventions targeting mental health clinicians to help mitigate mental health disparities in racially and ethnically minoritized groups.

OBJECTIVE

This study provides an exploratory analysis of mental health clinicians' perspectives on the acceptability of a web-based antiracism intervention.

METHODS

Mental health clinicians were recruited from a single academic medical center through outreach emails. Data were collected through individual 30-minute semistructured remote video interviews with participants, then recorded, transcribed, and analyzed using content analysis.

RESULTS

A total of 12 mental health clinicians completed the study; 10 out of 12 (83%) were female candidates. Over half (7/12, 58%) of the respondents desired more robust antiracism training in mental health care. Regarding the web-based antiracism intervention, (8/12, 67%) enjoyed the digitally delivered demo module, (7/12, 58%) of respondents suggested web-based content would be further enhanced with the addition of in-person or online group components.

CONCLUSIONS

Our results suggest a strong need for additional antiracist training for mental health clinicians. Overall, participants responded favorably to novel web-based delivery methods for an antiracism intervention. These findings provide important support for future development and pilot testing of a large-scale digitally enhanced antiracist curriculum targeting mental health clinicians.

A scoping review on the barriers to and facilitators of health services utilisation related to refugee settlement in regional or rural areas of the host country

BACKGROUND

Healthcare access and equity are human rights. Worldwide conflicts, violence, and persecution have increased the number of people from refugee or refugee-like backgrounds. Because urban areas are already densely populated, governments have aimed to increase refugee resettlement in rural and/or regional areas. Because of the complex healthcare needs of refugees, this creates challenges for healthcare service providers. Identifying barriers to accessing healthcare in rural areas is therefore important to better inform policy settings and programmes that will provide culturally appropriate patient-centred care to the refugee community.

METHODS

This review scoped 22 papers written in English between 2018 and July 2023 from five countries (Australia, New Zealand, Germany, Bangladesh, and Lebanon) in order to provide an overview of the barriers and possible solutions to facilitate refugees' access to healthcare.

RESULTS

The reviewed literature summarised the perceptions of at least 3,561 different refugees and 259 rural health service providers and/or administrators and identified major challenges. These include communication (illiteracy in the resettlement country language and lack of a suitable interpreter), lack of cultural awareness of health services, discrimination, and access difficulties (transportation, availability of health specialist services, cost). As a consequence, it was identified that improving access to affordable housing, employment through credential recognition, competence-level education for children, facilitating language training, and adapting health information would increase resettlement and encourage access to healthcare.

CONCLUSIONS

Refugees face significant barriers to accessing and engaging with healthcare services. This impacts their integration into rural communities and increases the prevalence of psychosocial issues like feelings of loneliness, low self-esteem, a lack of autonomy, and a lack of empowerment over informed decision-making, especially for women, jobless men, and the elderly. These findings support the need for additional support for refugees and healthcare providers to improve language proficiency and cultural competency. Policymakers need to improve the availability and accessibility of employment, housing accessibility, and service mobility. Additionally, more research is needed to assess the efficacy of emerging innovative programmes that aim to close the gap by delivering culturally appropriate patient-centred care to refugee communities in rural areas.

LGBTQ+ cultural-competence training effectiveness: Mental health organization and therapist survey outcome results from a pilot randomized controlled trial

Lesbian, gay, bisexual, transgender, queer/questioning and other sexual and gender diverse (LGBTQ+) persons frequently lack access to mental health service organizations (MHOs) and therapists who are competent with LGBTQ+ clients. Existing continuing education programmes to better equip therapists to work with LGBTQ+ clients are often not widely accessible or skills focused, evaluated for effectiveness and inclusive of MHO administrators who can address the organizational climate needed for therapist effectiveness. A virtual, face-to-face, multi-level (administrators and therapists) and multi-strategy (technical assistance, workshop and clinical consultations) LGBTQ+ cultural competence training-the Sexual and Gender Diversity Learning Community (SGDLC)-was tested in a pilot randomized controlled trial. Ten organizations were randomly assigned to the intervention (SGDLC plus free online videos) or control (free online videos only) group. Pretest/posttest Organization LGBTQ+ Climate Surveys (n = 10 MHOs) and pretest/posttest Therapist LGBTQ+ Competence Self-Assessments (n = 48 therapists) were administered. Results showed that at pretest, average ratings across organization LGBTQ+ climate survey items were low; twice as many items improved on average in the intervention (10/18 items) than control (5/18 items) group organizations. At pretest, therapist average scores (range 0-1) were highest for knowledge (0.88), followed by affirmative attitudes (0.81), practice self-efficacy (0.81), affirmative practices (0.75) and commitment to continued learning (0.69). Pretest/posttest change scores were higher for the intervention relative to the control group regarding therapist self-reported affirmative attitudes (cumulative ordinal ratio [OR] = 3.29; 95% confidence interval [CI] = 1.73, 6.26), practice self-efficacy (OR = 5.28, 95% CI = 2.00, 13.93) and affirmative practices (OR = 3.12, 95% CI = 1.18, 8.25). Average therapist and administrator satisfaction scores were high for the SGDLC. These findings suggest the SGDLC training can affect organizational- and therapist-level changes that may benefit LGBTQ+ clients.