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“An organization’s ability to recognize, respect, and address the unique needs,
worth, thoughts, communications, actions, customs, beliefs, and values that reflect an individuals racial, ethnic, religious, and/or
social groups or sexual orientation.
CARF Standard Manual
CULTURAL COMPETENCY
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Learn about resources and tools that could assist your organization with creating its cultural competency plan.
Assist your staff to develop an understanding of the values and beliefs of the individuals they support and how the tools will assist them with providing respectful, individualized and effective services and supports.
LEARNING OBJECTIVE
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Diversity is a growing part of our lives.◦ People are choosing to live in places that are
different from where they were born.◦ Woman and the elderly are employed more than
ever◦ Speed of travel and communication has increased◦ People with disabilities are working and living in
the community◦ A growing expectation that diversity will be
respected in public policy, business practices, and social services.
Why is Cultural Competency important?
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Knowledge
Attitudes Behaviors Skills Policies Protocols Programs Resources
Effective methods to work across cultures
Respect, empathy, awareness, insight
Ongoing process Embraces change Avoids
stereotyping
What is Cultural Competency?
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By 2050, minorities will represent 54% of the US population.
Source: U.S. Census Bureau
Did you know……..
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This table reflects the years when white becomes the minority group by age:
Total Population 2043
Age under 18 2018Age 18 – 29 2027Age 30 -44 2035Age 45 – 64 2051Age 65 + after 2060Source: William H. Frey, Brookings Institution analysis of U>S> Census Bureau population projections
2012
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The integrated pattern of human behavior that includes the thoughts, communication,
actions, customs, beliefs, values, and institutions of a racial, ethnic, religious,
social, or other group.
Culture
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R.E.G.A.R.D.S.• Race• Ethnicity• Gender• Age • Religion • Disability • Sexual Orientation
Culture includes:
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A classification of people based in part on distinctive physical characteristics such as
skin color; a socially-constructed not biologically-constructed aspect of humanity.
Race
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Special groups within a race who are defined by ancestry, cultural heritage, language,
nationality, or religion, or a combination of these human characteristics.
Ethnicity
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Race/Ethnicity and Nationality
White
England
Scotland
Ireland
Poland
Scandinavia
Italy
Russia
Black
Africa
Haiti
Jamaica
Dominican Republic
Hispanic/ Latino
Cuba
Puerto Rico
Mexico
Central America
South America
Spain
Asian/ Pacific
Islander
China
Japan
The Philippines
Vietnam
Cambodia
Korea
Samoa
Native America
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Hundreds of tribes in North America
including:
Cherokee, Navajo, Apache,
Blackfoot, Inuit.
Middle Eastern
Egypt
Iran
Yemen
Palestine
Lebanon
Jordan
Saudi Arabia
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Gender -◦ To include gender identity: a person’s innate perception
of gender which may not correspond to one’s sex Age (including generational differences) Religion Disability Sexual Orientation
◦ Emotional and physical attraction to others of a particular sex (other, same or both)
Culture continued
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The five elements of cultural competence include:◦ Valuing diversity.◦ Being able to understand your own cultural views
(and those of organizations or systems).◦ Being aware how culture may be affecting a
situation. ◦ Being able to learn about other cultures. Finding
ways to share and build on that knowledge.◦ Being able to change your behavior to meet the
needs of others and their cultures.
Using the Cultural Competence Continuum
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The first step to cultural competency is understanding your own culture –◦ What is family?◦ Where you live now and where you have lived before◦ How your family shared meals◦ How you celebrated holidays, and religious events◦ Gender roles◦ Your education◦ How much money you have◦ Your own disability, or that of a family member◦ Social customs and etiquette
Understanding your own culture:
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Understanding the Six Stages
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Individuals/ Organizations who
◦ Do not value diversity. ◦ Do not recognize culture. They see cultural
differences as expressions of "right" and "wrong." ◦ Do not desire to learn more about other cultures. ◦ Will resist changing behavior to meet the needs of
others.
What is Cultural Destructiveness?
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Have little understanding about their own prejudices.
May believe in the following types of stereotypes:
◦ Gay men are child molesters.◦ African-Americans are less intelligent than European-
Americans.◦ Women are not as good as men at math and science.◦ American Indians drink too much.◦ Women on welfare have babies to avoid working.◦ Muslims are terrorists.◦ Jews are rich.◦ People with developmental disabilities are dangerous.◦ A Korean neighbor will eat your pet dog.◦ Homeless people are drug abusers or lazy.
What is Cultural Incapacity?
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Individuals/ Organizations who
◦ Value diversity, but only superficially. ◦ See culture as a surface feature. ◦ Desire to learn more about other cultures but
resist or do not understand some important information.
◦ Will resist changing their behavior to meet the needs of others when the behavior reflects a deeper value choice.
What is Cultural Inattention?
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Individuals/ Organizations who◦ Value diversity and are beginning to understand
some of the deeper cultural differences.◦ See culture as important. However, they find it
difficult to understand.◦ Sometimes they are able to recognize when
culture is affecting a situation. ◦ Want to learn more about other cultures, yet lack
information and resources.◦ Do not know how to change behavior to meet the
needs of others.
What is Cultural Pre-Competence?
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Individuals/ Organizations who
◦ Value diversity. They understand why it is personally and professionally valuable to them.
◦ See culture as part of everything and understand that culture affects the daily choices that people make.
◦ Understand that interactions always require some level of cultural competence.
◦ Actively develop and use a variety of resources for learning more about different cultures.
◦ Willing to change their behavior to meet the needs of others.
What is Basic and Advanced Cultural Competence?
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Communication volumes (loudness) vary among cultures? Baseline speaking is
generally lower among Asians and Western Europeans. Americans tourists in these parts of the world are often seen as rude
and thoughtless.
Did you know……
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◦ Personal Space◦ Eye contact◦ Speaking volume◦ Touch◦ Time
Things to consider with cross-cultural communication:
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Influenced by:◦ Gender◦ Status◦ Degree of intimacy◦ Space available◦ Differences in “business size” space and
“personal size” space
Personal space -
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The duration and frequency of eye contact communicates a great deal but differs widely among cultures. For example:o Among Latinos, it is respectful to avoid direct eye
contact with authority figures. o Southern Europeans generally engage in more eye
contact than Americans.o Asians, direct eye contact is brief, especially with
superiors or members of the opposite sex.
Diversity Council 2008
Eye Contact -
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Volume as well as the words we speak, varies among cultures. ◦ For example, white Americans interpret raised
voices as a sign of anger while other ethnic groups such as Latin Americans or Africans, raised voices are simply an exciting conversation.
◦ In some African cultures, whispering is a sign of witchcraft or plotting.
Diversity Council 2008
Speaking volume -
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Compared to other cultures, Americans rarely touch each other, limiting ourselves to handshakes or pats on the back.
Latin Americans touch with much frequencies. In these cultures, it is not uncommon for two men to hold hands, showing nothing more than friendship
Touching someone on the head is offensive to most Asians
Diversity Council 2008
Touching –
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The way we use time also sends a message without a word being spoken. For example:
◦ In American business culture the emphasis is on punctuating while in Latin and Middle Eastern cultures, value is placed on the relationship so a meeting continues until it reaches a natural conclusion, even if you are late for the next one.
Diversity Council 2008
Time -
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Low context communicators (For example, American macro culture, Northern European) tend to:
◦ Emphasize straightforward, logical speech.◦ Are impatient with silence or indirect language (such as story telling).◦ Communicate primarily with words.◦ Are unaware of the past or think it is irrelevant.◦ Are less formal, more likely to extend equal status to all speakers.
High context communicators (For example, African-American, Asian, Native American, Latino) tend to:
◦ Be highly tuned to body language.◦ See the past as important as the present.◦ Rely less on words and more on the whole situation.◦ Use indirect language, story telling, and silence to convey messages.◦ Are more formal, taking into account status and position to guide interactions.
Differences in Communication:
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Smile at customers (Russia) Look someone in the eye when they are
speaking (in parts of Africa) Not let your friend smell your breath (in
some Arab cultures) Brag about your credentials in a job
interview (in the Netherlands) Bring white flowers to a host’s house (in
China)
Did you know it is considered rude to ……..
A way of improving our service delivery
A way of expanding our capacity to work with one another
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CULTURAL COMPETENCY IS
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Value Diversity Assess themselves Mange the dynamics of difference Acquire and institutionalize
cultural knowledge Adapt to diversity and the cultural
contexts of individuals and communities served
Key Elements of Culturally Competent Organizations and their Staff
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Nodding the head up and down does not always mean “yes”?
In the Middle East, when they nod the head down, it indicates agreement. While nodding it up means they disagree.
In Japan and most of Asia including the Philippines, nodding up-and-down is a way to show that someone is listening and is interested with what you are saying.
Did you know…
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How does a particular culture view: Illness and disability Role of Family Decision making authority
*Please note the following tools note differences in communication styles and values; but are to be used with caution to avoid stereotyping.
Service Delivery Implications
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http://mindlink.org/online_courses/cultural_competency_1.htm
Resources:
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Culture Clues (http://depts.washington.edu/pfes/CultureClues.htm)
Includes information on relationships, norms about eye contact & body language
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Diversity Tip Sheet: Cross-Cultural Communication, Translating Nonverbal cues and Communicating with Non-Native English Speakers
http://diversity.missouri.edu/learn/language.php
Resources:
Two million children are being raised by lesbian, gay, bisexual or transgender parents. Children of gay and lesbian parents live in 96% of U.S. counties
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Did you know…
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Am I using the correct terminology?
Are our service delivery processes flexible? Do I know how to reference same sex couples in their child’s
IP?
Am I aware of unique barriers individuals may be experiencing?
Typically LGBT Adults are more likely to be estranged from their biological family; and more likely to rely on friends and community members as their chosen family
Service Delivery Implications
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A resource that includes: terms to Use; terms to avoid; parenting & adoption and marriage for same sex coupleshttp://www.lgbtmap.org/allys-guide-to-terminology
Resources:
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An Ally’s Guide to Terminology—Talking about LGBT People & Equality
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Eid al-Fitr is an Islamic Holiday with significant work restrictions
Recommended Accommodations: Avoid scheduling important meetings, events, or activities on this date. Employees will likely ask to take a vacation day on this day, and that request should be granted if at all possible. If planning an evening event, provide food accommodations if requested (Islamic dietary restrictions apply).
Did you know…
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Are we aware and attentive to the religious and spiritual needs of: consumers their families and staff?
Service Delivery Implications
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This website identifies major holidays and suggested accommodationshttp://diversity.missouri.edu/get-involved/religion/holidays.php
Resources:
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Do you have an awareness of your actions as it relates to the individual’s culture?
Attire Take off shoes, when enter home? Accept food/drink if offered? Where do you sit? How reference individual- Mr. Smith or Tom…
Service Delivery: Home Visits
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Do you have an awareness of your actions as it relates to the individual’s culture?
Understand how culture influences decision making Explain why you must ask personal or sensitive
questions (such as: level of assistance needed when bathing)
Respect a families decision to use home treatments consistent with their culture
Service Delivery: Individual Plan Process
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What is your history? What is your home of origin? Why did you/your family settle in ____?
What are some of your family customs?
What are the roles of members within your family? What is your role?
What are the gender roles in your culture? And in your family?
How are decisions made at the family level?
What are your family beliefs about raising children? Discipline?
What are the practices of people who are considered to be excellent parents in your culture?
Source: http://www.d.umn.edu/~hrallis/courses/1100sp04/assignments/learn_cultures_qs.html
Questions in Learning about a Person’s Culture
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is a commitment to: culturally competent personnel culturally appropriate services culturally competent organizations
Cultural Competency Planning
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1. Assessment2. Planning3. Review
Areas to cover:(1) governance and organizational infrastructure (2) services and supports (3) planning and continuous quality improvement (4) collaboration (5) communication and (6) workforce development
Components of Cultural Competency Plans
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From CARF Connection March/April 2006
1. Do our services align with the beliefs and practices of the people we serve? Of the people within our organization?
2. Do the languages we speak, write, and sign within our organization include or exclude stakeholders?
3. Do we understand the unspoken pressures, issues, and cultural group norms that might affect how the person responds to our services?
4. Do we respond to regional differences or rural versus urban environments in which we operate?
Thoughts from CARF…
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Cultural Competency & Diversity Plan that includes: person served, personnel and other stakeholders
Addresses culture, age, gender, sexual orientation, spiritual beliefs, socioeconomic status and language
Reviewed at least annually
CARF Standards
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A. Identify the cultural characteristics within your community Evaluate demographics of your organization
and the community Are there unserved or underserved groups
in your community?B. Conduct Assessments
Step 1: Getting Started
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http://oseda.missouri.edu/
Who is OSEDA? Office of Social and Economic Data Analysis
Mission: OSEDA collaborates with partners in the analysis of social and economic data in ways that contribute to improvements in the well-being of people, enterprises and communities.
Priority Issues Improving the quality of public education Improving state and local government services. Improving the health status of people Improving the social strength of communities Improving the capacity for economic development
Resources for Data trends:
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Example of an OSEDA Report
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Statistic St. Charles Missouri National
English speaking 93% 94% 79%
Spanish speaking 4% 3% 13%
Caucasian 88.97% 83.12% 74.17%
African American 6.26% 11.53% 12.56%
Asian 1.82% 1.61% 4.81%
American Indian .22% .38% .82%
Mixed race 1.64% 2.24% 2.68%
Other race 1.09% 1.03% 4.79%
St. Charles County Statistic Comparision (U.S. Census Bureau)
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Conduct a comprehensive assessment of staff and organizational practices
What does your agency do or what do you do to effectively work with and serve the diverse groups in your community?
Do staff and the organization understand and respect the cultures represented?
Are agency processes responsive to a variety of cultures? (such as non-traditional families)
Self-Assessment:
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Simple Self Assessment example:
http://www.healthystartpinellas.org/pdf/Self_Assess_5.pdf
http://www.asha.org/uploadedFiles/Cultural-Competence-Checklist-Personal-Reflection.pdf
Extensive listing of Self-Assessment tools. University of Florida’s Intercultural Engagement program.
http://iengage.multicultural.ufl.edu/resources/campus_resources/cultural_competence_resources/
Competence Icebreakers, Exercises, Videos and Movies from Cultural and Linguistic Competence Community of Practice, Technical Assistance Partnership July, 2012:
http://www.tapartnership.org/docs/CLC%20Icebreakers%20and%20Exercises%20-%20FINAL%20(5).pdf
Community Tool Box, Building Competent Organizations
http://ctb.ku.edu/en/table-of-contents/culture/cultural-competence/culturally-competent-organizations/main
Resources for Assessments:
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Step 2: Planning
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To learn about populations served or underserved:
Develop & maintain partnerships with diverse constituency groups Immigrant service organizations Churches with services in non-English Ethnic markets
Have agency materials adapted to the cultural and linguistic contexts of populations served Printed materials– not only language; appropriate for the
literacy level of families served Ethnic media - television, radio, Internet, newspapers,
periodicals)
Planning Ideas:
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To improve service delivery:
Evaluate participation and satisfaction rates of families served from various cultures
Build capacity of provider network, do you have culturally competent providers?
Build an advisory committee that has knowledge of the groups served
Planning Ideas:
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To provide supports for Non-English speaking individuals:
Recruitment of Bilingual/bicultural staff Language interpretation services including
distance technologies (VRI: Video remote interpreting)
Use cultural brokers to confer with professionals who are not skilled in, or knowledgeable of, a client’s culture.
Planning Ideas:
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Language Line Interpreting
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To address staff training:
Initial staff training: self-awareness activities and knowledge focusing on cross-cultural communication and language
Establish cultural competence as an on-going learning process. This may include identifying the need for increased funding!
Establish a brown-bag lunch series in which a community member is invited to speak on a culturally related topic of interest.
Planning Ideas:
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At the Organizational level: Establish a goal to increase volunteers,
student practicum experiences, etc. to recruit a more diverse staff
Establish performance measures that assess cross-cultural knowledge and skills of the staff group
More ideas to evaluate at the policy level; Source: Policy Brief 1- Rationale for Cultural Competence in Primary Health Carehttp://nccc.georgetown.edu/documents/Policy%20Brief%201%20Checklist.pdf
Planning ideas:
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Support Coordinator: Demonstrates an awareness of and respect for coworker
and consumer’s cultural background Assesses patient’s ability to communicate in English and
assists in the provision of an interpreter, as needed
Supervisor: Arranges for translation of relevant patient information and
materials and assures that the materials are culturally appropriate
Provides on-going training, supervision and evaluation of staff on issues of cultural competence
Source: Lutheran Health Care
Job Description Examples:
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Use SMART GoalsSpecificMeasurableAttainableReasonableTime oriented
Review progress and revise as neededReassess and make needed adjustments; keep learning!
Step 3: Review
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National Center for Cultural Competencehttp://nccc.georgetown.edu/
Magellan Cultural Competency Resource Kithttps://www.magellanprovider.com/MHS/MGL/education/culturalcompetency/resourcekit.pdf
Office of Minority Health, US Department of Health & Human Serviceshttp://www.minorityhealth.hhs.gov/
Cultural Competency Plan Resources
Cultural Competence = Relationship Building
INDIVIDUAL: Get to know yourself ( worldview, values, uniqueness of others)
ORGANIZATION: Get to know your community (traditions, cultures, norms, practices, beliefs) so your agency can be more in tune with their assets and needs
SYSTEMS: Get to know your agency (culture, mission, values, staff, services, policies, practices, philosophies) so you can better serve the community
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Take Home Messages:
Robyn Peyton, Case Management Director, Developmental Disabilities Resource Board
Joanie Chenault, Director of Family & Community Living Supports, Boone County Family Resources
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THANKS FOR ATTENDING!
