FIDA NYC Online Training Module 2

Copyright 2014 ValueOptions.® All rights reserved.

Cultural Competency

& Disability Training

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Learning Objectives

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Define Cultural Competency1:

Comprehend laws and regulations2:

Recognize importance and integration into daily practice3:

Identify Person-Centered Service Planning (PCSP) Models4:


Defining Cultural Competency

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“ Cultural competence in health care describes the

ability of systems to provide care to patients with

diverse values, beliefs and behaviors, including

tailoring delivery to meet patients’ social, cultural,

and linguistic needs.”

Betancourt, Green, & Carillo, 2002


National Standards on Culturally and Linguistically

Appropriate Services (CLAS)

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Enacted through a Presidential Executive Order

Provide effective, equitable, understandable and

respectful quality care and services that are

responsive to diverse cultural health beliefs and

practices, preferred languages, health literacy

and other communication needs. (HHS, 2013)

Standards cover Governance, Leadership and

Workforce; Communication and Language

Assistance; Engagement, Continuous

Improvement and Accountability


The Americans with Disabilities Act (ADA) requires that

health care providers offer individuals with disabilities:

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• Full and equal access to their health care services and facilities.

• Reasonable modifications to policies, practices, and procedures when

necessary to make health care services fully available to individuals

with disabilities (including hearing, vision, cognitive, and psychiatric

disabilities), unless the modifications would fundamentally alter the

nature of the services.

• Flexibility in scheduling and appointment processes.

• Communication with participants in a manner that accommodates

their individual needs, including:

• Alternative communication or formats for those who are deaf or

hard of hearing

• Specialized care for individuals with cognitive limitations

• Interpreters for those who have limited English proficiency

• All care must be provided in accordance and compliance with the

ADA, as specified by the Olmstead decision.


Federal Legislation

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The American with Disabilities Act

And Title II

There can be no discrimination on the basis of

disability by public entities in civic life.

The Olmstead Decision

Supreme Court decision (1999) that affirmed persons

with mental disabilities must be accommodated in

community rather than institutional settings.


Federal Legislation: ADA Components for Providers

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To be considered ADA compliant, the following

access requirements are necessary:

• Transportation and parking

• Clear signage and way finding throughout

facilities

• Waiting areas and examination space

• Diagnostic equipment

• Bathroom facilities

Please note all medical, behavioral, community-based, and facility-based

LTSS Participating Providers must receive training in physical accessibility in

accordance with the US Department of Justice ADA guidance for Providers.

Full ADA compliance is not required to participate in the FIDA Plan but is

subject to change.


Transportation & Parking

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To be considered ADA compliant, your office must be

accessible along public transportation routes and/or with

accessible parking close to entrances.

There must also be an accessible front entrance with a ramp

and curb cut at appropriate grades and surfaces.

http://www.ada.gov/adata1.pdf


Accessibility: Visually Impaired

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For visually impaired members, you will need:

• Alternative formats for communicating instructions

and other health care information (e.g., explanations

of informed consent)

• Alternative formats include Braille, large print, audio

recording, and e-mail or digital documents (which are

accessible using a personal computer equipped with

“screen reading” software)

• Clear and consistent signage (e.g., color and symbol

signage) throughout facilities

• Raised lettering and Braille on selected signs such as

room and elevator controls


Waiting Rooms

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For members with mobility disabilities, ADA compliance

includes:

• Accessible routes to and through the room

• Entry doors with adequate clear width, maneuvering

clearance, and accessible hardware

• Adequate clear floor space inside the room for side

transfers and use of lift equipment


Bathroom Facilities

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• Clear floor space to a single

wheelchair of at least

30”x48”

• Features such as grab bars,

enlarged toilet stalls,

insulating pipes, or

accessible faucet controls

• Accessible door handles,

pulls, latches, locks, and other operable parts must

have a shape that is easy to

operate with one hand

For members with mobility disabilities, ADA compliance

includes:


ADA Resources

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Access To Medical Care For

Individuals With Mobility

Disabilities

• Includes an overview of

general ADA requirements

and illustrated examples of

accessible facilities,

examination rooms, and

medical equipment

2010 ADA Standards for

Accessible Design

• Standards for new

construction and alterations

Note: This list of requirements is not exhaustive. At this time, full ADA

compliance is not required for providers to participate in the FIDA

program.

http://www.ada.gov/medcare_mobility_ta/medcare_ta.pdf

http://www.ada.gov/2010ADAstandards_index.htm


Federal Legislation

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Title VI of the

Civil Rights Act of 1964

“No person shall be subjected to discrimination on

the basis of race, color, or national origin under any

program or activity that receives federal financial

assistance.”


Preventing Abuse & Neglect

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Practitioners are responsible to report incidents of

abuse/exploitation of members in all settings

including community and facility based Long-

Term Care Support Service (LTSS).

Practitioners should advise the member of their

ADA-related rights to the extent reasonable

accommodations are/were provided and

provide education on the grievance and appeals

process when information is received or observed

that indicates an incident or abuse occurred.


People with Disabilities May Experience Barriers

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Serious mental illness

Dementia / Alzheimer’s

Developmental disabilities

Dual diagnosis of mental

health and substance abuse

Dual diagnosis of intellectual

disabilities and mental

health

Disabilities with multiple

chronic illnesses or functional

or cognitive limitations

Substance abuse disorders

Homeless with a disability

Intellectual disabilities

Stereotypes influence the

way they are treated

Difficulty navigating the

healthcare system

Under-utilization of

healthcare services

Lack of health insurance

Limited access to health

information


Chronic Conditions Prevalent

Within FIDA Eligible Population

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Top 10 Diagnoses for FIDA Eligible Population

Hypertension

Hypertension NOS/NEC

Diabetes

Hyperlipidemia

Osteoarthritis

Minor Mental Health

Acute Joint and Musculoskeletal

Diagnoses

Coronary Atherosclerosis

Chronic Joint and

Musculoskeletal Diagnoses

Acute Gastrointestinal

Diagnoses and Symptoms

Physical Health Mental Health Status Daily Living

Urinary Incontinence 75.4% Confusion 62.7% Grooming 79.7%

Dyspnea 73.3% Daily Anxiety 22.2%Dressing Upper Body

89.8%

Chronic Pain 80.6% Depressive Feelings 23.3%Dressing Lower Body

95.1%

Medication Non-Adherence

27.0%Impaired Decision Making

26.7% Bathing 98.9%

Therapy Non-Adherence

31.5% Memory Deficient 26.3%


People with Disabilities May Experience Inequality

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Income

CoStigma

Paternalism IncomeCommunication Style

Education

and

Literacy

Level

Institutionalization

Access to appropriate services


Communication

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Communication can be spoken, written or

through sign language.

Tone is communicated by gestures, eye contact,

voice inflection and can mean different things in

different cultures.

Its important to consider your communication

style when treating patients with impairments:

• Visual

• Hearing

• Speech

• Mobility

• Cognitive


Use People-First Language

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Say: Instead of:

People with disabilities Handicapped, crippled, disabled

He has a cognitive disability He’s mentally retarded

She has autism She’s autistic

He has a physical disability He’s a quad or cripple

She uses a wheelchair She’s wheelchair-bound

He has an emotional disability He’s emotionally disturbed

Accessible parking Handicapped parking


Communication: Interpreter Services

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The FIDA plan makes resources available to

participants who require culturally, linguistically,

and/or disability competent care such as, but not

limited to, disability and language lines.

For assistance obtaining Interpreter or Language Line

resources, visit the NYS Office of Mental Health.

https://www.omh.ny.gov/omhweb/cultural_competence/translation/


Influential Models – Person-Centered Service

Planning

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Social Model of Disability

Independent Living

PhilosophyRecovery Model


The Social Model of Disability

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The Social Model of Disability:

empowers individuals with

disabilities to define

themselves as whole

members of society and

makes a clear distinction

between one’s disability

and the more limiting

effects of society’s

treatment of that disability

Example: Needing a wheelchair isn’t a problem; it’s a

problem when a building doesn’t include ramps.


Independent Living Philosophy

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The Independent Living

Philosophy builds on the

Social Model of Disability

by affirming that individuals

with disabilities have the

right to self-determination,

self-respect, and equal

opportunities.

This philosophy emphasizes the importance

of supporting and empowering the individual

to take an active role in accessing services.


Recovery Model

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The Recovery Model:

is a treatment concept wherein

consumers have primary control

over decisions about their own

care, and recovery is viewed as a

journey rather than an outcome

argues that if individuals with

mental illnesses have greater

control and choice in their

treatment, they will be able to take

increased control in their lives


Wellness Principles

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Physical

Spiritual

Social

Intellectual

Emotional / Mental

Occupational

Environmental

Financial


Crisis Prevention and Levels of Treatment

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Emergency: In an emergency situation, the Participant should be

seen in person immediately or referred to appropriate emergency

service providers. Participating providers who do not maintain

twenty-four (24) hour coverage must maintain a system for

referring members to a source of emergency assistance during

non-business hours. See Provider Handbook for more details.

Emergent: In an emergent situation, the Participant should be seen

within six (6) hours of the request for an appointment or referred to

appropriate emergency service providers.

Urgent: In an urgent situation, the Participant must be offered the

opportunity to be seen within forty-eight (48) hours of a request for

an appointment.

http://www.valueoptions.com/providers/Handbook/ValueOptions_Provider_Handbook.pdf


Module 2 Quiz: Cultural Competency & Disability

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True/False

1. The Americans with Disabilities Act (ADA) requires

health care providers offer equal access to services

and provide reasonable accommodations to ensure

services are accessible to individuals with disabilities.

2. The 3 influential models of person-centered

service delivery include: Social Model of Disability,

Independent Living Philosophy, and the Recovery

Model.


Module 2 Quiz Answers

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1. True

2. True

FIDA NYC Online Training Module 2

Healthcare

Transcript of FIDA NYC Online Training Module 2