Thank you. This is one of my favorite classes. It’s an experiential—very hands on and interactive— class, designed to give you time to think about something you probably are already doing.There is a sharing component in our activity, and because we are our own community, I ask that you share what you feel comfortable sharing in this environment. I know a number of you are well-experienced in performing outreach activities, identifying local populations, and are or have been designated outreach librarians for your institution. I hope that we can all learn from each other, including myself.
We all live in diverse communities today, and ND definitely ranks high in that regard and as you probably know, ND is growing and growing diversely by the minute. This diversity carries through to where we live, work, go to school, play, and worship.2010 census: 672,591 +30k since 2000;2013 estimate: 723,393Illinois, in contrast which had almost double population in 2010 as ND: 2010=12,830,632 2000=12,419,293; 2013 estimate: 12,882,135—an estimated 52k rise during the same periodStudents from linguistically cultural and linguistically diverse backgrounds are growing faster than any student group in North Dakota schools. Many of these students qualify as limited English proficient (LEP) or English Language Learners (ELL). ELLs make up over five percent of the total school enrollment. This number continues to increase as the total enrollment for school districts in North Dakota decreases.
Let’s get started with Cultural CompetencyThese are questions we will discuss in the next several minutes.
What does culture mean to you?
(*Definition adapted from Merriam-Webster via 2011 Health Literacy Institute) Before we can talk about “cultural competency,” we really need to define what is meant by “culture.”Another definition: (Office of Minority Health, “What is cultural competency?”)Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. (Office of Minority Health, “What is cultural competency?” http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=11 ) 'Competence' implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities. Differences between Western Caucasian and East Asian facial expressions/ - Western emoticons primarily use the mouth^.^/;_; - Eastern emoticons primarily use the eyesAn Asian friend told me, “I was taught not to reveal emotions through the eyes. Making eye contact indicates a boldness or challenge to others that is not acceptable. We are taught to remain emotionless and not communicate with the eyes.A smile indicates agreement or acquiescent so a smile (no teeth showing) is the most likely form of facial communication.”Reference: Library Connect Newsletter, May 2010. p. 5. Another article states, “Facial expressions of emotion are not culturally universal … our results show that facial expressions of emotion are culture specific … Easterners represent emotional intensity with distinctive dynamic eye activity.”
It’s not just about the words! MedlinePlus en espanol, for example, is not a mirror image of the English language version.Objects (such as the owl or other bird or prey) symbolize different things in various cultures. This tail art used at one time by Frontier airlines may actually be a symbol of death for Native American and some Latin American cultures. Another example is the white lotus flower – another symbol of death in many Asian cultures. The provider and the patient each bring their individual learned patterns of language and culture to the health care experience. (Office of Minority Health, “What is cultural competency?”)See the Purnell Model for Cultural Competence: http://tcn.sagepub.com/cgi/content/abstract/13/3/193 An Asian friend told me, “I was taught not to reveal emotions through the eyes. Making eye contact indicates a boldness or challenge to others that is not acceptable. We are taught to remain emotionless and not communicate with the eyes.A smile indicates agreement or acquiescent so a smile (no teeth showing) is the most likely form of facial communication.”Cao gio, also called coin rubbing or coining, is a dermabrasive therapy used to relive a variety of illnesses such as aches, pains, fevers, colds, cough, nausea, abdominal pain, chills and symptoms related to changes in the weather (Ostensen).New Joint Commission recommendations for hospitals, policy makers, and researchersWhat experiences do you have with the interaction between culture and patient health?Talk about handout: “The 4 C’s of Culture: A Mnemonic for Health Care Professionals” [http://ggalanti.org/ ]
Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals What’s New: Links to Joint Commission projects and reports have been updated throughout the document. Additional resources have been included in Appendix E. Appendix C has been revised to update the standards language. Although the requirements have not changed, the previous references indicating that the standards would not affect the accreditation decision have been deleted. Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community: A Field Guide What’s New: Minor editorial changes have been made throughout the documenWhat’s New: Links to Joint Commission projects and reports have been updated throughout the document.Additional resources have been included in Appendix E.Appendix C has been revised to update the standards language. Although the requirements have not changed, the previous references indicating that the standards would not affect the accreditation decision have been deleted.Previous statement from “Hospital Language and Culture: A Snapshot of the Nation”: “The delivery of health care services in a manner that is respectful and appropriate to an individual’s language and culture is more than simply a patient’s right, but is, in fact, a key factor in the safety and quality of patient care (Schyve, 2002). ”
http://www.diversitycouncil.org/toolkit/Activities_DiversityBingo.pdf1. Each square of the bingo worksheet lists a quality representing some dimension of diversity. 2. Participants meeting the description (e.g. a grandparent) may sign that box. 3. Have participants mingle, looking for others to sign each box. 4. Have participants stop after 7 minutes or when one person finishes. 5. To win, you must have a complete row of boxes (vertical, horizontal, or diagonal) signed by other players. 6. When time is called, have participants return to their seats and discuss the questions below. To raise awareness of perceptions and assumptions with regard to different dimensions of diversity. 1. What happened? (This is a broad question. Participants may answer in any way they like.) 2. How did you perceive others? 3. How were you perceived by others? 4. What assumptions did you make about other people? 5. What assumptions were made about you? 6. What did you hesitate to ask about? Why?
Its time to Play Barnga. See the handout for the rules of the game. I bought the book “Barnga: A Simulation Game on Cultural Clashes” http://www.amazon.com/Barnga-Simulation-Game-Cultural-Clashes/dp/1877864048 but you should be able to do this with just the handout. You will need at least three tables with four people at each table. So class size needs to be a minimum of 12 for this to work. There will be a wide range of reactions to this game. The key to this activity is the discussion that follows the game. The variety of reactions people have to the game are mirror reactions to what people experience when they step outside their comfort zone and come to a new country, go outside the library and try to work with a new group, and so on. Finding ways to get participants to achieve that “Aha!” moment where they see how not knowing the rules, not even realizing the rules are different can be frustrating, and cause us to “lose” is the goal.
Based on community needs assessments and environmental scans, obvious service needs will emerge. Thanks to the internet, it is relatively easy to find data about communities which can help in determining the right mix of services and information that is most relevant and appropriate for community populations. Primarily, knowing predominant languages spoken, ethnicity/race, age group percentages, and socioeconomic status will provide a snapshot of the community.
Based on community needs assessments and environmental scans, obvious service needs will emerge. Thanks to the internet, it is relatively easy to find data about communities which can help in determining the right mix of services and information that is most relevant and appropriate for community populations. Primarily, knowing predominant languages spoken, ethnicity/race, age group percentages, and socioeconomic status will provide a snapshot of the community.On the American Fact Finder, go to the State Fact sheets. Select a couple of state fact sheets to view based on who is in the room. Ask class for volunteers to introduce themselves and say something about their state and their particular community – then view the statistics online.Remind class about the Census Bureau State Data Center. Each state has one center, who’s role it is to provide access to the US Census Bureau data. Contacting someone at your state center can be one way to begin learning about the make up of your community. QuickFacts includes statistics for all states and counties, and for cities and towns with more than 5,000 peopleNorth Dakota Department of CommerceBismarck, ND 58502Office of Intergovernmental AssistanceNorth Dakota Division of Community ServicesNorth Dakota Department of CommerceDepartment of GeographyUniversity of North DakotaNorth Dakota State LibraryLiberty Memorial BuildingThe State Data Center (SDC) Program is one of the Census Bureau's longest and most successful partnerships. created in 1978 to make data available locally to the public through a network of state agencies, universities, libraries, and regional and local governments. The SDC lead organization is appointed by the Governor of each state/commonwealth, Puerto Rico, island area (American Samoa, Guam, The Commonwealth of the Northern Mariana Islands, Virgin Islands) or the Mayor of the District of Columbia. In 1988 the Business and Industry Data Center Program (BIDC) was added to meet the needs of local business communities for economic data. It provides businesses with education and access to Census Bureau data and products in addition to statistical resources. Since their creation, the State Data Center and Business Industry Network, have provided access and education on Census Bureau data and products as well as other statistical resources to millions of data usersMLA Language Map: “The Language Map Data Center provides data about over three hundred languages spoken in the United States, using data from the 2006–10 ACS, ACS 2005, and the 2000 US Census”
GermanSpanishPolish just across the border
Prevalent languages taught, excluding English and Spanish: German, Polish, Vietnamese & otherIdentify counties by languageGet city-level language information
Photo credit: James Neilsen/Chronicle, March 5, 2012ND Department of Public Instruction: http://www.dpi.state.nd.us/ Critical InformationCommon Core StandardsDual CreditEarly Childhood EducationND ScholarshipSchool District ProfileSmarter Balanced Field Test State Fiscal Stabilization Fund Phase II State PlanSuperintendent Addresses Questions about Common Core State StandardsAlso links to ELL English Language Learner programs
You may be surprised at the information you already know—or know if you think about it! Who are the people you see each day – where you live, work, play, and worship?What about grocery stores?Who Are the People in Your Neighborhood? Who’s moved recently? What have you noticed about the people in your new community vs. the one from which you moved?Activity:Who Are the People in Your Neighborhood?
If possible, order these books ahead of time so there are enough of the booklets to give each class participant. Read page 1 of the 1st booklet – the Introduction. Lots of good discussion material on effective community based health information outreach.“We consider ‘health information outreach’ to be promotional and educational activities designed to enhance community members’ abilities to find and use health information. A goal of these activities often is to equip members of a specific groups or community to better address questions about their own health or the health of family, peers, patients, or clients.” [Getting Started with Community-Based Outreach, 2nd Edition. Booklet 1]
Collaboration = “A Developmental Continuum of Change Strategies”Stages of change theoryPre contemplationContemplationPreparationActionMaintenance
You have done an initial assessment of the community through the statistical data you have gathered. What else do you need to know about your community? Who is already providing health information and health services, and what gaps are there? The ULC Welcome Stranger Toolkit has many resources and handouts with great questions to ask to assess neighborhoods, etc. Chapter 2 deals with Cultural and Langue Sensitivity Skills; Chapter 4 is a Partnership InventoryBuild the demographic pictureIdentify local agencies and resources in the communityWhat gaps are there in health status?Where are the needs for health information?Resource: Urban Libraries Council “Welcome Stranger” Toolkit (if available)
Its important to learn where people are, and to bring the information to them, not expect them to come to you. Where do people congregate?Where are the social activities?Where are the educational activities?Where do people shop and take care of business?Where do people go to get information? Build the demographic pictureIdentify local agencies and resources in the communityWhat gaps are there in health status?Where are the needs for health information?Resource: Welcome, stranger-- : public libraries build the global village : toolkit
What’s your community like? Is there a parish nursing program?
From: Collaboration Defined: A Developmental Continuum of Change Strategies by Arthur T. Himmelman1.) Networking: exchanging information for mutual benefit most informal reflects an initial level of trust, limited time availability, and reluctance to “share turf”2.) Coordinating: exchanging information and altering activities for mutual benefit and to achieve a common purpose more time, higher levels of trust yet little or no access to each other’s turf 3.) Cooperating: exchanging information, altering activities, and sharing resources for mutual benefit and to achieve common purpose greater organizational commitment may involve written and/or legal agreement substantial time, high level of trust, significant access to each other’s turf 4.) Collaboration: exchanging information, altering activities, sharing resources and enhancing the capacity of another for mutual benefit and to achieve a common purpose
These are three different techniques that can be used in groups or partnerships to draw out what already exists in a community, and what needs are still there. They are techniques that draw from the people at the table, so are good strategies to use to create meaningful partnerships that are relevant to each person present. The Next activity uses the Café to Go methodology to demonstrate to the class how easy it is to do.
Conducting an exciting Café Conversation is not hard—it’s limited only by your imagination! The Café format is flexible and adapts to many different circumstances. When these guidelines are used in combination, they foster collaborative dialogue, active engagement and constructive possibilities for action.
This format can work very well as a first meeting.
Context, environment, explore, encourage—make sure everyone feels to be a part of the conversationConnect diverse perspectives--
Café Conversations at a Glance ❧ Seat four or five people at small Café-style tables or in conversation clusters. ❧ Set up progressive (usually three) rounds of conversation of approximately 20-30 minutes each. ❧ Questions or issues that genuinely matter to your life, work or community are engaged while other small groups explore similar questions at nearby tables. ❧ Encourage both table hosts and members to write, doodle and draw key ideas on their tablecloths or to note key ideas on large index cards or placemats in the center of the group. ❧ Upon completing the initial round of conversation, ask one person to remain at the table as the “host” while the others serve as travelers or “ambassadors of meaning.” The travelers carry key ideas, themes and questions into their new conversations. ❧ Ask the table host to welcome the new guests and briefly share the main ideas, themes and questions of the initial conversation. Encourage guests to link and connect ideas coming from their previous table conversations—listening carefully and building on each other's contributions. ❧ By providing opportunities for people to move in several rounds of conversation, ideas, questions, and themes begin to link and connect. At the end of the second round, all of the tables or conversation clusters in the room will be cross-pollinated with insights from prior conversations. ❧ In the third round of conversation, people can return to their home (original) tables to synthesize their discoveries, or they may continue traveling to new tables, leaving the same or a new host at the table. Sometimes a new question that helps deepen the exploration is posed for the third round of conversation. ❧ After several rounds of conversation, initiate a period of sharing discoveries and insights in a whole group conversation. It is in these town meeting-style conversations that patterns can be identified, collective knowledge grows, and possibilities for action emerge. Once you know what you want to achieve and the amount of time you have to work with, you can decide the appropriate number and length of conversation rounds,
Open Space Technology is a simple way to run productive meetings, for five to 2000+ people, and a powerful way to lead any kind of organization, in everyday practice and extraordinary change. In a good learning event, people give of their best and often show more of themselves than they do otherwise. So everyone has a good insight into each other's strengths. When you hear about your strengths from others and acknowledge them to yourself, this builds your motivation and self-confidence.If you do this at the end of a workshop, you go away feeling good about yourself and your colleagues too.- See more at: http://www.nickheap.co.uk/articles.asp?ART_ID=206#sthash.LgioNZK1.dpuf
J AdvNurs. 2013 Jun;69(6):1224-34. doi: 10.1111/jan.12086. Epub 2013 Jan 14.Implementing the 4D cycle of appreciative inquiry in health care: a methodological review.Trajkovski S1, Schmied V, Vickers M, Jackson D.Author informationAbstractAIM:To examine and critique how the phases of the 4D cycle (Discovery, Dream, Design, and Destiny) of appreciative inquiry are implemented in a healthcare context. RESULTS: Nine qualitative studies met the inclusion criteria. Results highlighted that appreciative inquiry application is unique and varied between studies. The 4D phases were not rigid steps and were adapted to the setting and participants.CONCLUSION: Overall, participant enthusiasm and commitment were highlighted suggesting appreciative inquiry was mostly positively perceived by participants. Appreciative inquiry provides a positive way forward shifting from problems to solutions offering a new way of practicing in health care and health research.
The unconference* format creates space for peer-to-peer learning, collaboration and creativity.At the start, the whole group will gather together and be guided through creating an agenda using open space technology. The exact process is not important to understand in advance – the process will become clear as it happens. The important part is that all those gathered will have the opportunity to put conference sessions on the agenda. No session will be voted off or ‘won’t happen’ for some other reason. All sessions are welcome.The sessions convened will range from the formal to the informal:From the well thought out pre-prepared talk reflecting years of research and practice to the spur of the moment ‘new idea’ that would be fun to talk about.From the demonstration of a working tool to the whiteboarding of something completely new.Unconference: Attendees actively create the agenda with the assistance of a skilled facilitator where all the sessions become relevant and engaging.How is this different from a Task Force?
http://www.openspaceworld.org/cgi/wiki.cgi? WorkingInOpenSpace you use your two feet to go where you need to go and do what you need to do.
formation Literacy from Birth to Earth: An UnconferenceAcademic, school, public, and special librarians working together to improve Texans' information literacy skills, whether preparing individuals for higher education, careers, or life problem-solving. TLA PreconferenceTuesday, April 12, 8:30 AM to 5:00 PMWhat is the STELLA Unconference? 2014 StanfordAn UNCONFERENCE is a facilitated, participant-driven conference where the attendees drive the agenda and freely form new discussions and sub-groups as ideas emerge.This event is for current or aspiring science, technology, or medical/health librarians. You’ll get to meet other STEM-focused librarians and information professionals, and get to take part in talks and presentations that are decided at the time of the conference (instead of watching presentations on topics that were arranged a year or more before the conference).http://stellagroup.wordpress.com/category/stella14/HealthCampDC un-conference addressing the transformation of health care to a participatory model with active patient engagement through the use of social networking sites, open standards and web 2.0. This is part of the Health 2.0 movement towards participatory health care inspired by the definition that Ted Eytan and others (including patients) evolved for Health 2.0:
Step 1: Find Partners for Health Information OutreachStep 2: Learn more about the Outreach CommunityStep 3: Inventory resources and assets
Getting Started with Information Outreach in Your Community
GETTING STARTED WITH
IN YOUR COMMUNITY
Jacqueline Leskovec, MLIS, MA, RN
25 April 2014
LET’S GET STARTED!
2010 census: 672,591
2013 estimate: 723,393
Getting to Know You
• In what country were you born?
• What language did you first learn?
• What languages do you speak now?
• Describe one home remedy used by your family when you
were growing up.
• Define cultural competence
• Apply principles of cultural competence in outreach
• Examine ways to learn about local communities
• Learn about strategic collaboration
• Outline the steps in developing an outreach plan
• What is cultural competency and why is it important?
• Are there legal and health care guidelines?
• How do I find community demographics?
• Where are you in your cultural competency proficiency?
• Characteristic features, beliefs, social norms, and way of
life shared by a racial, religious, or social group, or by
people in a specific place or time
Photo from: Ethnomed.org via Free Burma Rangers
• A set of behaviors, attitudes, and policies that come
together in a system, agency or among professionals and
enable that system, agency or those professionals to work
effectively in cross-cultural situations.
• From: Cross T, Bazron B, Dennis K, and Isaacs M (1989). Towards a Culturally
Competent System of Care Volume I.
Culture and Patient Health
• Beliefs about objects, symbols, food, the body, blood,
non-traditional medicine, etc.
• Communication styles and norms
• Role of relationships
• Ways of learning new information
• Role of translators and interpreters
• Perception of authority figures
Rationale for Cultural Competency
• Perception of illness and disease varies by culture
• Diverse belief systems exist related to health, mental
health, healing, wellness
• Individual preferences affect approaches to health care
• Individuals must overcome personal experiences of bias
• The capacity of an organization and its personnel to
communicate effectively, and convey information in a manner
that is easily understood by diverse audiences including
persons of limited English proficiency, those who have low
literacy skills or are not literate, and individuals with disabilities.
• From: The National Center for Cultural Competence, Georgetown
University Center for Child and Human Development
• Title VI of the Civil Rights Act – 1964
• “No person in the United States shall, on the ground of race, color,
or national origin, be excluded from participation in, be denied
benefits of, or be subjected to discrimination under any program or
activity receiving Federal financial assistance.”
• The Joint Commission
• Advancing Effective Communication, Cultural Competence, and
Patient-and Family-Centered Care
• More than a patients’ rights issue…critical to safety and quality of
• Outreach activities that may increase diverse populations’ use of
hospital services through education and tailoring of services to
meet specific population needs is another important element.
Demographics – Census Data
• United States Census Bureau http://census.gov/
• State & County Quick Facts
• American Fact Finder
• People and Households
• State Data Centers
• The Modern Language Association Language Map
State & County QuickFacts
Demographics – Health Data
Photo credit: James
Neilsen/Chronicle, March 5, 2012
• Who Are the People in Your
“You have to leave the parking lot to do outreach.”
What is Outreach?
• “In community-based health information outreach,
organizations work together to improve peoples’ abilities
to find and use health information.”
Source: Getting Started With Community-Based Outreach
Finding Partners Within the Community
• Be consistent
• Demonstrate your
• Work with or join, already
• Attend health fairs,
conferences and other
events in your community
• Don’t forget your public
• Seek intermediaries
• Community leaders
• Early adopters
• Trusted community members
• Work with people of like passion
Networking, Coordinating, Cooperating, Collaborating
Methods for Strategic Collaboration
• Café to Go (World Café)
• Appreciative Inquiry
• Open Space Technology (the Unconference)
Identifying Health Information Needs
With your partners:
• Abandon preconceived ideas – think “outside the box”
• Think about language, ethnicities, country of origin
• Consider other needs – transportation, childcare, medical
• Identify potential barriers
• Café to Go!
Café to Go!
• “Hosting conversations about questions that matter”
Images from the World Café Image Bank:
Creating the Environment
• Set the theme
• Who are the participants?
• What are the questions?
• Café setting
• Tables with toys
• Table host(s)
• Tying it all together to the
• Next steps?
Café to Go Design Principles
• Focus on what matters
• Contribute your thinking
• Speak your mind and your heart
• Listen to understand
• Link and connect ideas
• Listen together for insights and deeper questions
• Play! Doodle! Draw!
• An approach to change that focuses on finding the
positive elements in people and places and using those
aspects of an organization as a foundation for change.
• Appreciations Exercise:
• “AI is intentional inquiry and directed conversation and
story-telling that leads to a place of possibility.”
(Steinbach, John. Contribution to the AI Listserve, July
4-D Cycle of AI
• The 4 Steps
• Discovery – The Best of “What Is”
• Dream – Envisioning “What Might Be”
• Design – Dialoguing “What Should Be”
• Destiny – Innovating “What Will Be”
• Possible Applications
• Mission Statement/Vision Building
• Strategic Planning
• Learning Strengths in Partners
• Civic/Community Development
• Health Care
Open Space Technology
• Facilitated (at some level)
• Common theme
• Other names:
• Library Camp
• The Unconference
Principles and Laws of OST
• Whoever comes is the right people.
• Whenever it starts is the right time.
• Whatever happens is the only thing that could have
• When it’s over, it’s over.
• The Law of Two Feet
Examples of OST
• Texas Library Association, April 2011: “Information
Literacy from Birth to Earth”
• Science, Technology and Engineering Library Leaders in
• HealthCamp DC 2010
• Get together in small groups and select a scenario from
• Select a “method” to use to set up a meeting to respond to
• Report highlights to the larger group.