Linguistically- and Culturally-Sensitive Psychotherapy: Training and Retaining Migrant & Minority Therapists

Mental health care in multicultural communities is enhanced when local therapists represent the population and when these therapists are trained in linguistically- and culturally-sensitive psychotherapy. Unfortunately, many trainees do not feel well-prepared for diversity and migrants/minorities face barriers to building a career in Québec.

We will: (1) use qualitative inquiry to study perceived training deficits and career barriers in psychologists trained at anglophone institutions; (2) use quantitative techniques to establish a consensus model of the changes needed to retain multicultural expertise in Québec. 

Participants will be 40 clinical psychology trainees and 40 licensed clinical psychologists. This project will use a cultural consensus design, a mixed methods approach with four sequential steps: (1) qualitative interviews (in this case, analysis of previously collected interviews); (2) free listing responses to open-ended questions; (3) sorting the most common responses while thinking aloud; and (4) survey design based on the consensual sorts.

The qualitative interview and think-aloud transcripts will be studied using qualitative inquiry, specifically thematic analysis. The free listing, sorting, and survey components will be studied using quantitative analysis; frequency analysis, multidimensional scaling, and cultural-consensus analysis, respectively.

We anticipate this project will improve training of mental health professionals and will yield steps to boost retention of migrant/minority psychologists in Québec. We will develop recommendations for the two anglophone training programs, and for the professional order. Our results will be relevant to other cultural settings characterized by linguistic and cultural complexity.

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Outputs:

• Zhao, Y., Segalowitz, N., Voloshyn, A., Chamoux, E., & Ryder, A. G. (2021). Language Barriers to Healthcare for Linguistic Minorities: The Case of Second Language-specific Health Communication Anxiety. Health communication, 36(3), 334–346. https://doi.org/10.1080/10410236.2019.1692488

• Ryder, A. G., Doucerain, M. M., Dere, J., Jurick, T., Zhou, B., & Zhou, X. (2021). On dynamic contexts and unstable categories: Steps towards a cultural-clinical psychology. In M. Gelfand, C.-Y. Chiu, & Y.-Y. Hong (Eds), Advances in culture and psychology, volume 8 (pp. 195-245). OUP.

• Voloshyn, A., Dussault, È., Segalowitz, N., Ryder, A. G. (2022, September). A qualitative study of clinical psychologists’ reflections on their work with linguistically- and culturally-diverse clients [Paper session]. Presentation at the 6th World Congress of the World Association of Cultural Psychiatry, Rotterdam, Netherlands.

Thinking social: Examining the efficacy of a social skills training group for young adults on the autism spectrum

Social skills are challenging for individuals on the autism spectrum (AS). Such deficits make everyday living difficult, and can lead to mental health difficulties, most notably anxiety and depression. Social skills training programs have been shown to improve social abilities adolescents and adults on the AS. However, little is known regarding their efficacy to improve mental health issues.

In Québec, few programs aimed at improving social skills in young adults are offered within the public healthcare system, and even fewer are offered to English speakers. Additionally, clinicians rarely receive training to intervene with ASD young adults.

Thus, this study aims to a) assess the efficacy of a program aimed at improving social skills young adults on the AS, b) examine whether increased social abilities and connection with peers lead to improved mental health in these adults, c) increase the availability of English-language intervention for adults on the AS within the public healthcare system and d) increase clinical capacity of English-speaking clinicians in Québec to deliver social skills interventions.

For this project, 12 young adults on the AS will participate in a 24-week social skills training program. Each participant will be paired with a peer social coach who will be recruited from clinical departments at McGill University (psychology, SCSD, etc.). Participants will undergo testing to assess social skills and mental health at baseline (T0), immediately after completing the program (T1), and six-month post-treatment (T2). ANCOVAs will be used to compare test scores at T0 to those at, T1 and T2.

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Outputs:

• Beauchamp, M. L. H., Amorim, K., Wunderlich, S. N., Lai, J., Scorah, J., & Elsabbagh, M. (2022). Barriers to access and utilization of healthcare services for minority-language speakers with neurodevelopmental disorders: A scoping review. Frontiers in psychiatry, 13, 915999. https://doi.org/10.3389/fpsyt.2022.915999

• Beauchamp, M. L. H., Rezzonico, S., Bennett, T., Duku, E., Georgiades, S., Kerns, C., Mirenda, P., Richard, A., Smith, I. M., Szatmari, P., Vaillancourt, T., Waddell, C., Zaidman-Zait, A., Zwaigenbaum, L., & Elsabbagh, M. (2023). The Influence of Bilingual Language Exposure on the Narrative, Social and Pragmatic Abilities of School-Aged Children on the Autism Spectrum. Journal of autism and developmental disorders, 53(12), 4577–4590. https://doi.org/10.1007/s10803-022-05678-w

• Beauchamp MLH, Rezzonico S, Elsabbagh M, Mirenda P, Bennett T, Duku E, Georgiades S, Kerns CM, Smith IM, Szatmari P, Ungar WJ, Vaillancourt T, Zaidman-Zait A, Zwaigenbaum L. (May 11-14, 2022). Examining the Influence of Bilingualism on the Narrative, Social and Pragmatic Abilities of School-Aged Children on the Autism Spectrum. International Society for Autism Research (INSAR) Conference, Austin, USA, hybrid format,

• Beauchamp MLH, Rezzonico S, Smith I, Duku E, Georgiades S, Kerns C, Mirenda P, Richard A, Szatmari P, Vaillancourt T, Waddell C, Zwaigenbaum L, Zaidman-Zait A, Elsabbagh M. (Nov 17–19, 2022). Narrative, Social and Pragmatic Abilities in Bilingual and Monolingual School-Aged Children on the Autism Spectrum. The American Speech-Language-Hearing Association (ASHA) Convention 2022, New Orleans USA.

• Beauchamp, M. L. H., Blanco Gomez, G., Rezzonico, S.,...Elsabbagh, M (2023). The Validity of the Narrative Scoring Scheme in School-Aged Children on the Autism Spectrum. International Society for Autism Research.

• Scorah, J; Beauchamp, M. L. H.; Amorim, K; Elsabbagh, M. (2022). Examining the Characteristics of Clinicians in an ECHO (Extension for Community Health Outcomes) Autism Program

• Beauchamp, M. L. H., Amorim, K., Wunderlich, S. N., Lai, J., Scorah, J., Elsabbagh, M. (2022, submitted). Identifying Barriers to Healthcare Access and Use for Minority-Language Speakers with Neurodevelopment Disorder

• Beauchamp, M. L. H., Blanco Gomez, G., Rezzonico, S.,...Elsabbagh, M (2023, submitted). The Narrative Scoring Scheme’s Validity with Bilingual and Monolingual Children on the Autism Spectrum

Linguistically- and Culturally-Sensitive Psychotherapy: Improving Communication to Improve Outcomes

Context: Linguistic mismatch can lead to communication problems that interfere with psychological treatments for mental health problems—not least, because these are linguistic interventions. Cultural misunderstandings can exacerbate these problems. Yet there ways in which psychotherapists can engage in positive ways with linguistic and cultural diversity. Studying how this is best done is particularly relevant to the Quebec situation.

Main Objectives: We will: (1) use quantitative techniques to study the impact of linguistically- and culturally-sensitive therapy on outcomes; and (2) use qualitative inquiry to study the conversations that unfold between clients and their therapists.

Research Procedures: Participants will be 12 anxiety and/or depression patients from a migrant and/or minority background, all bilingual but half who prefer English as their first official language, half who prefer French. Within each subgroup, half will be in a situation of language match with their therapist, half mismatch, in terms of their preferred language.

Data Analysis: Quantitative modeling will allow us to study the impact of change over time through daily self-report assessments. We will be able to see how specific therapeutic interventions benefit specific patients. Qualitative inquiry will give us a close reading on what works—and what does not work—when working with linguistic and cultural diversity.

Potential Contributions: We anticipate this project will improve mental health care for English-speaking patients in Quebec suffering from mental health problems, as well as improving training of mental health professionals. Our results will be relevant to other cultural settings characterized by linguistic and cultural complexity.

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Outputs:

• Zhao, Y., Segalowitz, N., Voloshyn, A., Chamoux, E., & Ryder, A. G. (2021). Language Barriers to Healthcare for Linguistic Minorities: The Case of Second Language-specific Health Communication Anxiety. Health communication, 36(3), 334–346. https://doi.org/10.1080/10410236.2019.1692488

• Ryder, A. G., Doucerain, M. M., Zhou, B., Dere, J., Jurcik, T., & Zhou, X. (2021). On dynamic contexts and unstable categories: Steps toward a cultural-clinical psychology. In M. J. Gelfand, C.-y. Chiu, & Y.-y. Hong (Eds.), Handbook of advances in culture and psychology (pp. 195–243). Oxford University Press. https://doi.org/10.1093/oso/9780190079741.003.0005

• De Oliveira Jr., O., Hammami, S., Quadrio, J., & Ryder, A. G. (2022, May). Creating a front-line transcultural mental health clinic for Montreal-Nord youth. Poster presented at the 2022 Summer Institute for School Psychology, Montréal, QC.

• Ryder, A. G., Quadrio, J., Stora, L., Taing, J., Yampolsky, M., Tao, D., & Segalowitz, N. (2022, May). La culture, la langue et la santé mentale: La « Acculturation Toolbox » pour les chercheurs et les cliniciens. Paper presented at the 44th Annual Congress of the SQRP, Saint-Sauveur, QC.

• Voloshyn, A., Segalowitz, N., Zhao, Y., Ryder, A. G. (2021, July). Linguistic minorities and access to mental healthcare: The case of second language health communication anxiety. Paper presented at the 25th conference of the IACCP, Olomouc, Czechia.

Portrait of birth care in Anglophones of Quebec

There is mounting evidence of inequality in newborn health between Francophones and Anglophones of Quebec, but differences in access to birth care have not been studied. The objectives of this project are to 1) assess the location and residential distance of hospitals where Anglophone infants are born, and 2) determine if Anglophones in metropolitan Montreal prefer to give birth in English hospitals or the hospital closest to their residence. Our hypothesis is that Anglophones are more likely to travel further to receive care in English. We will perform a population-based study using birth registration certificates in Quebec from 1981-2019. The main exposure will be English vs. French mother tongue. Outcomes will include the distance between residential postal code and postal code of the place of birth, and the official language of the birth hospital (English vs. French). We will measure the association between language and hospital distance using multivariable linear regression, and will investigate whether characteristics such as maternal age, region, education, country of birth, material deprivation, and time period influence the associations. We will use multivariable logistic regression to examine associations with the language of hospitals. We will explore whether Anglophones who are born in hospitals that are further from home have a greater risk of preterm birth, low birth weight, or stillbirth. The results will clarify whether access to birth care is a determinant of health among pregnant Anglophone women. This project falls under the “health or social inequalities” HCALM research theme and involves working with communities and governmental officials to reduce social inequalities among minority language groups.

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Outputs:

• Auger, N., Bilodeau-Bertrand, M., & Lafleur, N. (2023). Access to perinatal healthcare in minority Anglophones: Hospital type and birth outcomes. PloS one, 18(4), e0284586. https://doi.org/10.1371/journal.pone.0284586

• Auger, N., Bilodeau-Bertrand, M., Lafleur, N., & Lewin, A. (2024). Underlying Causes of Ethnocultural Inequality in Pregnancy Outcomes: Role of Hospital Proximity. Journal of immigrant and minority health, 26(1), 54–62. https://doi.org/10.1007/s10903-023-01545-7

• Abstract accepted to present the findings of work funded by Dialogue McGill (Ethnocultural inequality in pregnancy outcomes: Comparison of Francophones and Anglophones in Montreal) at the 2023 Colloquium on the Health of Official Language Minority Community by Health Canada, virtual poster session.

• Abstract accepted to present the findings of work funded by Dialogue McGill (Access to perinatal healthcare: Risk of adverse birth outcomes among minority Anglophones in Montreal, Canada) at the 2023 Colloquium on the Health of Official Language Minority Community by Health Canada, virtual poster session.

Safe Patient Handling and Mobility Training for English-Speaking Nursing Students using Augmented Reality: Prototype and Testing

Patient handling tasks are the biggest risk factor in the development of musculoskeletal injuries among nurses. Nursing students are equally vulnerable and today their education of ‘safe patient handling and mobility’ (SPHM) is shared between the academic and clinical settings. Students often deviate from what was taught in class, upon arrival in the workplace, which may be due to the use of passive learning instructions. While the use of augmented reality (AR) in nursing is in its early stages, benefits include the ability to gain hands-on experience in learning a skill, increased confidence, and instantaneous feedback. This project aims to develop and test 2 AR clinical scenarios to provide SPHM training to 1st year English-minority speaking nursing students enrolled at the Cégep Saint-Hyacinthe. The objectives are to: 1) create the clinical scenarios and algorithms to train students in SPHM, 2) develop the AR-environments, and 3) explore students’ and educators’ experiences using AR for SPHM training. After obtaining ethics approval, a qualitative descriptive design will be used to explore the experiences of a purposive sample of 14 students and 8 nurse educators. Data will be collected in Winter 2022, and transcripts will be content analyzed. Proper SPHM training of nursing students is critical as evidence suggests that they are developing lower back pain during their 1st year of training. There is potential in using AR for SPHM skill training of students, nurses, and other healthcare workers, and this approach should be integrated in healthcare organization to reduce injuries.

Do Language Barriers Impact COVID-19 Vaccine Hesitancy among Quebec Visible Minority Groups?

Language barriers are an important obstacle when it comes to vaccination and may even result in a lack of access to COVID-19 information. The prospect of new waves of COVID-19 infections poses a special risk to English-speaking visible minority communities across Quebec due to the increased levels of infection and death. Visible minorities bore the brunt of the first waves of the pandemic, and evidence suggests that they have high levels of vaccine hesitancy. Vaccine hesitancy is characterized by a lack of confidence in vaccination and/or complacency about vaccination. Black and other visible minority communities have shown greater hesitancy towards vaccinations compared to their white counterparts and receive significantly fewer vaccine doses. We will conduct a 3-wave, prospective, longitudinal study (over a 10-month period) that examines linguistic and motivational factors that impact the readiness of visible minority young adults to get COVID19 vaccines. The study represents an ongoing collaboration of the McGill Human Motivation Laboratory and the Black Community Resource Center (BCRC). The BCRC serves as the secretariat for 14 community agencies that provide services to English-speaking visible minority groups. A novel component of this research is that it will examine how young adults process and respond to public health information intended to promote vaccinations(e.g., emphasis on visibility, relatability, and equity). Both language minority status and visible minority status are expected to be associated with response to these communications. We will develop empirically based resources for Black and visible minority young adults to promote autonomous motivation and positive attitudes about vaccination.

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Outputs:

• Lafreniere, B., Audet, É. C., Kachanoff, F., Christophe, N. K., Holding, A. C., Janusauskas, L., & Koestner, R. (2023). Gender differences in perceived racism threat and activism during the Black Lives Matter social justice movement for Black young adults. Journal of Community Psychology. 10.1002/jcop.23043

• Nweze, N., Davids, J., Fang, X., Holding, A., & Koestner, R. (2023). The Impact of Language on the Mental Health of Black Quebecers. Journal of Racial and Ethnic Health Disparities, 1-11. 10.1007/s40615-022-01412-5

• Audet, É. C., Leboeuf, J., Holding, A. C., Davids, J., Fang, X., & Koestner, R. (2022). Better Together: Family and Peer Support for Black Young Adults During the COVID-19 Pandemic and the Black Lives Matter Movement. Trends in Psychology, 1-18. https://doi.org/10.1007/s43076-022-00157-8

• Audet, É. C., Thai, H., Holding, A. C., Davids, J., Fang, X., & Koestner, R. (2023). The depth of stories: How Black young adults' disclosure of high arousal negative affect in narratives about the COVID‐19 pandemic and the BLM protests improved adjustment over the year 2020. Journal of Community Psychology, 51(4), 1504-1517. 10.1002/jcop.22929