Transcript What’s the Next Step? Moving Your Health Service to the

What’s the Next Step?
Moving Your Health Service to the
Next Stage of Cultural Competency
Presenters:
David Braun, MD – University of Iowa
Dwayne Sackman, MPA – Illinois State
University
Goals
1)
2)
3)
Present a self-assessment mechanism
for any college health service.
Identify some potential challenges to
increasing cultural competency.
Present some ideas on overcoming
challenges and moving to the next
stage of cultural competency
Cultural Competence
Cultural Competence is when a community
member is aware of his/her own
assumptions, biases, and values; possesses an
understanding of the worldview of others; is
informed about various cultural groups; and
has acquired the skills to develop appropriate
intervention strategies and techniques (Sue,
Arrendondo, & McDavis, 1992).
Assumptions
Multiculturally competent persons understand:
 One will never reach an ultimate level of knowledge and
awareness about the self and various cultural groups.
 One’s identity, awareness, and skills are constantly evolving
in response to new information being received about the
self or the other
 One is continually seeking to raise awareness and develop
skills that help to effectively address diversity and social
justice issues.
 One must develop the stamina to sit with discomfort, to
continuously seek critical consciousness, and to engage in
difficult dialogues (Watt, 2007).
A Self Assessment Tool

http://www.aafp.org/fpm/20020600/39achi.html

Achieving a more minority friendly practice
Family Practice Management, June 2002, Vol. 9
No. 6 pg 39-43
Six Stages of Cultural Competence
Development:
1.
2.
3.
4.
5.
6.
Cultural Destructiveness
Cultural Incapacity
Cultural Blindness
Cultural Pre-Competence
Cultural Competence
Cultural Proficiency
Journal of College Student Development Ingrid
Grieger September/October 1996 Vol. 37 No. 5
“A Multicultural Organizational Development
Checklist for Student Affairs”
Monocultural
Nondiscriminatory
Multicultural
A Personal Self-Assessment Tool

Diversity Awareness Profile (DAP), 2nd edition by
Karen Stinson
 Naïve –
no awareness of one’s biases, prejudices,
and negative behaviors
 Perpetuator – aware of one’s biases, but
continue negative behaviors and reinforce
stereotypes
 Avoider – tolerates other’s unjust behaviors
 Change Agent – acts as a role model, takes
action when appropriate
 Fighter – always on lookout for prejudice and
takes action at all times
3 Phases to Move to the Next Level
 Phase
1 – Structural
 Phase 2 – Behavioral
 Phase 3 – Cultural
 “A
Multicultural Organizational Development
Checklist for Student Affairs” by Ingrid Grieger
in Journal of College Student Development;
September/October 1996, vol. 37 no. 5
Phase 1 – Structural
 Develop vision
 Communicate
 Find
 Set
vision
leaders
low-hanging fruit goals
 Form
culture competency committee
Phase 2 – Behavioral
 Create
opportunities
 Build
momentum
 Build
rewards
Phase 3 – Cultural
 Make
part of ongoing operations
 Commit
 Expand
financial resources in budget
scope
An exercise for today

What would you do if. . .

. . .a patient expresses unwillingness to be
seen by a provider because of racial/cultural
differences?
An exercise for today

What would you do if. . .

. . .a senior provider tells you in a staff
meeting that he’s “tired of the discussions of
theory”?
Here’s one from Gropper:

The Athlete (page 74)
 Charles Lear, an African-American whose family comes
from the rural south, has been a patient at [the student
health center] for over a year and Rita Barnes has been
his regular nurse practitioner. The young man comes in
for a physical examination because of a school
requirement prior to participation on the track team.
 Ms. Barnes is pleased that the youth is doing so well and
asks, “What subjects are you taking this term, Charlie?”
 He stiffens and mumbles, “English and math” and seems
anxious to terminate the interview.
 How would you explain this behavior?
Possible explanations
1.
2.
3.
4.
Charles is getting failing grades in his classes and is
embarrassed to admit it.
Charles has had to wait longer than he expected before
seeing Ms. Barnes, so he is in a hurry to leave.
In the rural South, African-Americans are raised to respect
the name given to them by their parents and they do not
convert it to a nickname as some other groups tend to do
to demonstrate friendliness. Charles is startled by the
liberties taken with his given name.
Charles does not like Ms. Barnes and wants to maintain his
distance from her indirect communication of friendliness.
Video Conversation Starters
 Short
and not too edgy: “Color Me Blind” on
YouTube, 5:39 video by WDrinker
 Longer,
edgy: “Hip-Hop: Beyond Beats and
Rhymes” by Byron Hurt

Info at www.bhurt.com
A classic medical cultural competency
book resource

The Spirit Catches You and You Fall Down
by Anne Fadiman

www.spiritcatchesyou.com
Some additional resources



Gropper, R. Culture and the Clinical Encounter: An
Intercultural Sensitizer for the Health Professions.
Intercultural Press, Inc., 1996
Wen-Shing, T. and Streltzer, J. Cultural Competence in
Health Care: A Guide for Professionals. Springer Science +
Business Media, 2008
Galanti, G. Caring for Patients from Different Cultures.
University of Pennsylvania Press, 2004
Nice Quick Clinic Reference

Mosby Pocket Guide to Cultural Health
Assessment – Nursing Pocket Guides

Organized by country of origin with
information on common religions, languages,
cultural beliefs and common barriers to US
health care