PAC 240 Module 8 Helping Diverse Populations Example

Who Leaves Before Week Four: Adapting Addiction Services for Mothers, Sexual Minority Clients and a Somali Community

Student Name

Psychology and Addiction Studies Program, Aspen University

PAC 240: Helping Skills

Instructor Name

Month Day, Year

Who Leaves Before Week Four: Adapting Addiction Services for Mothers, Sexual Minority Clients and a Somali Community

Riverside Recovery Services, the composite outpatient program used throughout this course, reviewed a year of discharge data and found that most clients who left treatment early did so before their fourth week. Three groups left early more often than others: mothers of children under five, clients who identified as gay or bisexual and clients from Columbus's large Somali community, most of them men treated for alcohol or khat use. Staff had assumed that clients who left were not ready to change. This paper examines what research says about each group and proposes changes. The program, its data and the clients described are made up for this assignment; the research is real.

Women in Treatment

Greenfield et al. (2007) reviewed research on women's entry into, retention in and outcomes from addiction treatment. Women faced distinct barriers to entering treatment, including child care responsibilities, fear of losing custody of their children, stigma, financial dependence and partners who used substances or opposed treatment. Once in treatment, gender itself was not a strong predictor of retention or outcomes, but certain factors were: women with more severe psychiatric problems or histories of trauma were at higher risk of leaving. Services designed with women's needs in mind, such as child care, women-only groups and integrated services for trauma and parenting, were associated with better retention and outcomes in several studies.

Riverside's mothers of young children described the problem plainly in exit calls: groups met in the late afternoon, when day care closed, and there was nowhere for children to wait.

Lesbian, Gay and Bisexual Clients

Green and Feinstein (2012) reviewed research on substance use in lesbian, gay and bisexual populations. Several studies found higher rates of substance use and substance use disorders in these groups than among heterosexual people, with variation by gender, substance and age. The authors connected these patterns to minority stress, including discrimination, stigma, concealment and internalized negative attitudes, and to social settings, such as bars, that have historically been central to community life. They found that research on treatment tailored to lesbian, gay and bisexual clients was limited, though some evidence suggested that affirming services and attention to minority stress could improve engagement.

Riverside's gay and bisexual clients reported hearing jokes in groups that staff did not address and intake forms that offered only husband or wife as relationship options.

Cultural Adaptation

Benish et al. (2011) pooled head-to-head trials that pitted culturally adapted psychotherapy with the same bona fide therapy without adaptation. Adapted therapies were more effective, with a moderate advantage. The strongest moderator was adaptation of the illness myth, the explanation of the problem, its causes and its remedy that therapist and client share. Therapies that adapted this explanation to fit the client's cultural understanding outperformed those that adapted other features, such as language alone.

For Riverside's Somali clients, many of them Muslim men for whom alcohol carries deep religious shame, the program's explanation of addiction as a disease treated in mixed-gender groups where drinking is discussed openly did not fit their understanding. Some described khat, a stimulant leaf chewed socially in parts of East Africa, as a cultural practice rather than a drug, and felt it was being equated with alcohol.

Barriers and Changes

Developing Changes With Communities

The changes were not designed by staff alone. Riverside formed an advisory group of current and former clients from each group and partners from a local LGBTQ community center, a Somali community health organization and a family services agency. The Somali community health workers helped staff develop an explanation of problem drinking and khat use that drew on concepts of health, family responsibility and faith, and an imam agreed to meet with clients who wished to discuss religious concerns. The LGBTQ center trained staff and co-led an affirming group. Mothers on the advisory group shaped the child care plan and the women's group schedule. Retention will be reviewed by group every quarter.

What the Changes Do Not Assume

None of the changes assumes that every member of a group shares the same needs. Some mothers prefer mixed groups, some gay clients have no interest in an affirming group and many Somali clients are not religious or do not use khat. Each change adds an option rather than assigning clients to a track by identity. Clients are asked at intake which services they want, and the advisory group will review whether the options are used and by whom. The aim is a program whose default settings no longer push particular clients out, not a set of separate programs for separate groups.

Reflection

This course has changed how I understand helping. When I began, I believed that good helping skills were the same for everyone. I now see that the skills are similar but the explanations, settings and supports around them must fit the person. In my internship, I was the counselor who did not address a joke in group because I did not know what to say; I now have the words, and I have practiced them. I also learned to ask clients how they understand their problem before offering my own explanation, because Benish and colleagues' finding suggests that a shared explanation matters more than any technique I add to it.

Conclusion

Riverside's early leavers were not unready to change; they faced barriers the program had not seen. Greenfield and colleagues show how child care and women-focused services help women stay, Green and Feinstein show how minority stress and unwelcoming settings affect sexual minority clients and Benish, Quintana and Wampold show that adapting the explanation of the problem makes therapy more effective. Changes developed with each community give Riverside a way to help the clients it was losing.

References

Benish, S. G., Quintana, S., & Wampold, B. E. (2011). Culturally adapted psychotherapy and the legitimacy of myth: A direct-comparison meta-analysis. Journal of Counseling Psychology, 58(3), 279-289. https://doi.org/10.1037/a0023626

Green, K. E., & Feinstein, B. A. (2012). Substance use in lesbian, gay, and bisexual populations: An update on empirical research and implications for treatment. Psychology of Addictive Behaviors, 26(2), 265-278. https://doi.org/10.1037/a0025424

Greenfield, S. F., Brooks, A. J., Gordon, S. M., Green, C. A., Kropp, F., McHugh, R. K., Lincoln, M., Hien, D., & Miele, G. M. (2007). Substance abuse treatment entry, retention, and outcome in women: A review of the literature. Drug and Alcohol Dependence, 86(1), 1-21. https://doi.org/10.1016/j.drugalcdep.2006.05.012