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https://learn.extension.org/events/2189
This material is based upon work supported by the National Institute of Food and A...
Research and evidence-based
professional development through
engaged online communities.
www.eXtension.org/militaryfamilie...
https://www.linkedin.com/groups/Military-Families-Learning-Network-8409844
2015 Military Caregiving VLE
“Reimaging your skills as a Helping Professional:
Working with Military Family Caregivers”
• ...
https://learn.extension.org/events/2189
VLE Session #2 Resources
Who’s Joining Us Today?
*Type your response in chat pod.
• Civilian
• Military Branch & Program
• Community-based
• Univer...
Tawara D. Goode
Assistant Professor and Director
Georgetown University National Center for Cultural Competence
Center for ...
Slide Source:© 2015 - Georgetown University National Center for Cultural Competence
OBJECTIVES
Participants will:
1. Defin...
Multiple Dimensions of
Slide Source:© 2015 - Georgetown University National Center for Cultural Competence
10
A 24 year old active duty service member
sustained an injury which has significantly
his/her limited mobility and capacity...
After a series of events, both at home and
on the installation, a 38 year old service
member with 15 years of service, was...
How do you
define culture
Slide Source:© 2015 - Georgetown University National Center for Cultural Competence
13
Culture is the learned and shared knowledge that specific groups use to
generate their behavior and interpret their experi...
CULTURE IS …
Comprised of beliefs about reality, how
people should interact with each other, what
they know about the worl...
Culture
Culture is akin to being the person
observed through a one-way mirror;
everything we see is from our own
perspecti...
Culture …
is applicable to all peoples
is value laden & rooted in belief systems
is active & dynamic
is multilayered & mul...
An Iceberg
Concept
of Culture
dress  age
gender  language 
 race or ethnicity
 eye behavior 
 facial expressions 
...
Intersectionality
Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 19
Data Sources:
Hays, Pamela. (2001). Addressing cultural complexities in practice. A framework for clinicians and counselor...
The extant literature indicates that we as human beings have
multiple cultural identities that can be grouped as follows.
...
ORGANIZATIONAL CULTURE
Organizational culture is a pattern of shared basic assumptions that the group learned
as it solved...
MILITARY ORGANIZATIONAL CULTURE
Slide Source: Georgetown University National Center for Cultural Competence, 2015.
Conside...
Health Care
System
Behavioral
Health Care
System
Disability
Evaluation
Center
School
System
Child Care
System
Legal System...
Thoughts About Culture:
Key Considerations & Lessons Learned
Understanding another culture is a continuous not a
discreet ...
Thoughts About Culture:
Key Considerations & Lessons Learned
What seems logical, sensible, important, and
reasonable in on...
Thoughts About Culture:
Key Considerations & Lessons Learned
Differences between cultures are often seen as
threatening an...
CULTURAL AND LINGUISTIC COMPETENCE:
Essential Approaches to Support Service Members and their Families
Slide Source:© 2015...
Cultural Diversity
and
Differing World Views
Slide Source:© 2015 - Georgetown University National Center for Cultural Comp...
Cultural Diversity
Goode & Jackson, 2009
The term cultural diversity is used to
describe differences in ethnic or racial
c...
Cultural Factors That Influence Diversity
Among Individuals and Groups
Adapted with permission from James
Mason, Ph.D., NC...
Cultural Factors That Influence Diversity
Among Individuals and Groups
Institutional Biases
Racism & Discrimination
Commun...
Reliance on traditional remedies and healers
Culture bound syndromes
Delaying access to care
Historical mistrust of health...
Let’s revisit our
case studies
Slide Source:© 2015 - Georgetown University National Center for Cultural Competence
34
A 24 year old active duty service member
sustained an injury which has significantly
his/her limited mobility and capacity...
POLLING QUESTION FOR CASE STUDY 1
Slide Source:© 2015 - Georgetown University National Center for Cultural Competence
Whic...
After a series of events, both at home and
on the installation, a 38 year old service
member with 15 years of service, was...
POLLING QUESTION FOR CASE STUDY 2
Slide Source:© 2015 - Georgetown University National Center for Cultural Competence
Whic...
Let’s take a closer look
at our cultural diversity
Slide Source:© 2015 - Georgetown University National Center for Cultura...
What are
demographic
trends for the
Slide Source:© 2015 - Georgetown University National Center for Cultural Competence
US...
The facts, nothing
but the facts …
A NEW DEMOGRAPHIC REALITY
A series of projections from the U.S.
Census Bureau estimates...
ACS 2014 United States Demographic Estimates
One Race or Latino or Hispanic and Race
Data Source: Source: U.S. Census Bure...
White and Black or African American
White and American Indian and Alaska Native
White and Asian
White and Native Hawaiian ...
Languages Spoken at Home in the U.S. in 2014
English only 78.0%
Other than English languages 21.1%
Speak Spanish or Spanis...
Limited English Speaking Households formerly (linguistic isolation)
refers to households in which no member 14 years old a...
What do these
demographic
trends look like
for the U.S.
Military Community?
Slide Source:© 2015 - Georgetown University Na...
47
Slide Source:© 2015 - Georgetown University National Center for Cultural Competence
A word about the implications of cultu...
 A bias is a preference for one
thing, person or group over
another.
 We all have biases.
 Bias becomes a concern when ...
DEFINING IMPLICIT OR UNCONSCIOUS BIAS
Bias in a
natural
human
reaction .
Implicit or unconscious bias operates outside of
...
 Age
 Disability
 Education
 English language
proficiency and fluency
(including the capacity to
speak Standard Englis...
CULTURAL AND LINGUISTIC COMPETENCE:
Essential Approaches to Support Service Members and their Families
Slide Source:© 2015...
DEFINITIONS AND CONCEPTUAL
FRAMEWORKS
Cultural Competence
Linguistic Competence
Slide Source:© 2015 - Georgetown Universit...
A service member’s daughter has a
developmental disability with complex
health issues. On a recent visit, the service
memb...
Are we on the same page?
culturally aware
cultural
sensitivity
culturally appropriate
culturally
effective
culturally
rele...
Cultural competence
requires that organizations
have a clearly defined,
congruent set of values
and principles, and
demons...
Five Elements of Cultural Competence
INDIVIDUAL LEVEL
acknowledge cultural differences
understand your own culture
engage ...
1
• value diversity
2
• conduct self-assessment
3
• manage the dynamics of difference
4
• institutionalize/embed cultural ...
ESSENTIAL ELEMENTS IN A
CULTURALLY COMPETENT SYSTEM
Slide Source:© 2011 - National Center for Cultural Competence
policy m...
Cultural
Destructiveness
Cultural
Incapacity
Cultural
Blindness
Cultural
Pre-Competence
Cultural
Competence
Cultural
Profi...
is the capacity of an organization and its personnel to
communicate effectively, and convey information in a
manner that i...
Health Literacy is ……
the ability to read, understand, and act on
health information.
Source: Center for Health Care Strat...
Functional Health Literacy is…
the ability to read, and
comprehend prescription
bottles, appointment
slips, and other esse...
Health Literacy is ……
the capacity of professionals and
health institutions to provide
access to information and support
t...
EVIDENCE-BASED TOOLS TO ADDRESS HEALTH LITERACY
Slide Source:© 2014 - National Center for Cultural Competence
Source: http...
Let’s revisit our
case study
Slide Source:© 2015 - Georgetown University National Center for Cultural Competence
66
A service member’s daughter has a
developmental disability with complex
health issues. On a recent visit, the service
memb...
POLLING QUESTION FOR CASE 2
Slide Source:© 2015 - Georgetown University National Center for Cultural Competence
What cultu...
69
 You are a cultural being and have multiple cultural
identities, one of which may be your professional
discipline or p...
70
Cultural and Linguistic Competence
Adapted from: Goode, T., Jones, W., & Christopher, J. Responding to cultural and lin...
71
Cultural and Linguistic Competence
Adapted from: Goode, T., Jones, W., & Christopher, J. Responding to cultural and lin...
As a culturally competent _________
I am capable of interacting positively with
people who do NOT
look like,
talk like,
th...
CONTACT US
National Center for Cultural Competence
http://nccc.georgetown.edu
cultural@georgetown.edu
The content of and t...
Reflect! Keep Calm & Carry On
(Mindfulness Audiocast Exercise)
Discover and observe your reactions to life’s stressors and...
Evaluation & Continuing
Education Credits/Certificates
The MFLNMC Concentration Area offers 1.5 credit hour(s)
from the Na...
Session #3: Recharging! Combating Compassion Fatigue
Time: 11:00 a.m. – 12:30 p.m. EDT
Date: Wednesday, November 4, 2015
L...
https://www.linkedin.com/groups/Military-Families-Learning-Network-8409844
Find all upcoming & recorded VLEs
& webinars covering:
Personal Finance Family Transitions
Military Caregiving Network Lit...
2015 MFLNMC VLE Session #1: Relating! Caring and Culture
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2015 MFLNMC VLE Session #1: Relating! Caring and Culture

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Centered around a theme of reenergizing and rejuvenating the work environment, this FREE web-based learning opportunity is open to the public and will be similar to a professional conference – no travel involved! Part 2 of the Virtual Learning Event Session will focus on professional development in the area of ‘Cultural Competencies.’

Cultural competence and linguistic competence are widely recognized as fundamental aspects of quality in health/behavioral health care and in the provision of social services and supports. Cultural and linguistic competence are viewed as essential approaches for reducing disparities and for promoting equity by improving access, utilization, service delivery, and health and well-being among patients, their families, and communities. While the evidence suggests the efficacy of these approaches, many in health/behavioral health care and social service organizations continue to struggle with the full integration of cultural and linguistic competence into their policies, structures, practices, and procedures. This VLE session will explore the conceptual frameworks of cultural and linguistic competence and examine their relevance for supporting service members and their families.

Published in: Education
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2015 MFLNMC VLE Session #1: Relating! Caring and Culture

  1. 1. https://learn.extension.org/events/2189 This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Readiness Policy, U.S. Department of Defense under Award Numbers 2012-48755-20306 and 2014-48770-22587. VLE Session #2: RELATING! Caring and Culture
  2. 2. Research and evidence-based professional development through engaged online communities. www.eXtension.org/militaryfamilies Sign up for webinar email notifications at: www.eXtension.org/62831
  3. 3. https://www.linkedin.com/groups/Military-Families-Learning-Network-8409844
  4. 4. 2015 Military Caregiving VLE “Reimaging your skills as a Helping Professional: Working with Military Family Caregivers” • Theme: Reenergizing and rejuvenating personal and professional growth with colleagues in caring disciplines. • Three-Part Session with topics surrounding building trust and credibility, cultural competency, and compassion fatigue.
  5. 5. https://learn.extension.org/events/2189 VLE Session #2 Resources
  6. 6. Who’s Joining Us Today? *Type your response in chat pod. • Civilian • Military Branch & Program • Community-based • University/Extension
  7. 7. Tawara D. Goode Assistant Professor and Director Georgetown University National Center for Cultural Competence Center for Child and Human Development Georgetown University Medical Center November 4, 2015 Cultural and Linguistic Competence: Essential Approaches to Support Service Members and their Families 8
  8. 8. Slide Source:© 2015 - Georgetown University National Center for Cultural Competence OBJECTIVES Participants will: 1. Define culture and its multiple manifestations. 2. Describe culturally defined belief systems that impact health, behavioral health, and disability. 3. List four rationales for cultural competence in health and human services. 4. Describe a conceptual framework for a cultural competence model and its relevance for their roles/responsibilities. 5. Define linguistic competence with an emphasis on the role of health literacy in the provision of care, services, and supports. 9
  9. 9. Multiple Dimensions of Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 10
  10. 10. A 24 year old active duty service member sustained an injury which has significantly his/her limited mobility and capacity to perform day to day activities. The medical team recommended surgery to minimize continued debilitation. During an appointment with the medical team’s social worker, the service member revealed that his/her family had encouraged delay of the surgery because “God heals all things in time.” The service member indicated feelings of conflict given how supportive his/her family has been and his/her fear of surgical procedures. CASE STUDY 1 Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 11
  11. 11. After a series of events, both at home and on the installation, a 38 year old service member with 15 years of service, was ordered to seek mental health treatment. The service member had returned after being deployed for 18-months. The service member was very reluctant to seek care indicating to his wife that, “Men in my unit have gone through worse things than me. We hold strong. I can get through this without help.” CASE STUDY 2 Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 12
  12. 12. How do you define culture Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 13
  13. 13. Culture is the learned and shared knowledge that specific groups use to generate their behavior and interpret their experience of the world. It includes but is not limited to: thought languages values beliefs customs practicescourtesies rituals communication roles relationships expected behaviors Culture applies to racial, ethnic, religious, political, professional, and other social groups. It is transmitted through social and institutional traditions and norms to succeeding generations. Culture is a paradox, while many aspects remain the same, it is also dynamic, constantly changing. manners of interacting Data Source: Gilbert, J. Goode, T., & Dunne, C., 2007. Slide Source:© 2015 - Georgetown University National Center for Cultural Competence14
  14. 14. CULTURE IS … Comprised of beliefs about reality, how people should interact with each other, what they know about the world, and how they should respond to the social and material environments in which they find themselves. Reflected in religion, morals, customs, politics, technologies, and survival strategies of a given group. It affects how groups work, parent, love, marry, and understand health, mental health, wellness, illness, disability, and end of life. Data Source: Gilbert, J., Goode, T. D., & Dunne, C. (2007). Cultural awareness. From the Curricula Enhancement Module Series. Washington, DC: National Center for Cultural Competence, Georgetown University Center for Child and Human Development. Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 15
  15. 15. Culture Culture is akin to being the person observed through a one-way mirror; everything we see is from our own perspective. It is only when we join the observed on the other side that it is possible to see ourselves and others clearly – but getting to the other side of the glass presents many challenges. (Lynch & Hanson 1992 Developing Cross Cultural Competence) Slide Source:© 2015 - Georgetown University National Center for Cultural Competence16
  16. 16. Culture … is applicable to all peoples is value laden & rooted in belief systems is active & dynamic is multilayered & multidimensional exists at conscious & unconscious levels is often viewed as thick, thin, or compartmentalized provides group member identity structures perceptions & shapes behaviors varies in expression both among and between individual group members permeates every aspect of life Goode, T. & Jones, W. Cultural Influences on Child Development: The Middle Years. In T. Gullotta T. & G. Blau (Eds.) Family Influences on Childhood Behavior and Development: Evidence-based Approaches to Prevention and Treatment Approaches. New York: Routledge, Taylor & Francis Group, 2008. Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 17
  17. 17. An Iceberg Concept of Culture dress  age gender  language   race or ethnicity  eye behavior   facial expressions  body language  sense of self   concept of justice  value individual vs. group   notions of modesty  concept of cleanliness  emotional response patterns  rules for social interaction  child rearing practices   decision-making processes   approaches to problem solving   perceptions of & beliefs about of mental health, health, illness, disability   patterns of superior and subordinate roles in relation to status by age, gender, class  sexual orientation  gender identity & expression and much more… Adapted by the NCCC  physical characteristics  Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 18
  18. 18. Intersectionality Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 19
  19. 19. Data Sources: Hays, Pamela. (2001). Addressing cultural complexities in practice. A framework for clinicians and counselors. Washington, DC: American Psychological Association. Hays, Pamela. Addressing the complexities of culture and gender in counseling. Journal of Counseling & Development. 74.4 (Mar./Apr. 1996). 332 THE HAYS ADDRESSING Model Addressing cultural complexities in practice: A framework for clinicians and counselors & Addressing the complexities of culture and gender in counseling 20
  20. 20. The extant literature indicates that we as human beings have multiple cultural identities that can be grouped as follows.  Categorization – people identify with one of their cultural groups over others  Compartmentalization – individuals maintain multiple, separate identities within themselves  Integration – people link their multiple cultural identities MULTIPLE CULTURAL IDENTITIES Multiple IdentitiesCultural Sources: Seth J.J. Schwartz, Koen Luyckx , and Vivian L.K. Vignoles (Eds.) Handbook of Identity Theory and Research. Springer. 2001. Verónica Benet-Martínez and Ying-yi Hong (Eds.) The Oxford Handbook of Multicultural Identity. Oxford University Press. 2014. Chao, G.T., & Moon, H. The Cultural Mosaic: A Metatheory for Understanding the Complexity of Culture. Journal of Applied Psychology 2005, Vol. 90, No. 6, 1128–1140 Yampolsky MA, Amiot CE, & de la Sablonnière, R. (2013). Multicultural identity integration and well-being: a qualitative exploration of variations in narrative coherence and multicultural identification. Front. Psychol. 4:126.doi: 10.3389/fpsyg. 2013.00126 21
  21. 21. ORGANIZATIONAL CULTURE Organizational culture is a pattern of shared basic assumptions that the group learned as it solved its problems of external adaptation and internal integration, that has worked well enough to be considered valid and therefore, to be taught to new members as the correct way to perceive, think, and feel in relation to those problems. Schein, E. (1985) .Organizational Culture and Leadership. Jossey Bass: San Francisco. Slide Source: Georgetown University National Center for Cultural Competence, 2015. 22
  22. 22. MILITARY ORGANIZATIONAL CULTURE Slide Source: Georgetown University National Center for Cultural Competence, 2015. Consider culture within the contexts of each of the five U.S. armed service branches.  identities  values & beliefs  traditions  language  dress 23
  23. 23. Health Care System Behavioral Health Care System Disability Evaluation Center School System Child Care System Legal System Military & Family Support Center Military Base Location Family Service Member Socio-Political Environment Convergence of Cultural Contexts: A Focus on the U.S. Military Community Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 24
  24. 24. Thoughts About Culture: Key Considerations & Lessons Learned Understanding another culture is a continuous not a discreet process. It requires experience as well as study to understand the many subtleties of another culture. Stereotyping is probably inevitable in absence of frequent contact with and study of other cultures. Goode, T. & Jones, W. Cultural Influences on Child Development: The Middle Years. In T. Gullotta . & G. Blau (Eds.) Family Influences on Childhood Behavior and Development: Evidence-based Approaches to Prevention and Treatment Approaches. New York, NY: Routledge, Taylor & Francis Group, 2008. Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 25
  25. 25. Thoughts About Culture: Key Considerations & Lessons Learned What seems logical, sensible, important, and reasonable in one culture may seem illogical, irrational, and unimportant to someone outside of that culture. When people talk about cultures other than their own, they tend to describe the differences rather than the similarities. Goode, T. & Jones, W. Cultural Influences on Child Development: The Middle Years. In T. Gullotta T. & G. Blau (Eds.) Family Influences on Childhood Behavior and Development: Evidence-based Approaches to Prevention and Treatment Approaches. New York: Routledge, Taylor & Francis Group, 2008. Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 26
  26. 26. Thoughts About Culture: Key Considerations & Lessons Learned Differences between cultures are often seen as threatening and often described in negative terms. It is probably necessary to know the language of another culture to understand that culture in depth. Goode, T. & Jones, W. Cultural Influences on Child Development: The Middle Years. In T. Gullotta T. & G. Blau (Eds.) Family Influences on Childhood Behavior and Development: Evidence-based Approaches to Prevention and Treatment Approaches. New York: Routledge, Taylor & Francis Group, 2008. Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 27
  27. 27. CULTURAL AND LINGUISTIC COMPETENCE: Essential Approaches to Support Service Members and their Families Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 28
  28. 28. Cultural Diversity and Differing World Views Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 29
  29. 29. Cultural Diversity Goode & Jackson, 2009 The term cultural diversity is used to describe differences in ethnic or racial classification & self-identification, tribal or clan affiliation, nationality, language, age, gender, sexual orientation, gender identity or expression, socioeconomic status, education, religion, spirituality, physical and intellectual abilities, personal appearance, and other factors that distinguish one group or individual from another. Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 30
  30. 30. Cultural Factors That Influence Diversity Among Individuals and Groups Adapted with permission from James Mason, Ph.D., NCCC Senior Consultant Cultural/Racial/Ethnic Identity Tribal Affiliation/Clan Nationality Acculturation/Assimilation Socioeconomic Status/Class Education Language Literacy Family Constellation Social History Military Status Perception of Time Health Beliefs & Practices Internal Factors Health & Mental Health Literacy Beliefs about Disability or Mental Health Lived Experience of Disability or Mental Illness Age & Life Cycle Issues Gender, Gender Identity & Expression Sexual Orientation Religion & Spiritual Views Spatial & Regional Patterns Political Orientation/Affiliation Slide Source:© 2015 - Georgetown University National Center for Cultural Competence31
  31. 31. Cultural Factors That Influence Diversity Among Individuals and Groups Institutional Biases Racism & Discrimination Community Economics Intergroup Relations Group & Community Resiliency External Factors Natural Networks of Support Community History Political Climate Workforce Diversity Community Demographics Adapted with permission from James Mason, Ph.D., NCCC Senior Consultant Slide Source:© 2015 - Georgetown University National Center for Cultural Competence32
  32. 32. Reliance on traditional remedies and healers Culture bound syndromes Delaying access to care Historical mistrust of health care, mental health, education, and social service professionals Experiences of racism, discrimination, and bias Cultural and linguistic barriers Stigma Cultural Influences on Beliefs and Practices Related to Health, Mental Health, and Social Services & Related Providers of Care/Services T.D. Goode Slide Source:© 2014 - National Center for Cultural Competence 33
  33. 33. Let’s revisit our case studies Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 34
  34. 34. A 24 year old active duty service member sustained an injury which has significantly his/her limited mobility and capacity to perform day to day activities. The medical team recommended surgery to minimize continued debilitation. During an appointment with the medical team’s social worker, the service member revealed that his/her family had encouraged delay of the surgery because “God heals all things in time.” The service member indicated feelings of conflict given how supportive his/her family has been and his/her fear of surgical procedures. CASE STUDY 1 Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 35
  35. 35. POLLING QUESTION FOR CASE STUDY 1 Slide Source:© 2015 - Georgetown University National Center for Cultural Competence Which of the following cultural factors are present in this case study? Select one answer. 1. Religion 2. Age 3. Health beliefs and practices 4. Family composition & dynamics 5. All of the above 36
  36. 36. After a series of events, both at home and on the installation, a 38 year old service member with 15 years of service, was ordered to seek mental health treatment. The service member had returned after being deployed for 18-months. The service member was very reluctant to seek care indicating to his wife that, “Men in my unit have gone through worse things than me. We hold strong. I can get through this without help.” CASE STUDY 2 Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 37
  37. 37. POLLING QUESTION FOR CASE STUDY 2 Slide Source:© 2015 - Georgetown University National Center for Cultural Competence Which of the following cultural factors are present in this case study? Select one answer. A. Cultural identify B. Military status C. Health literacy D. Mental health beliefs and practices E. A-D F. A, B, & D 38
  38. 38. Let’s take a closer look at our cultural diversity Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 39
  39. 39. What are demographic trends for the Slide Source:© 2015 - Georgetown University National Center for Cultural Competence USA Most recently available data from sources cited. 40
  40. 40. The facts, nothing but the facts … A NEW DEMOGRAPHIC REALITY A series of projections from the U.S. Census Bureau estimates:  In the year 2045 the nation will become “majority-minority” (all people except those that are non- Hispanic, single-race white)  The population under 18 years of age will reach this status by 2018 or 2019  The working age population is projected to become majority- minority between 2036 and 2042 Slide Source:© 2015 - Georgetown University National Center for Cultural Competence Data Source: U.S. Census Bureau. Retrieved on 10/11/15 from http://www.census.gov/newsroom.html 41
  41. 41. ACS 2014 United States Demographic Estimates One Race or Latino or Hispanic and Race Data Source: Source: U.S. Census Bureau, 2014 American Community Survey (ACS), Demographic & Housing Estimates, Table DP05 Slide Source:© 2015 - National Center for Cultural Competence RACE NUMBER Percent of POPULATION One Race 309,251,285 97.0% White 233,963,285 73.4% Black or African American 40,379,066 12.7% American Indian or Alaska Native 2,521,131 0.8% Asian 16,012,120 5.2% Native Hawaiian & Other Pacific Islander 557,154 0.2% Some Other Race 15,063,263 4.7% Two or More Races 9,605,771 3.0% HISPANIC OR LATINO AND RACE Hispanic or Latino of any Race 55,279,452 17.3% Total Population = 318,857,056 42
  42. 42. White and Black or African American White and American Indian and Alaska Native White and Asian White and Native Hawaiian and Other Pacific Islander White and Some Other Race Black or African American and American Indian and Alaska Native Black or African American and Asian Black or African American and Native Hawaiian and Other Pacific Islander Black or African American and Some Other Race American Indian and Alaska Native; Asian American Indian and Alaska Native and Native Hawaiian and Other Pacific Islander American Indian and Alaska Native and Some Other Race Asian and Native Hawaiian and Other Pacific Islander Asian and Some Other Race Native Hawaiian and Other Pacific Islander and Some Other Race Three or more races Population Self-Identified by Race & Ethnicity Categorical Listings Data Source: U.S. Census Bureau, American Fact Finder, Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 43
  43. 43. Languages Spoken at Home in the U.S. in 2014 English only 78.0% Other than English languages 21.1% Speak Spanish or Spanish Creole 39,254,342 (13.1%) Speak Indo European languages 10,808,453 (3.6%) [French (Patois, Cajun), French Creole, Italian, Portuguese, Portuguese Creole, German, Yiddish, Other West Germanic languages, Scandinavian languages, Greek, Russian, Polish, Serbo-Croatian, Other Slavic languages, Armenian, Persian, Gujarathi, Hindi, Urdu, Other Indic languages] Speak Asian and Pacific Island languages 10,134,871 (3.4%) [Chinese, Japanese, Korean, Mon-Kymer, Cambodian, Miao, Hmong, Thai, Laotian, Vietnamese, Tagalog, other Pacific Island language] Other Languages 2,980,821 (1.0%) [Navajo, Other Native American languages, Hungarian, Arabic, Hebrew, African languages, other unspecified languages] Total Population 5 years and over 299,084,046 Slide Source:© 2015 - Georgetown University National Center for Cultural Competence Data Source: U.S. Census Bureau, American Fact Finder, 2014 American Community Survey-1 Year Estimates, Table S1601 44
  44. 44. Limited English Speaking Households formerly (linguistic isolation) refers to households in which no member 14 years old and over: (1) speaks only English or (2) speaks a non-English language and speaks English “very well.” Limited English Speaking Households All households 4.5%% Households speaking--  Spanish 23.1%  Other Indo-European languages 15.60%  Asian and Pacific Island languages 26.5%  Other languages 17.8% Data Source: U.S. Census Bureau, American FactFinder, 2014 American Community Survey- 1 Year Estimates, Table S1602 Slide Source:© 2015 - Georgetown University National Center for Cultural Competence Limited English Speaking Households in the Unites States in 2014 45
  45. 45. What do these demographic trends look like for the U.S. Military Community? Slide Source:© 2015 - Georgetown University National Center for Cultural Competence USA 46
  46. 46. 47
  47. 47. Slide Source:© 2015 - Georgetown University National Center for Cultural Competence A word about the implications of culture and biases 48
  48. 48.  A bias is a preference for one thing, person or group over another.  We all have biases.  Bias becomes a concern when it becomes a prejudice against certain people or groups in ways that are unfair and lead to discrimination. DEFINING BIAS Bias in a natural human reaction . Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 49
  49. 49. DEFINING IMPLICIT OR UNCONSCIOUS BIAS Bias in a natural human reaction . Implicit or unconscious bias operates outside of the person’s awareness and can be in direct contradiction to a person’s espoused beliefs and values. What is so dangerous about implicit bias is that it automatically seeps into a person’s affect or behavior and is outside of the full awareness of that person. Implicit bias can interfere with:  clinical assessment  decision-making  communicating with others  relationships between: - coworkers - practitioners/staff and their patients and clients Source: Conscious and Unconscious Bias in Health Care: A Focus on Lupus. CME/CE developed by the National Center for Cultural Competence for American College of Rheumatology. http://thelupusinitiative.org/cmece/ Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 50
  50. 50.  Age  Disability  Education  English language proficiency and fluency (including the capacity to speak Standard English for native-born English speakers)  Ethnicity  Health status  Disease/diagnosis (HIV/AIDS)  Insurance  Obesity  Race  Socioeconomic status (SES)  Sexual orientation, gender identity, or expression  Skin tone  Substance use (injection drug user)  Social contact (amount of contact that practitioners have with patient populations) ENVIRONMENTAL SCAN OF THE LITERATURE Identified Areas of Bias Source: Conscious and Unconscious Biases in Health Care: A focus on lupus. Created by the NCCC for ACR Lupus Initiative. Retrieved on 4/19/15 from http://thelupusinitiative.org/cmece Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 51
  51. 51. CULTURAL AND LINGUISTIC COMPETENCE: Essential Approaches to Support Service Members and their Families Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 52
  52. 52. DEFINITIONS AND CONCEPTUAL FRAMEWORKS Cultural Competence Linguistic Competence Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 53
  53. 53. A service member’s daughter has a developmental disability with complex health issues. On a recent visit, the service member and spouse did not understand all of the terminology used by the health care team. The spouse complains that, “those doctors always talk over our heads.” The service member compensates by agreeing to read more when they get home. The service member is embarrassed about this issue and does not want the team to think they are not capable parents. CASE STUDY 3 Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 54
  54. 54. Are we on the same page? culturally aware cultural sensitivity culturally appropriate culturally effective culturally relevantculturally competent cultural humility culturally & linguistically competent linguistically competent cultural proficiency multicultural competence T.D. Goode culturally relevant cultural responsiveness linguistically appropriate Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 55
  55. 55. Cultural competence requires that organizations have a clearly defined, congruent set of values and principles, and demonstrate behaviors, attitudes, policies, structures, and practices that enable them to work effectively cross-culturally. (adapted from Cross, Bazron, Dennis & Isaacs, 1989. Policies Structures PracticesBehaviors Attitudes Cultural Competence Cultural Competence Conceptual Framework Slide Source:© 2015 - Georgetown University National Center for Cultural Competence
  56. 56. Five Elements of Cultural Competence INDIVIDUAL LEVEL acknowledge cultural differences understand your own culture engage in self-assessment acquire cultural knowledge & skills view behavior within a cultural context 1 2 3 4 5 (Cross, Bazron, Dennis and Isaacs, 1989)Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 57
  57. 57. 1 • value diversity 2 • conduct self-assessment 3 • manage the dynamics of difference 4 • institutionalize/embed cultural knowledge 5 • adapt to diversity (values, polices, structures & services) Five Elements of Cultural Competence ORGANIZATIONAL LEVEL (Cross, Bazron, Dennis and Isaacs, 1989) Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 58
  58. 58. ESSENTIAL ELEMENTS IN A CULTURALLY COMPETENT SYSTEM Slide Source:© 2011 - National Center for Cultural Competence policy making administration practice & service delivery patient & family community These five elements must be manifested at every level of an organization or system including: and reflected in its attitudes, structures, policies, practices, and services. Adapted from Cross, Bazron, Dennis, & Isaacs, 1989 Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 59
  59. 59. Cultural Destructiveness Cultural Incapacity Cultural Blindness Cultural Pre-Competence Cultural Competence Cultural Proficiency Cultural Competence Continuum (Cross, Bazron, Dennis and Isaacs, 1989) Slide Source:© 2015 - Georgetown University National Center for Cultural Competence
  60. 60. is the capacity of an organization and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse groups including persons of limited English proficiency, those who are not literate or have low literacy skills, individuals with disabilities, or those who are deaf or hard of hearing requires organizational and provider capacity to respond effectively to the health literacy and mental health literacy needs of populations served ensures policy, structures, practices, procedures and dedicated resources to support this capacity Linguistic Competence Goode & Jones, Revised 2009, National Center for Cultural Competence Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 61
  61. 61. Health Literacy is …… the ability to read, understand, and act on health information. Source: Center for Health Care Strategies, Inc. http://www.chcs.org/publications3960/publications_show.htm?doc_id+291711 Slide Source:© 2015 - Georgetown University National Center for Cultural Competence defined as the degree to which individuals have the capacity to obtain, process and understand basic health information needed to make appropriate health decisions and services needed to prevent or treat illness. Source: Institute of Medicine. Retrieved from http://www.hrsa.gov/publichealth/healthliteracy/healthlitabout.html 62
  62. 62. Functional Health Literacy is… the ability to read, and comprehend prescription bottles, appointment slips, and other essential health-related materials required to successfully function as a patient. Data Source: American Medical Association Council of Scientific Affairs http://www.chcs.org/publications3960/publications_show.htm?doc_id+291711 Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 63
  63. 63. Health Literacy is …… the capacity of professionals and health institutions to provide access to information and support the active engagement of people. Slide Source:© 2015 - Georgetown University National Center for Cultural Competence Rudd, R. Health Literacy: Time to Refocus &Expand. Retrieved on 10/26/15 from http://www.hsph.harvard.edu/healthliteracy/slide-presentation-by-rima-rudd/ 64
  64. 64. EVIDENCE-BASED TOOLS TO ADDRESS HEALTH LITERACY Slide Source:© 2014 - National Center for Cultural Competence Source: http://www.teachbacktraining.org/ Plain Language at NIH Source: http://www.nih.gov/clearcommunication/plainlanguage/index.htm Source: Askme3.org
  65. 65. Let’s revisit our case study Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 66
  66. 66. A service member’s daughter has a developmental disability with complex health issues. On a recent visit, the service member and spouse did not understand all of the terminology used by the health care team. The spouse complains that, “those doctors always talk over our heads.” The service member compensates by agreeing to read more when they get home. The service member is embarrassed about this issue and does not want the team to think they are not capable parents. CASE STUDY 3 Slide Source:© 2015 - Georgetown University National Center for Cultural Competence 67
  67. 67. POLLING QUESTION FOR CASE 2 Slide Source:© 2015 - Georgetown University National Center for Cultural Competence What culturally and linguistically competent practices would you recommend to this health team? Select one answer. A. Acquire cultural knowledge and skills B. Engage in self-assessment C. Address health literacy D. All of the above 68
  68. 68. 69  You are a cultural being and have multiple cultural identities, one of which may be your professional discipline or position in the military or other governmental or non-governmental entity.  You view and interpret the world through your own cultural lens which is comprised of both individual and group experiences over time.  Your cultural frame of reference may or may not be shared by the individuals to whom you provide care, services, and supports. Cultural and Linguistic Competence Adapted from: Goode, T., Jones, W., & Christopher, J. Responding to cultural and linguistic differences among people with intellectual disability. In Percy, M., Wehmeyer, M. L., Shogren, K. A., & Fung, A. (Eds.). A comprehensive guide to intellectual and developmental disabilities (2nd ed.). Baltimore, MD: Brookes Publishing. In press.
  69. 69. 70 Cultural and Linguistic Competence Adapted from: Goode, T., Jones, W., & Christopher, J. Responding to cultural and linguistic differences among people with intellectual disability. In Percy, M., Wehmeyer, M. L., Shogren, K. A., & Fung, A. (Eds.). A comprehensive guide to intellectual and developmental disabilities (2nd ed.). Baltimore, MD: Brookes Publishing. In press.  Your world view or cultural frame of reference influences your approach to delivering services, supports, or other responsibilities associated with your position/role.  Your world view is influenced by the “culture” of the organization, program, or agency in which you are employed.  You, as well as all people, have biases that manifest at both conscious and unconscious levels. Since one’s cultural frame of reference contributes to biases, it is necessary to identify, acknowledge, and address such biases if they interfere with your capacity to perform day-to-day responsibilities in a competent and respectful manner.
  70. 70. 71 Cultural and Linguistic Competence Adapted from: Goode, T., Jones, W., & Christopher, J. Responding to cultural and linguistic differences among people with intellectual disability. In Percy, M., Wehmeyer, M. L., Shogren, K. A., & Fung, A. (Eds.). A comprehensive guide to intellectual and developmental disabilities (2nd ed.). Baltimore, MD: Brookes Publishing. In press. Your willingness and capacity to address cultural differences are essential to: (a) supporting service members and their families from diverse racial, ethnic, and cultural groups; and (a) the working relationships with colleagues and others involved in the array of systems that provide services and supports to the military community.
  71. 71. As a culturally competent _________ I am capable of interacting positively with people who do NOT look like, talk like, think like, believe like, act like, live like... ME!!!Source: Multnomah County Department of Health. move like, Modification from Mike Magy, Massachusetts Department of Mental Health, November 2005 . love like... Slide Source:© 2015 Georgetown University National Center for Cultural Competence72
  72. 72. CONTACT US National Center for Cultural Competence http://nccc.georgetown.edu cultural@georgetown.edu The content of and this PowerPoint presentation are copyrighted and are protected by Georgetown University's copyright policies. Permission is granted to use this PowerPoint presentation in its entirety and/or individual slides for non- commercial purposes if:  the material is not to be altered and • proper credit is given to the author(s) and to the National Center for Cultural Competence. Permission is required if the material is to be: • modified in any way • used in broad distribution. To request permission and for more information, contact cultural@georgetown.edu. 73
  73. 73. Reflect! Keep Calm & Carry On (Mindfulness Audiocast Exercise) Discover and observe your reactions to life’s stressors and choose how to respond. Learn to balance work and life with this three-part mindfulness audiocast series. Audiocast #2: Stepping Back from Your Thoughts Link to Download: http://blogs.extension.org/militaryfamilies/military- caregiving/audiocasts-and-podcasts/
  74. 74. Evaluation & Continuing Education Credits/Certificates The MFLNMC Concentration Area offers 1.5 credit hour(s) from the National Association of Social Workers (NASW) / certificates of completion for today’s webinar. To receive CE credits or certificate of completion, please complete the evaluation and post-test found at: https://vte.co1.qualtrics.com/SE/?SID=SV_cRWEjqwLMf0SCZn *Must pass post-test with an 80% or higher to receive CE credit.
  75. 75. Session #3: Recharging! Combating Compassion Fatigue Time: 11:00 a.m. – 12:30 p.m. EDT Date: Wednesday, November 4, 2015 Location: https://learn.extension.org/events/2188 For more information on MFLN Military Caregiving go to: https://blogs.extension.org/militaryfamilies/military-caregiving/
  76. 76. https://www.linkedin.com/groups/Military-Families-Learning-Network-8409844
  77. 77. Find all upcoming & recorded VLEs & webinars covering: Personal Finance Family Transitions Military Caregiving Network Literacy Family Development Nutrition & Wellness Community Capacity Building www.extension.org/62581 This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Readiness Policy, U.S. Department of Defense under Award Numbers 2012-48755-20306 and 2014-48770-22587.

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