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Discuss about the Interventions to Treat Addictions in Indigenous Populations.

Cultural modification of the intervention

Ben is a 65-year-old Aboriginal man who is the eldest of the family comprising of four sons with their wives and children. He is a strong follower of the aboriginal traditions and cultures and is not fond of the western culture of professionalism, healthcare, education and many others. He is aware of the historical turmoil that the period of colonization had affected the mental and physical health of his ancestors and how it had affected their wealth and resources resulting in very poor living conditions. Therefore, he is not very fond of the western culture. From the last few days, he had been having symptoms of cardiac disorders and his excess reliance on alcohol and tobacco had been contributing to these symptoms. However, he believes strongly that smoking tobacco is part of their cultural traditions and he cannot overcome such traditions. His sons have requested him to visit the health clinic to get help regarding his substance abuse disorder so that his chances of becoming affected by cardiac disorders become less. He has never considered this to be of a concerning factor and does not believe that this habits and behavior can hardly cause any harm. However, he has just visited the ward to keep the request of the sons and can change his behavior for his sons.

The patient is attended by a western healthcare professional, who has proposed cognitive behavioral therapy for the modification of the behavior of the patient. The professional in this case cannot apply the "one treatment method for all" mode of technique for the cognitive behavioral therapy with the client. This is because of a number of factors. The patient does not trust the western mode of treatments, maintain strong native traditions that do not align with western healthcare and the patient does not himself want to be treated. These will be the barriers in the therapy. Therefore, the professional needs to modify the therapy in different ways so that it can help in the successful treatment of the client (Lee et al., 2015).

A number of innovative ideas can be developed for the modification of the therapy in ways by which it suits the cultural traditions, preferences and inhibitions of the patient.  The different new incorporations that should be done would be setting the therapy sessions in open green areas that would be free from regular rushes of patients probably in the garden or areas beside lakes. The second modification that should be done is allocating two extra sessions for developing a rapport with the patient following which the therapy sessions would be started. Extra 15 minutes would be allocated for his session every day for better rapport building. The third modification would be engaging an aboriginal healthcare expert along with the non-native professional as these would help in trust building of the patient over the system (Benett et al., 2016). The fourth modification would be showing video clips of other aboriginal patients who had hot help through this therapy and making them talk socially with such patients. These would help in developing the trust of the patient and increasing his compliance with the treatment therapy.

Effectiveness of the cultural modification

The first intervention would be the setting of the therapy sessions with the patient in areas that would be away from the healthcare centre in the midst of nature especially beside lakes, fields or in parks. The cultural preferences and traditions of the aboriginals state that they are nature lovers and want to remain in close connection with nature as well as prefer living with the natural resources beings close to nature as possible (Rowan et al., 2014). Therefore, this modification would make the patient feel closer to nature and he can easily connect to the nature and his roots of culture. Conducting the assessments within the four walls and closed door in the clinics would have given him the impression that he is treated under the western medical system. Therefore, this cultural modification is indeed helpful.

The second important modification that needs to be done is the allocation of extra time for about 15 minutes before the beginning of therapy sessions as well as the allocation of two extra sessions to the patient before initiation of the cognitive behavioral therapy. Researchers are of the opinion that aboriginal people are introvert by nature and they cannot disclose specific important information about their personal lives unless they are comfortable with the communicators (Leske et al., 2016). Moreover, they also do not want to reveal important information to western health care professionals, as they believe that the professionals might become judgmental and disrespect their culture. Therefore, more the time the professionals allocate for rapport building, the better will be chances of compliance of the client with the professionals. In the first two sessions, the professional would be empathizing with the situations of the aboriginals, as the client in the case believes that they have been oppressed of their rights and have gone through severe turmoil throughout the periods of colonization. Therefore, empathizing with the situation and developing rapport through informal discussions will help the client to develop a bond and relationship with the professional resulting in better outcomes (Wagner et al., 2017).

The third intervention that the professional would implement is the allocation of the aboriginal healthcare expert in the discussion with the patient when the western healthcare professional is applying the therapy to the patient. The presence of the aboriginal healthcare workers would help in easing the conversation with the patient helping him to relate with different aboriginal manners of thinking and style of working procedures (Newton et al., 2015). When the client will see that the session is being carried on by procedures that align with the aboriginal medium of thinking and conducting different actions, he would feel connected with the system. Moreover, the presence of an aboriginal person in the room will reduce his uncomfortable situation and would help in making the patient comply with the therapy with proper features that align with cultural traditions and receptions of the professional (Benson et al., 2016).

The fourth intervention is the allocation of the video clips where native people and their success with the cognitive behavioral therapy. This medium helps patients to feel that their native community members had got immense help from the therapy and starts believing that the approach would not affect their culture but would help in the development of health (Le Grande et al., 2017). Moreover, the patient would be also able to communicate with such members of the community and seek for their suggestion. This approach would help the patient to develop trust in the western healthcare methods and would help them to comply on the methods without being judgmental on the treatment outcomes.

 The modification of the cognitive behavioral therapy is important, as the handling of native Aboriginal patients requires separate considerations in comparison to the non-indigenous patients.  They have different cultural traditions, preference and inhibition and following such customs become extremely important for the healthcare professionals. Culturally competent therapy help in developing trust and bonding with the patient as the patient feels that the professionals are not judgmental about their traditions and that they are aware of their liking and disliking. They feel that they are honoured and the power struggle between them do not persist. In the case as well, the culturally modified interventions would help Ben to feel that professionals genuinely respect their traditions and that they are not judgmental and in turn helping him to overcome his disorders (Fernandez et al., 2015). Each of the modifications is evidence-based and aligns with their cultural norms that would satisfy him. Hence, these modifications are effective.

The patient would feel closer to nature when the therapy session would be held in natural surroundings. This would make him happier and he would feel comfortable. The building like structures, the rooms and the wring system of the health clinics might be foreign to him and he might not relate with them. Therefore, to help him overcome such barriers, the sessions are arranged in open and this would help him to feel comfortable in the session. Another effective outcome would be the development of a therapeutic relationship with the patient that would be based on proper rapport building. More the rapport built with the patient, the patient will be more comfortable (Bennett et al., 2014). This would increase chances of compliance of Ben with the system and rely on the western healthcare system. Moreover, when the clients would notice that similar members of the Aboriginal community have also been benefitted from this mode of therapy, he would develop trust on the system and would believe that the professionals would not provide culturally incompetent practices. These would have the positive outcome of developing trust in Ben about the western healthcare centre that he previously disliked. This would ensure the better outcome of the therapy on the substance abuse issues as well in the patient.

References:

Bennett, S. T., Flett, R. A., & Babbage, D. R. (2016). Considerations for culturally responsive cognitive-behavioural therapy for M?ori with depression. Journal of Pacific Rim Psychology, 10.

Bennett?Levy, J., Wilson, S., Nelson, J., Stirling, J., Ryan, K., Rotumah, D., ... & Beale, D. (2014). Can CBT be effective for Aboriginal Australians? Perspectives of Aboriginal practitioners trained in CBT. Australian Psychologist, 49(1), 1-7.

Bensonn, J., Thistlethwaite, J., & Moore, P. (2016). Mental Health Across Cultures: a practical guide for health professionals. CRC Press.

Fernández?Álvarez, H., Castañeiras, C., & Wyss, G. (2015). Commentary on Three Articles on Self?practice/Self?reflection in Cognitive?Behavioural Therapy. Australian Psychologist, 50(5), 335-339.

Le Grande, M., Ski, C. F., Thompson, D. R., Scuffham, P., Kularatna, S., Jackson, A. C., & Brown, A. (2017). Social and emotional well-being assessment instruments for use with Indigenous Australians: A critical review. Social Science & Medicine, 187, 164-173.

Lee, N. K. (2015). Cognitive behavioural therapies for substance use problems. Textbook of Addiction Treatment: International Perspectives, 793-809.

Leske, S., Harris, M. G., Charlson, F. J., Ferrari, A. J., Baxter, A. J., Logan, J. M., ... & Whiteford, H. (2016). Systematic review of interventions for Indigenous adults with mental and substance use disorders in Australia, Canada, New Zealand and the United States. Australian & New Zealand Journal of Psychiatry, 50(11), 1040-1054.

Newton, D., Day, A., Gillies, C., & Fernandez, E. (2015). A review of Evidence?Based Evaluation of Measures for Assessing Social and Emotional Well?Being in I ndigenous A ustralians. Australian Psychologist, 50(1), 40-50.

Rowan, M., Poole, N., Shea, B., Gone, J. P., Mykota, D., Farag, M., ... & Dell, C. (2014). Cultural interventions to treat addictions in Indigenous populations: findings from a scoping study. Substance Abuse Treatment, Prevention, and Policy, 9(1), 34.

Wagner, B., Fitzpatrick, J., Symons, M., Jirikowic, T., Cross, D., & Latimer, J. (2017). The development of a culturally appropriate school based intervention for Australian Aboriginal children living in remote communities: A formative evaluation of the Alert Program® intervention. Australian occupational therapy journal, 64(3), 243-252.

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