Cultural Competence Orientation

Carlos F. Martinez M.H.A. M.Ed.

Mecklenburg County Area Mental Health

carlosFmartinez.com

Creating Cultural and Creating Cultural and Linguistic Competence Linguistic Competence

in your Organizationin your Organization

Understanding the Context for Cultural Competence: Cultural Self-awareness

David Hoopes and Margaret Pusch

CULTURAL SELF AWARENESS

KNOW THYSELFThe “heal thyself before healing others” is a common philosophy understood by people across the world and yet the quest for cultural self awareness is not a simple process.

Becoming culturally aware of one’s self requires that individuals become functionally aware of the degree to which their own behavior is culturally conditioned by the past experiences

David Hoopes and Margaret Pusch

DEFINING CULTURAL SELF AWARENESS

David Hoopes and Margaret Pusch define cultural conditioning as “how learning provided by a cultural and/or social group fits a growing child to assure its survival”. They suggest we are all culturally conditioned by our past and present socialization experiences with family, friends, role models and teachers

David Hoopes and Margaret Pusch

DEFINING CULTURAL SELF AWARENESS

We are also culturally conditioned by our positive and negative interactions with culturally similar and culturally different people.

As a result of being culturally conditioned, we form definitions of what we consider, normal, acceptable and standard behaviors, communication styles, cultural values and patterns of thinking.

David Hoopes and Margaret Pusch

DEFINING CULTURAL SELF AWARENESS: Cultural Conflict

Hoopes suggest, “We assume that everyone perceives and experiences the world as members of our own particular ethnic, racial or cultural groups. The way we perceive the world, what we expect of it and what we think about it is basic and ingrained. It is buried so deep in our consciousness that we continuously act and react without thinking”.

Cultural Self Awareness

Socio-Cultural Awareness Exercise

David Hoopes and Margaret Pusch

DEFINING CULTURAL SELF AWARENESS Cultural Conflict

A decided outcome of this cultural conditioning is the tendency to recognize the problem in others and deny it in ourselves. The only way we come to grips with and take significant steps toward cultural self understanding is to become fully engaged with our own perceptions, behaviors and communication patterns.

David Hoopes and Margaret Pusch

DEFINING CULTURAL SELF AWARENESS Cultural Conflict

The process of assessing one’s self and culture enables one to break through the intellectual barriers and defenses. This enables one to be more aware and knowledgeable of the degree to which his or her perceptions and behaviors are culturally conditioned. This in effect is cultural self awareness.

David Hoopes and Margaret Pusch

DEFINING CULTURAL SELF AWARENESS Cultural Conflict

Even for those who pursue it, cultural

self awareness is elusive.

No matter how skillful, how much we experience and are conscious of the cultural dimensions of human relations and multicultural realities we are imprisoned by our own limited perception of reality.

Defining Culture

Maslow’s Hierarchy of Needs

Self

Actualization

Level 5

Esteem

Level 4

Social

Level 3

Safety

Level 2

Physiological

Level 1

Level 1: air, water, food, shelter

Level 2: knowing one’s survival is not in jeopardy

Level 3: feeling accepted by others;and being part of one’s social environment

Level 4: Feeling significant, important, effectual and competent

Level 5: Growing and expanding one’s personal capability, feeling fulfilled

Definition of Culture

The word “Culture” is used because it implies the integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social group.

Cultural CompetenceCultural Competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enable them to work effectively in cross-cultural situations.

Defining Cultural Competence Culturally competent systems have the capacity to expand on this knowledge and integrate it into All aspects of organizational policies, structures, Staffing, interventions, financing, and evaluation of results.Cultural competence is:

a developmental and dynamic process. synonymous with quality.a strategy for reducing disparities.

Linguistic CompetenceLinguistic competency requiresorganizational and provider capacity to respond effectively to the health literacy needs of the population served. The organization must have policies, structures, practices, procedures and Dedicated resource to support the capacity. Goode, T. (2002). Promoting Cultural Diversity and Cultural Competency- Self Assessment Checklist for

Personnel Providing Services and Supports to Children with Disabilities & Special Health Care Needs, NCCC, GUCDC

Model for Developing Cultural Competence

The Case For Cultural Competence

Cultural Insights, Inc

“Even more than other areas of health and medicine, the mental health field is plagued by disparities in the availability of and access to its services. These disparities are viewed readily through the lenses of racial and cultural diversity, age, and gender.”

Surgeon General David Satcher, M.D., Ph.D. in Mental Health: A Report of the Surgeon General (DHHS, 1999, p.vi.).

The Business Case for Providers

Title VI MOA for Endorsed Providers State Contracts Accreditation Community-wide expectation Competitive marketplace

Rationale for Cultural CompetenceCultural Competence = Quality of CareCultural Competence = Disparity ReductionCultural Competence = Risk ManagementCultural Competence = Parity (within MH system)Cultural Competence = Linguistic CompetenceCultural Competence = A Fundamental Social

Responsibility

Benefits of Cultural Competence in Healthcare

Improved Health Outcomes

Maximal Use of Limited Resources

Increased Customer Retention and Access to Care

Increased Customer Recruitment Increased Customer Satisfaction

Provide Products and Services Consistent with Client Needs

Culturally Competent Management, Staff and Practitioners

(Adapted from American Association of Health Plans, Minority Management Program, 1997)

Current Context

Total Population: 756,016Total Population: 756,016Total Disabled Ages 5+: 72,271Total Disabled Ages 5+: 72,271

Demographic Characteristics of Mecklenburg County Female 50.2% Male 49.8 Age

Under 5 8% 5 to 17 16% 18 to 65 65% 65+ 8%

Race White 64% African American 28% Asian 3.5% Multiracial 3.2% Other 1.5%

Hispanic/Latino 8.7% (48% Mexican, 23% Central American)

Source: 2004 American Community Survey (www.census.gov)

Population ProjectionsRace/EthnicityRace/Ethnicity 19951995 20502050

WhiteWhite 73.673.6 52.852.8

BlackBlack 12.012.0 13.513.5

Hispanic/LatinoHispanic/Latino 10.210.2 24.524.5

AsianAsian 3.33.3 8.28.2

American IndianAmerican Indian 0.70.7 0.90.9

Hispanics/Latinos are the fastest growing ethnic group in the United States.

In the United States, the Hispanic population is expected to increase 14.3% by the year 2050.

By the year 2050, there will be approximately 97 million Latinos in the United States.

Population Projections

Race/Ethnicity: County and LME Comparison

0

10

20

30

40

50

60

70

Hispanic White African American

Mecklenburg Co. LME

%

Definition of DisproportionateDisproportionate representation refers to a

situation in which a particular racial/ethnic group of children are represented in a system at a higher or lower percentage than their representation in the general population.

It can also serve to highlight:underutilization of or access to services; anddisproportional rates of poor prevention

and child service outcomes

Adapted from the Casey Family Programs (2002).

Cultural Competence Cultural Competence ContinuumContinuum

Cultural Destructiveness

Cultural Incapacity

Cultural Blindness

Cultural Pre-Competence

Cultural Competence

Cultural Proficiency

Cultural Assessment

Some thoughts on CultureSome thoughts on Culture…..…..If there is not the understanding that cultures are different and that people have different ways of responding to the basic realities of life and economics and politics and love and eating and a million things because of what Their cultures have been, then we can’t Understand each other.

- by Carlos Fuentes

Cultural AssessmentCultural assessment of the consumer is an

important step in identifying the consumer’s views

and beliefs related to health and illness. Beliefs

About the cause, prevention, and treatment of illness

Vary among cultures. Such beliefs dictate the

Practices used to maintain health. Studies have

Classified Health (Mental) Practices into several

categories: folk practices, spiritual or psychic

Healing practices, and conventional medical

practices.

Concepts: Culture

Political

Economic

Goals

Culture

Views Of

Truth

SocialRelationship

s

Visual

Arts

Literature

Actions

Personal

Habits

CommunicationStyles

Performing

Educational

Social

ExperiencesBeliefs

Includes

Includes

Includes

Includes

Includes Includes

Reflects

May Result

In

Influences Influences

.

Developed b LM Lopez, OMH, 1

Concepts: Beliefs

Views Of Truth

Religion

Supernatural Beings

God

Human Nature

Values

One

Redeemable

ManyBad

Good

BeliefsBeliefs

InterpersonalRelations

TimeOrientation

Focus Of Human Activity

RelationshipWith Nature

Influence

Include

Include

Include

May BeConsidered

MayInclude

May Focus On

May Be Perceived As

Include Influence

Developed by LM Lopez, OMH, 1995.

Concepts: Personal HabitsPersonal

HabitsEating

HealthPractices

FoodFoodTableManners

PreferencesPreparations

Methods

Functions

NourishmentNourishmentSocialSocial

Include Include

Include

Influences

InvolvesInvolves

IncludesHygiene

Include

Affects

Healing Practices

Emotional

PhysicallTraditionalTraditionalBiomedicalBiomedical

Views OfWell-being

Spirituall

May Include

May Be

Include

Can Include

Can Be

May Influence

Developed by LM Lopez, OMH, 1995

Dress and Appearance

Consumers strengths, needs and preferences should drive the type and mix of services provided, and should take into account the development, gender, linguistic, or Cultural aspects of providing and receiving services. Providers should develop these individualized plans in full partnership with consumers and families, while understanding changes in individual needs across the lifespan and the obligation to review treatment plans regularly.

Source: Models, Principles and Values of Person /Family-Centered Planning, Neal Adams, MD MPH,Diane Grieder, M.Ed., Tom Nerney

Provider Competencies for Direct Care Staff

Documentation of the person’s aspirations and goals for an improved quality of life

Identify problems, needs and required interventionsActively involve users, caregivers and families where

appropriateProvide a comprehensive assessment of health and

social care needs (including caregivers and families support needs)

Source: Models, Principles and Values of Person /Family-Centered Planning, Neal Adams, MD MPH,Diane Grieder, M.Ed., Tom Nerney

Competencies Cont’dRegularly monitor review & systematically

evaluate service impacts and health gain Identify the health and social care

resources required to meet the person’s needs

Develop positive risk management strategies and crisis prevention/response plans

Benefits of Culturally Diverse StaffResearch indicates that when children and families are matched to Research indicates that when children and families are matched to

their therapist, service coordinator or clinician ethnically and their therapist, service coordinator or clinician ethnically and linguistically…linguistically…

They are engaged in and complete their interventions more often than those who are not

There is a reduction in premature termination of interventions, which is common in many clinics serving ethnic minorities populations and the poor

Children and families have the ability to express emotions and feelings without having to explain themselves

Source: J.T Romero Operationalizing Cultural Competency: Recruitment, retention and training of culturally diverse mental health stff. (1996 June)

Benefits of Culturally Diverse StaffResearch indicates that when children and families are matched to their therapist, service coordinator or clinician ethnically and linguistically…The use of their primary language in therapy provides them

with control of their internal cognitive processes, which is the source of emotions. Thus children and families’ emotions are not subject to “translation” by way of the effects of linguistic translation, which can include intonation patterns, voice volume, and gestures.

Allows clinician to assess the totality of the information the child and family are providing

Provider Competencies for Change Management

1. Develop a strategic planning process

2. Operationalize plan in a logic model

3. Good data and research

4. Racial/ethnic impact analyses of policies and programs

5. Targeted training and technical assistance

Provider Competencies for Change Management6. Tools to support change

7. Adaptations of services and supports

8. Infrastructure

9. A powerfully framed message and an active communications strategy

10. Champions, allies and coalition building

Cultural Insights, Inc

How Do We get There?

COMPETENCECOMPETENCE

Model for Developing Cultural Competence

Community Context

What are the next steps?

What policies, practices and strategies need to be put into place at each provider agency?

In what ways can providers work together with the LME to create technical assistance and resource sharing opportunities?

Questions?

carlos@carlosFmartinez.com