Cultural competence pdf


Published on

Published in: Health & Medicine, Spiritual

Cultural competence pdf

  1. 1. Speaking of Disparities, did you know that?… Racial/ethnic groups  Have less access to, and availability of, mental health services  Are less likely to receive needed mental health services  Often receive poorer quality mental health treatment  Are underrepresented in mental health research African Americans have higher death rates than Whites for 12 of the 15 leading causes of death
  2. 2. Did you also know that?… Hispanic/Latino and African American children are less likely to receive specialty mental health care as opposed to white children Suicide is the second leading cause of death for American Indian and Alaska Native youth in the 15-24 age group, 2.5x the national average 82% of youth charged in adult courts are youth from racial/ethnic groups
  3. 3. And… Hispanic/Latina and Asian American female teens have the highest rates of depression Children of Color are over-represented in the JJ and Child Welfare systems and for the most part under-represented in the community based mental health system Reducing disparities for ethnic/racial groups would have saved $229.4 billion in 2003-2006 Eliminating disparities for racial/ethnic groups would have reduced indirect costs associated with illness and premature death by more than $1 trillion between 2003 and 2006
  4. 4. Safe Schools/Healthy StudentsStrategic Planning for Sustainability Ken Martinez, Psy.D. Technical Assistance Partnership American Institutes for Research Washington, D.C. / Corrales, New Mexico May 18-19, 2011
  5. 5. The Color of Americais Changing Even Morein 2011_____________ White (Non-Hispanic) 196.8 million 63.7% + 1% Latino/Hispanic 50.5 million 16.0% +43% African American 38.9 million 12.6% +12% Asian American 14.6 million 4.8% +43% American Indian/ Alaska Native 2.9 million .9% +18.4 Native Hawaiian and other Pacific Islander .5 million .2% +35.4 Other race 19.1 million 6.2% +24.4 Bi/Multi-racial 9.0 million 2.9%__ +32.0_ People of Color >135.4 million/308.7 43% (Not counting all other ethnic groups) (US Census Bureau, 2011) Ken Martinez, Psy.D. 5
  6. 6. Ken Martinez, Psy.D. 6
  7. 7. Ken Martinez, Psy.D. 7
  8. 8. Projected Rate of Increase of Youth of Color in US from 1995-2015 American Indian/Alaska Native +17% African American +19% Hispanic/Latino +59% Asian American, Native Hawaiian and other Pacific Islanders +74% Caucasian/White - 3% Ken Martinez, Psy.D. 8
  9. 9. 9Ken Martinez, Psy.D.
  10. 10. What is Cultural and LinguisticCompetence (CLC)?  Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or amongst professionals and enables that system, agency, or those professionals to work effectively in cross-cultural situations. (Cross, et al., 1989)  It is about “respect” and ultimately, about eliminating disparities and disproportionalities Ken Martinez, Psy.D. 10
  11. 11. Examples of what CLC is… Vision, mission, logic modeling, and strategic planning that is aligned and reflects commitment & action to CLC values, practices and outcomes at all levels - A safe organizational climate based on trust and mutual respect Individual and organizational self- assessment which leads to individual and organizational change that addresses challenges Sufficient resources (human and financial) to reflect the leadership’s commitment to infuse CLC into practice and sustain it over time Ken Martinez, Psy.D. 11
  12. 12. Examples of what CLC is… Administration, management and staff mirroring the population(s) served proportionately – Adult role modeling/Practicing what we preach Policies and procedures that operationalize CLC in daily work (organizational structure, planning, design, budgeting, P&P, implementation, evaluation) Contracts with providers, agencies, community partners, etc. that include specific contractual expectations about CLC with incentives/penalties Ken Martinez, Psy.D. 12
  13. 13. Examples of what CLC is… Administrative and staff performance appraisals that include CLC performance measures that are directly linked to salary increases and promotions A receptive organizational environment that promotes addressing race, ethnicity, class, disability, privilege, power, gender, sexual orientation, historical trauma, spirituality and other psychosociocultural issues relevant to the school, community and staff A CQI process (productive use of data) that is directed to eliminating disparities in access, availability, quality and outcomes for un-served/underserved student populations Ken Martinez, Psy.D. 13
  14. 14. Examples of what CLC is not… A “color-blind” philosophy and approach An “add on” or “overlay” or “just another (unfunded) government requirement” Limited to ethnic/racial groups Just a translated brochure Just literature with faces of children of different colors Just serving ethnic food or playing ethnic music in class or at trainings/gatherings Ken Martinez, Psy.D. 14
  15. 15. Examples of what CLC is not… Choosing a youth of color to make a presentation because s/he is a youth of color Asking a receptionist or maintenance worker to interpret Having a person of color on an advisory board as the token representative of the diverse community Assuming that a staff member of color is culturally or linguistically competent – stereotyping and unfairly placing burden on him/her Assigning all work associated with CLC to one individual – relieving everyone else of ownership, reducing likelihood of system infusion which undermines sustainability Ken Martinez, Psy.D. 15
  16. 16. Examples of what CLC is not… Collecting demographics on ethnic/racial populations and not using the data to address and eliminate disparities – cost and burden vs. value Stereotyping individuals because they belong to an ethnic/racial group, lower SES group or underserved population (LGBTQI2-S), based upon our limited and sometimes incorrect knowledge of that group Ignoring “youth culture” “Western benevolence” – we know what is best for you! (cultural deprivation/ disadvantaged model) Ken Martinez, Psy.D. 16
  17. 17. Besides Doing the “Right Thing” What is the Ultimate Goal of Cultural and Linguistic Competence?…. Eliminating/Reducing Disparities Eliminating/Reducing Disproportionalities Improving access, availability, quality/appropriateness, accountability, affordability, utilization and outcomes Ken Martinez, Psy.D. 17
  18. 18. Definitions Disproportionality refers to a situation in which a particular racial/ethnic group of children is represented in child welfare, juvenile justice, mental health or other child serving systems at a higher percentage than other racial/ethnic groups and the general population.  Over/Under-representation - the difference between how children/ youth are represented Disparity refers to disparate or inequitable treatment (how the individual is treated) or services (types, access, availability, utilization, affordability, quality, appropriateness, quantity) provided to children/youth from ethnic/racial groups and their outcomes as compared to those provided to similarly situated White children/youth. Adapted from Race Matters Consortium, 2001
  19. 19. Causes of Disparities Institutional ○ Laws, policies and practices ○ Structural/Institutional racism Social Determinants ○ Socio-economics, education, employment, housing, transportation ○ Geography / physical environments ○ Biology ○ Access to/availability/affordability/utilization/quality of services ○ Individual discrimination/prejudice by race, gender, or class ○ Social or environmental stressors / support ○ Court/agency culture Cultural Differences ○ World view ○ Historical trauma - issues of trust ○ Health/wellness/illness/curative beliefs ○ Language, values, beliefs, traditions, practices and rituals
  20. 20. Disparities and Disproportionalities of Childrenof Color “Do your homework” - learn about what D & D exists in your schools/communities  Over-representation in juvenile justice/ child welfare/special education  Under-representation in prevention activities, mentoring programs and community based services/supports  Develop strategies to reduce/ eliminate/increase accordingly That is all great, but HOW do we do this? Ken Martinez, Psy.D. 20
  21. 21. Data, Data, Data… Did I say Data? If you don’t identify it, it won’t get counted If you don’t count it, it won’t get measured If you don’t measure it, it won’t be in the budget If it isn’t in the budget, nothing will happen! Ken Martinez, Psy.D. 21
  22. 22. Steps to Gathering and Using Data Get baseline data – collect only what you need  Value vs. Burden  Use available Federal, state, county, local, agency sources  Begin with census data and projections, American Community Survey General data points to review  Ethnicity, race, income, language preferences/ spoken, length of residency, acculturation, generation in US Agency data to review  Ethnic/racial percentage/proportion at various points in the systems (child welfare, juvenile justice, special education, other) “Mine the data” – Dig deeper Ken Martinez, Psy.D. 22
  23. 23. Systems Data from Juvenile Justice -Proportionately by Race/Ethnicity Type of alleged offense Time of alleged offense Location of alleged offense Rates of arrest Rates of, and lengths of stay in, detention/long- term placement Type of prosecutorial and judicial decisions at disposition Diversion rates Alternative service rates Availability/quality of services/supports in lock-up Ken Martinez, Psy.D. 23
  24. 24. Systems Data from Mental Health -Proportionately by Race/Ethnicity Rates of inpatient/residential care Rates of outpatient/community based care Rates of preventive activities/programs Rates of access, availability, utilization, affordability, appropriateness, quality and outcomes of services/supports Ken Martinez, Psy.D. 24
  25. 25. Systems Data from Schools –Proportionately by Race/Ethnicity Rates of expulsions Rates and lengths of in/out of school detention Rates and lengths of suspensions Reasons for expulsions/suspensions/detentions Rates of special education placements by type Rates of gifted program placements Rates of IEPs Rates of referrals for mental health/substance abuse services/supports Rates of referrals to police/juvenile authorities Ken Martinez, Psy.D. 25
  26. 26. Ken Martinez, Psy.D. 26
  27. 27. Steps to Gathering and Using Data Develop community needs assessment to specifically identify individual/community needs through an inclusive participatory action research process Attempt to  Set up data systems uniformly across agencies  Collect data uniformly for comparison purposes  Set up data systems to be able to disaggregate/stratify data Mine the data (again) Ken Martinez, Psy.D. 27
  28. 28. Community Example A case of disproportionalities – Special Ed and JJ Used data to track every referral – to deal with the elephant(s) in the room  Analyzed demographics  Student Climate Survey and clinical data Outcomes  Parent Advisory Board  Parent University  Student Advisory Committee  Staff development/training  Study sessions  Family involvement is crucial  Engagement of all partners “authentically”  Mined the data – dug deeper, disaggregated/stratified data  Continuous quality improvement processes Ken Martinez, Psy.D. 28
  29. 29. What does this have to do with me? Engage all partners authentically It is all about the community and what it needs If you don’t ask the hard questions (confront the elephant), no significant change will happen Data driven planning and implementation promotes sustainability Don’t be satisfied with just what you see, dig deeper Focusing on one or more of the disparities or disproportionalities can make a significant contribution to community Ken Martinez, Psy.D. 29
  30. 30. How do we become good stewards in ourcommunities and focus on sustainability? Leadership with vision Political will Commitment and resolve Shared ownership Dedicated resources Meaningful and authentic partnership and collaboration with community Ken Martinez, Psy.D. 30
  31. 31. How do we become good stewards in ourcommunities and focus on sustainability?  Collecting and using data smartly and strategically – dig deeper again  CQI process directed at eliminating disparities and addressing domains  Accountability to our community  Training/technical assistance Ken Martinez, Psy.D. 31
  32. 32. Safe Schools/Healthy Students What have you done to promote and infuse CLC by eliminating/ reducing disparities/ disproportionalities in your communities? Are you using data wisely (addressing the elephants in your room)? What are your outcomes? What are your challenges? How have you met those challenges? What do you need to succeed and sustain? Ken Martinez, Psy.D. 32
  33. 33. Muchas Gracias Ken Martinez, Psy.D. 33
  34. 34. References Cross, T., Bazron, B., Dennis, K., and Isaacs, M. Toward a Culturally Competent System of Care, Volume 1. Washington, D.C.: Georgetown University. (1989.) U.S. Census Bureau 02.pdf Ken Martinez, Psy.D. 34