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Learn basic concepts about cultural competence and the importance to deliver services to diverse populations.
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Cultural Competence Orientation
Carlos F. Martinez M.H.A. M.Ed.
Mecklenburg County Area Mental Health
carlosFmartinez.com
Creating Cultural and Creating Cultural and Linguistic Competence Linguistic Competence
in your Organizationin your Organization
Understanding the Context for Cultural Competence: Cultural Self-awareness
David Hoopes and Margaret Pusch
CULTURAL SELF AWARENESS
KNOW THYSELFThe “heal thyself before healing others” is a common philosophy understood by people across the world and yet the quest for cultural self awareness is not a simple process.
Becoming culturally aware of one’s self requires that individuals become functionally aware of the degree to which their own behavior is culturally conditioned by the past experiences
David Hoopes and Margaret Pusch
DEFINING CULTURAL SELF AWARENESS
David Hoopes and Margaret Pusch define cultural conditioning as “how learning provided by a cultural and/or social group fits a growing child to assure its survival”. They suggest we are all culturally conditioned by our past and present socialization experiences with family, friends, role models and teachers
David Hoopes and Margaret Pusch
DEFINING CULTURAL SELF AWARENESS
We are also culturally conditioned by our positive and negative interactions with culturally similar and culturally different people.
As a result of being culturally conditioned, we form definitions of what we consider, normal, acceptable and standard behaviors, communication styles, cultural values and patterns of thinking.
David Hoopes and Margaret Pusch
DEFINING CULTURAL SELF AWARENESS: Cultural Conflict
Hoopes suggest, “We assume that everyone perceives and experiences the world as members of our own particular ethnic, racial or cultural groups. The way we perceive the world, what we expect of it and what we think about it is basic and ingrained. It is buried so deep in our consciousness that we continuously act and react without thinking”.
Cultural Self Awareness
Socio-Cultural Awareness Exercise
David Hoopes and Margaret Pusch
DEFINING CULTURAL SELF AWARENESS Cultural Conflict
A decided outcome of this cultural conditioning is the tendency to recognize the problem in others and deny it in ourselves. The only way we come to grips with and take significant steps toward cultural self understanding is to become fully engaged with our own perceptions, behaviors and communication patterns.
David Hoopes and Margaret Pusch
DEFINING CULTURAL SELF AWARENESS Cultural Conflict
The process of assessing one’s self and culture enables one to break through the intellectual barriers and defenses. This enables one to be more aware and knowledgeable of the degree to which his or her perceptions and behaviors are culturally conditioned. This in effect is cultural self awareness.
David Hoopes and Margaret Pusch
DEFINING CULTURAL SELF AWARENESS Cultural Conflict
Even for those who pursue it, cultural
self awareness is elusive.
No matter how skillful, how much we experience and are conscious of the cultural dimensions of human relations and multicultural realities we are imprisoned by our own limited perception of reality.
Defining Culture
Maslow’s Hierarchy of Needs
Self
Actualization
Level 5
Esteem
Level 4
Social
Level 3
Safety
Level 2
Physiological
Level 1
Level 1: air, water, food, shelter
Level 2: knowing one’s survival is not in jeopardy
Level 3: feeling accepted by others;and being part of one’s social environment
Level 4: Feeling significant, important, effectual and competent
Level 5: Growing and expanding one’s personal capability, feeling fulfilled
Definition of Culture
The word “Culture” is used because it implies the integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social group.
Cultural CompetenceCultural Competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enable them to work effectively in cross-cultural situations.
Defining Cultural Competence Culturally competent systems have the capacity to expand on this knowledge and integrate it into All aspects of organizational policies, structures, Staffing, interventions, financing, and evaluation of results.Cultural competence is:
a developmental and dynamic process. synonymous with quality.a strategy for reducing disparities.
Linguistic CompetenceLinguistic competency requiresorganizational and provider capacity to respond effectively to the health literacy needs of the population served. The organization must have policies, structures, practices, procedures and Dedicated resource to support the capacity. Goode, T. (2002). Promoting Cultural Diversity and Cultural Competency- Self Assessment Checklist for
Personnel Providing Services and Supports to Children with Disabilities & Special Health Care Needs, NCCC, GUCDC
Model for Developing Cultural Competence
The Case For Cultural Competence
Cultural Insights, Inc
“Even more than other areas of health and medicine, the mental health field is plagued by disparities in the availability of and access to its services. These disparities are viewed readily through the lenses of racial and cultural diversity, age, and gender.”
Surgeon General David Satcher, M.D., Ph.D. in Mental Health: A Report of the Surgeon General (DHHS, 1999, p.vi.).
The Business Case for Providers
Title VI MOA for Endorsed Providers State Contracts Accreditation Community-wide expectation Competitive marketplace
Rationale for Cultural CompetenceCultural Competence = Quality of CareCultural Competence = Disparity ReductionCultural Competence = Risk ManagementCultural Competence = Parity (within MH system)Cultural Competence = Linguistic CompetenceCultural Competence = A Fundamental Social
Responsibility
Benefits of Cultural Competence in Healthcare
Improved Health Outcomes
Maximal Use of Limited Resources
Increased Customer Retention and Access to Care
Increased Customer Recruitment Increased Customer Satisfaction
Provide Products and Services Consistent with Client Needs
Culturally Competent Management, Staff and Practitioners
(Adapted from American Association of Health Plans, Minority Management Program, 1997)
Current Context
Total Population: 756,016Total Population: 756,016Total Disabled Ages 5+: 72,271Total Disabled Ages 5+: 72,271
Demographic Characteristics of Mecklenburg County Female 50.2% Male 49.8 Age
Under 5 8% 5 to 17 16% 18 to 65 65% 65+ 8%
Race White 64% African American 28% Asian 3.5% Multiracial 3.2% Other 1.5%
Hispanic/Latino 8.7% (48% Mexican, 23% Central American)
Source: 2004 American Community Survey (www.census.gov)
Population ProjectionsRace/EthnicityRace/Ethnicity 19951995 20502050
WhiteWhite 73.673.6 52.852.8
BlackBlack 12.012.0 13.513.5
Hispanic/LatinoHispanic/Latino 10.210.2 24.524.5
AsianAsian 3.33.3 8.28.2
American IndianAmerican Indian 0.70.7 0.90.9
Hispanics/Latinos are the fastest growing ethnic group in the United States.
In the United States, the Hispanic population is expected to increase 14.3% by the year 2050.
By the year 2050, there will be approximately 97 million Latinos in the United States.
Population Projections
Race/Ethnicity: County and LME Comparison
0
10
20
30
40
50
60
70
Hispanic White African American
Mecklenburg Co. LME
%
Definition of DisproportionateDisproportionate representation refers to a
situation in which a particular racial/ethnic group of children are represented in a system at a higher or lower percentage than their representation in the general population.
It can also serve to highlight:underutilization of or access to services; anddisproportional rates of poor prevention
and child service outcomes
Adapted from the Casey Family Programs (2002).
Cultural Competence Cultural Competence ContinuumContinuum
Cultural Destructiveness
Cultural Incapacity
Cultural Blindness
Cultural Pre-Competence
Cultural Competence
Cultural Proficiency
Cultural Assessment
Some thoughts on CultureSome thoughts on Culture…..…..If there is not the understanding that cultures are different and that people have different ways of responding to the basic realities of life and economics and politics and love and eating and a million things because of what Their cultures have been, then we can’t Understand each other.
- by Carlos Fuentes
Cultural AssessmentCultural assessment of the consumer is an
important step in identifying the consumer’s views
and beliefs related to health and illness. Beliefs
About the cause, prevention, and treatment of illness
Vary among cultures. Such beliefs dictate the
Practices used to maintain health. Studies have
Classified Health (Mental) Practices into several
categories: folk practices, spiritual or psychic
Healing practices, and conventional medical
practices.
Concepts: Culture
Political
Economic
Goals
Culture
Views Of
Truth
SocialRelationship
s
Visual
Arts
Literature
Actions
Personal
Habits
CommunicationStyles
Performing
Educational
Social
ExperiencesBeliefs
Includes
Includes
Includes
Includes
Includes Includes
Reflects
May Result
In
Influences Influences
.
Developed b LM Lopez, OMH, 1
Concepts: Beliefs
Views Of Truth
Religion
Supernatural Beings
God
Human Nature
Values
One
Redeemable
ManyBad
Good
BeliefsBeliefs
InterpersonalRelations
TimeOrientation
Focus Of Human Activity
RelationshipWith Nature
Influence
Include
Include
Include
May BeConsidered
MayInclude
May Focus On
May Be Perceived As
Include Influence
Developed by LM Lopez, OMH, 1995.
Concepts: Personal HabitsPersonal
HabitsEating
HealthPractices
FoodFoodTableManners
PreferencesPreparations
Methods
Functions
NourishmentNourishmentSocialSocial
Include Include
Include
Influences
InvolvesInvolves
IncludesHygiene
Include
Affects
Healing Practices
Emotional
PhysicallTraditionalTraditionalBiomedicalBiomedical
Views OfWell-being
Spirituall
May Include
May Be
Include
Can Include
Can Be
May Influence
Developed by LM Lopez, OMH, 1995
Dress and Appearance
Consumers strengths, needs and preferences should drive the type and mix of services provided, and should take into account the development, gender, linguistic, or Cultural aspects of providing and receiving services. Providers should develop these individualized plans in full partnership with consumers and families, while understanding changes in individual needs across the lifespan and the obligation to review treatment plans regularly.
Source: Models, Principles and Values of Person /Family-Centered Planning, Neal Adams, MD MPH,Diane Grieder, M.Ed., Tom Nerney
Provider Competencies for Direct Care Staff
Documentation of the person’s aspirations and goals for an improved quality of life
Identify problems, needs and required interventionsActively involve users, caregivers and families where
appropriateProvide a comprehensive assessment of health and
social care needs (including caregivers and families support needs)
Source: Models, Principles and Values of Person /Family-Centered Planning, Neal Adams, MD MPH,Diane Grieder, M.Ed., Tom Nerney
Competencies Cont’dRegularly monitor review & systematically
evaluate service impacts and health gain Identify the health and social care
resources required to meet the person’s needs
Develop positive risk management strategies and crisis prevention/response plans
Benefits of Culturally Diverse StaffResearch indicates that when children and families are matched to Research indicates that when children and families are matched to
their therapist, service coordinator or clinician ethnically and their therapist, service coordinator or clinician ethnically and linguistically…linguistically…
They are engaged in and complete their interventions more often than those who are not
There is a reduction in premature termination of interventions, which is common in many clinics serving ethnic minorities populations and the poor
Children and families have the ability to express emotions and feelings without having to explain themselves
Source: J.T Romero Operationalizing Cultural Competency: Recruitment, retention and training of culturally diverse mental health stff. (1996 June)
Benefits of Culturally Diverse StaffResearch indicates that when children and families are matched to their therapist, service coordinator or clinician ethnically and linguistically…The use of their primary language in therapy provides them
with control of their internal cognitive processes, which is the source of emotions. Thus children and families’ emotions are not subject to “translation” by way of the effects of linguistic translation, which can include intonation patterns, voice volume, and gestures.
Allows clinician to assess the totality of the information the child and family are providing
Provider Competencies for Change Management
1. Develop a strategic planning process
2. Operationalize plan in a logic model
3. Good data and research
4. Racial/ethnic impact analyses of policies and programs
5. Targeted training and technical assistance
Provider Competencies for Change Management6. Tools to support change
7. Adaptations of services and supports
8. Infrastructure
9. A powerfully framed message and an active communications strategy
10. Champions, allies and coalition building
Cultural Insights, Inc
How Do We get There?
COMPETENCECOMPETENCE
Model for Developing Cultural Competence
Community Context
What are the next steps?
What policies, practices and strategies need to be put into place at each provider agency?
In what ways can providers work together with the LME to create technical assistance and resource sharing opportunities?
Questions?