Transcript Delivering Health Care to Hispanics: An Interactive

Second World Congress on Spina Bifida
Research and Care
Health Issues for Latinos with Spina Bifida
Las Vegas, NV
March 13, 2012
Introduction to Cultural Proficiency
Magdalena Castro Lewis
Director, Center for Community Services
National Alliance for Hispanic Health
National Alliance for Hispanic Health
Vision: Strong healthy communities whose contributions
are recognized by a society that fosters the health, wellbeing, and prosperity of all its members.
Mission: Improve the health of Hispanic communities and
work with others to secure health for all.
We are unique:
Since 1973 represent all Hispanic groups.
Dedicated to community-based solutions.
No funds from tobacco or alcohol companies.
Reputation: Nation’s foremost information source and
advocate for Hispanic health.
Alliance
members
are…
Individuals
Professionals
Consumers
Students
Retirees
Organizations
National
Community-based
For-profit corporations
Foundations
Government
Hospitals
Universities
Purpose
This session is intended to provide
basic information on cultural proficiency
to health and human service
professionals delivering services to
children with spina bifida and their
families.
Agenda
 Rationale for cultural proficiency in the
delivery of cross-cultural services.
 How values, beliefs and attitudes
influence health and delivery of
services.
 A cultural proficiency model
Rationale for Culturally Proficient
Health Care
 Complying with legislative, regulatory,
and accreditation mandates
 Responding to demographics
 Reducing cost and improving the
quality of services and outcomes
Adapted from; Cohen E, Goode T. Policy Brief 1: Rationale for Cultural Proficiency in primary health care. Georgetown University
Child Development Center, The National Center for Cultural Proficiency. Washington, D.C., 1999.
Mandates and Regulations
 National Standards C.L.A.S
 Federal Law
 Title VI
 EO 13166
 The Hill-Burton Act
 Medicaid
 Medicare
 Federal Categorical Grant Programs
 Emergency Medical Treatment and Active Labor Act
 State Laws
 Private Sector
Hispanic Population in the U.S.
One out of six people in the U.S. is Hispanic
Hispanic Pop.
Puerto Rico
Total:
50.4 million
3.7 million
54.1 million
Source: U.S. Census Bureau. Overview of Race and Hispanic Origin:2010, March
2011. Annual Estimates of the Resident Population for Municipios of Puerto Rico:
April 1, 2000 to July 1, 2009, (PMR-EST2009-01), March 2010. and, U.S. Census
Bureau, 2010 Census Redistricting Data (Public Law 94-171) Summary
File, Table P1.
Note: Figures do not include the Commonwealth of Puerto Rico.
American Indian proportion is less than 1 percent.
Source: U.S. Bureau of the Census, Population Division. Percent of the Projected
Population by Race and Hispanic Origin for the United States: 2010 to 2050
(NP2008-T6) August 14, 2008
Women’s rate of having children with
spina bifida
4.5
4
per 10,000
3.5
3
2.5
2
Women's rate of having a child
affected by Spina Bi ida
1.5
1
0.5
0
Hispanic
NonHispanic
Black
NonHispanic
White
Race
Source: Centers for Disease Control. (2011). Spina Bifida Data and Statistics. Retrieved from
http://www.cdc.gov/ncbddd/spinabifida/data.html
Improving Quality of Services and
Outcomes
 Nearly half (45%) of uninsured Spanish speaking Hispanic patients
reported problems communicating with their doctor, compared to
28% of uninsured whites, and 30% of uninsured African Americans.1
 Only 33.8% of adult Hispanics aged 40 and over with diabetes
received three recommended annual screenings – foot exams, eye
exams, and A1C tests – compared with 42.4% of non-Hispanic
whites.2
 Rate of potentially preventable hospital stays among Hispanic adults
is more than double that for non-Hispanic white adults (37 vs. 17
hospitalizations per 10,000 population).3
1Doty,
Michelle M. Hispanic Patients’ Double Burden: Lack of Health Insurance and Limited English. The Commonwealth Fund, 2003.
for Healthcare Research and Quality (AHRQ). 2008 National Healthcare Disparities Report. AHRQ Pub. No. 09-0002; 49-50. U.S.
Department of Health and Human Services, AHRQ, Rockville, MD, 2009.
3E. Stragnes et al., Potentially Preventable Hospital Stays Among Hispanics, 2006. HCUP Statistical Brief #61 (2008). Agency for Healthcare
Research and Quality (AHRQ), Rockville, MD, 2008.
2Agency
About Culture
The word ”culture” implies patters of human
behavior including thoughts, actions,
customs, values, and beliefs that can bind
a racial, ethnic, religious or social group
within a society.
It is Challenging for individuals to recognize
and change their own cultural practices.
Culture affects our health decisions
Such decisions are strongly
influenced by the ideas, beliefs,
and customs passed down to us
through our families, traditions
and cultural groups.
What is Cultural Proficiency?
 Individual“the ability to use knowledge and communication
skills to work effectively with people of different
cultures… the state of being capable of functioning
effectively in the context of cultural differences”
 Organizational“the integration of behaviors, skills, attitudes,
policies and procedures which will come together
in a system to enable people to work effectively
across cultures”
Cultural Proficiency comprises four
components
a.
Awareness of one's own cultural
worldview
b. Attitude towards cultural differences
c.
d.
Knowledge of different cultural practices
and worldviews
Cross-Cultural Skills / Abilities
A Cultural Proficiency Model
Example
Towards Cultural
Proficiency
Cultural Proficiency
Holding culture in
high esteem
Cultural Competency
Acceptance of and
respect for differences
Cultural Pre-competence
Movement toward reaching out
to other cultures
Cultural Blindness
Predominant system
..philosophy to being
unbiased
Cultural
Incapacity
No capacity to help clients
from other cultures
Cultural
Destructiveness
Destructive to cultures
Adapted with permission from: Cross, T.L., Bazron,
K.W., Dennis, and M.R. Isaccs. 1989; p. 13.
Towards Cultural Proficiency
 Cultural Destructiveness “No desire”
Attitude, policies and practices that are
destructive to cultures and the
individuals within these cultures.
 Cultural Incapacity “No capacity”
Agencies do not intentionally seek to be
culturally destructive but rather have no
capacity to help clients from other
cultures.
Toward Cultural Proficiency
 Cultural Blindness “One size fits all”
Agencies provide services with the
express philosophy of being unbiased.
Color or culture makes no difference.
 Cultural Pre-Competence “Moving
forward” Implies movement towards
reaching out to other cultures. Attempt to
improve services. Desire to deliver
quality services.
Toward Cultural Proficiency
 Culturally Competent “Experts in the field”
Acceptance of and respect for difference,
continuing self assessment regarding culture,
expansion of cultural knowledge and
resources, adaptations of service models.
 Culturally Proficient “Leaders of the pack”
Highest level of performance and refers to
excellence and sustained commitment in
addressing cross-cultural issues. Agencies
hold culture in high esteem.
Final Message
Cultural proficiency is not a static
point. Periodic assessments,
initiatives for change, and training
/ education are necessary to
achieve and sustain personal
and/or organizational cultural
proficiency.
Resources
 Su Familia: The National Hispanic Family Health Helpline (1-866
SU Familia) 1-866-786-2645
 Delivering Health Care to Hispanics. A Manual for Providers.
National Alliance for Hispanic Health. ww.hispanichealth.org
 Office of Minority Health www.omhrc.gov
 National Standards on Culturally and Linguistically Appropriate
Services (CLAS)
http://www.minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15
 Health Resources and Services Administration (HRSA)
www.hrsa.gov/culturalcompetence
Any Questions?
¡Gracias!
www.hispanichealth.org
Considering
Hispanic/Latino Core
Values
Hispanic/Latino Core Values
 Respeto
 Confianza
 Personalismo
Respeto / Respect
Based on age, sex, social position, position of
authority
Reciprocal
Personalismo/Personalism
 Personal versus impersonal
 Individual versus institution
 Family values
Confianza/Trust
 Trust developed over time
 Based on relationships