Learn basic concepts about cultural competence and the importance to deliver services to diverse populations.

1. Cultural Competence
Orientation
Carlos F. Martinez M.H.A. M.Ed.
Mecklenburg County Area Mental Health
carlosFmartinez.com

2. Creating Cultural and
Linguistic Competence
in your Organization

3. Understanding the Context
for Cultural Competence:
Cultural Self-awareness

4. CULTURAL SELF AWARENESS
KNOW THYSELF
The “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

5. 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

6. 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

7. DEFINING CULTURAL SELF
AWARENESS: Cultural Conflict
H oopes 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”.
David Hoopes and Margaret Pusch

8. Cultural Self Awareness
Socio-Cultural Awareness Exercise

9. 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

10. 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

11. 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.
David Hoopes and Margaret Pusch

12. Defining Culture

13. 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

14. 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.

15. Cultural Competence
Cultural 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.

16. 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.

17. Linguistic Competence
Linguistic competency requires
organizational 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

18. Model for Developing Cultural
Competence

19. The Case For
Cultural Competence
Cultural Insights, Inc

20. “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.).

21. The Business Case for Providers
Title VI
MOA for Endorsed Providers
State Contracts
Accreditation
Community-wide expectation
Competitive marketplace

22. 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

23. 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)

24. Current Context
Total Population: 756,016
Total Disabled Ages 5+: 72,271

25. 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)

26. Population Projections
Race/Ethnicity 1995 2050
White 73.6 52.8
Black 12.0 13.5
Hispanic/Latino 10.2 24.5
Asian 3.3 8.2
American Indian 0.7 0.9

27. Population Projections
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.

28. Race/Ethnicity: County and LME
Comparison
70
60
50
%
40
30
20
10
0
Hispanic White African American
Mecklenburg Co. LME

29. 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 outcomes
Adapted from the Casey Family Programs (2002).

30. Cultural Competence
Continuum
Cultural
Proficiency
Cultural
Competence
Cultural
Pre-Competence
Cultural
Blindness
Cultural
Incapacity
Cultural
Destructiveness

31. Cultural Assessment

32. Some 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

33. Cultural Assessment
Cultural 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.

34. Concepts: Culture
.
Culture Reflects
Includes
Includes
Beliefs Experiences
Influences Influences
Includes Actions Economic
Includes
May
Goals 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

35. 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
Redeemable
May Be Perceived As
Bad
One Many
Developed by LM Lopez, OMH, 1995.

36. Concepts: Personal Habits
Personal
Include Include
Habits Dress and
Eating Appearance
Include
Involves Involves
May Influence
Table Food Health
Manners 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

37. 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

38. 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

39. 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

40. 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)

41. 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

42. Provider Competencies for
Change Management
t Develop a strategic planning process
g Operationalize plan in a logic model
l Good data and research
s Racial/ethnic impact analyses of policies and programs
p Targeted training and technical assistance

43. Provider Competencies for
Change Management
6. 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

44. How Do We get There?
COMPETENCE
Cultural Insights, Inc

45. Model for Developing Cultural
Competence

47. Community Context

49. 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?

50. Questions?
carlos@carlosFmartinez.com