Enhancing Culturally and Linguistically Appropriate Services in Public Health Preparedness Ira...
Transcript of Enhancing Culturally and Linguistically Appropriate Services in Public Health Preparedness Ira...
Enhancing Culturally and Linguistically Appropriate Services in Public Health Preparedness
Ira SenGupta
Cross Cultural Health Care Program
Seattle, WA
A CLAS Act
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Inspiration
“If you want to move people,
it has to be toward a vision
that’s positive for them, that
taps important values, that
gets them something they
desire, and it has to be
presented in a compelling
way that they feel inspired
to follow.”
— Martin Luther King Jr.
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Session Goals
Identify the key concepts of the 14 Culturally and Linguistically Appropriate Services (CLAS) standards
Define the concepts of diversity, culture, and cultural competency and their relevance in public health preparedness
Describe practical applications of culturally competent communication strategies in public health preparedness
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Culturally and Linguistically Appropriate Services (CLAS) Standards
14 National Recommended Standards: To inform, guide, and facilitate implementation of CLAS
Three themes:
1. Culturally competent care (Standards 1-3)
2. Language access services (Standards 4-7)
3. Organizational supports for cultural competence (Standards 8-14)
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CLAS Goals
To contribute to the elimination of racial and ethnic health disparities
To improve the health of all Americans
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Cultural Competency
“To be culturally competent doesn’t mean you
are an authority in the values and beliefs of
every culture. What it means is that you hold a
deep respect for cultural differences and are
eager to learn, and willing to accept, that there
are many ways of viewing the world.”
— Okokon O. Udo, PhDIntegrative Health and Wellness
Northwestern Health Sciences University
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The Compelling Reasons for Cultural Competence
1. Responding to demographic changes
2. Eliminating disparities in the health status of people of diverse racial, ethnic, & cultural backgrounds
3. Understanding the impact of individual and organizational culture
4. Improving the quality of services & outcomes
5. Enhancing the workplace environment
6. Meeting legislative, regulatory, & accreditation mandates
Adapted from: National Center for Cultural Competence, Georgetown University
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US’s Changing Demographics
Demographics beyond black and white—now a complex mosaic of races & ethnicities.
- 35 million Hispanics - 34.5 million Blacks - 10.5 million Asian Americans- 4 million Native Americans Most significant trend is the record growth of Hispanic Americans.
Persons with physical and mental impairments are the largest single “minority” (approx. 49 million).
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US Demographics:Language & Adult Literacy Skills
According to Census 2000:Among the 262.4 million people aged 5 and over, 47.0 million (18%) speak a language other than English at home.
21% to 23% or some 40 to 44 million of the 191 million adults in the U.S. have extremely limited reading and quantitative skills (Level 1).
Source: US Census Bureau Census 2000
National Center for Educational Statistics
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Question
What proportion of the 40–44 million people who speak a language other than English at home were born outside of the US?
A. 1%
B. 10%
C. 20%
D. 30%
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Many Factors Contribute to Health Disparities
• Behavioral choices
• Genetic predisposition
• Nutrition
• Access to medical care
• Environmental and occupational conditions
• Poverty Source: Final Report of the Health Disparities
May 9, 2001 Washington State Board of Health
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Inequality
“Of all the forms of inequality, injustice in
health is the most shocking and the most
inhuman.” — Dr. Martin Luther King Jr.
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From Cultural Bump to Cultural Congruence
Defining culture, diversity, and understanding the impact on human interactions
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Diversity Encompasses Issues Related to….
• race
• color
• class
• age
• experience
• ability
• gender
• ethnicity
• language
• religion
• politics
• sexual orientation
• gender identity
• socio-economic status
• resident status
...within each community
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“Actually, the most important
part of culture ... is that which
is hidden and internal but
which governs the behavior
encounter.”* *Source: Edward T. Hall, 1976
Understanding Culture
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Cultural Competence Actualized
The state of being capable of functioning effectively in the context of cultural differences*
*Adapted from Terry Cross, PhDNorthwest Indian Child
Welfare Association
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Elements of Cultural Competence
• Awareness of one’s own culture
• Awareness and acceptance of difference
• Understanding the dynamics of difference
• Development of cultural knowledge
• Celebration of diversity
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The Impact of Personal Culture on Communication
• Incorrect assumptions about the other
• Language and communication style issues
• Biases against the unfamiliar
• Personal values in conflict
• Expectations that others will conform to established norms
Adapted from Selma Myers
Conflict and Culture
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Experience
“We are either equipped by our past
experiences or handicapped by them.”
— Ehab Hanna, M.D.
Department of Head and Neck Surgery
M.D. Anderson Cancer Center
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Working in Communities
To offer culturally appropriate care requires being open to the expec-tations, perceptions, and realities of the various communities.
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Survey Findings: Barriers to Services
• Cultural issues
• Perceived limitations of western approach to healthcare
• Money
• Bias
• Language
• Interpreters
• Transportation
• Child care
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Categories of Flu Treatments—Ingested Herbal Treatments
Hundreds are used in this country.
Modern forms are often processed and lack traditional treatment information and context.
Many teas are popular and most are mildly effective at treating symptoms.
Source: Margie Akin PhD
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Foods to Fight the Flu
African groundnut (peanut) chicken soup
Other traditional soups have other nutrients that may be lacking in everyday diet—such as extra protein in this traditional African chicken soup.
Source: Margie Akin PhD
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Cultural Bump...
As a result of a personal interaction you are:
• confused
• frustrated
• angry
• misunderstood
• helpless
• hopeless
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Ethnocentrism
Misinterpretation and misjudgment based
on looking at another person’s behavior
from your own cultural reference point.
Ethnocentric misjudgments result in
culturally biased interactions.
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Power
Involves the capacity to influence, for one’s own benefit, the forces that affect one’s life. Powerlessness thus is the inability to exert such influence.
Basch (1975, p. 513) has stated that “the feelingof controlling one’s destiny to some reasonable extent is the essential psychological component of all aspects of life.”
This means that a sense of power is critical to one’s mental health. Everyone needs it.
Elaine Pinderhughes Understanding Race, Ethnicity, and Power.
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The Negative Cycle of Communication
Person A Emotions
• Angry
• Hopeless
• Helpless
• Frustrated
• Confused
• Misunderstood
• Depressed
Person BActions
• Violence
• Withdrawal
• Passive-aggressive
• Blame
• Substance Abuse
• Homicide
• Suicide
©Ira SenGupta, 2002
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Question
What does it take to bring you out of this negative communication cycle?
(We are opening the phone lines for group discussion. Please tell us your answer either verbally or via text chat.)
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Five Steps to Cultural Competency
• Awareness of self and the other
• Acknowledgement
• Honest validation
• Negotiation
• Action: choices and options
©Ira SenGupta, May, 2002, Health and Healing
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Communication Across Cultures:Skills That Make a Difference
Realize your viewpoint may not be the only one.
• Strive to be non-judgmental.
• Question your assumptions constantly.
Understand what others feel.
• Be more flexible ... less resistant.
• Celebrate & honor differences.
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Key Learning
The more accurate information we have about others, the more likely we will be able to respond with respect and understanding.
The more familiar we are, the more comfortable we become. And with comfort and time, comes trust resulting in effective communications.
Familiarity Comfort Trust Effective Communications
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A Summary
• Dare to bridge across barriers
• Allow for fragility due to circumstance
• Honor the mystery of building connections
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Cultural Competency—A Practical View
“To be culturally competent doesn’t mean
that you will never encounter cultural
bumps. What it means is that you will be
more aware of how and why cultural
bumps happen while skillfully navigating
them for best outcomes.”
—Ira SenGupta, CCHCP, December 05
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Final Thoughts...
You and IWe meet as strangers, each carrying a mysterywithin us. I cannot say who you are.I may never know you completely.But I trust that you are a person in your own right, possessed of a beauty and value that arethe Earth's richest treasures.So I make this promise to you;I will impose no identities upon you, but willinvite you to become yourselfwithout shame or fear.I will hold open a space for you in the worldand allow your right to fill it with an authenticvocation and purpose. For as long as your searchtakes, you have my loyalty.
Author Unknown
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Human Rights
“Where after all do
universal Human Rights
begin? In small places and
close to home, so small
and so close that they
cannot be seen on any
map of the world.”
— Eleanor RooseveltNY Times, Dec. 1965
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The Cross Cultural Health Care Program
Vision: Healthcare in every community every community in healthcare
Contact information:
Ira SenGupta, Executive Director
270 South Hanford St. Ste. 208
Seattle, WA. 98134
Ph: 206-860-0329
Email: [email protected]
Website: www.xculture.org
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Further Readings
1. Quality Health Services for Hispanics: The Cultural Competency Componenthttp://www.ask.hrsa.gov/detail.cfm?id=PC00029
2. World's Apart, the video series: http://www.fanlight.com/catalog/films/912_wa.shtml
3. An excellent video: Communicating Effectively through an Interpreter http://www.xculture.org/resource/order/detail.cfm?PID=27&list=27%2C25%2C23
4. Quiz for healthcare providers on quality & culture http://erc.msh.org/quiz.cfm?action=question&qt=all
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References
Quality Health Services for Hispanics: The Cultural Competency Component, 2001, p.10
U.S. Bureau of the Census, Resident Population Projections of the United States: Middle, Low, and High Series, 1996 to 2050
Boston Public Health Commission, Disparities Project Data Report, June 2006http://www.bphc.org/director/disp_data.asp