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E. The Cultural Consultation Service database and website projects

Sadeq Rahimi & Caminee Blake

The CCS project included the development of information resources based on computerized data management and internet technologies, specifically through the development of Organizational and Consultant Databases, and a comprehensive website with interactive data management capabilities. These originally computerized aspects of the CCS project are currently accessible either through the Internet for public use or through the Cultural Consultation's internal network for process evaluation, further research, or clinical reference purposes. The following report provides an overview of the structure and scope of the databases and CCS website.

Development of the Consultant Database

One of the critical components involved in the development of the Cultural Consultation Service was the identification of individuals who have experience with and knowledge about working with various ethnocultural groups and communities. Identification of these individuals served two purposes. The first was to find potential consultants to conduct cultural consultations as part of the service. The second was to help create a resource in the form of a computer database of all these individuals, which might be eventually accessible to mental health professionals seeking assistance.

Consultants were identified largely through word of mouth. Individuals with experience working with various cultural communities known within the community for their work were interviewed and asked to help to identify resources on either the individual or the community level. The individuals interviewed ranged from individual practitioners in private or hospital settings to members of community organizations. Our interest in their knowledge ranged from their clinical skills to their knowledge about legal or immigration matters.

Information collected about each consultant and entered in the database included the languages they spoke, the cultural communities they have experience working with, their experience working with interpreters, and their training backgrounds to name a few (see Appendix for questionnaire).

The Cultural and Community Organization Database

The CCS developed and maintained a database of the organizations offering services to ethnocultural groups, indigenous peoples, immigrants, and refugees throughout the greater Montreal region. The Organization Database, is also accessible online through a Web interface designed for the use of both clinicians and consumers. A sample of the database layout is appended to this report.

A compilation of information about the various community organizations that offer various social, community and mental services to ethnocultural communities had been previously developed by members of the Montreal Children's Hospital Multiculturalism Department (currently affiliated with the CCS). While useful, one of the limitations of this information was that it was only available in hard copy and was thus difficult to update on a regular basis. Similar attempts by other organizations in the past have quickly become out of date. As part of the CCS project, one of the goals was to convert the existing data into a computer database, which would allow for greater access to the information and for a simpler means of updating the information.

The first step towards achieving this goal was to update the existing information available for each community organization as well as to add any additional community resources that had not been previously identified. To accomplish this task, questionnaires were developed (see Appendix for questionnaire) and mailed along with a cover letter to each community organization explaining the purpose of the mailing and a tentative deadline for its completion. Community organizations that did not return the questionnaires were contacted within a few weeks by the Clinical Coordinator to collect the information by telephone. Community organizations that returned incomplete information or for which responses were unclear were also contacted by telephone for clarification. The information from these questionnaires were then used to update the existing information collected which had been converted into database form. The electronic version is more accessible for the following reasons:

  1. it is directly available for online use, through its Web interface

  2. it is flexible; hard copies can be produced in any format needed

  3. it is searchable: all the content information can be keyword searched

The database currently covers 87 organizations selected based on the type of services they provide and the populations they serve. The services provided by these organizations are especially useful to immigrant and refugee populations, and include: food, clothing and residence assistance, social support, language courses, free individual consultation and/or therapy services, help find employment or job-finding courses, child-care and babysitting services, translation of texts and interpreters for legal or other occasions, health-related services, legal consultation and assistance, social support, help with home care and domestic affairs, and more. The database contains organizations' mailing addresses, areas of city they cover, contact information (Names, phone and/or fax and/or email information), types of services provided by the organization, the languages in which their services are available, and the specific population (age, gender, ethnic or racial group, etc.) to which their services are directed.

The organizations included in this database are located within the Greater Montreal area. This area covers a range of regions including: Montreal, St. LĂ©onard, Laval, TMR (Town of Mount Royal), Chomedey, St. Laurent, Longueuil, Anjou, LaSalle, Brossard, Montreal-Nord, and St. Jerome.

The Cultural Consultation Service Website

The CCS project developed and maintain an Internet Web Site as a clearinghouse of information useful to patients, clinicians, researchers, educators and policy makers.

The Web Site is divided into two French and English sections that mirror each other as closely as possible, in terms both of content, format and of accessibility of information and services.

The following document reviews the structure and content of the website in terms of material useful for:

  1. consumers and carers (patients, families, etc.)

  2. clinicians and health professionals

  3. educators and students

  4. researchers

When the results of the CCS evaluation project are made public, we will add material of specific interest to planners.

Section 1: Information for Consumers and Carers

In the context of the CCS, consumers include clinicians and community organizations who might wish to make use of the CCS services. While material intended for the use of mental health consumers and care givers is available throughout the website, the sections containing material specifically intended for these groups of users are sections titled CCS "News", and "Clinical" sections. Further material for the general public will be developed once the report of the CCS project has been accepted, as part of the next phase of dissemination of results.

The CCS News section contains information on monthly talks organized by CCS members in the Montreal Jewish General and in the Montreal Children's Hospitals. These seminars, titled as "Culture and Community Mental Health Lectures" (Jewish General) and the "Clinic and Culture Seminars" (Children's) are held every month. Dates, titles, and content information on past and upcoming seminars are accessible through the CCS Web Site.

A "FAQ" document contains frequently asked questions and their answers concerning the consultation service, its scope and accessibility questions, methods of consultation and consultation request procedure. It is now possible for clinicians and care givers to make complete online consultation requests using our Web-based Consultation Request Form.

The Organizations Database accessible online through a Web interface is another item useful to mental health consumers in the Montreal area. A list of individuals involved in various aspects of the CCS project as well as information on their duties and professional backgrounds, and a "Contact Page" containing information on various methods of contacting the CCS (including contact forms and online email links) are also among the documents available to consumers through the CCS News page.

Another area with useful information for mental health consumers is the section titled "Clinical". In this area users can find information and access a comprehensive collection of online resources for mental health consumers.

Information resources available in this section include pamphlets on a wide range of mental health disorders related coping skills for both patients and family members, and mental health types of services available. These documents are accessible to consumers for online reading/printing, or in downloadable format (PDF, etc.)

The information pamphlets discussed above are directly accessible in English as well as in translation in many other languages. In addition to the translated material, we have provided links to specialized mental health and medical dictionaries in tens of languages, as well as a glossary of mental health related terms in English and their equivalents in Chinese, Italian, Spanish and Vietnamese.

Section 2: Information for clinicians and health professionals

The online section corresponding to this group is primarily accessible through the menu item designated "Clinical", while information pertinent to clinical training and research is also available through other sections of the Site.

The Clinical section is broken into sub-sections including the Cultural Consultation Clinical Handbook, information on Cultural Competence, the online Database of Organizations offering services for cultural and ethnic groups in Montreal, Online translation resources for clinical purposes, and online clinical resources for mental health consumers.

The Cultural Consultation Clinical Handbook offers a set of detailed information through its further sub-sections, which include: details of the procedure involved in a consultation, a list of information required for intake of a consultation, a description of CCS consultants, their background, duties, and a check-list of the role expected of a consultant in the course of a CCS consultation, as well as the role of culture brokers and interpreters and the relationship between consultants, consultees, patients, and the brokers or interpreters. Finally, this sub-section also provides a further sub-directory containing detailed information on Cultural Case Assessment and Formulation. This sub-directory offers two separate documents, each containing a slightly different approach to the questions of assessment and formulation. These two formulations were developed in two CCS centers representing slightly different clinical environments: the Montreal Children's Hospital, and the Montreal Jewish General Hospital subsequently, it was decided to provide both formulations as alternative and yet complementary guideline documents for cultural assessment. These are offered as Version A and Version B of the assessment and formulation guide.

The cultural competence section provides further links to a variety of online documents containing information on standards of cultural competence, including documents discussing definitions for cultural competence, documents providing standards for assessing cultural competence, and those providing further informational resources and contacts for those interested in more detailed and specialized study of the issue of cultural competence.

The Organization Database provides direct online access to a database produced by CCS. This database contains detailed service and contact information covering various organizations providing services for minority cultural and ethnic groups throughout greater Montreal (see above for further details).

A next subsection of this module is dedicated to online translation and interpretation resources for clinical use. This section provides access to a variety of interactive resources for clinicians working with patients in languages other than English. These include clinical Phrase Books, Electronic Dictionaries, Interactive Translators, pharmaceutical Guides, Sign Language References, Glossaries, and finally some psychological testing scales translated in different languages.

A subsection under the title Online Clinical Resources for Mental Health Workers and Consumers provides resources pertaining to both clinicians and consumers, including linguistic resources as well as clinical informational material in the form of pamphlets, guidelines and detailed online informational projects. These documents are all translated into languages other than English and can be either used online or downloaded to the user's computer. This section provides comprehensive reference guides for various mental health disorders, coping skills, and therapeutic options.

The information collected under the "Clinical" section of the web site thus address issues originally proposed including: best practice guidelines for mental health services, cultural formulation guidelines and diagnostic and assessment tools, access to consultants, translators and culture brokers.

Section 3: Information for educators and students

The "Training" section of the CCS web site includes various information pertinent to the question of training, both in terms of the programs offered by and through the CCS and programs available elsewhere. A sub-document titled General Introduction to Clinical Internship and Rotations Offered by the CCS explains the setting of consultations and in-service training which is provided by the CCS in the two centers (Montreal Children's Hospital and Montreal Jewish General Hospital). This document details the general philosophy of this training approach in terms of the emphases on practical implications, the view on cultural assumptions, and the inherent issues pertinent to current mental health theories including the questions of racism, power, ethnicity, language, and religion, and finally the responsibilities of participant trainee.

A next link provides online access to the detailed American Psychological Association Guideline for Providers of Psychological Services to Ethnic, Cultural and Linguistically Diverse Populations.

Further documents provide information on the training program available to CCS, namely the transcultural mental health training offered through the McGill Summer Program in Social and Cultural Psychiatry. This subsection contains comprehensive information on the Division of Social and Transcultural at the department of Psychiatry at McGill University. This includes general information regarding the program, instructors and research projects currently in progress, as well as the courses offered through the year and the Summer program, with the possibility for contact and online application to these courses/programs.

In addition to the local training possibilities, a comprehensive list of different programs at various centers around the world is also available in this section. This is a growing list of programs that offer mainly postgraduate training in mental health with a cross-cultural focus. The information on these programs is directly accessible through hyperlinks from CCS training section.

Also accessible in the Training module is an annotated list of online material pertaining to various aspects of cross-cultural training in mental health. These are documents provided by various sources (educational, governmental, commercial, etc.) which one or more of the issues of concern to the CCS project. This list has been collected over time by the CCS and includes access links and brief descriptions of the content of tens of resource provider centers around the globe.

An annotated bibliography on "Cultural Psychiatry and Related Topics" in this section provides references and brief descriptions of a comprehensive collection of literature. These references are also rated according to their degree of usefulness to a researcher of cultural consultation. This bibliography is arranged alphabetically and is broken into hypertext-formatted sections for easier access.

A sub-section provides access to the CCS comprehensive bibliography of further literature related to cross-cultural mental health and research. This is a comprehensive bibliographic database that contains over 850 titles. This database is also arranged in alphabetic order and is accessible in full hypertext format. The bibliographic databases are indexed by the CCS Web Site's search engine program, and thus searchable by keyword, title, author's name, etc.

The CCS online Database of Organizations is also accessible also through this module. These are organizations throughout Montreal which provide not only personal, community-related, and mental health related services for immigrants and refugees, but often they have research branches as well as access to subject pools and other community based resources which might be of great benefit to researchers. The database reflects among other things the nature of services and the orientation of each one of these organizations, as well as the specific populations each organization is targeting.

Section 4. Information for Researchers

The "Research" section provides further information and resources for those interested in doing research work relevant to the concerns of Cultural Consultation Project.

The Research Module also includes links to other online documents related to culture and mental health research, including a comprehensive documentation by ATMHN (the Australian Transcultural Mental Health Network). This document is a large source of information for culture and mental health research containing various resources such as research projects in progress, funding sources, other (culture and mental health) research units around the world, online research papers and other texts, and other data banks.

A second website developed within the CCS project is the International Transcultural Mental Health (ITMH) Web Site, which is intended to address a larger audience beyond Montreal. The ITMH Site in turn provides a complete site of resources, references, resource persons (clinicians and researchers) around the world and other relevant information for researchers working on Culture and Mental Health related questions.

A comprehensive document containing contact and content information on a wide range of culture and mental health related resources world-wide developed for the ITMH is directly accessible through the Research Module of the CCS Site.

A list of researchers (and clinicians) working on various aspects of culture and mental health around the world is also available through this section. These are individuals who work in research and educational organizations. The list contains names, description of research interests, setting, and contact information for each individual. This growing list is intended to initiate a useful network of researchers and cultural-consultants which might be drawn on in the future phases of cultural consultation, with the vision of a globally-networked consultation service available through the World Wide Web accessible to clinicians and care-givers worldwide.

TCPSYCH, also accessible through the CCS Research Module, is an electronic discussion forum of clinicians, researchers, educators and graduate students in cultural mental health related areas around the world. The TCPSYCH list currently has over 120 subscribers who participate in ongoing discussions concerning culture and mental health. Researchers are invited to subscribe to and participate this forum. The discussions of the forum are also posted and accessible to the public in a searchable database onto the World Wide Web. This forum provides a useful means of communicating events, ideas, and culture-related questions for researchers, students, and clinicians alike.

Utilization of the website

One commonly agreed-upon method of assessing a Web project's success is statistical analysis of visits to the site. We implemented an ongoing evaluation by incorporating a program that traces user's visits to the website.

According to the records kept by the program, the CCS Web site has had over 6550 visitors since the date the statistical program was installed, i.e., mid-May 2000. About 63% of these visitors are from Canadian Internet Access Providers, the rest a combination of business, governmental, and other providers from around the world. Each visitor has, on average, returned to the CCS Web Site 6 times. According to these records, the highest rates of access have been on Wednesdays (about 21% of visits) and Tuesdays (about 19% of visits), followed by Mondays (about 17%), Thursdays (about 15%), and Fridays (13%). A breakdown of the visits by the hour of the day further showed that the rise and fall of intensity of visits to the Web Site have followed a rather normal distribution with the peak being at about 2 pm. An interesting finding from this breakdown, however, is the number of visits done over the late night hours (by local time). A high proportion of visits (about 11%) occurred at about 5 am EST, and almost 30% of all visits were between midnight and 8 am, reflecting access of the site by users outside North America.

Conclusion

The current CCS Web Site provides a comprehensive and interactively accessible source of information and support for the various groups of users it is designed to serve. The site is designed with an emphasis on ease of use. The complete website, including all documents inside and outside the virtual directories is accessible through a simple frame-based interface, which enforces a 'standard look' throughout the users' navigation of the site. A search engine continually updates its index database by re-indexing the complete site on a regular basis, a function which ensure accurate and comprehensive coverage of new additions and updates.

The CCS website is a work-in-progress and we hope that it can become a useful resource for clinicians in Montreal and across Canada and form the basis for a national network to exchange clinical and research information in culture and mental health.