Transcript Slide 1

A CLAS Act
Enhancing Culturally and Linguistically
Appropriate Services in Public
Health Preparedness
Ira SenGupta
Cross Cultural Health
Care Program
Seattle, WA
[email protected]
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.
© Cross Cultural Health Care Program
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
© Cross Cultural Health Care Program
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, PhD
Integrative 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).
© Cross Cultural Health Care Program
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%
© Cross Cultural Health Care Program
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
© Cross Cultural Health Care Program
Diversity Encompasses Issues
Related to….
• race
• language
• color
• religion
• class
• politics
• age
• sexual orientation
• experience
• gender identity
• ability
• socio-economic status
• gender
• resident status
• ethnicity
...within each community
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Understanding Culture
“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
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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, PhD
Northwest 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 expectations, 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
© Cross Cultural Health Care Program
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
© Cross Cultural Health Care Program
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 feeling
of 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.
© Cross Cultural Health Care Program
The Negative Cycle of Communication
Person A
Emotions
Person B
Actions
• Angry
• Violence
• Hopeless
• Withdrawal
• Helpless
• Frustrated
• Passive-aggressive
• Blame
• Substance Abuse
• Confused
• Homicide
• Misunderstood
• Suicide
• Depressed
©Ira SenGupta, 2002
© Cross Cultural Health Care Program
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.)
© Cross Cultural Health Care Program
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
© Cross Cultural Health Care Program
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
© Cross Cultural Health Care Program
A Summary
• Dare to bridge across barriers
• Allow for fragility due to circumstance
• Honor the mystery of building
connections
© Cross Cultural Health Care Program
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
© Cross Cultural Health Care Program
Final Thoughts...
You and I
We meet as strangers, each carrying a mystery
within 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 are
the Earth's richest treasures.
So I make this promise to you;
I will impose no identities upon you, but will
invite you to become yourself
without shame or fear.
I will hold open a space for you in the world
and allow your right to fill it with an authentic
vocation and purpose. For as long as your search
takes, you have my loyalty.
Author Unknown
© Cross Cultural Health Care Program
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 Roosevelt
NY Times, Dec. 1965
© Cross Cultural Health Care Program
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
© Cross Cultural Health Care Program
Further Readings
1. Quality Health Services for Hispanics: The Cultural
Competency Component
http://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?PI
D=27&list=27%2C25%2C23
4. Quiz for healthcare providers on quality & culture
http://erc.msh.org/quiz.cfm?action=question&qt=all
© Cross Cultural Health Care Program
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 2006
http://www.bphc.org/director/disp_data.asp
© Cross Cultural Health Care Program