Cultural Brokering

Refugee Trauma & Resilience CenterBoston Children’s Hospital

WHAT IS CULTURAL BROKERING?The act of bridging, linking or mediating between groups or persons of different cultural backgrounds for the purpose of

reducing conflict or producing change(Jezewski, 1990)

ROLE OF CULTURAL BROKERSIN TST-R

INTERPRETERS VS. CULTURAL BROKERS: WHAT’S THE DIFFERENCE?

Interpreters pass information from one person to another without making changes

Cultural brokers add to information, facilitating deeper understanding

Cultural brokers add context, provide background knowledge to enhance provider’s understanding of situation

Cultural brokers are partners to clinicians

WHY USE CULTURAL BROKERS?

Using a cultural broker can improve access and quality of care, and ultimately significantly improve outcomes,

by: Creating trust Building better communication Improving assessment and treatment Enriching the knowledge of both systems De-stigmatizing treatment Building capacity in the community Fostering a more holistic treatment approach

Adapted from: Georgetown University Center for Child and Human Development. (2004). Bridging the Cultural Divide in Health Care Settings: The Essential Role of Cultural Broker Programs, from. http://nccc.georgetown.edu/resources/brokering.html

IDENTIFYING CULTURAL BROKERS

Who are the community helpers? Who are the gatekeepers? Who knows the mental health system? Who do community members go to for information

and assistance? What are program priorities and what are barriers to

hiring? Who is trusted?

WHO SHOULD BE A CULTURAL BROKER?

Positive community-level

standing

Able to navigate community politics and diversity

(religious, economic, etc.)

Strong community networks

Strong understanding of

the service system

Children should NOT be used as cultural brokers

High/ethical values/integrity

Cross-cultural communication Advocacy Negotiation of service delivery systems Mediation Conflict management Ability to hold contradictory and conflicting

positions/ideas

Attribute of Cultural Brokers: Skills

Adapted from: Georgetown University Center for Child and Human Development. (2004). Bridging the Cultural Divide in Health Care Settings: The Essential Role of Cultural Broker Programs, from. http://nccc.georgetown.edu/resources/brokering.html

QUESTIONS TO CONSIDER: SKILLSWhat languages do you speak? What experiences have you had with interpreting and/or translating? What experience do you have with advocacy? What do know about the local and nationally health and mental systems? How well do you think you can navigate between cultures? What experience do you have with mediation or conflict resolution? How have you navigated differing beliefs in the past? How have you navigated differing beliefs in the past? How do you typically deal with stressful situations?

Values, beliefs & practices related to illness, health, mental health and well-being of cultural groupsTraditional mental health practices and mental health care network within diverse communitiesMedical and mental health care systems knowledge

Adapted from: Georgetown University Center for Child and Human Development. (2004). Bridging the Cultural Divide in Health Care Settings: The Essential Role of Cultural Broker Programs, from. http://nccc.georgetown.edu/resources/brokering.html

Attribute of Cultural Brokers: Knowledge

What are some of the traditional cultural values that guideattitudes and behaviors in your community? How has thatchanged since being the U.S.?

What are some of your community’s traditional beliefs andvalues about health/mental health? How has that changedsince being the U.S.?

What are some of your community’s traditional health/mentalhealth practices? How have they changed in the U.S.?

QUESTIONS TO CONSIDER: KNOWLEDGE

Own cultural identity Others’ cultural identity Own place within communities Social, political, religious & cultural factors

affecting communities Openness to community understanding

Adapted from: Georgetown University Center for Child and Human Development. (2004). Bridging the Cultural Divide in Health Care Settings: The Essential Role of Cultural Broker Programs, from. http://nccc.georgetown.edu/resources/brokering.html

Attribute of Cultural Brokers: Awareness

How would you describe your cultural identity? How is that similar or different from others in the community? How do you think your cultural identity impacts working with

community members and clinicians? What role or roles do you play in the community? What do you think are the traditional gender roles in your community?

How have they changed in the West? Are there social, political, & cultural differences in your community? If

so, how have you dealt with them?

QUESTIONS TO CONSIDER: AWARENESS

TRAINING CULTURAL BROKERS: WHAT’S INVOLVED

Help cultural brokers

understand and apply TST-R through role

playing

Clearly identify program

priorities and insure CBs

understand them

Foster an open exchange of knowledge

between cultural brokers and

clinicians through team

building

Start the process of exchange, equality and

communication

Help clinicians/cultural brokers role

play clinical interaction scenarios

SUPERVISOR-SUPERVISEE RELATIONSHIP

Build trust Learn from each other Facilitate effective communication Be flexible both interpersonally and

professionally Recognize power differential Initiate discussion about cultural difference

and clinical/cultural difficulties

CROSS CULTURAL HUMILITY IN CLINICAL SUPERVISION

What is cross cultural humility? Cultivated and evolves over time

Cultural diversity includes but is not limited to: Age, gender, religion, generational status, sexual orientation,

socio-economic status, race, ethnicity, and country of origin

CULTURAL HUMILITY OF CLINICAL SUPERVISOR

Awareness (of values, biases, and attitudes) Knowledge (of culture, oppression/racism/

prejudice, heterogeneity within and betweengroups)

Skills (of how to be effective cross culturally) Power dynamic (acknowledgement)

ASSESSING ORGANIZATIONAL CAPACITY

Financial considerations

Culture of organization

Community resources

Potential barriers

FUNDING SOURCES

Billing state health programs

• Sustainable• Dependent on client

volume• Not possible in every

state• Specific training and

documentation required

Grants/Private

• Not dependent on client volume

• Flexibility• Limited funding

availability can be a problem

• Time-limited

Assess Staff Readiness for Cultural Brokering

Do staff understand and support the new service?

What are the norms at your agency and how will they be affected by this new service?

What are staff’s thoughts and concerns about its effect on their practice?

BUILDING PARTNERSHIPS

Awareness of other community

services supporting clients

Collaboration where possible to

prevent duplication of effort

Open communication with local, state, school and city

offices that work with target population

Building positive and collaborative relationships with Mutual Assistance

Agencies

PARTNERSHIP BUILDING QUESTIONS

How do you begin to engage communities? What are

community hopes and concerns?

How do your services align with other services in the community?

What community strengths can be engaged in the

services?

How do you explain your

services to the community?

ORGANIZATIONAL READY-SET-GO

Assess integration of cultural brokering services into existing services and create a plan to meet identified gaps

Identify funding mechanism for cultural brokers

Identify community resources Identify barriers and plan

for them

THANK YOU!

"A journey of a thousand miles starts with one step.”

-Lao-tzu, ancient Chinese philosopher