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4. culturalcompetence
- 1. Developing Cultural CompetenceAn Introductory Look at Cultural Competency in Health Care Presented by Tom Rue, M.A., CASAC, CCMHC – AC II Richard C. Ward Addiction Treatment Center At Core Training – March 2008
- 2. “ Cultural competence…a journey, not a destination”
- 3. Objectives Increase awarenessof cultural competence Understand the elements of cultural competence in health care Apply cultural competence mindset to your job/responsibilities . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
- 4. Cultural Norms “Should’s and ought’s of the group. Examples are standards of behavior such as: - productivity norms - equity norms - styles of dress - power and control in relationships - acceptable behaviors, etc.
- 5. What is Culture?Culture is the acquired knowledge that people use to interpret experience and generate social behavior.
- 6. Cultural Value OrientationsInnate Human Nature Relationship to Nature Relationship to Time Purpose of Being Relationship to Other Persons
- 7. What is CulturalDiversity? Culture is shared . . . Values, norms, traditions/customs Arts History, folklore Institutions Cultural Diversity Differences in race, ethnicity, language, nationality, religion, other beliefs
- 8. Cultural Components RaceCountry of origin Native language Socio-economic status Education level Religion Mental or physical abilities
- 9. More Cultural ComponentsHeritage Acculturation Age Gender Sexual orientation Definition of normality Such as “mental illness” Responses to abnormality Stigma vs. Acceptance
- 10. Functional Definition Useof knowledge about individuals and groups of people to produce policies practices attitudes specific standards
- 11. Components of CulturalCompetence Awareness and acceptance of cultural differences Self Awareness Understanding of dynamic differences among cultures Basic knowledge about a client’s culture Adaptation
- 12. Cultural Competence inHealth Care Set of attitudes, skills, behaviors, policies Enables organizations and individuals to work effectively cross-culturally Understands importance of health-related beliefs, attitudes, and practices communication patterns of beneficiaries Eliminates disparities in health status
- 13. Cultural Competence inHealth Care A demonstrated awareness and integration of three population specific issues health-related beliefs and cultural values disease incidence and prevalence examples: gender, Native Americans, Irish, etc. treatment efficacy
- 14. Cultural Competence inHealth Care Responds to demographic changes in US Improves quality services health outcomes Meets mandates of credentialing bodies: Commission on Accreditation of Rehabilitation Facilities (CARF) Joint Commission on Accreditation of Hospital Organizations (JCAHO) US Department of HHS, Office of Minority Health
- 15. National Standards forCulturally and Linguistically Appropriate Services in Health Care (CLAS) Main Themes Culturally competent standards (1-3) Language access services (4-7) Organizational support (8-14) Varying Stringency Mandates (4,5,6, & 7) Guidelines 1,2,3,8,9,10,11,12,13) Recommendations (14) Full document is on the website of U.S. Department of Health & Human Services, Office of Minority Health at http://www.omhrc.gov/clas/finalcultural1a.htm .
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- 17. Demographic Statistics 67million (1 in 4) classified as minority Latinos Represent almost half of minority Americans Nearly equal in number to African Americans Largest racial/ethnic minority population by 2025 People of color 1 in 3 Americans by 2050 Higher birth rates Higher immigration rates
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- 19. Health Care StatisticsMortality rates higher until age 44 African Americans Latinos Native Americans Infant mortality Twice as high among African Americans Deaths due to HIV/AIDS Dramatically increased African Americans Latinos
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- 22. Individual Cultural CompetenceContinuum Model Cultural Proficiency Cultural Pre-Competency Cultural Competence Cultural Blindness Cultural Destructiveness Cultural Incapacity
- 23. Organizational Cultural CompetenceA journey, not a destination... Unaware, Competent Aware, Incompetent Aware, Competent Unaware, Incompetent
- 24. Journeying to aCulturally Competent Organization Communication is encouraged Staff represent the diversity of community members Leadership is committed and supportive All employees are involved Inclusive organizational structures and policies exist
- 25. Our Journey Sharingexperiences Progressing along our personal continuum Moving closer to our destination AND always . . . Improving the quality of health care in the communities we serve
- 26. Acknowledgements Charlotte Newman& Jan Kelley (2001). Cultural Quality: An Introductory Look into Cultural Competency in Health Care , slide show for the Delmarva Foundation Hope Center for Advance Technologies (2001). Psychology With Sociology , a course developed by faculty from Lawrence Technological University, University of Detroit-Mercy, and Wayne State University Joan Engebretson (2001). Culture and Health Care , class notes for Advance Practice Nursing: Health Promotion, The University of Texas-Houston, Health Science Center School of Nursing
Editor's Notes
- #8 Let’s break down this term “cultural diversity” so we better understand its meaning. The term “culture” refers to the patterns and conditions that bind people together as an identifiable group. Culture is shared with those with similar experiences. Cultural diversity refers to differences in race, ethnicity, language, nationality, religion, and other beliefs and practices among various groups within a community, organization, or nation. Although we usually associate culture with race and ethnicity, there are other cultural groups that add to diversity. What are some other cultures? Note: Ask group to name different cultural groups. Facilitate brief discussion. Note: Deaf community Single women Working mothers Working fathers Religious community People living with HIV Vegetarians Homeless
- #9 We often think of cultural diversity as referring to our differences in racial background. In fact, many other things that contribute to who we are, are factors in our cultural diversity. These include not only race but: Country of origin Native language Socio-economic status Education level Religion Mental or physical abilities Note: List continued on next page.
- #10 And: Heritage Acculturation Age Gender Sexual orientation Other characteristics that may result in a differing perspective, decision-making process, or learning style Now that we have defined culture, let’s look at why HCFA chooses to address culture in training.
- #11 Cultural Competence is use of knowledge about individuals and groups of people to produce specific standards policies practices attitudes to be used in appropriate cultural settings to increase the quality of services, thereby producing better outcomes.
- #13 Note: HCFA’s definition of Cultural Competency. Please read: “ Cultural Competency in health is a set of attitudes, skills, behaviors, and policies that enable organizations and individuals to work effectively in cross-cultural situations. It reflects an understanding of the importance of acquiring and using knowledge of the unique health-related beliefs, attitudes, practices, and communication patterns of beneficiaries and their families to improve services, enhance beneficiary understanding of programs, increase community participation, and eliminate disparities in health status among diverse population groups.” This definition was taken from Cross, T, 1992 Culture shapes how people experience their world, interpret their environment, live with their families, choose their lifestyles, work, play, and reside in their communities. Most importantly, culture defines: How health care information is received How rights and protections are exercised What is considered to be a health problem How symptoms and concerns about the problem are expressed Who should provide treatment for the problem What type of treatment should be given
- #15 Some Current and Projected Socio-Demographic Characteristics : An estimated 1 in 4 Americans (about 67 million) is classified by the U.S. Census as a member of one of the four major racial or ethnic minority population groups: African American, Latino/Hispanic, Native American, or Asian/Pacific Islander. Latinos almost equal African Americans in number, representing almost half of minority Americans: and, they are projected to be the largest racial/ethnic minority population by 2025 By the year 2050, the U.S. Census estimates that people of color will represent 1 in 3 Americans. This is largely due to higher birth rates and immigration among racial and ethnic minority populations. Diversity is found not only between the major U.S. minority population groups, but within them as well. Using Latinos as an example, the health beliefs or practices of a person with origins in Puerto Rico may differ greatly from those of someone from Mexico or El Salvador. Minority Americans, on average, are poorer than whites. While more than 20% of whites are poor or near poor (i.e., incomes below 200% of poverty), at least one-half of African Americans, Latinos, and Native Americans are poor or near poor. Similarly, elderly minority Americans are far more likely than their white counterparts to live in poverty. Eliminate disparities in the health status of people of diverse racial, ethnic and cultural backgrounds While the gap between blacks and whites cardiac catheterizations (used to diagnose heart disease) has narrowed over time, large racial disparities in the treatment of heart disease with angioplasty and coronary bypass surgery persist, with the chances of blacks undergoing these procedures about half those for whites Most telling are the (HCSUS) indicators that looked at the use of triple drug anti-retroviral therapy, a treatment regimen that is very effective in delaying disability and prolonging the life to persons with HIV. African Americans were more than twice as likely as whites to not receive combination drug therapy and 1.5 times more likely to not get preventive treatment for pneumocystic carinii pneumonia (a common, but preventable, infection in people with HIV) than whites. Latinos were 1.5 times more likely than whites to not get combination drug therapy (Shapiro et al, 1999). In a study of Medicaid beneficiaries (all from low-income families with health coverage for preventive services) African American children were more likely than white children to be treated for their asthma in emergency departments, to be hospitalized for asthma, and were less likely to have office visits for their asthma. While there were no differences in the amount of well-child care visits or prescriptions for asthma drugs, African American children were less likely to receive the drug therapy recommended in national asthma guidelines. A study of previously hospitalized African American and white adults (age 18-50) enrolled in a health maintenance organization, where financial barriers to care are minimized, found that African Americans made more emergency department visits, while whites made more primary care and allergy/pulmonary visits. In addition, while there were no racial differences in re-hospitalization for asthma, African Americans with Medicaid coverage were twice as likely to be re-hospitalized than African Americans with private coverage. Even in studies where everyone is similarly insured, racial differences in the use of cardiac procedures remain. For example, among Medicare beneficiaries, blacks were 60% less likely than whites to undergo heart bypass surgery. Adjusting for income made little difference in the findings -- black beneficiaries were still less than half as likely to undergo surgery than white beneficiaries. Improve the quality of Services and Health outcomes . In making a diagnosis, health care providers must understand the beliefs that shape a person’s approach to health and illness. Knowledge of customs and healing traditions are indispensable to the design of treatment and interventions. Health care services must be received and accepted to be successful. Increasingly, cultural knowledge and understanding are important to personnel responsible for quality assurance programs. In addition, those who design evaluation methodologies for continual program improvement must address hard questions about the relevance of health care interventions. Cultural competence will have to be inextricably linked to the definition of specific health outcomes and to an ongoing system of accountability that is committed to reducing the current health disparities among racial, ethnic and cultural populations. Some Current and Projected Socio-Demographic Characteristics : An estimated 1 in 4 Americans (about 67 million) is classified by the U.S. Census as a member of one of the four major racial or ethnic minority population groups: African American, Latino/Hispanic, Native American, or Asian/Pacific Islander. Latinos almost equal African Americans in number, representing almost half of minority Americans: and, they are projected to be the largest racial/ethnic minority population by 2025 By the year 2050, the U.S. Census estimates that people of color will represent 1 in 3 Americans. This is largely due to higher birth rates and immigration among racial and ethnic minority populations. Diversity is found not only between the major U.S. minority population groups, but within them as well. Using Latinos as an example, the health beliefs or practices of a person with origins in Puerto Rico may differ greatly from those of someone from Mexico or El Salvador. Minority Americans, on average, are poorer than whites. While more than 20% of whites are poor or near poor (i.e., incomes below 200% of poverty), at least one-half of African Americans, Latinos, and Native Americans are poor or near poor. Similarly, elderly minority Americans are far more likely than their white counterparts to live in poverty. Eliminate disparities in the health status of people of diverse racial, ethnic and cultural backgrounds While the gap between blacks and whites cardiac catheterizations (used to diagnose heart disease) has narrowed over time, large racial disparities in the treatment of heart disease with angioplasty and coronary bypass surgery persist, with the chances of blacks undergoing these procedures about half those for whites Most telling are the (HCSUS) indicators that looked at the use of triple drug anti-retroviral therapy, a treatment regimen that is very effective in delaying disability and prolonging the life to persons with HIV. African Americans were more than twice as likely as whites to not receive combination drug therapy and 1.5 times more likely to not get preventive treatment for pneumocystic carinii pneumonia (a common, but preventable, infection in people with HIV) than whites. Latinos were 1.5 times more likely than whites to not get combination drug therapy (Shapiro et al, 1999). In a study of Medicaid beneficiaries (all from low-income families with health coverage for preventive services) African American children were more likely than white children to be treated for their asthma in emergency departments, to be hospitalized for asthma, and were less likely to have office visits for their asthma. While there were no differences in the amount of well-child care visits or prescriptions for asthma drugs, African American children were less likely to receive the drug therapy recommended in national asthma guidelines. A study of previously hospitalized African American and white adults (age 18-50) enrolled in a health maintenance organization, where financial barriers to care are minimized, found that African Americans made more emergency department visits, while whites made more primary care and allergy/pulmonary visits. In addition, while there were no racial differences in re-hospitalization for asthma, African Americans with Medicaid coverage were twice as likely to be re-hospitalized than African Americans with private coverage. Even in studies where everyone is similarly insured, racial differences in the use of cardiac procedures remain. For example, among Medicare beneficiaries, blacks were 60% less likely than whites to undergo heart bypass surgery. Adjusting for income made little difference in the findings -- black beneficiaries were still less than half as likely to undergo surgery than white beneficiaries. Improve the quality of Services and Health outcomes . In making a diagnosis, health care providers must understand the beliefs that shape a person’s approach to health and illness. Knowledge of customs and healing traditions are indispensable to the design of treatment and interventions. Health care services must be received and accepted to be successful. Increasingly, cultural knowledge and understanding are important to personnel responsible for quality assurance programs. In addition, those who design evaluation methodologies for continual program improvement must address hard questions about the relevance of health care interventions. Cultural competence will have to be inextricably linked to the definition of specific health outcomes and to an ongoing system of accountability that is committed to reducing the current health disparities among racial, ethnic and cultural populations.
- #18 An estimated 1 in 4 Americans (about 67 million) is classified by the US Census as a member of one of the four major racial or ethnic population groups: African American, Latino/Hispanic, Asian/Pacific Islander.
- #20 At each age of the life-span until age 44, African Americans, Latinos, and Native Americans have, on average, higher mortality rates than whites. Only Asians have, on average, lower mortality rates than whites. When overall mortality is examined by a measure of socio-economic conditions (e.g., income), differences between African Americans and whites are reduced but not eliminated. Infant mortality rates, considered one of the most sensitive indicators of the health and well-being of a population, are twice as high among African American infants as whites, even when analyzed by a measure of socio-economic conditions, such as the mother’s education. African Americans are more likely to rate their health as fair or poor than whites of similar incomes; however, this disparity is smaller between those with higher incomes than between those with lower incomes. In 1996, the top five leading causes of death for whites and minority Americans were very similar, with heart disease and cancer ranking number one and two across all groups. However in the past decade deaths due to HIV/AIDS have increased dramatically in the African American and Latino populations, moving this disease to the top five causes of death for both groups. In a study of Medicaid beneficiaries (all from low-income families with health coverage for preventive services) African American children were more likely than white children to be treated for their asthma in emergency departments, to be hospitalized for asthma, and were less likely to have office visits for their asthma. While there were no differences in the amount of well-child care visits or prescriptions for asthma drugs, African American children were less likely to receive the drug therapy recommended in national asthma guidelines.
- #21 Rates on chart represent deaths per 1,000 people.
- #22 Rates on chart represent deaths per 1,000 people.