What is Culture and Cultural Competence?

1
What is Culture and Cultural Competence?
Cecily Rodriguez Director, Office of Cultural and
Linguistic Competence DBHDS
2
Todays Outcomes

• Give a rationale for this work
• Explore the cultures with which we are affiliated
• Define Cultural Competency
• Look at some strategies to deepen your ability to
  provide culturally and linguistically appropriate
  services.

3
Rationale for Cultural Competency
Why We Cant Wait!
4
Why Cultural Competence?

• Growing Population diversity
• Disparities in access and outcomes
• Limited staff with CLC expertise
• Lack of organizational and systemic focus on CLC
  Efforts
• Legal requirements related to language access
• Federal and state expectations and accreditation
  criteria

5
What is culture?
DBHDS defines culture in the broad sense, as
there are other things in addition to race,
language, and ethnicity that contribute to a
persons sense of self in relation to others.
Multiple memberships in these subgroups
contribute to an individuals personal identity
and sense of own culture.
6
How is culture like an iceberg? Model from the
National Center for Cultural Competence

• Visible Part
• Ways of life
• Laws and customs
• Institutions
• Rituals
• Language
• Hidden Part
• Norms
• Roles
• Ideologies
• Beliefs
• Philosophy
• Values
• Tastes
• Attitudes
• Assumptions
• Expectations
• Myths

7
Dimensions of Culture
8
REMEMBER!

• Using generalizations to understand a group of
  people is productive and helps one gain insight
  into communication styles and behaviors
• Using stereotypes to categorize or judge people
  is destructive and discriminatory.

9
The Traditional Culture of the Health and Human
Services System

• Emphasis on diagnosis and disability labels
• Focus on interventions, goal setting, and data
  collection
• Terminology, acronyms and jargon
• Focus on professionals determining what is best
  for the individual and how to satisfy rules and
  regulations.

10
Traditional American Macro Culture

• American culture has at its roots
• Belief in the value of equality, self
  determination, self-reliance, and independence
• Preference for informality and direct
  communication
• Focus on clock time and calendars, meeting
  deadlines and punctuality
• Faith in technology and sciences

11
Micro Cultures

• Is a small unit of culture within a wider general
  culture. It is the identity and traits of a
  particular people within a dominant culture that
  is never lost to assimilation.
• It is the customary beliefs, social forms and
  material traits of a racial, religious or social
  group.
• There are many micro cultures living in the US
• Immigrant communities
• Minority communities
• Religious communities
• Ideological communities
• Most people in micro cultures have to straddle
  their own culture and that of the macro culture
  to navigate daily life.

12
Examples of differences in macro and
micro/immigrant cultures related to disabilities

• American Macro Culture
• Sees disability caused by medical problems or
  physical trauma during pregnancy
• Assumes it is best to do something about the
  disability. The focus in on improving the
  situation
• Response to disability is to provide treatment
  and research.

• Micro/Immigrant Culture
• Sees disability as caused by a spiritual crisis
  (blessing or punishment). May blame some action
  like a susto
• May take a wait and see approach. They may
  feel that the disability is there for a purpose
  and should not try to cure it.
• May respond through prayer, talisman, rebalancing
  of the body (through food or drink). Use
  acupuncture or ceremonies to deal with or heal
  the disability.

13
WHAT IS CULTURAL COMPETENCE?

• There are five abilities that are considered
  necessary to achieve individual cultural
  competence.
• We value diversity
• We are able to understand our own cultural views
  (and those of our affiliated organizations and
  systems)
• We are aware of how culture may be affecting a
  life situation
• We are willing and able to learn about other
  cultures
• We are able to change our behavior to meet the
  needs of others and other cultures.

14
Strategies to improve cultural competence
15
National Standards on Culturally and
Linguistically Appropriate Services (CLAS)

• Organized by themes
• Culturally Competent Care (Standards 1-3)
• Language Access Services (Standards 4-7)
• Organizational Supports for Cultural Competence
  (Standards 8-14)

16
Definition of Cultural Competence
17
CLAS 1-3

• Standards for Culturally Competent Care

18
CLAS 1-3

• Take the time to recruit retain diverse and
  culturally competent employees
• Participate in networks for diversity recruiting
• Post in diverse papers and/or websites
• Make accommodations for language and technology
  barriers for applicants
• Host internal support groups for new hires

19
CLAS 1-3

• DONT FORGET ADMINISTRATIVE STAFF!!
• We spend a lot of time training health care and
  other professionals to provide culturally and
  linguistically competent services and supports.
• BUT! families have to make appointments, ask
  questions about insurance, check in, and provide
  information at each visit.

20
CLAS 1-3

• Minimal training activities for all staff
• Cross cultural communication
• Communicating complex information to individuals
  who possess low literacy skills or who are not
  literate or not verbal.
• confronting bias, discrimination, and racism in
  health, mental health, and social service
  systems.

21
CLAS 4-7

• Language Access Services

22
Definition of Linguistic Competence

• 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 have low literacy
  skills or are not literate, and individuals with
  disabilities.

23
Language Access Services

• Ensure that interpreting and translating services
  are considered mission critical.
• Budget for those costs as you would any overhead
  and consider them the cost of doing business, not
  just a luxury.
• Request/require all bi-lingual staff to become
  certified interpreters and pay them for that
  additional skill when the perform it.
• Train ALL staff to work effectively with
  interpreters

24
CLAS 4-7
25
Literacy

• The NAAL (National Assessment of Adult Literacy)
  administered tests which revealed that an
  estimated 14 of US residents would have extreme
  difficulty with reading and written comprehension
  
• Fourteen percent of adults (30 million people)
  have Below Basic health literacy. 

26
CLAS 8-14

• Organizational Supports for
• Cultural Competence

27
CLAS 8-14
28
CLAS 8-14
29
Whats Next?

• The most important thing you can do to become
  more culturally competent is to understand your
  own culture and assess your bias and the lens
  with which you view your world.
• Take the online tests to deepen your
  self-awareness.
• https//implicit.harvard.edu/implicit/demo/
• http//erc.msh.org/mainpage.cfm?file3.0.htmmodul
  eprovider languageEnglish
• Take some time to learn about the culture and
  languages of the communities in your service area.

30
(No Transcript)
31
For More Information

• http//www.dbhds.virginia.gov/OHRDMCLC.htm
• Cecily Rodriguez
• Cecily.rodriguez_at_dbhds.virginia.gov
• 804.786.5872