Training and Education to Advance Multicultural (TEAM) Mental Health Care Delivery Model

As we become a more diverse and globalized society, health care providers are tasked with being able to recognize the complex contexts that influence the lives of patients from all walks of life. In particular, experiences with systemic oppression (like racism, sexism, xenophonia, and LGBTQ+ intolerance) can have negative effects on one’s health and wellbeing. And it is also true that vulnerable groups most affected by oppression often do not have adequate access to proper health care, contributing to health inequities. Further, it has been widely-documented that even when they are able to receive health care, they sometimes face discrimination in clinical encounters or receive care that doesn’t map well onto their identities and cultural backgrounds. These experiences combine to make health care settings generally unwelcoming to individuals from minoritized groups. These realities compound to develop and maintain vast and varied health inequities.

To off-set the aforementioned challenges, health care providers must make deliberate and active attempts to provide culturally-conscious care, defined as the:

“…process through which providers, educators, and researchers provide care that is attentive, sensitive, and responsive to all clients or study participants, especially those from marginalized, vulnerable, socially disadvantaged, underrepresented, and/or traditionally harmed backgrounds” (Nagy et al, 2020)

Patients have a basic right to quality health care that is attentive and respectful of their lived experiences, as they can influence health and wellbeing. All patients deserve respect, especially while seeking health care, which can be a vulnerable experience.

Despite the recognition for training in this area, health care providers often report not receiving enough multicultural education in their graduate and medical training. And, trainees commonly report that their clinical supervisors have not receive adequate training in this area leaving gaps in the supervision they receive.

In recognition of the need for such multicultural education, my colleagues and I developed the TEAM Mental Health Care Delivery Model through several iterations of this curriculum with psychology doctoral students, psychiatry residents, and mental health psychiatric nurse practitioners.

The TEAM Model incorporates experiential, discussion, and didactic components. Training content centers on constructs broadly applicable to multiple identities and emphasizes intersectionality and within-group heterogeneity. Topics broached include:

• Orientation to multicultural psychology/cultural psychiatry

• Identity development and intersection of identities

• Power, unearned privilege, oppression

• Psychological impacts and unique challenges of immigration on families

• Inequities in mental health care

• Language barriers in treatment and use of translation services in clinical care

• Cultural idioms of distress

• Culturally-conscious care for LGBTQI+ individuals

• Conducting cultural assessment (Cultural Formulation Interview)

• Developing a cultural case conceptualization

• Behavioral indicators (strategies) of providing culturally-conscious care

• Implicit bias, microaggressions, and discrimination in clinical care

Efforts to evaluate this model have evidenced high efficacy, acceptability, and feasibility.

References:

Nagy, G. A., LeMaire, K. L., Miller, M. L., Bhatt-Mackin, S., & Railey, K. (2020). Training and education to advance multicultural mental health-care delivery (the “TEAM mental health-care delivery model”): A pilot evaluation of outcomes, acceptability, and feasibility. Training and Education in Professional Psychology. Advance online publication. https://doi.org/10.1037/tep0000347.

Nagy, G. A., Arnold, M. L., Gagliardi, J. P., Convoy, S., Molloy, M., Wall, P. Mauro, C., & Rosenthal, M. Z. (2021). Adaptation of the TEAM Mental Healthcare Delivery Model: A mixed-methods evaluation. Issues in Mental Health Nursing. https://doi.org/10.1080/01612840.2021.1975330.