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Cultural and Linguistic Competence Policy in Action VCU MSW Lecture Feb 2014
 

Cultural and Linguistic Competence Policy in Action VCU MSW Lecture Feb 2014

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An introduction to key concepts in cultural and linguistic competence and laws and policies that are connected with these concepts.

An introduction to key concepts in cultural and linguistic competence and laws and policies that are connected with these concepts.

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  • So let’s take a look at some common definitions we will be using in this webinar.
  • Individual level….this level really deals with an employees individual desire to work effectively with consumers from across all cultures and perspectives. Learning about different cultures and cross cultural communication strategies are an exampleOrganizational level- deals with evaluating and modifying policies and procedures to ensure equal access to and effective treatment of illness, disabilities and disorders. Making sure that language services are in place to provide access to LEP consumers is an example.Systems level…..deals with how to develop infrastructure that addresses equity in healthcare. Laws prohibiting discrimination based on race and ethnicity is an example.
  • Another report came out in 2002 by the Institute of Medicine – it concluded that even when members of minority groups have the same incomes, insurance coverage and medical conditions as whites, they receive notably poorer care and that these biases, prejudices and negative racial stereotypes, the panel concludes, may be misleading doctors and other health professionals.Additionally, in 2003, the President’s New Freedom Commission Report found that the system has neglected to incorporate respect or understanding of the histories, traditions, beliefs, languages and value systems of culturally diverse groups.
  • ASK- HOW MANY LANGUAGES ARE SPOKEN IN THIS COMMUNITY?POPULATIONImmigrants are 14% of the US workforce10% of the population in Virginia is foreign born. Between 2000 and 2006, the number of foreign born Limited English Proficient (LEP) population increase by 44.5% in VirginiaVirginia is in the top 15 states for refugee resettlement. the second generation is projected to generate over 60 percent of the growth in the US labor force between 2030 and 2050.
  • http://en.wikipedia.org/wiki/Lau_v._NicholsLau v Nichols found people who had limited English proficiency were entitled to language services under Title VI of the Civil Rights Act of 1964 because of national origin.Because any program or activity receiving Federal financial assistance includes organizations that receive medicaid reimbursements and federal grant dollars, almost every organizations in the DBHDS system is required to provide language services for its LEP populations.
  • (1) the number or proportion of LEP persons eligible to be served or likely to be encountered by the program or grantee; (2) the frequency with which LEP individuals come into contact with the program; (3) the nature and importance of the program, activity or service provided by the recipient to its beneficiaries; and (4) the resources available to the grantee/recipient and the costs of interpretation/translation services. There is no "one size fits all" solution for Title VI compliance with respect to LEP persons, and what constitutes "reasonable steps" for large providers may not be reasonable where small providers are concerned.
  • Patient centeredness, cultural competence and healthcare quality – Saha, Beach, & Cooper, 2010.CARF ContinuumAgency for Healthcare Research and Quality (AHRQ)

Cultural and Linguistic Competence Policy in Action VCU MSW Lecture Feb 2014 Cultural and Linguistic Competence Policy in Action VCU MSW Lecture Feb 2014 Presentation Transcript

  • DBHDS Virginia Department of Behavioral Health and Developmental Services “Policy in Action” Planning for Culturally and Linguistically Appropriate Services in Human Services Cecily Rodriguez Office of Cultural & Linguistic Competence
  • DBDHS Virginia Department of Behavioral Health and Developmental Services Topics • Common understanding of the terms • Why is CLC in health & human services important? • CLC Planning and Policy Development Page 2
  • DBDHS Virginia Department of Behavioral Health and Developmental Services A COMMON FRAMEWORK What is culture? Office of Cultural and Linguistic Competency - DBHDS Page 3
  • DBDHS Virginia Department of Behavioral Health and Developmental Services Rethinking Culture Office of Cultural and Linguistic Competency - DBHDS Page 4
  • DBDHS Virginia Department of Behavioral Health and Developmental Services Dimensions of Culture Page 5
  • DBDHS Virginia Department of Behavioral Health and Developmental Services Is Culture an Iceberg? RACE GOVERNING CHILD-RAISING VISIBLE ATTITUDE TOWARDS ANIMALS LANGUAGE CONCEPTS OF HUMOR DEFINITION OF SIN AGE CULTURAL ARTIFACTS (CLOTHING, HAIRSTYLE, ETC) Culture is Not an Iceberg – Milton J. Bennett PhD. 2013 HIDDEN Don’t forget to adjust for acculturation, generational differences and other6 variables Page
  • DBDHS Virginia Department of Behavioral Health and Developmental Services ROCCO RODRIGUEZ and the Iceberg Effect Office of Cultural and Linguistic Competency - DBHDS Page 7
  • DBDHS Virginia Department of Behavioral Health and Developmental Services What is Cultural Competence National Center for Cultural Competence Value Diversity Conduct Self Assessment Manage the Dynamics of difference Acquire and institutionali ze cultural knowledge Adapt to the cultural contexts of your community And incorporate the above in all aspects of policy making, administration, practice, Page 8 service delivery and involve systematically consumers, key stakeholders and
  • DBDHS Virginia Department of Behavioral Health and Developmental Services Levels of Cultural Competency Individual Level Right skills, knowledge, and attitude to work for a diverse population Organizational Systems Policies and procedures in place and an infrastructure that supports diverse communities System’s Levels Laws and regulations in place and an infrastructure that supports diverse communities Page 9
  • DBDHS Virginia Department of Behavioral Health and Developmental Services What is Linguistic Competence? 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. National Center for Cultural Competence Page 10
  • DBDHS Virginia Department of Behavioral Health and Developmental Services The Case for CLC Disparities in Access and Outcomes Mental Health: Culture, Race, Ethnicity Supplement to Mental Health: Report of the Surgeon General Minority populations have a disproportionate burden of death and disability. Research has proven that communities of color don’t access services in proportion to the white community and their outcomes are less successful than that of the white community. • Documented disparities for people of color include: – Less availability and access to services – Lower likelihood of receiving services – Greater likelihood of receiving poorer quality of care and disproportionate treatment outcomes – Over represented in hospitalizations (more restrictive settings) – Under represented in research 2001 Page 11
  • DBDHS Virginia Department of Behavioral Health and Developmental Services The Case for CLC • Over 350 languages are spoken in the U.S. • More women in the workplace than ever • There are more than 47 million people in the nation who speak a language other than English, and over 30 million who were born outside the United States • During the past decade, the number of Spanish and Asian-language speakers grew by 50% • Over 17% of the nation’s population speak a language other than English at home. • Range of ages in the workplace • New workforce tends to be more culturally diverse Page 12
  • DBDHS Virginia Department of Behavioral Health and Developmental Services The Case for CLC FEDERAL LAW Civil Rights Act of 1964 The Civil Rights Act of 1964 says that no person shall be excluded from participation in, be denied the benefits of, or be subjected to discrimination based on race, gender, ethnicity or national origin under any program or activity receiving Federal financial assistance." Four factor analysis video clip - Presidential Executive Order 13166 http://www.lep.gov/13166/eo13166.html Page 13
  • DBDHS Virginia Department of Behavioral Health and Developmental Services The Case for CLC Title VI - “Meaningful Access” Organizations are required to take reasonable steps to ensure meaningful access to their programs and activities by LEP persons. The Guidance explains that the obligation to provide meaningful access is fact-dependent and starts with an individualized assessment that balances four factors: 1. 2. 3. 4. Number or Proportion of LEP Individuals Frequency of Contact With the Program Nature and Importance of the Program Resources Available Page 14
  • DBDHS Virginia Department of Behavioral Health and Developmental Services The Case for CLC Inova Health System Fairfax – $145,000 settlement for failure to provide signlanguage interpreting for parents of a newborn with medical complications. Maryland Department of Health and Mental Hygiene DOJ required periodic language needs assessments to ensure all populations were considered in services. DBHDS investigation into allegations of discrimination based on national origin. As a result, language policy and procedures were developed. US Dept. of Justice Page 15
  • DBDHS Virginia Department of Behavioral Health and Developmental Services Challenges To Cultural Competence Individual challenges • • • • Lack of self awareness of bias and value systems Unclear connection b/w bias and decision making Individual “isms” Cultural blindness • Ethnocentrism Organizational challenges • • • • • • • Lack of valid performance measures Operationalization of CLC Competing priorities Systemic “isms” Budget constraints Regulatory ambiguousness Staff turnover Page 16
  • DBDHS Models for Culturally and Linguistically Appropriate Services Patient centeredness, cultural competence and healthcare quality – Saha, Beach, & Cooper, 2010. Standards for Culturally & Linguistically Appropriate Services 2013 Agency for Healthcare Research and Quality (AHRQ) Commission on Accreditation of Rehabilitation Facilities Virginia Department of Behavioral Health and Developmental Services Page 17
  • DBDHS Virginia Department of Behavioral Health and Developmental Services Organizational Planning Any plan should address the six critical domains related to cultural and linguistic competence. Technical Assistance Partnership www.tapartnership.org/docs/clcPlanTemplateFinal.doc Page 18
  • DBDHS Virginia Department of Behavioral Health and Developmental Services Utilize outreach strategies and engage cultural brokers? CLC in Practice Do we explore new methods for recruitment and retention of culturally competent staff Diversity Councils Safe venues for people to discuss their communication differences? Provide training on addressing bias, discrimination, and racism in systems. Standardize ways to assess a candidate’s cross cultural skills Page 19
  • DBDHS Virginia Department of Behavioral Health and Developmental Services CLC in Practice Use varied approaches to communicate With individuals who experience cognitive disabilities Hire bilingual/ bicultural staff Require the use of qualified interpreters Linguistic Competence Pre-test the readerfriendliness of enrollment and education materials with focus groups Offer multilingual Tele-communication systems Page 20
  • DBDHS Virginia Department of Behavioral Health and Developmental Services Critical Components of a CLC Plan You don’t know where to go if you don’t know where you are. Engagement Evaluate/ Document Achievement Assessment Organizational Cultural Competence Implement Plan Page 21