Good afternoonIntro self Intro Practice/SRA Intro TCH
Elements of culture include, but are not limited to, the following:Age Cognitive ability or limitations Country of origin Degree of acculturation Educational level attainedEnvironment and surroundings Family and household composition Gender identity Generation Health practices, including use of traditional healer techniques such as Reiki and acupuncture.Linguistic characteristics, including language(s) spoken, written, or signed; dialects or regional variants; literacy levels; and other related communication needs.Military affiliation Occupational groups Perceptions of family and community Perceptions of health and well-being and related practicesPerceptions/beliefs regarding diet and nutrition Physical ability or limitations Political beliefsRacial and ethnic groups including but not limited tothose defined by the U.S. Census Bureau.Religious and spiritual characteristics, including beliefs, practices, support systems related to defining meaning in oneslife.Residence (i.e., urban, rural, or suburban)Sex Sexual orientation Socioeconomic status
valuing diversityValuing diversity means accepting and respecting differences.Be aware and accepting of difference in communication, life view, and definition of health and familyWalking the talkconducting self-assessmentsIndividual and organizational level Have a sense of your own culture and your relationship to othersmanaging the dynamics of differenceUnderstand that both the consumer and service provider bring culturally prescribed patterns of communication, etiquette, and problem solving styles to the situationAlso, different histories and experiences shape our perceptionsacquiring & institutionalizing cultural knowledgeThe knowledge developed regarding culture and cultural dynamics, must be integrated into every point of contactadapting to diversity & cultural contexts in communitiesSystem/organization would make adjustments to create a better fit between the consumer and service by adapting policies, structure, values, and the service
“Our organization is culturally competent – the team speaks about 9 different languages – we are like a mini-United Nations” Mexicans & Tortillas… When describing an immigrant group to the participants, "you know, fresh off the boat.“
Knowing who works in your community and who calls it home – data wise as well as from outreach. Not just that they should know you are nice and offer great care…
An international pot-luck does not a cultural competency program make… nor does putting up the ‘culture of the month’ posters. It has to be more engaging, more deliberative, and it needs to be something that is ‘lived’ all year round… not just during a particular month.
“flash cards” – “cliff notes” – or “cheat sheets” does not equal cultural competency… They can in some instances be a place to start… I know many people from X believe this… is this something that we should consider/discuss in your treatment/care/program/etc.
Culture informs our actions and reactions – how we perceive and receive care… Cultural competency works in both directions… just as the provider may not be aware of the client/patient’s culture – the client may not be aware of the institutional culture or many aspects of the culture of medicine…
There are many metaphors or analogies that are ascribed to cultural competency – a journey – and it certainly isn’t perfect. Flip chart Ultimately, cultural competency can not be viewed as an ‘add on’… it must be infused throughout an organization… it isn’t about doing more, it is about doing what you are doing – better, more efficiently, more effectively…
The National Center for Cultural Competence at Georgetown University is a great resource for all things cultural competency and in a policy brief from 2003 they outlined 6 points of compelling need for cultural and linguistic competency… For me, these six points generally fall under two umbrellas:(1) The social justice umbrella and the (2) business case umbrella…
It is projected that by 2050 the U.S. demographic makeup will be 47% non-Hispanic White, 29% Hispanic, 13% Black and 9% Asian (Passel & Cohn, 2008). According to the most recent data, approximately 20% of the U.S. population, or a little over 58 million people, speak a language other than English at home, and of that 20%, almost 9% (over 24 million people) have limited proficiency in English (Au, Taylor, & Gold, 2009; U.S. Census Bureau, 2010), which has implications for their proficiency in health and health care (The Joint Commission, 2010).
Disparities occur for a whole host of reasons – including miscommunication… A friend of mine when working as an EMS first responder heard more than one of his colleagues “Where does it hurt-o?” when speaking to Spanish speaking patient in the field.
Culture influences health beliefs and practices, as well as health seeking behavior and attitudes (IOM, 2003). When health and health care professionals are aware of culture’s influence on health beliefs and practices, they can use this awareness to consider and address issues such as access to care.
State and Federal Legislation Hospital Accrediting Bodies such as the Joint Commission
Although the implementation of culturally and linguistically appropriate services certainly requires resources, there are numerous business-related advantages to investing these resources. By implementing culturally and linguistically appropriate services – including the provision of communication and language assistance, as well as partnerships with the community – an organization can develop a positive reputation in the service area and therefore expand its market share. The provision of effective, equitable, understandable, and respectful quality care and services helps cultivate a loyal consumer base, which then solidifies this market share (AMA, 2006).
Culturally and linguistically appropriate services can reduce the possibility of such errors. For example, a first responder in Florida misinterpreted a single Spanish word, “intoxicado,” to mean "intoxicated" rather than its intended meaning of "feeling sick to the stomach." This led to a delay in diagnosis, which resulted in a potentially preventable case of quadriplegia, and ultimately, a $71 million malpractice settlement (Flores, 2006).
In addition to the National Center for Cultural Competence at Georgetown University, I wanted to leave you with a few resources that are out there in case you want to investigate further some of the concepts covered today…
Think Cultural Health is an Department of Health and Human Services, Office of Minority Health sponsored web site. The web site houses many of the offices cultural and linguistic competency policy and education related initiatives including:Suite of e-learning programs – free on-line continuing education, CLAS Clearinghouse – key word searchable database of resources Join the CLCCHC – newsletter, calendar, and other educational materials National CLAS Standards & The Blueprint
The Blueprint was designed to provide individuals, agencies and organizations of all kinds the guidance to implement the National CLAS Standards. The Blueprint contains – Case, Enhancements and Standard by Standard chapters. Standard by Standard chapters: PurposeDescriptionStrategies Resources
Now, I think we will open it up for discussion. I hope that the chairs and other representatives will jump in to help answer questions as they relate to the directives of this group…
1. 1 Presentation to the MHQCC - Cultural and Linguistic Competency Workgroup Darci L. Graves, MPP, MA, MA Senior Health Education and Policy Specialist Health Determinants & Disparities Practice at SRA international, Inc.Bringing CLAS and Equity to Systems Impacting Health
2. 2Overview• Terminology• Cultural competency - Is and Isn’ts• Compelling Need
4. 4Culture Culture is dynamic inThe integrated pattern nature, & individuals mayof thoughts, identify with multiplecommunications, cultures over the courseactions, customs, beliefs, of their lifetimes.values, & institutionsassociated, wholly orpartially, with racial,ethnic, or linguisticgroups as well asreligious, spiritual,biological, geographical,or sociologicalcharacteristics.
5. 5Cultural CompetencyA developmental process in whichindividuals or institutions achieveincreasing levels of awareness,knowledge, and skills along acontinuum.
6. 6 Cultural competency is a developmental process in which individuals or institutions achieve increasing levels of awareness, knowledge, & skills along a continuum.• valuing diversity• conducting self-assessments• managing the dynamics of difference• acquiring & institutionalizing cultural knowledge• adapting to diversity & cultural contexts in communities
7. 7CULTURAL COMPETENCYWhat it is… What it isn’t…
8. 8Cultural competency is: is not:Knowing your Simply good community intentions
9. 9Cultural competency is: is not:Understanding all Cultural people have a celebrations at unique world designated times view of the year, in designated ways
10. 10 Cultural competency is not: is: A list of stereotypes Providing services about what people respectful of and from a particularrelevant to the cultures cultural group do represented in the patient population Assumptions that everyone from one culture operates in similar ways and has had similar experiences
11. 11Cultural competency is: is not:Being alert to the Solely theways that culture responsibility of affects who we patients, their are families or the community
12. 12Cultural competency is: is not: Examining Simple systems, tolerance structures, policies andpractices for their impact
13. 13COMPELLING NEEDSocial… Business…
14. 14Compelling Need: Social • To respond to current and projected demographic changes in the United States. • To eliminate long-standing disparities in the health status of people of diverse racial, ethnic and cultural backgrounds. • To improve the quality of services and health outcomes.National Center for Cultural Competence (2003)
15. 15To respond to current and projecteddemographic changes in the United States.
16. 16To eliminate long-standing disparities in the health status ofpeople of diverse racial, ethnic and cultural backgrounds.
17. 17To improve the quality of services and healthoutcomes.
18. 18Compelling Need: Business • To meet legislative, regulatory and accreditation mandates. • To gain a competitive edge in the market place. • To decrease the likelihood of liability/ malpractice claimsNational Center for Cultural Competence (2003)
19. 19To meet legislative, regulatory and accreditationmandates.
20. 20To gain a competitive edge in the market place.
21. 21To decrease the likelihood of liability/ malpracticeclaims intoxicado
23. 23Think Cultural Health Advancing health equity at every point of contact National CLAS E-learning Standards programs TCH CLAS Join the CLCCHC Clearinghouse
24. 24National CLAS Standards: The Blueprint • The Case for CLAS • The Enhancements • Standard by Standard chapters: • Purpose • Description • Strategies • Resources
25. 25FOR MORE INFORMATION: Darci_Graves@sra.com www.ThinkCulturalHealth.hhs.gov