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2. Mental Health Literacy Program
3. Transcultural Ed-LinQ Position
Building Resilience in Transcultural Australians (BRiTA Futures). Program for Primary School Aged Children, Adolescents and Adults and Parents.
A program brochure can be viewed here (PDF)
History of the BRiTA Futures program
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What is resilience and why is it important?
Resilience refers to a person's capacity to "bounce back" or adapt successfully after negative life experiences, lifespan transitions or difficult circumstances. It develops throughout the lifespan in response to the balance between risk factors (such as traumatic life events and the stress of acculturation) and protective factors (such as supportive relationships), and underpins mental wellbeing and quality of life.
BRiTA Futures builds on the existing resilience of children and young people from a CALD background. The Qld Centre for Mental Health Research recently analysed the pre-program data of a total of 260 participants and found that they had relatively high levels of resilience.
Why develop a resilience program for CALD children, young people and adults?
The breakdown of family ties and community cohesiveness, social isolation, loss of employment or "under-employment", high density living conditions, lack of access to culturally appropriate health services, language barriers, inter-generational conflicts, and breakdown of traditional cultural lifestyles and values are just some of the many risk factors faced by children, young people and adults arising from migration and acculturation. These risk factors have consistently been linked to early school dropout and poor achievement, as well as numerous mental health and social problems throughout the lifespan. However, no programs specifically designed to help either children, young people or adults from CALD backgrounds to develop skills for coping positively with these issues had been developed either nationally or overseas.
What makes the BRiTA Futures Program unique?
Most programs designed to promote lifeskills in children and young people make the implicit assumption that resiliency protective traits are common across all cultural groups, and therefore interventions tend to be developed according to the "one-size-fits-all" model. The BRiTA Futures Program is unique in that all of its three versions are founded on an extensive review of the national and international research literature to identify those elements of resiliency that are culturally-determined, while the content has been carefully selected to ensure that cultural issues are woven into each module, both in terms of group activities (both content and processes) as well as topics to trigger group discussions and personal reflection activities.
There are currently two different versions of the BRiTA Futures program, one for adolescents and one for primary school aged children with the one designed for adults and parents being close to completion. Both versions of the resiliency building program utilize creative and interactive activities, discussion questions and take home activities to facilitate the learning of key objectives. Each version of the program has a training program for facilitators, a facilitator's manual and evaluation materials. The BRiTA Futures program is designed for use with small groups in school or community settings or in CALD or youth related agencies. It can be used with children and young people who were born overseas and migrated here either recently or sometime ago, with those with a recent refugee background, or those who are from second or subsequent generation migrant families who are still still strugling with acculturation issues. (BRiTA Futures - Adolescents Program Outline - PDF) (BRiTA Futures - Primary School Aged Children Program Outline - PDF ).
The Aims of BRiTA Futures:
BRiTA Futures trains facilitators and co-facilitators in the running of the BRiTA Futures program. There are currently 157 group facilitators trained. Adolescent facilitator training lasts two full days, while the Primary School Aged Children facilitator training goes for one full day.
See 'What's on' for current training being offered.
The BRiTA Futures program is evaluated using pre and post-questionnaires developed to measure change in the key learning areas. The questionnaires used include tools developed specifically for this program called the Multicultural Child Resiliency Survey© and the Multicultural Youth Resiliency Questionnaire© and the existing tools, the Personal Wellbeing Index - School Children (PWI-SC) 3rd Edition© Cummins, R. A. & Lau, A. L. D. 2005, and the General Health Questionnaire-12. The Personal Wellbeing Index and the GHQ-12 have been internationally validated in its use with CALD children and young people. The Qld Centre for Mental Health Research has recently reviewed the MCRS and the MYRQ resulting in tools more appropriate for program participants.
BRiTA Futures evaluation also has weekly/sessional questionnaires for both the participants and the facilitators to measure responses to each session and questions for a focus group to be held at the completion of the program.
Is the BRiTA Futures Program effective?
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The BRiTA Futures Primary-School program was evaluated within a Healthy Promoting schools framework. It was piloted in six schools across Brisbane using a whole-class approach with students in years five and six.
The BRiTA Futures Adolescents program was piloted in Brisbane, Logan, the Gold Coast, Townsville and Canberra with CALD young people including those with a recent refugee background. The pilot program was evaluated using a self-report questionnaire measuring seven resilience factors; three indicators of social connectedness; measures of depression, anxiety and stress; and acculturation stress. Overall, the results from the piloting of BRiTA Futures were positive. Quantitative results showed a significant improvement in the variables: "goals & aspirations" and "help-seeking". The other five variables increased slightly. Community connectedness was noticeably weaker than family and school connectedness, which increased slightly. Acculturation stress was rated dramatically higher than general stress, depression and anxiety, and improved slightly but not significantly. Also noted was a strengthening of pro-social relationships with peers, improvements in young people helping others outside the home, believing they could make a difference and trying to work out problems by talking about them. These results clearly suggest that addressing specific issues related to acculturation, such as defining cultural identity, is significantly more relevant than general stress management interventions and that culturally relevant resilience protective skills rather than universal life skills are clearly more effective for CALD young people. The recent analysis of data since the pilot phase shows that participants significantly decreased their levels of psychological distress.
Qualitative feedback from participants has also shown that they enjoyed learning more about other people and other cultures, having an opportunity to talk about issues relevant to them and learning through interactive group activities. What they saw as their core learning also reflected the themes for each session, as did the goals that they committed to as a result of each session. These had a strong emphasis on taking more responsibility for their lives and actions, eg. "Make more effort to understand own feelings and those of others", "Go for help with problems", "Manage stress better".
Programs Delivered
From November 2007 until June 2010, over 600 children and adolescents have been reported as participating in the BRiTA Futures Program. The year 2007 saw BRiTA Futures - Adolescents being delivered to a group of young Samoan-Australians and to students at Milpera State High School (a secondary school providing an intensive English language program and settlement services to prepare mainly newly arrived students with a refugee background to attending regular secondary schools around the Brisbane area); since then this school has been regularly delivering BRiTA Futures. In 2008, the QTMHC delivered a program for young Muslims, funded Yeronga State High School and the Townsville Intercultural Centre to deliver BRiTA Futures at youth camps and supported other groups with the program implementation. Kedron State High School also ran two programs in partnership with Community Connections, and the Cairns Migrant Settlement Service partnered with Trinity Bay State High School to deliver BRiTA Futures. Moorooka State School also completed a PS Program. The year 2009 was filled with activities whereby both schools and communities delivered programs. Milpera State High School, Yeronga State High School, Woodridge State High School, the Australian International Islamic College, Community Connections, Kedron State High School, Islamic College of Brisbane, the East Creek Neighbourhood Centre in Toowoomba, the Multicultural Settlement Services in Cairns, the Southside International Chinese Church in Sunnybank, the Vietnamese program of Inala Youth Services, and Mercy Family Services are among those who have completed programs.
BRiTA Futures for Adults and Parents
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Following the development of a conceptual framework and some material on building on cultural strengths for better mental health and wellbeing by the QTMHC, the final draft of BRiTA Futures for Adults and Parents has been completed following the testing of the program activities and content. The eight sessions of this group program include:
The development of this program is being guided and supported by a steering committee and a reference group. The piloting phase is about to commence. If you are interested in becoming involved, please contact the QTMHC.
Publications, presentations and conferences
BRiTA Futures has been published in the International Journal of Mental Health Promotion and presented at the 18th World Conference on Health Promotion & Health Education in Melbourne and the Multicultural Families Conference at the University of Sunshine Coast, the CHERI Conference in Sydney, Building Cross-Cultural Bridges - Brisbane Catholic Education Seminar and many other more recent education and mental health promotion forums.
For finding out more about BRiTA Futures contact:
Increasing the mental health literacy of CALD communities is a priority for QTMHC. The working definition of transcultural mental health literacy developed by the QTMHC, which is included in the Transcultural Mental Health Literacy Framework, is as follows:
Transcultural mental health literacy is the knowledge, attitudes and abilities of CALD individuals, families and communities to use culturally inherent traditional practices and beliefs as well as those of the host culture to protect and enhance their social, emotional, spiritual and mental health and wellbeing regardless of their mental health status; to take action to prevent preventable mental health problems and disorders; to recognise alerting symptoms of mental health problems and disorders; to promptly seek appropriate help, articulate and negotiate cultural explanatory models with service providers and comply with prescribed treatments; to practice traditional and western self-help treatments; and to accept and include others and themselves in the community when experiencing mental health problems and disorders.
Although the QTMHC has been implementing strategies to increase mental health literacy over the last 12 years, a more defined program started with the development and implementation of the Stepping Out the Shadows: Reducing Stigma in Multicultural Communities in Queensland between 2007 and 2009; the development of the Transcultural Mental Health Literacy Framework (2009); and the Operational Framework: Bicultural Community Mental Health Promoter Positions (2009). Consistent with the working mental health literacy definition above, stigma reduction is a key ongoing component of the overall mental health literacy strategy.
The Mental Health Literacy Program is a comprehensive approach that implements a range of initiatives aiming to increase the levels of mental health literacy of members of CALD communities to at least the same levels of those of the general community. To achieve this, the program employs sessional Bicultural Community Mental Health Promoters (BCMHPs) who work directly with their cultural communities to increase mental health promotion, mental illness prevention and early identification awareness and skills among members and discuss stigma around mental illness. Strategies implemented to date include, the development and delivery of mental health literacy modules; attracting, upskilling and retaining BCMHPs; gaining the support of community and religious leaders; and linking with agencies providing direct services to members of CALD communities.
The role of the BCMHPs include the following:-
The Mental Health Literacy Program endeavours to work with those communities that have been prioritised following the Guidelines for Community Identification, Prioritisation and Engagement.
The Stepping out of the Shadows: Promoting acceptance and inclusion in multicultural communities in Queesland program aims to reduce stigma that exists around mental health and mental illness in multicultural communities in Queensland. It uses the Stepping out of the Shadows Community Trainer Manual, which includes a 10 minute teaching DVD in 14 languages, to equip Bicultural Community Mental Health Promoters to deliver workshops in their own cultural communities. Workshops can be as short as two hours or as long as 10 hours. The program also uses the dissemination of five chapters of a story about a family dealing with, and overcoming stigma, using the most effective communication mechanisms of each community, for example, in radio programs, print media, plays and skits.
The report of the Stigma Reduction Project implemented between April 2008 and June 2009 can be viewed here - Part 1 (Introduction & implementation), Part 2 (Achievements, conclusion & future directions), Part 3 (Appendices 1-4), Part 4 (Appendices 5-12 & references) (PDF). It shows that 58% of those attending the 10 hour Stepping out of the Shadows program reported at post-evaluation that they would behave differently towards people with mental illness in their community as a result of attending the workshop.
Stigma happens around the world in every culture and as mental illness does not discriminate, it can happen to any person in any culture. Each culture has its own values that can protect against stigma or contribute to any stigma that may exist.
The Stigma Reduction program for multicultural communities uses cultural values and belief frameworks and empowers communities to address the issues in ways that are most appropriate for them.
If you are interested in having a stigma reduction workshop delivered to your cultural community or multicultural group, please contact the QTMHC.
Elvia Ramirez
Mental Health Promotion, Prevention & Early Intervention Co-ordinator
Elvia_Ramirez@health.qld.gov.au
Ph. (07) 3167-8333
Fax (07) 3167-8322
The Building on Cultural Strengths for Better Settlement and Wellbeing module has been developed by the QTMHC. The module acknowledges that getting used to living in a new culture, while maintaining own culture of origin, is a long process that causes different levels of stress and acculturation stress. The focus of the workshops delivered using this module is to increase awareness among members of multicultural communities about this process and to increase their confidence in using values and practices from cultures of origin during the complex process of acculturation to the Australian culture. People who learn to live and function between two or more cultures have better mental wellbeing.
The workshops, delivered by training Bicultural Community Mental Health Promoters, provide participants with an opportunity to share their acculturation experiences, reflect on them and start finding new ways to see and feel about their life in Australia. Topics covered include:
Elvia Ramirez
Mental Health Promotion, Prevention & Early Intervention Co-ordinator
Elvia_Ramirez@health.qld.gov.au
Ph. (07) 3167-8333
Fax (07) 3167-8322
The Mental Health First Aid (MHFA) course aims to increase knowledge and skills on the early identification of the most common mental health problems in the Australian adult population -anxiety, depression and substance use disorder, and one of the most uncommon illnesses - psychosis. This course has been adapted by the QTMHC to include available data, issues and cultural explanations pertinent to CALD communities. It is delivered by an accredited instructor, Elvia Ramirez. The MHFA course also upskills participants in the crises response related to the same mental health problems. Courses are regularly delivered to bicultural mental health workers, leaders of CALD communities and workers in the multicultural NGO sector. Since 2008, 100 people have completed the 14 hour course.
Elvia Ramirez
Mental Health Promotion, Prevention & Early Intervention Co-ordinator
Elvia_Ramirez@health.qld.gov.au
Ph. (07) 3167-8333
Fax (07) 3167-8322
The Transcultural Ed-LinQ Co-ordinator position based at the Qld Transcultural Mental Health Centre is part of the Queensland Ed-LinQ initiative which aims to establish a comprehensive and sustainable approach to the identification, management and support of students with mental health problems with a focus on mental illness prevention. Click here to download the Ed-LinQ brochure.
The Transcultural Ed-LinQ Co-ordinator is playing a strategic and clinical advisory role that involves increasing the capacity of education and mental health services to respond to the cultural needs of students with a CALD background. This is achieved by prioritising school seetings with the highest proportion of CALD students with complex needs. Convening the Young Refugee Mental Health Interagency Network and Working Group, which organises bi-annual forums, is another role of this position. This network co-ordinators bi-annual forums that listen to the perspectives of young people with a recent refugee background, and discusses topics such as:
Colleen Hunter
Transcultural Ed-LinQ Co-ordinator (Mon-Thurs)
Email: colleen_hunter@health.qld.gov.au
Ph: (07) 3167 8333
Fax: (07) 3167 8322
This project ran from August 2004 until June 2006 and aimed to learn how to prevent family violence among the Samoan community in the Logan, Caboolture & Ipswich-Inala areas. The project also aimed to learn how to increase the capacity of services to provide more culturally appropriate services to Samoan families. The project officer, who was a religious leader, was instrumental in establishing linkages with other religious leaders in this community as Samoans strongly revolve around church groups. Up-skilled bilingual Samoan Community Facilitators conducted community information sessions that were catalysts to initiate discussions on family violence and culturally appropriate ways to prevent it. Regular dissemination of information through Samoan radio programs - including a song developed by the project - was also an effective means of communication.
The report describes how 10 CALD communities prepared and showcased their traditional practices to maintain mental health and wellbeing.
Early Intervention and Clinical Care Project for Refugees on Temporary Protection Visas: This project focused on the outreach and provision of support to refugees on TPVs to access mental health services and was a partnership between the Qld Program of Assistance to Survivors of Torture and Trauma, the Princess Alexandra Hospital Division of Mental Health, South Brisbane Child & Youth Mental Health Service and QTMHC.
Between 2002 and 2003, the QTMHC worked in collaboration with the Islamic Women's Association of Qld to increase the knowledge and skills of isolated women to enable them to manage and participate in group physical activities to promote their mental and emotional wellbeing.
The project involved the broadcasting of a series of radio programs on mental health and wellbeing topics in 14 languages. The "Family Help Kit" and "Health and Wellbeing of Older People" are two series of radio interviews with bilingual mental health professionals that are now available free of charge in up to 15 languages from the QTMHC. The audio resources were developed by the Transcultural Mental Health Centre (NSW) and were adapted for Queensland by the Australian Transcultural Mental Health Network and the QTMHC. These valuable resources are offered to language specific radio programs and could be used for group discussions or lent to families and individuals. Contact the Information and Resources Officer for more information.
A partnership project with Youth Affairs Network of Qld Inc. This study involved Queensland, South Australia and Western Australia. It explored the needs of young people, carers and service providers in regard to young people dealing with anxiety, depression and extreme stress. A final study report Coping in a New World along with 15 snapshots of the communities involved in the study were produced followed by a journal article: Gorman, D., Brough, M. and Ramirez, E. (2003) How young people from culturally and linguistically diverse backgrounds experience mental health: Some insights for mental health nurses. In International Journal of Mental Health Nursing 12(3). 194-202, available from the QTMHC Resource Library.
The EFFORT Program was an exercise and conversation program that aimed to promote the mental health of men and women from a refugee background by engaging them in a safe environment where they exercised in a group and discussed psycho-social topics. Pre and post program evaluation showed that EFFORT was effective in decreasing some symptoms of psychological distress and increasing feelings of emotional and social wellbeing. EFFORT was a partnership between QTMHC, the Princess Alexandra Hospital Mental Health Service, the Qld Program of Assistance to Survivors of Torture and Trauma (men's programs), the Multicultural Centre for Mental Health and Wellbeing Inc (women's programs), the QEII Hospital Community Health Services and the School of Human Movement Studies at the University of Queensland. A DVD on the first men's exercise program is available from the QTMHC Resource Library.
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