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Presentation to the
MHQCC - Cultural and Linguistic
Competency Workgroup
Darci L. Graves, MPP, MA, MA
Senior Health Education and Policy Specialist
Health Determinants & Disparities Practice
at SRA international, Inc.
Bringing CLAS and Equity to Systems Impacting Health
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Culture
Culture is dynamic in
The integrated pattern
nature, & individuals may
of thoughts,
identify with multiple
communications,
cultures over the course
actions, customs, beliefs,
of their lifetimes.
values, & institutions
associated, wholly or
partially, with racial,
ethnic, or linguistic
groups as well as
religious, spiritual,
biological, geographical,
or sociological
characteristics.
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Cultural Competency
A developmental process in which
individuals or institutions achieve
increasing levels of awareness,
knowledge, and skills along a
continuum.
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Cultural competency is a developmental
process in which individuals or institutions
achieve increasing levels of
awareness, knowledge, & skills along a
continuum.
• valuing diversity
• conducting self-assessments
• managing the dynamics of difference
• acquiring & institutionalizing cultural knowledge
• adapting to diversity & cultural contexts in communities
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Cultural competency
is: is not:
Understanding all Cultural
people have a celebrations at
unique world designated times
view of the year, in
designated ways
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Cultural competency
is not:
is:
A list of stereotypes
Providing services
about what people
respectful of and
from a particular
relevant to the cultures
cultural group do
represented in the
patient population
Assumptions that
everyone from one
culture operates in
similar ways and has
had similar experiences
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Cultural competency
is: is not:
Being alert to the Solely the
ways that culture responsibility of
affects who we patients, their
are families or the
community
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Cultural competency
is: is not:
Examining Simple
systems, tolerance
structures,
policies and
practices for their
impact
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Compelling Need: Social
• To respond to current and projected
demographic changes in the United States.
• To eliminate long-standing disparities in the
health status of people of diverse
racial, ethnic and cultural backgrounds.
• To improve the quality of services and health
outcomes.
National Center for Cultural Competence (2003)
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To respond to current and projected
demographic changes in the United States.
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To eliminate long-standing disparities in the health status of
people of diverse racial, ethnic and cultural backgrounds.
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Compelling Need: Business
• To meet legislative, regulatory and
accreditation mandates.
• To gain a competitive edge in the market
place.
• To decrease the likelihood of liability/
malpractice claims
National Center for Cultural Competence (2003)
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Think Cultural Health
Advancing health equity at every point of contact
National CLAS E-learning
Standards programs
TCH
CLAS
Join the CLCCHC
Clearinghouse
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National CLAS Standards: The Blueprint
• The Case for CLAS
• The Enhancements
• Standard by
Standard chapters:
• Purpose
• Description
• Strategies
• Resources
Good afternoonIntro self Intro Practice/SRA Intro TCH
Elements of culture include, but are not limited to, the following:Age Cognitive ability or limitations Country of origin Degree of acculturation Educational level attainedEnvironment and surroundings Family and household composition Gender identity Generation Health practices, including use of traditional healer techniques such as Reiki and acupuncture.Linguistic characteristics, including language(s) spoken, written, or signed; dialects or regional variants; literacy levels; and other related communication needs.Military affiliation Occupational groups Perceptions of family and community Perceptions of health and well-being and related practicesPerceptions/beliefs regarding diet and nutrition Physical ability or limitations Political beliefsRacial and ethnic groups including but not limited tothose defined by the U.S. Census Bureau.Religious and spiritual characteristics, including beliefs, practices, support systems related to defining meaning in oneslife.Residence (i.e., urban, rural, or suburban)Sex Sexual orientation Socioeconomic status
valuing diversityValuing diversity means accepting and respecting differences.Be aware and accepting of difference in communication, life view, and definition of health and familyWalking the talkconducting self-assessmentsIndividual and organizational level Have a sense of your own culture and your relationship to othersmanaging the dynamics of differenceUnderstand that both the consumer and service provider bring culturally prescribed patterns of communication, etiquette, and problem solving styles to the situationAlso, different histories and experiences shape our perceptionsacquiring & institutionalizing cultural knowledgeThe knowledge developed regarding culture and cultural dynamics, must be integrated into every point of contactadapting to diversity & cultural contexts in communitiesSystem/organization would make adjustments to create a better fit between the consumer and service by adapting policies, structure, values, and the service
“Our organization is culturally competent – the team speaks about 9 different languages – we are like a mini-United Nations” Mexicans & Tortillas… When describing an immigrant group to the participants, "you know, fresh off the boat.“
Knowing who works in your community and who calls it home – data wise as well as from outreach. Not just that they should know you are nice and offer great care…
An international pot-luck does not a cultural competency program make… nor does putting up the ‘culture of the month’ posters. It has to be more engaging, more deliberative, and it needs to be something that is ‘lived’ all year round… not just during a particular month.
“flash cards” – “cliff notes” – or “cheat sheets” does not equal cultural competency… They can in some instances be a place to start… I know many people from X believe this… is this something that we should consider/discuss in your treatment/care/program/etc.
Culture informs our actions and reactions – how we perceive and receive care… Cultural competency works in both directions… just as the provider may not be aware of the client/patient’s culture – the client may not be aware of the institutional culture or many aspects of the culture of medicine…
There are many metaphors or analogies that are ascribed to cultural competency – a journey – and it certainly isn’t perfect. Flip chart Ultimately, cultural competency can not be viewed as an ‘add on’… it must be infused throughout an organization… it isn’t about doing more, it is about doing what you are doing – better, more efficiently, more effectively…
The National Center for Cultural Competence at Georgetown University is a great resource for all things cultural competency and in a policy brief from 2003 they outlined 6 points of compelling need for cultural and linguistic competency… For me, these six points generally fall under two umbrellas:(1) The social justice umbrella and the (2) business case umbrella…
It is projected that by 2050 the U.S. demographic makeup will be 47% non-Hispanic White, 29% Hispanic, 13% Black and 9% Asian (Passel & Cohn, 2008). According to the most recent data, approximately 20% of the U.S. population, or a little over 58 million people, speak a language other than English at home, and of that 20%, almost 9% (over 24 million people) have limited proficiency in English (Au, Taylor, & Gold, 2009; U.S. Census Bureau, 2010), which has implications for their proficiency in health and health care (The Joint Commission, 2010).
Disparities occur for a whole host of reasons – including miscommunication… A friend of mine when working as an EMS first responder heard more than one of his colleagues “Where does it hurt-o?” when speaking to Spanish speaking patient in the field.
Culture influences health beliefs and practices, as well as health seeking behavior and attitudes (IOM, 2003). When health and health care professionals are aware of culture’s influence on health beliefs and practices, they can use this awareness to consider and address issues such as access to care.
State and Federal Legislation Hospital Accrediting Bodies such as the Joint Commission
Although the implementation of culturally and linguistically appropriate services certainly requires resources, there are numerous business-related advantages to investing these resources. By implementing culturally and linguistically appropriate services – including the provision of communication and language assistance, as well as partnerships with the community – an organization can develop a positive reputation in the service area and therefore expand its market share. The provision of effective, equitable, understandable, and respectful quality care and services helps cultivate a loyal consumer base, which then solidifies this market share (AMA, 2006).
Culturally and linguistically appropriate services can reduce the possibility of such errors. For example, a first responder in Florida misinterpreted a single Spanish word, “intoxicado,” to mean "intoxicated" rather than its intended meaning of "feeling sick to the stomach." This led to a delay in diagnosis, which resulted in a potentially preventable case of quadriplegia, and ultimately, a $71 million malpractice settlement (Flores, 2006).
In addition to the National Center for Cultural Competence at Georgetown University, I wanted to leave you with a few resources that are out there in case you want to investigate further some of the concepts covered today…
Think Cultural Health is an Department of Health and Human Services, Office of Minority Health sponsored web site. The web site houses many of the offices cultural and linguistic competency policy and education related initiatives including:Suite of e-learning programs – free on-line continuing education, CLAS Clearinghouse – key word searchable database of resources Join the CLCCHC – newsletter, calendar, and other educational materials National CLAS Standards & The Blueprint
The Blueprint was designed to provide individuals, agencies and organizations of all kinds the guidance to implement the National CLAS Standards. The Blueprint contains – Case, Enhancements and Standard by Standard chapters. Standard by Standard chapters: PurposeDescriptionStrategies Resources
Now, I think we will open it up for discussion. I hope that the chairs and other representatives will jump in to help answer questions as they relate to the directives of this group…
