2. Introduction
Research studies have reported that
Haitian children have low utilization
of mental health services and
retention in care is often quite low
(Fawzi et al, 2009; Carson et al,
2010).
3. Children’s Behavioral Health
Initiative
The Child Behavioral Health Initiative
(CBHI), has community-based programs
that use the wrap-around model of care to
ensure children with significant
behavioral, emotional and mental health
needs and their families have access to
needed services in their school, home and
community.
4. In-Home Therapy
• Service is delivered by a clinician (Master’s level
mental health professional) and paraprofessional staff.
The aim of In-Home Therapy (IHT) is to address
children’s mental health issues by strengthening
family structures and supports.
• The IHT model is based on the wrap-around approach(
a team planning process that link children with mental
health needs to community-based services that focus
on the strengths and needs of the child and family.)
5. Overview of In-Home Therapy
• Strength-based approach to improve family dynamics
centered on collaboration from individuals and
systems relevant to the well being of the child.
family
MH
Providers
School
PCPs
DCF
Community
Resources
Child
Courts
6. Benefits of IHT for Haitian
Families
• Increases utilization and retention in
mental health care
• Increases family participation in the
therapy process
7. Benefits of IHT for Haitian
Families(cont.)
• Reduces stigma around accessing mental
health services
• Connects families who may be isolated
to needed community resources
8. Cultural Factors to consider when
providing IHT services to Haitian Families
• Level of trust is correlated with the type of
information that is divulged
• Haitian hospitality can be ways families try to build
trust
• Understanding of family members roles and family
dynamics
• The importance of faith and religion
9. Service Delivery Considerations
• Non-Haitian Creole speaking providers
must ensure that interpreters can
convey mental health information
accurately to clients.
• Therapy approaches that are task
oriented appear to be more effective
• Maintaining therapeutic focus
Hinweis der Redaktion
Historically, Haitian families have entered the mental health system either through school referrals or involvement with Department of Children and Families. The delivery of mental health services would often take place in a school or at a clinic office. The low rates that are being reported by the two studies cited above were for mental health care that were delivered at clinic sites.
The Children's Behavioral Health Initiative (CBHI) was established to implement the Rosie D v Patrick class action law suit filed on behalf of MassHealth-enrolled children under age of 21 with serious emotional disturbance (SED). Through CBHI, MassHealth recipients are able to receive home and community-based behavioral health services. So In-Home Therapy services is one of the community-based services provided under CBHI.
Under CBHI there are about six home and community-based services that are offered for children under the age of 21. In Home therapy is one of those services.
The case that I will use as an example consisted of a Haitian family involved with the following systems. When the family first presented the referral was for individual therapy for the child but after the intake process, IHT was offered because of the mom’s schedule and the issues they faced.
A compelling example of how well IHT increases utilization and retention in care is when compared to in office individual therapy. The case that I referred to of the Haitian family kept over 30 visits over the course of the year that they were in care. Compared to 15 visits for a client who was receiving individual therapy at the office. The only times that the IHT clients cancelled was for summer vacation and for holidays that fell during our
The IHT family would gather around the kitchen table for our sessions and both the parent and child had opportunities to express their thoughts. Whereas in the individual session the child started out on their own and the parent was allowed to come in later once the child agreed.
The obvious way that IHT reduces stigma for Haitian families is the it is provided in their homes. In addition to that IHT services help to take the focus away from the child as being the one in need of “fixing” to one where the family needs to pull together to help the child. Treatment goals are developed not just for the child but for parents and other members of the family.
Many Haitian families that come to IHT sometimes do not know how to navigate the different systems such as school, primary care, DCF etc, having teams members such as Therapeutic mentors and Therapeutic training and support specialists involved with the case help in linking the family to needed services and educate them about how these systems operate.
The In-Home Therapy team must be willing to invest a good amount of time to build a professional relationship with families. Families will often provide sensitive information that is crucial to the case once they felt that trust has been established. Providers must also be knowledgeable of cultural values as it relates to building trust and relationships.
This is crucial when providing feedback about psychological assessments and mental health concepts. Because the home environment is less formal than a clinic office, providers must ensure that a therapeutic structure is maintained in the delivery of services. Family wanting to get your opinion on decisions they should be making on their own.
