When does it stop being a party and start becoming a problem? Is there a way to steer clear of addiction? Every Wednesday, Mike McGowan, host of the podcast "Avoiding the Addiction Affliction," explores substance use disorders with expert guests. The podcast series is sponsored by the Kenosha County Substance Abuse Coalition.
Original cover art created by
Kelly P. of Kenosha, Wisconsin
Independently licensed clinical social worker and the owner of Relevant Connections in Cleveland, Ohio
Not everyone is served equally by the mental health and substance abuse system. Chardé Hollins discusses the obstacles those of diverse ethnic and cultural backgrounds have accessing substance abuse and mental health treatment and what can be done to level the treatment playing field. Chardé is an independently licensed clinical social worker and the owner of Relevant Connections in Cleveland, Ohio. Ms. Hollins consults with organizations committed to increasing their cultural awareness and access to behavioral health services by naturally integrating emotional wellness supports and inclusive policies into their agencies’ cultures, services, and missions. She can be reached at https://www.relevantconnections.org.
[00:00:00] [Jaunty Guitar Music]
[00:00:11] Mike: Welcome everyone to Avoiding the Addiction Affliction, brought to you by the Kenosha County Substance Abuse Coalition. As always, I'm Mike McGowan. You know, not everybody is served by the mental health and substance abuse system equally. For a lot of people, access to treatment and resources is difficult, and when they get them, they often are not sensitive to the cultural or ethnic background of the individual seeking treatment.
Well, that's the topic of our conversation today. I am so glad to have as our guest, Chardé Holland. Chardé is an independently licensed clinical social worker who is highly regarded for her ability to gain rapport and provide innovative strategies for cultural adaptations that support inclusivity for persons of color.
She specializes in creating safe [00:01:00] places for meaningful conversations, which is so important. Chardé consults with organizations committed to increasing their cultural awareness and access to behavioral health services by naturally integrating emotional wellness supports and inclusive policies into their agency's culture, services, and mission. And she does so as the owner of Relevant Connections in Cleveland, Ohio. Welcome, Chardé.
[00:01:28] Chardé: Hello there. I'm so happy to be on with you. Thank you for having me, and hello to everyone listening.
[00:01:35] Mike: Oh, that's great. I always think it's a really good idea to start by letting us get to know you a little bit. So tell us a little bit about your background and your work at Relevant connections.
[00:01:44] Chardé: Yes. So I am a mother of two and I live here in Cleveland, Ohio. My background is as an independently licensed clinician. Did some work within the community, hospitals, as well as, the corrections facilities [00:02:00] and with adjudicated youth for over 10 years, and so that really gave me a lot of experience of learning how to adapt very quickly the evidence-based models that I was using, because oftentimes when I was working with these populations, I had to learn very quickly that the treatment modality that I had, the curriculum that I had, didn't necessarily fit with each one of those young people or adults that were sitting in front of me.
[00:02:29] Mike: Oh, man, you could have just written my early career right now. That's so true. Okay, let's get down to it. So, I say this a lot, a lot of research over the years was done, especially in this field.
[00:02:41] Chardé: Mm-hmm.
[00:02:41] Mike: Was done on middle class, working white men with insurance.
[00:02:47] Chardé: You said it, not me, Mike, you said it.
[00:02:49] Mike: Because you know, I worked in these places where we had researchers because they were there and you know, we have, fortunately we have a lot more research now, thank goodness. On other populations, women, [00:03:00] adolescents - that you and I have worked - with different ethnic groups, but what do we still need to learn about differing populations?
[00:03:07] Chardé: So many things. So with the demographics that you just shared, right? When we talk about white middle class males with insurance, which means they come from some type of economic background that allows them to have a job and have insurance and make minimum wage or higher. And as clinicians and those who work within the social service field, we look at the population we serve now and that is not it at all. So many of the modalities that we're using were not even based on the people that we now serve. Even if we take just having the white population now, majority of them are not white males, middle class. Right? So even if we just took the majority and it was the same race, the social economics have changed, the gender has changed, sexuality has changed. So many things have changed in who we serve, and so when we look at that, we have to [00:04:00] start thinking about, okay, who is our majority population that we're serving and that changes from different areas of the work, right?
And based off of that, we need to really start figuring out how it is that we can get modalities that fit them. How can we research more about the Native American population, the Asian American population, the AAPI, the Black Community, and I say "black" because that alone in itself is such a large demographic. There are Afro-Latinos, there are African-Americans, there are Africans, there's so many levels to the word "black". And so how is it that we can make sure we're breaking down those things so that way when we're talking to someone who's from the Caribbean, it's a different type of culture than when I'm talking to someone who identifies as African-American or who identifies as Afro-Latina.
Like what does all of those things mean and how can we as clinicians, how can we as researchers, those of us [00:05:00] who are in the academics and you're tied to a hospital or a university, these are the gold mines that we really need your support in because we can provide evidence-based research partnering with these types of institutions to find a modality that better serves the community.
[00:05:17] Mike: Okay. So, you know, all of those populations you talked about are historically underserved in this field. You know, I think the statistics are pre pandemic. This is almost stunning: 90% of Black Americans, if we lump that the way you - over the age of 12 with a substance use disorder, 90% did not receive treatment and two thirds of Black Americans with major depression didn't receive mental healthcare. Now that's a significantly higher percentage than the population at large. What are the barriers?
[00:05:53] Chardé: Oh, so I'm gonna blow people's mind right here too as well because what majority of society is saying [00:06:00] is because of the stigma of mental health, right? There is a stigma that's within the Black Community about mental health, receiving support, things of that nature.
And we are right, there is a stigma, right? There's a stigma. But I will tell you, that that stigma has decreased, and we have done a great job in getting the message out that mental health is important, that mental health is physical health. The conversations are happening at the dinner table. If people were to go back and do research now about the stigma of mental health, they will find that the stigma has decreased, what has not increased its access. What has not increased is cultural competence of care. So therefore, now we have decreased stigma and you have all of these black individuals who are ready and willing to take part in treatment, but there's nobody who knows how to help them because the modalities that we're using are European models.
So now you finally got me to figure out that yes, I need help, and then I show up and I'm like, oh, this ain't the help I was looking for. Let me go back to my [00:07:00] table and figure out how to cope the way I was coping, because now, just forget it. And that is where the problem lies.
[00:07:07] Mike: Well, and that was pre pandemic. This didn't get fixed during Covid. Right?
[00:07:11] Chardé: No, cause, cause now the access is even wider now, because now not only do I have barriers of just stigma or everyday life, that was before pre pandemic, now there's an additional barrier of I have to work an extra job, I have health problems, you know, all of these other things. And we know what the workforce is like in everything, let alone behavioral health, and there's not as many people there, so there's a backlog, but yeah. So it's a problem. Definitely.
[00:07:36] Mike: Are the modalities that are being used, you referenced the European model, is that also part of the reason why in these populations, especially the Black population, mental illness is more susceptible to overdiagnosis and institutionalization than in the white population?
[00:07:53] Chardé: Ooh, that's a layered question, hopefully we have time, but it's a good question. So [00:08:00] oftentimes mental illness shows itself differently based off of cultures and based off of lived experience. So many times when someone is experiencing depression or someone is experiencing ADHD or things of that nature that are very common, we're looking for someone who's talkative, hyperactive for ADHD, things of that nature, lack ability to concentrate. For depression or anxiety, we're looking for someone who's, you know, quiet or maybe if it's self-injury, you know, they're cutting themselves, whatever the case may be, but it's usually something that's internal that if we're honest, allows people to feel empathetic towards them.
So you have this sense of empathy for someone who's experiencing depression cause you can see and feel their pain through their eyes, through their body, all those things. However, when it comes to the Black Community, especially our black males, that is not your signs and symptoms. Many of their signs and symptoms turn [00:09:00] towards anger, toward turn towards rage. And so now you have this oppositional science disorder that really is depression, anxiety, or ADHD.
And so what ends up happening is they become criminalized. So behavior health within the Black Community has become criminalized because of how it is translated into action because the modalities that we have been learned to look for, the signs and symptoms that we often look for don't look like what a young black boy is going through, it doesn't look like that. It looks more similar to what a young white woman is going through, or even a white boy, so then we're able to pick it up. But if somebody is cursing, if somebody is lashing out, if someone is fighting, we're suspending, we're expelling, we're putting in detention, we're, you know, locking them away and throwing away the key. No one's sitting there trying to figure out like, oh wow, this is actually [00:10:00] suicidal behavior because they no longer care about their life. So instead of them cutting themselves, they place themselves in reckless, reckless behavior because whether I live or die is no longer important. And it's the same mindset as someone who's self-injurious or who is, I'm taking pills whatever case may be, but the treatment is totally different. One is punished, and one is cared for.
[00:10:28] Mike: You know, I wanna go back to something you just said.
[00:10:31] Chardé: I know I said a lot, I'm sorry.
[00:10:33] Mike: No, it was great! So I work a lot in schools, right? I'm, in schools almost every single day. What I just heard you say is that the way depression may manifest itself in a young black male is not dissimilar to the way it manifests itself in a young, white female, which is that outward behavior rather than turning inward.
That young, white female is treated significantly different than the young black male [00:11:00] showing the same behavior.
[00:11:01] Chardé: Yes. Yes. And, and to the point where even, you know, there's lots of studies and things like that in regards to the black girl, as well. black females, especially in the young - were often over oversexualized just because of how the body is, right?
Oftentimes as a black woman, you'll hear the phrase, strong black woman, or she's too aggressive, and it's because a lot of times when we get passionate, it can come across like our voices raised, we start moving, even as I'm talking to you in this podcast, like if they could see me, I'm like, do, do, do! I'm all in the camera, and Mike it's just taking it, I love it. But that's just how we express ourselves. And oftentimes it can be looked at as being aggressive or disrespectful, right? So in the same regard, that white girl, white boy is seen as heart hurting themselves or quiet, or you know, low self-esteem, and so now we have to empower them, enrich them, and support them.
While the black young man, he is [00:12:00] acting out, he's angry, he's cursing. The black young girl is insubordinate, quote-unquote, you know, she's giving attitude or whatever the case may be. I mean, it's even within our policies and procedures. So on side note, another thing that I do is I work closely with schools to make sure that their policies and procedures on how they handle behavior is actually culturally competent.
Because even when we think about our policies and procedures, when it comes to, you know behavior, it leaves no room for cultural competence. Because if the way I react to depression or to anxiety is to be physical, that's automatic expulsion, is it right? Absolutely not. No one needs to put their hands on someone, but at the same time, what are we telling that child who just got into a fight and now they have no chance of getting education, [00:13:00] but they're going back to the same environment that caused them to fight in the first place because they're depressed or sad about something that's happening at home. And now we wonder why they're worse when we come back, because we just sent them home for two weeks.
[00:13:11] Mike: You know, how do you get the agencies you're working with to understand the groups that they're servicing? I would think that one of the first things you have to be able to do, and I I wanna ask you this because I would think this is difficult, is to just get them to talk about it because people are so -, or have you found that people are reluctant to talk about it because they don't wanna be labeled?
[00:13:35] Chardé: Yes. Yes. So anytime we talk about anything when it comes to race, sex, sexuality or gender, people get just so uuuuugh, you know, it's like, oh my goodness, culture, whatever. So that's why when I do my trainings, I love to just jump right out of the gate and talk about the 10 elements of culture and how none of them are race, sexuality, or gender.
So the three things that [00:14:00] cause us to cringe and feel so super uncomfortable because we don't want to offend anyone, actually have nothing to do with culture. Yes, we can have commonalities surrounding those things because of how we identify as race, gender, and sexuality. But those are not actually what the basis of culture is implemented in, and once we realize that, then we can be more free to have these open conversations because now we're just talking about everyday humanistic things that we can find commonality in. Right? And so that's the first thing, and then moving to the place where, I'm very comfortable with making people uncomfortable.
Especially, especially people within the field of social services and education. Literally, our whole job is to move people outta their comfort zone. As a clinician, my whole job is to challenge you. So how dare I not be willing to be challenged? The whole job of an educator is to [00:15:00] challenge your thoughts and the way in which you, you know, take in things and express yourself. So how dare you as an educator not be willing to be challenged? And so with that, knowing that those are often the two populations I work with outside of healthcare, which is also you know, you all in people's business there too, right? How dare we be so, you know, high and mighty because of our degrees and our licensures that we can't now be in the place of those we serve and be humbled to check ourselves and feel uncomfortable in order to better serve them. So, yes.
[00:15:34] Mike: You used something called the, I think you said the Ecological Validity Model or EVM, right? You also referenced something about the 10 ways that culture's organized.
[00:15:44] Chardé: Yes. So there's a variety of frameworks in regards to culturally adapting evidence-based models.
So when we talk about culturally adapting evidence-based models, the premise is that we understand that what it is that we do and how we got to do what [00:16:00] we do came from somewhere and there is some substance to it. Like the cognitive behavioral therapy, it makes sense. It has great aspects to it. DBT has great aspects to it. So no one is saying to throw out all the evidence-based models and never use them again. But what we are saying is how can we culturally adapt them and take the principle of what it is that they were saying and the end result of what it is that we want to get and make sure that it better aligns with the populations and the communities that we're serving.
So what does that look like? What it looks like is a variety of people did their own frameworks and came out with different models. And so the model that I often talk about is the EVM model, which is the Ecological Validity Model, and so that actually came to support the Latino populations to culturally adapt it for them. And I like to use their model because to me it is kind of the simplest form. It just makes [00:17:00] sense. There's eight elements of adaptation language. Clearly there's a different language, right? Persons, especially when it talks about family. The family structure within the Latino culture is so strong and close knit. Right? And so, when I'm talking with people, you know, when we talk about that interdependence and codependence, we have to be really careful how you describe what that looks like to a Latino family, because it's all about multi-generational love and support. So, persons, what does mom look like? What does grandma look like? What do those roles look like? Right? It talks about metaphors and content. We know that even in the American language, what one word means here will mean something totally different in the south, will mean something totally different in the UK, right? So making sure that we understand metaphors, content concepts, and things of that nature.
But there are several different modalities. And you know, when all else fails, [00:18:00] being eclectic and kind of just pulling it all together to figure out what best serves your community. Because honestly, that's one of the reasons why I love that I'm independent now with my own organization, is because I truly believe that just as different as people are is different the modalities that you may have to utilize to serve them. So being open to that and taking the different pieces that we've learned in our textbook and through our lived experiences to see how we can serve.
[00:18:30] Mike: You know, and I'll add one more. I've always liked to plead stupid, and I don't mean that in - but if I don't know something to be self assured enough to say, explain that to me. And I've learned a lot over the years about different cultures just by asking questions about why?
I'll give you an example. I was paired up with a young woman in a school just cuz we had an odd number and she needed a partner and she was from Somali and she was wearing a hijab. And I just said, do you get to pick your own colors? And [00:19:00] she burst out laughing. And I immediately thought I stepped in something right? And I said, why are you laughing? She goes, because I bet you that every other person in this meeting room wanted to ask me that but hasn't. And so when we finished our conversation, she got up and I said, she's open a conversation, and the young people in that meeting room asked her a ton of questions, and she'd only been going to school for four years. Right.
[00:19:26] Chardé: Wow.
[00:19:27] Mike: So in a Black population, the role of an African American grandma,
[00:19:32] Chardé: Mm-hmm.
[00:19:33] Mike: and a mom is pretty important if you're gonna do therapy.
[00:19:38] Chardé: Oh, absolutely. Absolutely. And, and even outside the home, right? We know what the statistics are in regards to single mothers and things of that nature, but there's always a community structure. Not only is mom and grandma important, but that individual has some type of father figure, whether it's a big brother, a cousin, their actual [00:20:00] father who's just not in the home, but still a part of their life. An uncle, whatever the case is, their coach that's at their school who does track - finding out who their family is and what that means, right? And being able to engage all aspects of them in order to support them.
Sometimes when we come in as clinicians, we try to- which makes social work kind of different from psychology and the fact of psychology is you and that person, what's in the mind of that person, you know, talking about your mind and your thoughts, right? Social work kind of looks at all the different aspects, right? That's the environment. So each one plays its benefit, but when we're specifically talking about those within social work, you have to be social like find out who those different aspects are in the family.
I never understand when I'm talking with clinicians, specifically social workers to understand the role of psychology and things of that nature, how you [00:21:00] have not been to the school, you don't know who their teachers are, you don't know who their coach is. And I'm like, well, you're not a social worker, you're not at all doing the prime things of what it is we do as clinicians, you know, because that is literally the premise of social work. We recognize that the environment plays a very key factor in who a person is and how a person copes through life. Therefore, we have to become engaged with that environment.
[00:21:28] Mike: You know, a lot of our, well, you just hit the nail on the head, a lot of our listeners are practitioners, right? Whether they're therapists or social workers or whatever. And so how do they goabout increasing their own cultural awareness to a group that they don't belong to?
[00:21:43] Chardé: Oh, good question. So one Google. I know that sounds really bad, but what I'm going to say too is that it's a very thin line and I encourage you all to ride that line, okay? Because it is okay to feel uncomfortable, [00:22:00] but what we can't do is find like the one, you know, a black person and expect them to express everything that there is to know about black people for you to understand, right?
So it's kind of like, hey, you have to do your own research, find some things. Because how I relate to black people here in Cleveland may be totally different than what's going on in Wisconsin and totally different than what's in Utah, right? Because demographics are different, right? But I would definitely look things up, kind of figure out some things about the culture and and what makes sense. I would also encourage people to go to environments where black people are, and just sit. Find the local park, find a restaurant. You know what neighborhoods there are. And there is a difference. There is a difference between being uncomfortable and feeling unsafe.
[00:22:49] Mike: Hmm.
[00:22:50] Chardé: And it is very important that you recognize that you are only uncomfortable, you are not unsafe. And that because of that feeling, [00:23:00] that is something that you need to take in and say, what is it about this moment that's making me feel uncomfortable? You know, and why do I feel as though my discomfort is leaning towards unsafe?
And so now you're able to challenge yourself and recognize some of the biases that you didn't know you had, you know, and recognize that, oh, you know what, like I do feel kind of weird being the only white person in the room. And I wanna be like, well, welcome to our life! Because you know how many times we're the only black people in the room, you know? But that is part of being able to bond with us, right? Being able to bond into like, you know what, yeah, I did feel uncomfortable, and it's okay. It's not, you're not racist because you feel uncomfortable. You are not racist because you have a bias. So that a lot of times we kind of don't want to feel those feelings or we would reject having those feelings because then we'll be labeled as racist and that's not the case at [00:24:00] all.
That's being human. I am uncomfortable when I walk in a room and there's people who do not look like me there. It's like, okay, let me make sure you know, present myself however, I need to present myself. That's a natural feeling. No matter whether it's race, gender, no matter, it's because there's a whole bunch of black people in a room, but I just don't know anyone that's natural, right?
So be able to sit with yourself in a situation that you're not comfortable with and analyze what's happening to your body, analyze what's happening in your mind, how you're feeling about it, right? And pay attention to it and be open to it, you know, if you can, take notes, if you can actually take notes, do that, but if not, don't because, I mean, I'm trying to think, if I was at the park and somebody was just writing while they were looking at me, that's kinda weird. But if you're in a position, maybe a coffee shop or a restaurant where you can take notes in regards to how you feel, right? Not necessarily what's happening around you, but I've recognized [00:25:00] that, you know, when this person walked by you know, I felt something right, but when this person walked by, it wasn't that bad, you know?
Or I recognize that, you know, this triggered me because of X, Y, Z, whatever the case is. So that way then you can take time to later go back and reflect, and then you can go to therapy or you can talk to somebody and work through it. Just like how you work through everything else, working through racism, working through implicit bias is a reason to go to therapy and a reason to do treatment, and that is okay.
That is okay. So I know I - Mike, I'm sorry.
[00:25:40] Mike: No, I would imagine that that's the conversation when you work with an agency that is really healthy for the individuals in the agency to have.
[00:25:49] Chardé: Yeah. And a lot of times what I'm learning, cause when I first started this work, I apologized a lot and not like, just because I said a lot, but like, because of what I said, like hopefully that wasn't too - [00:26:00] I don't do that anymore. But, I say that because one, I do think that you know, I've been blessed to know how to communicate to people and be authentic so that when I'm talking, even if it's something that may be jarring, it doesn't come across offensive. I am not in the business of making you feel comfortable, but I do not want to offend. Right? And the question is, if you are offended. What about it was offensive? Because then we need to break down if it's truly offensive or if you're just uncomfortable.
And those are the types of things we have to talk about when I'm working with organizations. Right? To really, before we can try and push cultural competency and diversity and equity because it just sounds good, what internal work are we doing?
[00:26:51] Mike: That's great.
[00:26:52] Chardé: Because if we're only just pushing it out there and putting some, you know, Black and AAPI books on the bookshelves or, you know, [00:27:00] we're having new faces on our brochures just to, you know, diversify. I mean, that's nice, but what's really going on internally? Because have we looked at our board? Have we looked at our board and seen if our board actually reflects the people we're serving? What, what does that look like?
[00:27:20] Mike: That's outstanding. That's just incredible. And, you know, I wanna be sensitive to your time and so we'll obviously put a link to your website because I know people will want more information, but for those who like hearing it and in addition to reading it, how do people get ahold of you and your services?
[00:27:37] Chardé: Yes. So my organization is Relevant Connections because you can connect people to a whole lot of things, but if it is not relevant, then it won't do anything. So we wanna make sure that while we're working with you, it's always a relevant connection. And so I can be found www.relevantconnections.org. You can email me [00:28:00] directly. My last name is Hollins: H-O-L-L-I-N-S, R as in relevant, T as in Tom, connects, plural, .org.
And so go to the website, that's the easiest way to contact me, and then of course, email and all that's stuff is there. And I would love to support people, organizations who are interested in really deep diving beyond a checklist when it comes to equity and cultural competence. Whether it's your policies and procedures, whether it's your board, whether it's how you do a RFP and contracts, whether it is your direct services and actually looking at culturally adapting a modality because it sounds nice, but one of the biggest premises of utilizing it to make sure that it's still within fidelity is that it's something that can be translated across your agency. So [00:29:00] what does it look like to actually have a team that's for culturally adapting your modality?.
This is the curriculum that our agency has approved to use. This is what our grant funding, you know, says we have to use. That's fine, that's fine. Let's use it, but let's make sure that it supports the people in which you want to serve. And that is something I am very, very, very passionate about and would love to support anyone and everyone in doing so.
[00:29:29] Mike: That's great. And for those of you who aren't quick, and that would be me you have the link on the end of this podcast. Chardé, thank you so much for joining us. This was really delightful, it just flew too.
[00:29:40] Chardé: It did, it did. Thank you for having me, Mike, and I look forward to another time and to hear from you all as well.
[00:29:46] Mike: Great. And for those of you listening, please listen in next time when we'll have more discussions like this, and until then, stay safe, and go make a relevant connection.
The Kenosha County Substance Abuse Coalition’s mission is to support networking, encourage education, explore gaps, and realize solutions to improve treatment and reduce alcohol and other drug abuse in our community with a primary focus on families.