De rol van beliefs bij gebruik van zorg. Marjolijn Blom. EFCAP studiedag op 26 jan 2010

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1 Jeugdcriminaliteit: een internationaal vergelijkend onderzoek naar culturele verschillen De rol van beliefs bij gebruik van zorg Marjolijn Blom EFCAP studiedag op 26 jan 2010

2 jeugdcriminaliteit minderheden relatief overgerepresenteerd in jeugdinrichtingen i Minderheden onder gerepresenteerd bij gebruik mental health services, zoeken in laat stadium hulp (verergerde problemen), en vroegtijdige drop out therapie

3 Beliefs/ Tijdsgeest Malmö International Fice Conference (1990) from mere custodial care in past generations, community [residential] care has developed into a really qualified and efficient aid to education in recent years. Versus Stockholm Declaration on Children and Residential Care (2003)..Indisputable evidence that institutional [residential] care has negative consequences for both individual children and for society at large.

4 Gebruik van ggz Lokatie hulpbehoevenden versus lokatie mental health services wantrouwen vanuit minderheden Although few therapists overtly discriminate against clients of color many therapists are not familiar with the cultural worldviews, lifestyles, and histories of various racial/ethnic groups

5 Een pleidooi voor het belang van beliefs voorbeelden uit vergelijkend onderzoek naar kinderlijke ontwikkeling voorbeelden uit de literatuur naar community health services en parenting

6 The Daily Lives of Infants in Four Cultures: Implications for Development Sara Harkness, Jong-Hay Rha, Ughetta Moscardino, Marjolijn Blom, On-Kang Hyun, and Charles M. Super Paper presented in the symposium Culturally Structured Daily Activities: Effects on Infant Development and Maternal Well-being (C. M. Super & U. Moscardino, organizers) 2009 meeting of the Society for Research in Child Development, Denver, April 2

7 Four Cultural Study Sites Italy Padova (n=52) The Netherlands Bloemenheim (n=40) Korea Daijon and Incheon (n=30) US northeast Connecticut (n=45)

8 Settings CHILD Caretaker Psychology Customs 1996 C M S d S H k

9 Hoe cultuur ontwikkeling beinvloedt 1. Herhaling over tijd 2. Herhaling over thema s 3. Kettingreactie

10 Implicit Cultural Models Family Child Parent Specific beliefs About child (outcomes) About settings About customs/ practices Intervening Child Parent Aspects of factors characteristics characteristics the culture Actual practices Settings Daily activities Interactions Actual outcomes Child Mother

11 Physical and Social Settings of Baby s Day at 2 & 6 months When are babies awake during the day? Where do they spend their time? Who is with the baby? What are the baby s activities? How do babies days vary in relation to stimulation and restfulness?

12 STIMULATION IT KO NL US Out and about Non-family present Social density Play & Grooming Total stimulation score

13 CONCLUSIONS Settings of daily life reflect culture-specific profiles for these infants, although there are also some general similarities. These differences hold up across age and in some cases become more pronounced at 6 months. The differences reflect variability in culture-specific ethnotheories and customs. Babies days vary across cultural groups in terms of how restful or stimulating they are. There are striking cultural differences in HOW the same general class of activity or setting is structured in each cultural place. These differences can be expected to influence the development of self-regulation and social competence.

14 review Pachter Beperkt aantal studies naar racisme en ggz Tonen samenhang tussen perceived racism en gedrag en geestelijke gezondheid. Kans dat LatinAmericans geestelijke gezondheid van hun adolescenten als matig of slecht scoren minder waarschijnlijk, kans dat ze rapporteren adolescenten ontevreden zijn met hun leven of dat ze een geestelijke gezondheidsklacht hadden in het afgelopen jaar - twee keer zo laag. Schatten mijlpalen in ontwikkeling later

15 Effect van de buurt op opvoeding (Roche, 2007), of community based care (Pachter) minder sterk bij Latino s dan bij African Americans.

16 Pachter Verschillen kunnen worden verklaard door onderliggende cultural beliefs and values en specifieke opvoedingspraktijken.

17 Griner & Smith, 2007 Overall, interventies aangepast aan de cultuur resulteerde in significante verbeteringen voor de clienten over groot aantal condities en domeinen. Interventies gericht op groepen van 1 etniciteit (d.49) waren 4 keer meer effectief dan gemixte groepen (bijv surinaams en antilliaans?)

18 Griner & Smith, 2007 (vervolg) studies in which the Hispanic/Latino(a) participants were characterized by low levels of acculturation had an average effect size that was twice as large as studies in which the Hispanic/Latino(a) participants were characterized by moderate levels of acculturation (!) Studies in which clients were not apparently matched to therapists based on ethnicity had average effect sizes that were higher than studies in which ethnic matching was generally attempted but not consistently conducted (!) IF however client was matched with a therapist based on language (other than English) outcomes were twice as effective