Colorado Developmental Disabilities Council

1
Colorado Developmental Disabilities Council
Learning From Each Other- Things We
Share October 3-4, 2008
2
Wendy Jones National Center for Cultural
Competence Georgetown University Center for
Child and Human Development Center for Excellence
in Developmental Disabilities Georgetown
University Medical Center
3
Cultural Linguistic Competency Definitions,
Frameworks
Slide Source National Center for Cultural
Competence,2008
4
Culture

• Culture is an integrated pattern of human
  behavior which includes but is not limited to

roles
values
rituals
communication
languages
relationships
courtesies
thought
beliefs
practices
customs
manners of interacting
expected behaviors
of a racial, ethnic, religious, social,
disability or political group ability to
transmit the above to succeeding generations
dynamic in nature.
Slide Source National Center for Cultural
Competence,2008
5
Culture is

• applicable to all peoples
• active dynamic
• changes over time
• changes with migration
• changes to meet new challenges to group
• changes through interactions with other groups
• changes based on climate

Adapted from Vivian Jackson, NCCC, 2003
Slide Source The National Center for Cultural
Competence, 2008
6
Culture is

• multi-layered
• at personal, family, community level
• home, school, work/profession levels
• malleable over time
• always considered within a context

Adapted from Vivian Jackson, NCCC, 2003
Slide Source The National Center for Cultural
Competence, 2008
7
Culture is

• viewed as thick, thin or compartmentalized
• thick - permeates all aspects of life
• thin - reflected in surface aspects
• compartmentalized - different expression
  
• of culture at home and in public

Adapted from Vivian Jackson, NCCC, 2003
Slide Source The National Center for Cultural
Competence, 2008
8
Culture

• structures perceptions
• shapes behaviors
• is the total way of life it tells group
• members how to behave and
• provides their identity

Adapted from Vivian Jackson, NCCC, 2003
Slide Source The National Center for Cultural
Competence, 2008
9
Culture as Lens

• Our beliefs, values, experiences and cultural
  expectations create a lens that gives meaning to
  our world. Each lens is different and all
  interactions are somewhat cross-cultural.

Slide Source National Center for Cultural
Competence,2008
10
Culture is a system of collectively held
values, beliefs, and practices of a group which
guides decisions, and actions in patterned and
recurrent ways. It encompasses the organization
of thinking, feeling, believing, valuing and
behaving collectively that differentiates one
group from another. (Wenger, A. , 1991).
Slide Source National Center for Cultural
Competence,2008
11
An Iceberg Concept of Culture
dress?age
gender ? language ? race or ethnicity ?
physical characteristics
? eye behavior? ? facial expressions ?
Adapted by the NCCC
? body language ?sense of self ? ? gender
identity ?
notions of modesty?concept of cleanliness

• ? emotional response patterns ?rules for social
  interaction ?child rearing practices ?
• decision-making processes ?
• approaches to problem solving ?

? concept of justice ?value individual vs. group
?
? perceptions of mental health, health, illness,
disability ?
? patterns of superior and subordinate roles in
relation to status by age, gender, class ? sexual
identity orientation ?
and much more
Slide Source The National Center for Cultural
Competence, 2008
12
Culture

• Culture is akin to being the person
• observed through a one-way mirror
• everything we see is from our own
• perspective.
• It is only when we join the observed
• on the other side that it is possible to see
  ourselves and others clearly but getting to the
  other side of the glass presents many challenges.
• (Lynch Hanson, 1992, Developing Cross-Cultural
  Competence)

Slide Source National Center for Cultural
Competence, 2008
13
Cultural Factors That Influence Diversity Among
Individuals and Groups
Internal Factors

• Cultural/Racial/Ethnic Identity
• Tribal Affiliation/Clan
• Nationality
• Acculturation/Assimilation
• Socioeconomic Status/Class
• Education
• Language
• Literacy
• Family Constellation
• Social History
• Perception of Time

• Health Beliefs Practices
• Health Literacy
• Perception of Disability
• Perception of Mental Health
• Age Life Cycle Issues
• Gender Sexuality
• Sexual Orientation Identity
• Religion Spiritual Views
• Spatial Regional Patterns
• Political Orientation/Affiliation

Modified from James Mason, Ph.D., NCCC Senior
Consultant
Slide Source The National Center for Cultural
Competence, 2008
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Cultural Factors That Influence Diversity Among
Individuals and Groups
External Factors

• Institutional Biases
• Racism Discrimination
• Community Economics
• Intergroup Relations
• Group Community
• Resiliency

• Natural Networks of Support
• Community History
• Political Climate
• Workforce Diversity
• Community Demographics

Modified from James Mason, Ph.D., NCCC Senior
Consultant
Slide Source The National Center for Cultural
Competence, 2008
15
Cultural Competence
requires that organizations have a clearly
defined, congruent set of values and principles,
and demonstrate behaviors, attitudes, policies,
structures, and practices that enable them to
work effectively cross-culturally
Adapted from from Cross, Bazron, Dennis and
Isaacs, 1989)
Slide Source National Center for Cultural
Competence,2008
16
Five Elements of Cultural Competence

• Organizational Level
• value diversity
• conduct cultural self-assessment
• manage the dynamics of difference
• institutionalize cultural knowledge
• adapt to diversity
• - policies - structures
• - values - services

(Cross, Bazron, Dennis and Isaacs, 1989)
Slide Source National Center for Cultural
Competence,2008
17
Five Elements of Cultural Competence
Individual Level

• acknowledge cultural differences
• understand your own culture
• engage in self-assessment
• acquire cultural knowledge skills
• view behavior within a cultural context

(Cross, Bazron, Dennis and Isaacs, 1989)
Slide Source National Center for Cultural
Competence,2008
18
ESSENTIAL ELEMENTS IN ACULTURALLY COMPETENT
SYSTEM

• These five elements must be manifested at every
  level of an organization including
• policy makers
• administration
• practice service delivery
• consumer/patient/family
• community
• and reflected in its attitudes, structures,
  policies, practices, and services.

Adapted from Cross, Bazron, Dennis, Isaacs, 1989
Slide Source National Center for Cultural
Competence,2008
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Cultural Competence Continuum
(Cross, Bazron, Dennis and Isaacs, 1989)
CulturalProficiency
CulturalCompetence
CulturalPre-Competence
Cultural Blindness
CulturalIncapacity
Cultural Destructiveness
Slide Source National Center for Cultural
Competence, 2008
20
What Cultural Competence is Not

• Cookbook approaches to specific racial or ethnic
  groups
• Translating materials into other languages as the
  only action
• Making alterations in programs or approaches at
  one point in time
• Treating everyone the same
• Only the concern of providers/employees

Slide Source National Center for Cultural
Competence,2008
21
Linguistic Competence

• is the capacity of an organization and its
  personnel to
• communicate effectively, and convey
  information in a
• manner that is easily understood by diverse
  audiences
• including persons of limited English
  proficiency, those
• who are not literate or have low literacy
  skills, and
• individuals with disabilities
• requires organizational and provider capacity
  to
• respond effectively to the health literacy
  needs of
• populations served
• insures policy, structures, practices,
  procedures
• and dedicated resources to support this
  capacity

Goode Jones, Revised 2004, National Center
for Cultural Competence
Slide Source National Center for Cultural
Competence,2008
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LINGUISTIC COMPETENCE FRAMEWORK
Slide Source National Center for Cultural
Competence,2008
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COLORADO Data
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Colorado Statistics

• 12.6 of individuals and children in Colorado
  report having a disability (physical, sensory,
  cognitive, mental health or self care)
• Children 5-15 years of age 5.2
• Individuals 16-64 years of age 10.5
• Individuals 65 and over 38.3

Data Sources 1-United Health Foundation, 2-U.S.
Census Bureau-American Fact Finder, Colorado
Disability Characteristics
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2005/2006 National Survey of Children with
Special Health Care Needs Colorado Chart book
Page

• Estimated number of CSHCN 149,000 or 12.5
• Percent of children who have special health care
  needs by Age
• Age 0-5 years 8.4
• Age 6-11 years 13.0
• Age 12-17 years 16.1
• Prevalence by Sex Male 14.6 Female 10.4
• CSHCN Prevalence by Poverty Level
• 0-99 FPL 9.7 100-199 FPL 12.1
• 200-399 FPL 13.1 400 FPL or more 13.3

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Population Distribution in Colorado All
Children vs Children with Special Health Needs
Disability
Children with Special Needs and Disabilities
149,000
All Children 0-17 1,193,203

• Green Small Town/Rural Pink Suburban
• Violet Large Town Red Urban Center

Data Source Data Resource Center
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2005/2006 National Survey of Children with
Special Health Care Needs Colorado Chart book
Page

• Prevalence by Race and Hispanic Origin
• Non-Hispanic 13.7
• White 13.4
• Black 15.6
• Asian (sss)
• American Indian/Alaskan Native(sss)
• Native Hawaiian/Pacific Islander (sss)
• Multiple Races 21.2
• Hispanic 8.9

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2005/2006 National Survey of Children with
Special Health Care Needs National Chart book
Indicators

• 23.4 report conditions affect their activities
  usually, always, or a great deal
• 14.3 miss 11 or more days of school due to
  illness
• 12.7 had no insurance at some point in past year
• 5.4CSHCN without insurance at time of survey
• 34.6 have inadequate insurance
• 20.0 have an unmet need for specific health
  care services
• 5.0 have unmet needs for family support services
• 24.9 report needing a referral and have
  difficulty getting it

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2005/2006 National Survey of Children with
Special Health Care Needs National Chart book
Indicators

• 6.5 CSHCN without a usual source of care when
  sick (or who rely on the emergency room)
• 6.5 CSHCN without any personal doctor or nurse
• 32.6 CSHCN report services lack family-centered
  care
• 23.9 CSHCN whose conditions cause financial
  problems for the family
• 8.4 of families spend 11 or more hours per week
  providing or coordinating child's health care
• 20.6 CSHCN whose conditions cause family members
  to cut back or stop working

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Guiding Values and Principles of Cultural
Linguistic Competency
Slide Source National Center for Cultural
Competence,2008
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Guiding Values Principles of Cultural Competence

• Organizational
• Systems and organizations must sanction, and in
  some cases mandate, the incorporation of cultural
  knowledge into policy making, infrastructure, and
  practice.
• Cultural competence embraces the principles of
  equal access and non-discriminatory practices in
  service delivery.

Slide Source The National Center for Cultural
Competence, 2008
32

Guiding Values Principles

• Cultural competence is achieved by identifying
  and understanding the needs and help-seeking
  behaviors of individuals and families.
• Culturally competent organizations design and
  implement services that are tailored or matched
  to the unique needs of individuals, children,
  families, organizations, and communities served.
   

Slide Source National Center for Cultural
Competence, 2008
33
 
Guiding Values Principles
Language Access

• Services and supports are delivered in the
  preferred language and/or mode of delivery of
  populations served.
• Written materials are translated, adapted and/or
  provided in alternative formats based on the
  needs and preferences of the population served.

Slide Source National Center for Cultural
Competence, 2008
34
 
Guiding Values Principles
Language Access

• Interpretation and translation services comply
  with all relevant Federal, state and local
  mandates.
• Consumers are engaged in evaluation of language
  access and other communication services to ensure
  quality and satisfaction.

Slide Source National Center for Cultural
Competence, 2008
35
Guiding Values Principles Implications for
Cultural Linguistic Competency

• CommunityEngagement
• Cultural competence
• Extends the concept of self-determination to
• the community
• Involves working with natural, informal,
• support and helping networks

Slide Source National Center for Cultural
Competence, 2008
36
Guiding Values Principles Implications for
Cultural Linguistic Competency

• Community Engagement
• Communities determine their own needs
• Community members are full partners in
  decision-making
• Communities should economically benefit from
  collaboration
• Should result in reciprocal transfer of
  knowledge and skills
• among all collaborators

Slide Source National Center for Cultural
Competence, 2008
37
A Framework for Putting Values into Policy
Practice
Slide Source The National Center for Cultural
Competence, 2008
T.D. Goode
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Whats culture got to do with it?




Slide Source National Center for Cultural
Competence,2008
39
Roles of Equal Importance to Assist in Getting
to the Next Level
Families
Organizations
Advocates
Providers
Community
Individuals
Cultural Brokers
T.D. Goode
Slide Source National Center for Cultural
Competence, 2008
40
What will it take to bring cultural and
linguistic competence to shared decision-making?

• Providers
• Examine and know own cultural values
• Elicit information about family and cultural
  beliefs, values and concerns as part of history
• Include cultural considerations in all care,
  discharge,education,and rehabilitation plans
• Know natural support networks in community served
• Know how families view community supports

Slide Source National Center for Cultural
Competence,2008
41
What will it take to bring cultural and
linguistic competence to shared decision-making?

• Providers
• Get regular feedback from families in
  practice/organization about decision-making
• Connect with and use ethics committees to deal
  with cross-cultural dynamics

Slide Source National Center for Cultural
Competence,2008
42
What will it take to bring cultural and
linguistic competence to shared decision-making?

• Families
• Identifying your values and beliefs
• Providing information to providers about what you
  think a problem might be, acceptable solutions,
  key decision makers, roles for you, your
  child/youth, others, providers
• Identifying authorities/cultural brokers in your
  cultural community to help inform providers
• Learning to talk about culture

Slide Source National Center for Cultural
Competence,2008
43
What will it take to bring cultural and
linguistic competence to shared decision-making?

• Advocates
• Examine and know own cultural values
• Elicit information from families about cultural
  beliefs, values and concerns
• Include cultural considerations in your intake
  procedures
• Know natural support networks in community served
• Know how families view community supports

Slide Source National Center for Cultural
Competence,2008
44
What will it take to bring cultural and
linguistic competence to shared decision-making?

• Advocates
• Elicit information about families views on
  advocacy
• Dont challenge authority
• Experiences of discrimination and bias
• Experiences of trauma
• Immigration issues even if documented
• Support needs for language access within your
  organization and with providers
• Advocate for systems, health care organizations
  and practices to address cultural issues
• Be a champion

Slide Source National Center for Cultural
Competence,2008
45
What will it take to bring cultural and
linguistic competence to shared decision-making?

• Advocacy and support organizations
• Assess your awareness, knowledge and skills
• Advocates that reflect the diversity of the
  community served
• Address language access
• Dynamics of differencebuild skills
• Partner with support networks in community served
• Policies to support cultural and linguistic
  competence

Slide Source National Center for Cultural
Competence,2008
46
INTEGRALLY LINKED Pieces of the Same Puzzle
T.D. Goode
Slide Source National Center for Cultural
Competence,2008
47
Cultural and linguistic competency are a lifes
journey not a destination Safe travels!
T.D. Goode Slide Source National Center for
Cultural Competence, 2008