Fulfilling the Promise of Community Living

1
Fulfilling 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
2
Achieving 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
3
Rationale 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
4
Rationale 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
5
Percentage 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
6
Trends 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
7
Top 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
8
Top 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
9
DATA 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
10
Cultural 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
11
Cultural 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
12
Cultural 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
13
Culture

• 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
14
An 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
15
Competence

• 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
16
Five 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
17
ESSENTIAL 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
18
CULTURAL 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
19
Culturally Competent Practices

• Policy making
• Administrative
• Service delivery
• Consumer

(Excerpted from Policy Brief 1 - NCCC)
Developed by National Center for Cultural
Competence, 2002
20
Culturally 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
21
As 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