Cultural Competency Integrating Differences into Community Services Objectives Understand Stigma. Understand Culture Competency. Learn Culturally competent care for people with Mental Health, IDD and Addictions.
Download ReportTranscript Cultural Competency Integrating Differences into Community Services Objectives Understand Stigma. Understand Culture Competency. Learn Culturally competent care for people with Mental Health, IDD and Addictions.
Slide 1
Cultural Competency
Integrating Differences
into Community Services
Slide 2
Objectives
Understand Stigma.
Understand Culture Competency.
Learn Culturally competent care for
people with Mental Health, IDD and
Addictions.
Slide 3
Some important
definitions
Related to Cultural
Competency
Slide 4
Stigma
Definitions from the U. of Chicago PSR Training Manual
“Stigmas are negative attitudes about a
group that lead to depriving them of
some fair opportunities.”
Slide 5
Stereotypes
from The Asian Health Coalition of Illinois
Stereotypes are exaggerated beliefs
or fixed ideas about a person or
group which is held by people and
sustained by selective perception and
selective forgetting.
Slide 6
Prejudice
from The Asian Health Coalition of Illinois
Prejudice is a preconceived idea or
negative attitude formed before the
facts are known and sustained over
generations. A bias without reason,
resisting all evidence…
Slide 7
Discrimination
from The Asian Health Coalition of Illinois
Discrimination refers to treatment in
favor or against a person based on
the group to which that person
belongs and not on merit.
Slide 8
People are often stigmatized by:
Mental Illness
Intellectual Developmental Disability
Physical Disability (including blindness, deafness)
Alcoholism /and or Drug Addiction
HIV or AIDS, Cancer or other terminal illnesses
Criminal behavior
Poverty
Alternative Lifestyles/sexual orientation
Wheelchair bound
Gender
Obesity
Slide 9
“Different” people are
“Stigmatized”
IDD inmates in a sanitorium in Germany
Slide 10
All our Consumers belong to
stigmatized groups!
Slide 11
We live in an world
which often separates us.
Racism
Sexism
Ageism
Feminism
Classism
Atheism
Slide 12
Culture
from King,et. al
The Office of Special Programs, U.S. Dept. of Education
“The integrated patterns of human
behavior that includes thoughts,
communications, actions, customs,
beliefs,values, and institutions of
racial, ethnic, religious, or social
groups.”
Slide 13
The Bottom Line:
People are different, even within
their own culture!
These differences
matter when
planning and
providing services.
Slide 14
Here at Hill Country MHDDC
Consumers are very diverse in their
language and culture.
Slide 15
How Can We Communicate?
Think Language first!
Do we need an interpreter?
Communicate respectfully.
Be sensitive to the consumer and the family.
Consider your dress, tone of voice, eye contact,
location, seating arrangement, privacy, etc.
Slide 16
Religion
Religious beliefs shape how the world is viewed.
Is illness a punishment? The devil’s work? An
evil spell? Bad karma?
For Hispanics, the curandero is a trusted healer.
For Lakota Sioux, the ritual Vision Quest,
praying and fasting at a holy site is life
changing.
Slide 17
Treatment Issues of Mentally
Challenged
People need to have meaningful activity
and purpose in their lives.
People need to feel acknowledged and
appreciated.
People need safety, structure, and security.
Lack of continuity can cause crisis!
They may need vocational assistance.
Slide 18
How Do We Best Serve Our
Consumers?
Examine own stereotypes.
Build trust.
Use People First language!
Slide 19
How do we best serve our
consumers?
Pronounce the person’s name correctly.
Get an interpreter, if necessary.
Educate yourself from the consumer, his
family, co-workers, etc.
Remember differences do matter!
Slide 20
Cultural Diversity and Health Care
Cultural Competence – Definition
A set of congruent behaviors, practices,
attitudes and policies that come together in
a system or agency or among
professionals, enabling effective work to be
done in cross-cultural situations
Slide 21
Cultural Diversity and Health Care
The Cultural Competence Continuum
Where Am I Now?
Where Could I Be?
Slide 22
The Cultural Competence Continuum
Slide 23
Cultural Diversity and Health Care
Cultural Competence Definitions
Cultural Destructiveness: forced
assimilation, subjugation, rights and
privileges for dominant groups only
Cultural Incapacity: racism, maintain
stereotypes, unfair hiring practices
Cultural Blindness: differences ignored,
“treat everyone the same”, only meet
needs of dominant groups
Slide 24
Cultural Diversity and Health Care
Cultural Competence Definitions
Cultural Pre-competence: explore cultural issues,
are committed, assess needs of organization and
individuals
Cultural Competence: recognize individual and
cultural differences, seek advice from diverse
groups, hire culturally unbiased staff
Cultural proficiency: implement changes to
improve services based upon cultural needs, do
research and teach
Slide 25
Cultural Diversity and Health Care
Acquiring Cultural Competence
Starts with Awareness
Grows with Knowledge
Enhanced with Specific Skills
Polished through Cross-Cultural Encounters
Slide 26
The Explanatory Model
Auther Klienman, PH.D.
Culturally sensitive approach to asking
inquiring about a health problem
What do you call your problem?
What do you think caused your problem?
Why do you think it started when it did?
What does your sickness do to you? How does it
work?
How severe is it? How long do you think you will
have it?
(continued next page)
Slide 27
The Explanatory Model
Auther Klienman PH.D.
Culturally sensitive approach to asking
about a health problem
What do you fear most about your illness?
What are the chief problems your sickness has
caused you?
Anyone else with the same problem?
What have you done so far to treat your illness:
What treatments do you think you should receive?
What important results do you hope to receive
from the treatment?
Who else can help you?
Slide 28
The LEARN Model
Berlin and Fowkes
Listen to the patient’s perception of the problem
Explain your perception of the problem
Acknowledge and discuss differences/similarities
Recommend treatment
Negotiate treatment
Slide 29
Working with Interpreters
Qualifications:
Bilingual, bicultural, understands English
medical vocabulary
Comfort in the medical setting,
understands significance of the health
problem
Preserves confidentiality
Slide 30
Working with Interpreters
Multiple Roles:
Translator of Language
Culture Broker
Patient Advocate: Convey expectations,
concerns
Slide 31
Working with Interpreters
Use language to identify the interpreter
as the go-between, not as the person to
be blamed, e.g., the interpreter might
say, “The doctor has ordered tests and
this is what he says”
Slide 32
Working with Interpreters
Translation factors
Language: how are new words created?
Navajo: Penicillin = “the strong white medicine shot you
get for a cold”
Minimize jargon, e.g., “machine to look at your
heart” instead of “EKG”
Nonverbal communication = 60% of all
communication
Nodding may indicate politeness, not
comprehension
Bilingual interviewing takes at least twice as long
as monolingual interviews!
Slide 33
Caretakers’ Responsibilities
Learn and use a few phrases of greeting
and introduction in the patient’s native
language. This conveys respect and
demonstrates your willingness to learn
about their culture.
Tell the patient that the interpreter will
translate everything that is said, so they
must stop after every few sentences.
Slide 34
Caretakers’ Responsibilities
When speaking or listening, watch the
patient, not the interpreter. Add your
gestures, etc. while the interpreter is
translating your message.
Reinforce verbal interaction with visual aids
and materials written in the client’s language.
Repeat important information more than
once.
(continued on next page)
Slide 35
Caretakers’ Responsibilities
Always give the reason or purpose for a treatment or
prescription.
Make sure the patient understands by having them
explain it themselves.
Ask the interpreter to repeat exactly what was said.
Personal information may be closely guarded and
difficult to obtain.
Patient often request or bring a specific interpreter to
the clinic.
(continued on next page)
Slide 36
Caretakers’ Responsibilities
In some cultures it may not be appropriate to
suggest making a will for dying patients or
patients with terminal illnesses; this is the
cultural equivalent of wishing death on a
patient.
Avoid saying “you must... Instead teach
patients their options and let them decide,
e.g., “some people in this situation would...”
Slide 37
Cultural Diversity and Health Care
It is because we are different that
each of us is special.
Slide 38
References
Putsch III RW. Cross-cultural
communication: The special case of
interpreters in health care. JAMA
1985;254(23):3344-48
Sockalingum adapted from Hayes,
Cultural Competence Continuum, 1993
and Terry Cross Cultural Competency
Continuum.
Slide 39
What is a TTY
Slide 40
TTY = Text Telephone
Also sometimes called a TDD or
Telecommunication Device for the Deaf.
A TTY is a special device that lets people who are
deaf, hard of hearing, or speech impaired use the
telephone to communicate by typing back and
forth instead of talking and listening.
A TTY is required at both ends of
the conversation to communicate.
Slide 41
TTY Use
To use a TTY, you set the telephone
Handset on to special acoustic cups built into the TTY.
Then type the message you want to send on the TTY’S
keyboard. As you type, the message is sent over the
phone line just like your voice would be sent over the
phone line if you talked.
You can read the other person’s response on the TTY’S text
display.
Slide 42
Telecommunications Relay
Service
If you don’t have a TTY, you can still call a person who
is deaf, hard of hearing, or speech impaired by using
the TRS.
With TRS a special operator types
whatever you say so that the person
you are calling can read your words on
their TTY display.
When they type a response the TRS operator will read
it aloud for you to hear over the phone.
Cultural Competency
Integrating Differences
into Community Services
Slide 2
Objectives
Understand Stigma.
Understand Culture Competency.
Learn Culturally competent care for
people with Mental Health, IDD and
Addictions.
Slide 3
Some important
definitions
Related to Cultural
Competency
Slide 4
Stigma
Definitions from the U. of Chicago PSR Training Manual
“Stigmas are negative attitudes about a
group that lead to depriving them of
some fair opportunities.”
Slide 5
Stereotypes
from The Asian Health Coalition of Illinois
Stereotypes are exaggerated beliefs
or fixed ideas about a person or
group which is held by people and
sustained by selective perception and
selective forgetting.
Slide 6
Prejudice
from The Asian Health Coalition of Illinois
Prejudice is a preconceived idea or
negative attitude formed before the
facts are known and sustained over
generations. A bias without reason,
resisting all evidence…
Slide 7
Discrimination
from The Asian Health Coalition of Illinois
Discrimination refers to treatment in
favor or against a person based on
the group to which that person
belongs and not on merit.
Slide 8
People are often stigmatized by:
Mental Illness
Intellectual Developmental Disability
Physical Disability (including blindness, deafness)
Alcoholism /and or Drug Addiction
HIV or AIDS, Cancer or other terminal illnesses
Criminal behavior
Poverty
Alternative Lifestyles/sexual orientation
Wheelchair bound
Gender
Obesity
Slide 9
“Different” people are
“Stigmatized”
IDD inmates in a sanitorium in Germany
Slide 10
All our Consumers belong to
stigmatized groups!
Slide 11
We live in an world
which often separates us.
Racism
Sexism
Ageism
Feminism
Classism
Atheism
Slide 12
Culture
from King,et. al
The Office of Special Programs, U.S. Dept. of Education
“The integrated patterns of human
behavior that includes thoughts,
communications, actions, customs,
beliefs,values, and institutions of
racial, ethnic, religious, or social
groups.”
Slide 13
The Bottom Line:
People are different, even within
their own culture!
These differences
matter when
planning and
providing services.
Slide 14
Here at Hill Country MHDDC
Consumers are very diverse in their
language and culture.
Slide 15
How Can We Communicate?
Think Language first!
Do we need an interpreter?
Communicate respectfully.
Be sensitive to the consumer and the family.
Consider your dress, tone of voice, eye contact,
location, seating arrangement, privacy, etc.
Slide 16
Religion
Religious beliefs shape how the world is viewed.
Is illness a punishment? The devil’s work? An
evil spell? Bad karma?
For Hispanics, the curandero is a trusted healer.
For Lakota Sioux, the ritual Vision Quest,
praying and fasting at a holy site is life
changing.
Slide 17
Treatment Issues of Mentally
Challenged
People need to have meaningful activity
and purpose in their lives.
People need to feel acknowledged and
appreciated.
People need safety, structure, and security.
Lack of continuity can cause crisis!
They may need vocational assistance.
Slide 18
How Do We Best Serve Our
Consumers?
Examine own stereotypes.
Build trust.
Use People First language!
Slide 19
How do we best serve our
consumers?
Pronounce the person’s name correctly.
Get an interpreter, if necessary.
Educate yourself from the consumer, his
family, co-workers, etc.
Remember differences do matter!
Slide 20
Cultural Diversity and Health Care
Cultural Competence – Definition
A set of congruent behaviors, practices,
attitudes and policies that come together in
a system or agency or among
professionals, enabling effective work to be
done in cross-cultural situations
Slide 21
Cultural Diversity and Health Care
The Cultural Competence Continuum
Where Am I Now?
Where Could I Be?
Slide 22
The Cultural Competence Continuum
Slide 23
Cultural Diversity and Health Care
Cultural Competence Definitions
Cultural Destructiveness: forced
assimilation, subjugation, rights and
privileges for dominant groups only
Cultural Incapacity: racism, maintain
stereotypes, unfair hiring practices
Cultural Blindness: differences ignored,
“treat everyone the same”, only meet
needs of dominant groups
Slide 24
Cultural Diversity and Health Care
Cultural Competence Definitions
Cultural Pre-competence: explore cultural issues,
are committed, assess needs of organization and
individuals
Cultural Competence: recognize individual and
cultural differences, seek advice from diverse
groups, hire culturally unbiased staff
Cultural proficiency: implement changes to
improve services based upon cultural needs, do
research and teach
Slide 25
Cultural Diversity and Health Care
Acquiring Cultural Competence
Starts with Awareness
Grows with Knowledge
Enhanced with Specific Skills
Polished through Cross-Cultural Encounters
Slide 26
The Explanatory Model
Auther Klienman, PH.D.
Culturally sensitive approach to asking
inquiring about a health problem
What do you call your problem?
What do you think caused your problem?
Why do you think it started when it did?
What does your sickness do to you? How does it
work?
How severe is it? How long do you think you will
have it?
(continued next page)
Slide 27
The Explanatory Model
Auther Klienman PH.D.
Culturally sensitive approach to asking
about a health problem
What do you fear most about your illness?
What are the chief problems your sickness has
caused you?
Anyone else with the same problem?
What have you done so far to treat your illness:
What treatments do you think you should receive?
What important results do you hope to receive
from the treatment?
Who else can help you?
Slide 28
The LEARN Model
Berlin and Fowkes
Listen to the patient’s perception of the problem
Explain your perception of the problem
Acknowledge and discuss differences/similarities
Recommend treatment
Negotiate treatment
Slide 29
Working with Interpreters
Qualifications:
Bilingual, bicultural, understands English
medical vocabulary
Comfort in the medical setting,
understands significance of the health
problem
Preserves confidentiality
Slide 30
Working with Interpreters
Multiple Roles:
Translator of Language
Culture Broker
Patient Advocate: Convey expectations,
concerns
Slide 31
Working with Interpreters
Use language to identify the interpreter
as the go-between, not as the person to
be blamed, e.g., the interpreter might
say, “The doctor has ordered tests and
this is what he says”
Slide 32
Working with Interpreters
Translation factors
Language: how are new words created?
Navajo: Penicillin = “the strong white medicine shot you
get for a cold”
Minimize jargon, e.g., “machine to look at your
heart” instead of “EKG”
Nonverbal communication = 60% of all
communication
Nodding may indicate politeness, not
comprehension
Bilingual interviewing takes at least twice as long
as monolingual interviews!
Slide 33
Caretakers’ Responsibilities
Learn and use a few phrases of greeting
and introduction in the patient’s native
language. This conveys respect and
demonstrates your willingness to learn
about their culture.
Tell the patient that the interpreter will
translate everything that is said, so they
must stop after every few sentences.
Slide 34
Caretakers’ Responsibilities
When speaking or listening, watch the
patient, not the interpreter. Add your
gestures, etc. while the interpreter is
translating your message.
Reinforce verbal interaction with visual aids
and materials written in the client’s language.
Repeat important information more than
once.
(continued on next page)
Slide 35
Caretakers’ Responsibilities
Always give the reason or purpose for a treatment or
prescription.
Make sure the patient understands by having them
explain it themselves.
Ask the interpreter to repeat exactly what was said.
Personal information may be closely guarded and
difficult to obtain.
Patient often request or bring a specific interpreter to
the clinic.
(continued on next page)
Slide 36
Caretakers’ Responsibilities
In some cultures it may not be appropriate to
suggest making a will for dying patients or
patients with terminal illnesses; this is the
cultural equivalent of wishing death on a
patient.
Avoid saying “you must... Instead teach
patients their options and let them decide,
e.g., “some people in this situation would...”
Slide 37
Cultural Diversity and Health Care
It is because we are different that
each of us is special.
Slide 38
References
Putsch III RW. Cross-cultural
communication: The special case of
interpreters in health care. JAMA
1985;254(23):3344-48
Sockalingum adapted from Hayes,
Cultural Competence Continuum, 1993
and Terry Cross Cultural Competency
Continuum.
Slide 39
What is a TTY
Slide 40
TTY = Text Telephone
Also sometimes called a TDD or
Telecommunication Device for the Deaf.
A TTY is a special device that lets people who are
deaf, hard of hearing, or speech impaired use the
telephone to communicate by typing back and
forth instead of talking and listening.
A TTY is required at both ends of
the conversation to communicate.
Slide 41
TTY Use
To use a TTY, you set the telephone
Handset on to special acoustic cups built into the TTY.
Then type the message you want to send on the TTY’S
keyboard. As you type, the message is sent over the
phone line just like your voice would be sent over the
phone line if you talked.
You can read the other person’s response on the TTY’S text
display.
Slide 42
Telecommunications Relay
Service
If you don’t have a TTY, you can still call a person who
is deaf, hard of hearing, or speech impaired by using
the TRS.
With TRS a special operator types
whatever you say so that the person
you are calling can read your words on
their TTY display.
When they type a response the TRS operator will read
it aloud for you to hear over the phone.