REMEMBER: To avoid confusion, the terms “ Hispanic ” and “ Latino ” will be used interchangeably during this presentation.
Destructiveness-Represented by attitudes, policies and practices that are destructive to cultures and the individuals within the culture. For example: agencies, institutions that promote cultural genocide: US Chinese Exclusion Laws; and the KKK and other racial superiority groups. Incapacity--Supports segregation as desirable policy Enforces racial policies and maintains stereotypes Disproportionately applies resources. Discriminates on basis of whether people of color “know their place” Lacks the capacity or will to help minority participants and employees. System remains extremely biased, believes in the racial superiority of the dominant group. Maintains paternal posture toward “lesser races”. For example, lower expectations of minorities an subtle messages that they are not valued. Blindness--Color or culture makes no difference and that all people are the same Ignores cultural strengths Encourages assimilation; thus, those who don’t are isolated Blames victim for their problems. Views ethnic minorities as culturally deprived Pre-Competence--“What can we/ I do?” Desires to deliver quality services; commitment to civil rights. Realizes its weaknesses and attempts to improve some aspect of their service Explores how to better serve minority communities. Agency may believe that their accomplishments of one goal or activity fulfills their obligation to minority communities; may engage in token hiring practices Often only lacks information on possibilities on how to proceed. Competence--Acceptance and respect for difference. Expands cultural knowledge and resources. Continuous self-assessment.Pays attention to dynamics of difference to better meet client needs. Variety of adaptations of service models. Seeks advice and consultation from the minority community. Commits to policies that enhance services to diverse clientele. Proficiency--Holds culture in high esteem. Agency seeks to add to its knowledge base. Agency advocates continuously for cultural competence throughout the system.
Denise—includes beliefs, actions, and experiences, influences and may result in, and culture reflects our experiences. They influence all other areas of our lives… Also—experiences can reinforce beliefs, actions, etc…
Denise—like having a bag of beliefs and a bag of values that we carry with us. We need to understand people’s beliefs and values and how they affect how people think, feel, and interact. Especially in terms of service delivery. Jill—example—Native American views of truth…
Denise—now consider how all of the personal habits, beliefs, values make up the individuals that walk in the door seeking mental health services. All of these concepts come with them and we need to be aware of that in order to provide quality services. All health care is cultural—no right or wrong—just different—we need to see the individual that seeks care. CHECK CLIMATE
Cultural Competence Orientation Carlos F. Martinez M.H.A. M.Ed.Mecklenburg County Area Mental Health carlosFmartinez.com
Creating Cultural andLinguistic Competence in your Organization
Understanding the Context for Cultural Competence: Cultural Self-awareness
CULTURAL SELF AWARENESS KNOW THYSELFThe “heal thyself before healing others” is acommon philosophy understood by peopleacross the world and yet the quest for culturalself awareness is not a simple process.Becoming culturally aware of one’s self requires thatindividuals become functionally aware of the degreeto which their own behavior is culturally conditionedby the past experiences David Hoopes and Margaret Pusch
DEFINING CULTURAL SELF AWARENESSDavid Hoopes and Margaret Puschdefine cultural conditioning as “howlearning provided by a cultural and/orsocial group fits a growing child toassure its survival”. They suggestwe are all culturally conditioned byour past and present socializationexperiences with family, friends, rolemodels and teachers David Hoopes and Margaret Pusch
DEFINING CULTURAL SELF AWARENESSWe are also culturally conditioned by ourpositive and negative interactions withculturally similar and culturally differentpeople.As a result of being culturally conditioned,we form definitions of what we consider,normal, acceptable and standardbehaviors, communication styles, culturalvalues and patterns of thinking. David Hoopes and Margaret Pusch
DEFINING CULTURAL SELF AWARENESS: Cultural ConflictH oopes suggest, “We assume thateveryone perceives and experiences theworld as members of our own particularethnic, racial or cultural groups. The way weperceive the world, what we expect of it andwhat we think about it is basic and ingrained. It is buried so deep in our consciousnessthat we continuously act and react withoutthinking”. David Hoopes and Margaret Pusch
Cultural Self AwarenessSocio-Cultural Awareness Exercise
DEFINING CULTURAL SELF AWARENESS Cultural ConflictA decided outcome of this culturalconditioning is the tendency to recognizethe problem in others and deny it inourselves. The only way we come to gripswith and take significant steps towardcultural self understanding is to becomefully engaged with our own perceptions,behaviors and communication patterns. David Hoopes and Margaret Pusch
DEFINING CULTURAL SELF AWARENESS Cultural ConflictThe process of assessing one’s self andculture enables one to break through theintellectual barriers and defenses. Thisenables one to be more aware andknowledgeable of the degree to which hisor her perceptions and behaviors areculturally conditioned. This in effect iscultural self awareness. David Hoopes and Margaret Pusch
DEFINING CULTURAL SELF AWARENESS Cultural ConflictEven for those who pursue it, culturalself awareness is elusive.No matter how skillful, how much weexperience and are conscious of thecultural dimensions of human relationsand multicultural realities we areimprisoned by our own limitedperception of reality. David Hoopes and Margaret Pusch
Maslow’s Hierarchy of Needs Self Actualization Level 5 Esteem Level 4 Social Level 3 Safety Level 2 Physiological Level 1Level 1: air, water, food, shelterLevel 2: knowing one’s survival is not in jeopardyLevel 3: feeling accepted by others;and being part of one’s social environmentLevel 4: Feeling significant, important, effectual and competentLevel 5: Growing and expanding one’s personal capability, feeling fulfilled
Definition of CultureThe word “Culture” is used because itimplies the integrated pattern of humanbehavior that includes thoughts,communications, actions, customs, beliefs,values, and institutions of racial, ethnic,religious, or social group.
Cultural CompetenceCultural Competence is a set ofcongruent behaviors, attitudes, andpolicies that come together in asystem, agency, or amongprofessionals that enable them towork effectively in cross-culturalsituations.
Defining Cultural CompetenceCulturally competent systems have the capacityto expand on this knowledge and integrate it intoAll aspects of organizational policies, structures,Staffing, interventions, financing, and evaluationof results.Cultural competence is: a developmental and dynamic process. synonymous with quality. a strategy for reducing disparities.
Linguistic CompetenceLinguistic competency requiresorganizational and provider capacity torespond effectively to the health literacyneeds of the population served. Theorganization must have policies,structures, practices, procedures andDedicated resource to support thecapacity.Goode, T. (2002). Promoting Cultural Diversity and Cultural Competency- Self Assessment Checklist for PersonnelProviding Services and Supports to Children with Disabilities & Special Health Care Needs, NCCC, GUCDC
The Case ForCultural Competence Cultural Insights, Inc
“Even more than other areas ofhealth and medicine, the mentalhealth field is plagued by disparitiesin the availability of and access to itsservices. These disparities are viewedreadily through the lenses of racialand cultural diversity, age, andgender.” 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 ProvidersTitle VIMOA for Endorsed ProvidersState ContractsAccreditationCommunity-wide expectationCompetitive marketplace
Rationale for Cultural Competence Cultural Competence = Quality of Care Cultural Competence = Disparity Reduction Cultural Competence = Risk Management Cultural Competence = Parity (within MH system) Cultural Competence = Linguistic Competence Cultural 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 CareIncreased 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 ContextTotal Population: 756,016Total Disabled Ages 5+: 72,271
Demographic Characteristics ofMecklenburg 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 Projections Race/Ethnicity 1995 2050White 73.6 52.8Black 12.0 13.5Hispanic/Latino 10.2 24.5Asian 3.3 8.2American Indian 0.7 0.9
Population ProjectionsHispanics/Latinos are the fastest growingethnic group in the United States.In the United States, the Hispanicpopulation is expected to increase 14.3% bythe year 2050.By the year 2050, there will beapproximately 97 million Latinos in theUnited States.
Race/Ethnicity: County and LMEComparison706050 %40302010 0 Hispanic White African American Mecklenburg Co. LME
Definition of Disproportionate Disproportionate 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; and disproportional rates of poor prevention and child service outcomesAdapted from the Casey Family Programs (2002).
Cultural Competence Continuum Cultural Proficiency Cultural Competence Cultural Pre-Competence Cultural Blindness Cultural Incapacity CulturalDestructiveness
Some thoughts on Culture…..If there is not the understanding that culturesare different and that people have differentways of responding to the basic realities of lifeand economics and politics and love andeating and a million things because of whatTheir cultures have been, then we can’tUnderstand each other. - by Carlos Fuentes
Cultural AssessmentCultural assessment of the consumer is animportant step in identifying the consumer’s viewsand beliefs related to health and illness. BeliefsAbout the cause, prevention, and treatment of illnessVary among cultures. Such beliefs dictate thePractices used to maintain health. Studies haveClassified Health (Mental) Practices into severalcategories: folk practices, spiritual or psychicHealing practices, and conventional medicalpractices.
Concepts: Culture . Culture Reflects Includes Includes Beliefs Experiences Influences Influences Includes Actions Economic Includes MayGoals Result Social Literature In Includes Relationship s Political Communication Educational Views Styles Of Truth Arts Persona l Habits Social Includes Visual Performing Developed b LM Lopez, OMH, 1
Concepts: Beliefs Beliefs Include Influence Views Of Truth Influence Values May Focus On Include Human Include Religion Nature Interpersonal Relations Focus Of Include May May Be Human Activity Include Considered Supernatural Time Beings Good Orientation Relationship God With Nature RedeemableMay Be Perceived As Bad One Many Developed by LM Lopez, OMH, 1995.
Concepts: Personal Habits Personal Include Include Habits Dress and Eating Appearance Include Involves Involves May Influence Table Food HealthManners Include Practices Hygiene Views Of Includes Include Well-being Affects Preferences Influences May Include Preparations Healing Methods Practices Spiritual Functions Can Include May Be Physical Traditional Can Be Biomedical Nourishment Emotional Social Developed by LM Lopez, OMH, 1995
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 interventions Actively involve users, caregivers and families where appropriate Provide 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’d Regularly 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 Staff Research indicates that when children and families are matched to their therapist, service coordinator or clinician ethnically and 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 Staff Research 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 forChange Managementt Develop a strategic planning processg Operationalize plan in a logic modell Good data and researchs Racial/ethnic impact analyses of policies and programsp Targeted training and technical assistance
Provider Competencies forChange Management6. Tools to support change7. Adaptations of services and supports8. Infrastructure9. A powerfully framed message and an active communications strategy10. Champions, allies and coalition building
How Do We get There? COMPETENCE Cultural Insights, Inc
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?