Moving Your Health Service to the Next Stage of Cultural Competency

What’s the Next Step?

Presenters:

David Braun, MD – University of Iowa

Dwayne Sackman, MPA – Illinois State University

Goals

1) Present a self-assessment mechanism for any college health service.

2) Identify some potential challenges to increasing cultural competency.

3) Present some ideas on overcoming challenges and moving to the next stage of cultural competency

Cultural Competence

Cultural Competence is when a community member is aware of his/her own assumptions, biases, and values; possesses an understanding of the worldview of others; is informed about various cultural groups; and has acquired the skills to develop appropriate intervention strategies and techniques (Sue, Arrendondo, & McDavis, 1992).

AssumptionsMulticulturally competent persons understand: One will never reach an ultimate level of knowledge and

awareness about the self and various cultural groups. One’s identity, awareness, and skills are constantly evolving

in response to new information being received about the self or the other

One is continually seeking to raise awareness and develop skills that help to effectively address diversity and social justice issues.

One must develop the stamina to sit with discomfort, to continuously seek critical consciousness, and to engage in difficult dialogues (Watt, 2007).

A Self Assessment Tool

http://www.aafp.org/fpm/20020600/39achi.html

Achieving a more minority friendly practiceFamily Practice Management, June 2002, Vol. 9 No. 6 pg 39-43

Six Stages of Cultural Competence Development:

1. Cultural Destructiveness 2. Cultural Incapacity3. Cultural Blindness4. Cultural Pre-Competence5. Cultural Competence6. Cultural Proficiency

Journal of College Student Development Ingrid Grieger September/October 1996 Vol. 37 No. 5 “A Multicultural Organizational Development

Checklist for Student Affairs”

Monocultural

Nondiscriminatory

Multicultural

A Personal Self-Assessment Tool

Diversity Awareness Profile (DAP), 2nd edition by Karen Stinson

Naïve – no awareness of one’s biases, prejudices, and negative behaviors

Perpetuator – aware of one’s biases, but continue negative behaviors and reinforce stereotypes

Avoider – tolerates other’s unjust behaviors Change Agent – acts as a role model, takes action

when appropriate Fighter – always on lookout for prejudice and

takes action at all times

3 Phases to Move to the Next Level

Phase 1 – Structural Phase 2 – Behavioral Phase 3 – Cultural

“A Multicultural Organizational Development Checklist for Student Affairs” by Ingrid Grieger in Journal of College Student Development; September/October 1996, vol. 37 no. 5

Phase 1 – Structural Develop vision

Communicate vision

Find leaders

Set low-hanging fruit goals

Form culture competency committee

Phase 2 – Behavioral

Create opportunities

Build momentum

Build rewards

Phase 3 – Cultural

Make part of ongoing operations

Commit financial resources in budget

Expand scope

An exercise for today What would you do if. . .

. . .a patient expresses unwillingness to be seen by a provider because of racial/cultural differences?

An exercise for today What would you do if. . .

. . .a senior provider tells you in a staff meeting that he’s “tired of the discussions of theory”?

Here’s one from Gropper: The Athlete (page 74)

Charles Lear, an African-American whose family comes from the rural south, has been a patient at [the student health center] for over a year and Rita Barnes has been his regular nurse practitioner. The young man comes in for a physical examination because of a school requirement prior to participation on the track team.

Ms. Barnes is pleased that the youth is doing so well and asks, “What subjects are you taking this term, Charlie?”

He stiffens and mumbles, “English and math” and seems anxious to terminate the interview.

How would you explain this behavior?

Possible explanations1. Charles is getting failing grades in his classes and is

embarrassed to admit it.2. Charles has had to wait longer than he expected before

seeing Ms. Barnes, so he is in a hurry to leave.3. In the rural South, African-Americans are raised to respect

the name given to them by their parents and they do not convert it to a nickname as some other groups tend to do to demonstrate friendliness. Charles is startled by the liberties taken with his given name.

4. Charles does not like Ms. Barnes and wants to maintain his distance from her indirect communication of friendliness.

Video Conversation Starters

Short and not too edgy: “Color Me Blind” on YouTube, 5:39 video by WDrinker

Longer, edgy: “Hip-Hop: Beyond Beats and Rhymes” by Byron Hurt Info at www.bhurt.com

A classic medical cultural competency book resource The Spirit Catches You and You Fall Down

by Anne Fadiman www.spiritcatchesyou.com

Some additional resources Gropper, R. Culture and the Clinical Encounter: An

Intercultural Sensitizer for the Health Professions. Intercultural Press, Inc., 1996

Wen-Shing, T. and Streltzer, J. Cultural Competence in Health Care: A Guide for Professionals. Springer Science + Business Media, 2008

Galanti, G. Caring for Patients from Different Cultures. University of Pennsylvania Press, 2004

Nice Quick Clinic Reference Mosby Pocket Guide to Cultural Health

Assessment – Nursing Pocket Guides Organized by country of origin with information

on common religions, languages, cultural beliefs and common barriers to US health care