Title: Fulfilling the Promise of Community Living
1Fulfilling the Promise of Community Living
Center for Medicare Medicaid Services New
Freedom Initiative Second Annual Systems Change
Conference Baltimore, MD March 25, 2002
Developed by National Center for Cultural
Competence, 2002
2Achieving Cultural Competence in Organizations
Implications for Systems of Support for
Individuals with Disabilities
- Tawara D. Goode
- National Center for Cultural Competence
- Georgetown University Child Development Center
- University Center for Excellence in Developmental
Disabilities Education, Research Service
Developed by National Center for Cultural
Competence, 2002
3Rationale for Cultural Competence in Health Care
Human Services
- Respond to current and projected demographic
changes - Eliminate long-standing health disparities
- Improve quality of services and health outcomes
(Excerpted from NCCC Policy Brief series)
Developed by National Center for Cultural
Competence, 2002
4Rationale for Cultural Competence in Health Care
Human Services
- Meet legislative, regulatory and accreditation
mandates - Gain a competitive edge in the market place
- Decrease risk of liability/malpractice
(Excerpted from NCCC Policy Brief series)
Developed by National Center for Cultural
Competence, 2002
5Percentage Increase in the Hispanic/Latino
Population in the United States 1990-2000
FL
SC
AL
LA
NC
TN
VA
GA
KY
MS
WV
Source Census 2000 Summary File 1990 Summary
Tape File
Developed by National Center for Cultural
Competence, 2002
6Trends for U.S. Immigrants
19.8 million
28.4 million
millions
Source Profile of the Foreign Born Population in
the U.S., www.census.gov.
Developed by National Center for Cultural
Competence, 2002
7Top Five Countries of Origin for U.S. Immigrants
(in Millions)
1990
millions
Source USA Today article USA just wouldnt work
without immigrant labor, July 2001
Developed by National Center for Cultural
Competence, 2002
8Top Five Countries of Origin for U.S. Immigrants
(in Millions)
2000
millions
Source USA Today article USA just wouldnt work
without immigrant labor, July 2001
Developed by National Center for Cultural
Competence, 2002
9DATA FROM 2000 CENSUS
- Diversity is much more complex than ever measured
by the census bureau. - Almost one-third of the U.S. Population is from
racially, ethnically and culturally diverse
groups. - 2.4 of people described themselves as belonging
to more than one race. - Single largest multiracial category is white and
Some Other Race.
Source Overview of Race Hispanic Origin, U.S.
Census Bureau
Developed by National Center for Cultural
Competence, 2002
10Cultural Factors That Influence Diversity Among
Individuals and Groups
- External Factors
- Institutional Biases
- Community Economics
- Intergroup Relations
- Natural Networks of Support
- Community History
- Political Climate
- Workforce Diversity
- Community Demographics
- Internal Factors
- Cultural/Racial Identity
- Socioeconomic Status/Class
- Nationality
- Language
- Family Constellation
- Social History
- Health Beliefs Practices
- Perception of Disability
- Age Life Cycle Issues
- Spatial Regional Patterns
- Gender Sexuality
- Sexual Orientation
- Religion Spiritual Views
- Political Orientation Affiliation
Modified from James Mason, Ph.D., NCCC Senior
Consultant
Developed by National Center for Cultural
Competence, 2002
11Cultural Influences on Perceptions of Disability
, Health Beliefs Practices
- Superstition
- Malevolent Forces
- Religiosity
- Spirituality
- Familial Folklore
- Natural life occurrence
T.D. Goode
Developed by National Center for Cultural
Competence, 2002
12Cultural Competence
Is a congruent set of behaviors, attitudes,
policies structures and practices that come
together in a system, agency or among
professionals and enables that system and agency
or those professionals to work effectively in
cross-cultural situations. (Modified from Cross,
Bazron, Dennis and Isaacs, 1989)
Developed by National Center for Cultural
Competence, 2002
13Culture
- Culture is an integrated pattern of human
behavior which includes - thought, communication,
languages, beliefs, values, practices, customs,
courtesies, rituals, manners of interacting,
roles, relationships, and expected behaviors of a
racial, ethnic, religious or social group the
ability to transmit the above to succeeding
generations.
Developed by National Center for Cultural
Competence, 2002
14An Iceberg Concept of Culture
dress?age
surface level
race/ethnicity
gender ? language
Adapted by the NCCC
eye behavior?facial expressions
body language ?sense of self
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
roles in relation to status by age, gender class
and much more
Developed by National Center for Cultural
Competence, 2002
15Competence
- The word competence is used because it
implies having the capacity to function within
the context of culturally-integrated patterns of
human behavior values, attributes, knowledge and
a skill set to work effectively cross culturally.
(Modified from Cross, Bazron, Dennis and Isaacs,
1989)
Developed by National Center for Cultural
Competence, 2002
16Five Elements of Cultural Competence
Organizational
- valuing diversity
- cultural self-assessment
- managing the dynamics of difference
- institutionalization of cultural knowledge
- adapting to diversity
- - policies - structures
- - values - services
(Cross, Bazron, Dennis and Isaacs, 1989)
Developed by National Center for Cultural
Competence, 2002
17ESSENTIAL ELEMENTS IN A CULTURALLY COMPETENT
SYSTEM
- These five elements must be manifested at
every level of an organization - policy making,
administrative, practice/service delivery and
consumer/family levels - and reflected in its
attitudes, structures, policies and services.
(Modified from Cross, Bazron, Dennis and Isaacs,
1989)
Developed by National Center for Cultural
Competence, 2002
18CULTURAL COMPETENCE CONTINUUM
Cultural Proficiency
Cultural Competence
Cultural Pre-Competence
Cultural Blindness
Cultural Incapacity
Cultural Destructiveness
(Cross, Bazron, Dennis and Isaacs, 1989)
Developed by National Center for Cultural
Competence, 2002
19Culturally Competent Practices
- Policy making
- Administrative
- Service delivery
- Consumer
(Excerpted from Policy Brief 1 - NCCC)
Developed by National Center for Cultural
Competence, 2002
20Culturally Competent PracticesConsumer Level
- advocacy
- partnerships with other families/individuals
- advisory groups
- board membership
- knowledge beacon
Source Georgetown University Child Development
Center, Tawara D. Goode
T.D. Goode
Developed by National Center for Cultural
Competence, 2002
21As a culturally competent manager, I am capable
of interacting positively with people who do NOT
look like,
talk like,
think like,
believe like,
act like,
live like...
ME!!!
Source Multnomah County Department of Health,
Oregon.
Developed by National Center for Cultural
Competence, 2002