Transcript Cultural Competency for Anti

2011 Annual Conference
August 25, 2011
Orlando, FL
Michael D. Dozier, President & CEO
Mississippi Community Partnership
(601) 953-6930
[email protected]
Section 1.
CORE CONCEPTS
Culture
The shared values, traditions, norms, customs, arts,
history, folklore, and institutions of a group of
people that are unified by race, ethnicity, language,
nationality, or religion
Source: “Perspectives of Difference,” Division of General Internal Medicine, University of
California, San Francisco
Culture of Origin
“One’s culture of origin provides him/her with a
basic understanding of the world. It provides the
means to perceive and explain our experiences. It
teaches about customs, philosophy, and behavior.”
Culture - an individual can identify
with multiple groups
 National origin
 Ethnicity
 Race
 Gender
 Sexual orientation
 Religion
 Rural, urban, suburban
 Socio-economic status
Competence
Acquisition of knowledge, skills,
and experience necessary for the
development and implementation of
services to different groups served
U.S. Dept. of Health
and Human Services
“A set of behaviors, attitudes and policies that come
together in a system, agency, or program or among
individuals, enabling them to function effectively in
diverse cultural interactions and similarities within,
among, and between groups.”
Cultural Competence is a point on
a continuum that represents the
POLICIES and PRACTICES of an
organization, or the VALUES and
BEHAVIOR of an individual
which enable that organization or
person to interact effectively in a
culturally diverse environment.
Cultural Competence Continuum
Destructiveness
Pre-Competence
Incapacity
Competence
Proficiency
Four levels to the concept
1. Cultural knowledge – Individuals know about
some cultural characteristics, history, values, beliefs,
and behaviors
2. Cultural Awareness – next stage, individual is open
to the idea of changing cultural attitudes
Four levels to the concepts
3. Cultural Sensitivity – knowing differences exist
between cultures, but not assigning values to the
difference. At this point clashes, and internal
conflicts most often occur.
Four levels of the concept
4.
Cultural Competence, brings together the
previous stages, and adds operational
effectiveness. A culturally competent organization
brings together different behaviors, attitudes, and
policies and works effectively in cross-cultural
settings to produce better results
Source: Community Tool Box, Univ. of Kansas
Cultural Competence is not
the same as cultural
diversity.
Cultural Diversity – DIFFERENCES in
race, ethnicity, language, nationality, or religion
among various groups within a community. A
community is said to be culturally diverse its its
residents include members of different groups.
Guiding Principles of Cultural
Competency
Each group has unique cultural
needs
Action: Make room in your organization for
several paths that lead to the same goal
Guiding Principles of Cultural
Competency
Diversity within cultures is
important
Action: Recognize that cultural groups are
complex and diverse, do not view them as
monolithic
Guiding Principles of Cultural
Competency
People have group identities and
personal identities
Action: Although it is important to treat all
people as individuals, also acknowledge their
group identity
Guiding Principles of Cultural
Competency
People are served in varying degrees by the
dominant culture
Action: Recognize that what works well for the
dominant cultural group, may work against
members of other cultural groups
Guiding Principles of Cultural
Competency
Culture is ever-present
Action: Acknowledge culture as a predominant
force in shaping behaviors, values, and institutions.
Section 2
Value and importance of
cultural competence
Cultural Competence
Why is cultural competence important
for you, your organization, and your
community?
Why is being culturally
competence important to you?
Benefits of Organizational Cultural
Competence
 Increase respect and mutual understanding among
those involved
 Increases civility in problem-solving through new
perspectives, ideas, strategies
 Decreases unwanted surprises that might slow
progress
Benefits of Organizational Cultural
Competence
 Increases participation and involvement of other
cultural groups
 Increases trust and cooperation
 Helps overcome fear of misteaks, competition or
conflict
 Promotes inclusion and equity
Source: Community Tool Box, Univ. of Kansas
Thus,
How could your organization
benefit from being culturally
competent (if it isn’t already!)?
“Organizations have a ‘culture’ of
policies, procedures, programs, and
processes, and incorporate certain
values, beliefs, assumptions and
customs… An organizational culture
may not lend itself to culture
competence, so that’s where skill
building comes in.”
Source: Univ. of Kansas, Community Took Box
Cultural Competency Domains
Policy
Physical
Environment
Values
Effective
Prevention
Training
Communication
Style
Organizational Diversity
Primary
 Ethnicity
 Gender
 Sexual Orientation
 Social Class
 Spiritual beliefs and practice
 Physical and mental ability
Organizational Diversity
Other types – less salient
 Age
 Language
 Education
 Customs
 Customs
 Skills and Talents
 National/regional origins
Challenges for Professional
 Value Diversity
 Understand their cultural biases
 Internalize Cultural Knowledge
 Develop Adaptations to Diversity
 Source: HRSA – Office of Minority Health
Indicators of culturally competent
organizations
 Outreach – outreach to diverse groups is encouraged
and is part of organizational plan
 Cultural concepts – inclusive language is used:
cross-cultural concepts are understood
Indicators of culturally competent
organizations
 Leadership – leadership is supportive and
committed to cultural competence
 Vision/Mission – diversity is integral to the program
vision/mission
 Staff composition – staff reflects the diversity of the
community
Indicators of culturally competent
organizations
 Training/staff development – Organization
provides/facilitates training on cultural diversity
issues.
 Collaboration – staff and diverse community
members work together and share responsibility for
addressing substance abuse problems
Section 3
Building a Culturally
Competent Organization
Action Steps for Achieving Cultural
Competence
1.
Develop support for change throughout the
organization (who wants change and who
doesn’t?)
Is this a top-down mandate? How deep is the “buy
in?”
Do you need a representative committee?
Action Steps for Achieving Cultural
Competence
2.
Identify the cultural groups to be involved.
Who needs to be involved in the planning,
implementation, and reinforcement of the change?
Action Steps for Achieving Cultural
Competence
3.
Identify barriers to cultural competence at work in
your organization
What is currently not working, what will slow you
down or stop you?
Organizations barriers
 Lack of understanding
 Lack of resources
 Lack of leadership commitment
 Lack of training opportunities
 Staff resistance
Cross-Cultural Stumbling Blocks
 Language – different languages, dialects, certain
concepts hard to translate
 Class-related values
 Culture-related values – different meanings and
values attached to behavior, events, situations
 Non-verbal communication – gestures, facial
expressions, eye contact may have different
meanings
Cross-cultural Stumbling Blocks
 Stereotyping – assignment of characteristics or
beliefs about another culture based on prejudice, or
limited exposure
 Racism
 Ethnocentricity – belief that ones ethnicity provides
the true or correct view of the world
Action steps for Achieving Cultural
Competence
4. Assess your current level of cultural competence
 What knowledge, skills, and resources can you build
on? Where are the gaps?
Some guideposts for assessing
organizational cultural competence
 Experience or track record of involvement



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with the target population
Staffing
Training availability and scope
Community representation
Language
Further guideposts for assessing
organizational cultural competence
 Environment
 Materials
 Evaluation
 On-going self-assessment
Action Steps for Building Cultural
Competence
5.
Identify the resources needed
How much funding is required to bring about the
changes? Where can you find the resources?
Action Steps for Building Cultural
Competence
6 Develop goals and implementation steps and
deadlines for achieving them.
Action Steps for Achieving Cultural
Competence
7. Commit to an ongoing evaluation of progress
(measuring outcomes) and be willing to respond to
change
 What will success look like? How do you know you
are on the right track?
Interventions for increasing
organizational cultural competence
 Increase the number of diverse persons in the
organization
 Develop educational plan for employees, coalition
members, volunteers, to improve competencies
required for effective cross-cultural work
Interventions for increasing
organizational cultural competence
 Identify and re-write policies, practices, and
structures that limit the full participation of diverse
communities
 Hold educational events exploring diverse group’s
history, cultural, issues, and strengths
Interventions for increasing cultural
competence
 Assure that the right voices are “at the table”
 Establish, communicate, and model how the
mission, vision, goals and values of the coalition
align with and are served by a diverse
membership and inclusive practices.
Section 4
Building Cultural Competency
in your Community Coalition
Why is understanding culture
important to build community?
 Need large number of people to join forces.
 Each group has unique strengths and
perspectives we can all benefit from.
 Understanding culture will help us overcome
and prevent racial and ethnic divisions.
Why is understanding culture
important to build community?
 People from different cultures have to be included in
the decision-making process.
 Appreciation of culture goes hand-in-hand with a
just and equitable society.
 Should understand the contributions of all to our
common history
Coalition cultural competence
community assessment
Assessment Activities:
Does your community assessment include
information about the major cultural groups
in your community?
Have members of diverse groups assisted the
organization in analyzing and interpreting
the data?
Cultural Assessments
 Values and lifeways
 Religious, philosohical, and spiritual
belfeifs
 Economic Factors
 Educational Factors
 Technological Factors
 Kinships and social ties
 Political and Legal Factors
Source: Leninger “Conceptualization of
transcultural Health Care Systems, 1993
Cultural Assessments
 Values and lifeways
 Religious, philosohical, and spiritual
belfeifs
 Economic Factors
 Educational Factors
 Technological Factors
 Kinships and social ties
 Political and Legal Factors
Source: Leninger “Conceptualization of
transcultural Health Care Systems, 1993
Cultural competence community
assessment
Planning:
Does your strategic plan address needs of diverse
groups in your community?
Do your organizational plans incorporate cultural
competence concepts?
Organizational cultural competence
community assessment
Community mobilization:
 Does your organization engage all sectors of your
community in a community-wide prevention effort?
Are some groups not adequately represented or “at
the table?”
Program Selection
 Who conducted the research, developed the
program?
 How did the researchers/program developers
control for cultural competency in the program
design?
 What groups were included in the studies?
Program Selection
 Have any replications been done in diverse
communities?
 Are materials available in languages other than
English? Who did the translation? Were they
tested?
 Is the program developer willing to work with
others to adapt the program?
Organizational cultural competence
assessment
Implementation:
Have you selected a prevention program that
needs to be adapted to meet the needs of diverse
groups?
Fidelity and Adaptation
 Identify the theory base behind the program
 Employ core components analytic data
 Assess fidelity/adaptation concerns for the
particular implementation site
 Consult with model program developer
Fidelity and Adapatation
 Consult with organization and/or community in




which the implementation will take place
Conduct focus groups
Identify other adaptations
Identify translations, is possible
Identify local experts for assistance, your state SSA,
national organizations
Fidelity and Adaptation
Develop an overall
implementation plan
based on these inputs
Evaluation Guidelines
 Define the population precisely
 Develop collaborations with the target population
 Encourage buy-in
 Provide timely feedback and results in clear, useful
formats conveyed through culturally appropriate
methods
Evaluation Guidelines
 Consider acculturation and biculturalism in
interpretation and utilization of data
 Know when to aggregate the within-group data
from a heterogeneous sample and still maximize
external validity
 Avoid deficit model interpretations
Best Practices for Culturally
Competent Evaluation
 Develop specific cultural knowledge
 Explicitly examine the theoretical framework that is
the foundation of your research
 Define and measure ethnicity in a meaningful
manner
Best Practices
 Make sure your analyses reflect study question
and that you have sufficient power to get
accurate answers
 Interpret results to reflect the lives of the people
studied.
Source: Guidelines and Best Practices for
Culturally Competence Evaluations, The
Colorado Trust, 2002.
Section 5
Culturally Proficient
Behavior
Culturally proficient behavior
 Value Diversity (name the differences)
 Celebrate and encourage the presence of a variety of
people in ALL activities
 Assess your culture/claim your identity
Culturally Proficient Behavior
 Recognize how your culture affects others
 Understand how the culture of your organization
affects those whose culture is different
Culturally proficient behavior
 Have in place effective strategies for resolving
conflict among people whose cultural backgrounds
and values may be different from your.
 Understand the effect that historic distrust has on
present day interactions
Culturally proficient behavior
 Have a training/staff development program that
provides information and skills that enable all to
interact effectively in a variety of cross-cultural
situations and incorporates cultural knowledge.
Section 6
Resources
Cultural Competence Resources
 Caldwell, C., Jackson, J., Tucker B., & Bowman, P.
“Culturally-Competent Research Methods” in
Advances in African American Psychology, 1999.
 Catalano R., Morrison D., Wells E., Gillmore M.,
Iritani B., and Hawkins D., “Ethnic Differences in
Family Factors Related to Early Drug Initiation”
Journal of Studies on Alcohol, Vol. 53, No. 3, 1992.
 Burchum, J., “Cultural Competence: An Evolutionary
Perspective” Nursing Forum, Vol. 37, No. 4, 2002.
Cultural Competence Resources
 Geron, S. “Cultural Competency: How is it Measured? Does it
make a Difference?” Generations, Fall 2002.
 Luquis R., and Perez, M. “Achieving Cultural Competence: The
Challenges for Health Educators” American Journal of Health
Education, May/June 2003.
 Resnicow, K., Soler, R., and Braithwaite R. “Cultural Sensitivity
in Substance Abuse Prevention” Journal of Community
Psychology, Vol. 28, No. 3, 2000.
 Roosa, M., Dumka, L., Gonzalez, N., and Knight, G.
“Cultural/Ethnic Issues and the Prevention Scientist in the 21st
Century” APA, Prevention and Treatment, Vol. 5, Art 5, 2002.
Cultural Competence
Resources
 Terrell, D. “Ethnocultural Factors and Substance
Abuse: Toward Culturally Sensitive Treatment
Models” Psychology of Addictive Behaviors, Sept.
1993, Vol. 7, No.
 University of Kansas, Community Tool Box, Tools,
Chap. 27. Cultural Competence in a Multicultural
World.
http://ctb/ku/edu/tools/en/chapter_1027.htm
 Zickler, P.“Ethnic Identification and Cultural Ties May
Help Prevent Drug Use” NIDA Notes, Research
Findings, Vol 14, No. 3, Sept. 1999.
Cultural Competency Resources
 U.S. Dept. of Health and Human Services, Health Resources and
Services Administration, Office of Minority Health,
“Conceptualizing Cultural Competence and Identifying Critical
Domains” http://www.hrsa.gov/OMH/cultural/sectionii.htm
 U.S. Dept. of Health and Human Services, Office of Minority Health,
National Standards for Culturally and Linguistically Appropriate
Services in Health Care. Washington, D.C. 2001
 U.S. Dept. of Health and Human Services, Office of the Surgeon
General, Mental Health: Culture, Race and Ethnicity. Rockville,
2001