The ABCs OF Cultural Competency For Community Based Prevention Program

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The ABCs OF Cultural Competency For Community
Based Prevention Program

• 2006 Multicultural Conference
• June 8, 2006
• Ft. Lauderdale, FL

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• Michael D. Dozier, President CEO
• Partnership For A Healthy Scott County, Inc.

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Section 1.

• CORE CONCEPTS

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Culture

• The shared values, traditions, norms, customs,
  arts, history, folklore, and institutions of a
  group of people that are unified by race,
  ethnicity, language, nationality, or religion
• Source Perspectives of Difference, Division of
  General Internal Medicine, University of
  California, San Francisco

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Culture of Origin

• Ones culture of origin provides him/her with
  a basic understanding of the world. It provides
  the means to perceive and explain our
  experiences. It teaches about customs,
  philosophy, and behavior.

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Culture - an individual can identify with
multiple groups

• National origin
• Ethnicity
• Race
• Gender
• Sexual orientation
• Religion
• Rural, urban, suburban
• Socio-economic status

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Competence

• Acquisition of knowledge, skills, and
  experience necessary for the development and
  implementation of services to different groups
  served

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U.S. Dept. of Health and Human Services

• A set of behaviors, attitudes and policies that
  come together in a system, agency, or program or
  among individuals, enabling them to function
  effectively in diverse cultural interactions and
  similarities within, among, and between groups.

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Cultural Competence is a point on a continuum
that represents the POLICIES and PRACTICES of an
organization, or the VALUES and BEHAVIOR of an
individual which enable that organization or
person to interact effectively in a culturally
diverse environment.
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Cultural Competence Continuum
Incapacity
Destructiveness
Blindness
Proficiency
Competence
Pre-Competence
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Four levels to the concept

• 1. Cultural knowledge Individuals know about
  some cultural characteristics, history, values,
  beliefs, and behaviors
• 2. Cultural Awareness next stage, individual is
  open to the idea of changing cultural attitudes

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Four levels to the concepts

• 3. Cultural Sensitivity knowing differences
  exist between cultures, but not assigning values
  to the difference. At this point clashes, and
  internal conflicts most often occur.

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Four levels of the concept

• Cultural Competence, brings together the previous
  stages, and adds operational effectiveness. A
  culturally competent organization brings together
  different behaviors, attitudes, and policies and
  works effectively in cross-cultural settings to
  produce better results
• Source Community Tool Box, Univ. of Kansas

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Cultural Competence is not the same as cultural
diversity.

• Cultural Diversity DIFFERENCES in race,
  ethnicity, language, nationality, or religion
  among various groups within a community. A
  community is said to be culturally diverse its
  its residents include members of different groups.

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Guiding Principles of Cultural Competency

• Each group has unique cultural needs
• Action Make room in your organization for
  several paths that lead to the same goal

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Guiding Principles of Cultural Competency

• Diversity within cultures is important
• Action Recognize that cultural groups are
  complex and diverse, do not view them as
  monolithic

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Guiding Principles of Cultural Competency

• People have group identities and personal
  identities
• Action Although it is important to treat all
  people as individuals, also acknowledge their
  group identity

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Guiding Principles of Cultural Competency

• People are served in varying degrees by the
  dominant culture
• Action Recognize that what works well for
  the dominant cultural group, may work against
  members of other cultural groups

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Guiding Principles of Cultural Competency

• Culture is ever-present
• Action Acknowledge culture as a predominant
  force in shaping behaviors, values, and
  institutions.

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Section 2

• Value and importance of cultural competence

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Cultural Competence

• Why is cultural competence important for you,
  your organization, and your community?

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• Why is being culturally competence important to
  you?

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Benefits of Organizational Cultural Competence

• Increase respect and mutual understanding among
  those involved
• Increases civility in problem-solving through new
  perspectives, ideas, strategies
• Decreases unwanted surprises that might slow
  progress

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Benefits of Organizational Cultural Competence

• Increases participation and involvement of other
  cultural groups
• Increases trust and cooperation
• Helps overcome fear of misteaks, competition or
  conflict
• Promotes inclusion and equity
• Source Community Tool Box, Univ. of Kansas

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Thus,

• How could your organization benefit from being
  culturally competent (if it isnt already!)?

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Organizations have a culture
of policies, procedures, programs, and processes,
and incorporate certain values, beliefs,
assumptions and customs An organizational
culture may not lend itself to culture
competence, so thats where skill building comes
in.Source Univ. of Kansas, Community Took Box
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Critical Domains for Measuring Cultural
CompetenciesLiterature suggests that cultural
competence must be evidenced or manifested in a
broad range of spheres or areas.Source HRSA
- OMH
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Cultural Competency Domains
Policy
Physical Environment
Effective Prevention
Values
Training
Community Participation
Communication Style
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Organizational DiversityPrimary

• Ethnicity
• Gender
• Sexual Orientation
• Social Class
• Spiritual beliefs and practice
• Physical and mental ability

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Organizational DiversityOther types less
salient

• Age
• Language
• Education
• Customs
• Customs
• Skills and Talents
• National/regional origins

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Challenges for Professional

• Value Diversity
• Understand their cultural biases
• Internalize Cultural Knowledge
• Develop Adaptations to Diversity
• Source HRSA Office of Minority Health

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Indicators of culturally competent organizations

• Outreach outreach to diverse groups is
  encouraged and is part of organizational plan
• Cultural concepts inclusive language is used
  cross-cultural concepts are understood

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Indicators of culturally competent organizations

• Leadership leadership is supportive and
  committed to cultural competence
• Vision/Mission diversity is integral to the
  program vision/mission
• Staff composition staff reflects the diversity
  of the community

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Indicators of culturally competent organizations

• Training/staff development Organization
  provides/facilitates training on cultural
  diversity issues.
• Collaboration staff and diverse community
  members work together and share responsibility
  for addressing substance abuse problems

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Section 3

• Building a Culturally Competent Organization

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Action Steps for Achieving Cultural Competence

• Develop support for change throughout the
  organization (who wants change and who doesnt?)
• Is this a top-down mandate? How deep is the
  buy in?
• Do you need a representative committee?

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Action Steps for Achieving Cultural Competence

• Identify the cultural groups to be involved.
• Who needs to be involved in the planning,
  implementation, and reinforcement of the change?

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Action Steps for Achieving Cultural Competence

• Identify barriers to cultural competence at work
  in your organization
• What is currently not working, what will
  slow you down or stop you?

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Organizations barriers

• Lack of understanding
• Lack of resources
• Lack of leadership commitment
• Lack of training opportunities
• Staff resistance

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Cross-Cultural Stumbling Blocks

• Language different languages, dialects, certain
  concepts hard to translate
• Class-related values
• Culture-related values different meanings and
  values attached to behavior, events, situations
• Non-verbal communication gestures, facial
  expressions, eye contact may have different
  meanings

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Cross-cultural Stumbling Blocks

• Stereotyping assignment of characteristics or
  beliefs about another culture based on prejudice,
  or limited exposure
• Racism
• Ethnocentricity belief that ones ethnicity
  provides the true or correct view of the world

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Action steps for Achieving Cultural Competence

• 4. Assess your current level of cultural
  competence
• What knowledge, skills, and resources can you
  build on? Where are the gaps?

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Some guideposts for assessing organizational
cultural competence

• Experience or track record of involvement with
  the target population
• Staffing
• Training availability and scope
• Community representation
• Language

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Further guideposts for assessing organizational
cultural competence

• Environment
• Materials
• Evaluation
• On-going self-assessment

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Action Steps for Building Cultural Competence

• Identify the resources needed
• How much funding is required to bring about the
  changes? Where can you find the resources?

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Action Steps for Building Cultural Competence

• 6 Develop goals and implementation steps and
  deadlines for achieving them.

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Action Steps for Achieving Cultural Competence

• 7. Commit to an ongoing evaluation of progress
  (measuring outcomes) and be willing to respond to
  change
• What will success look like? How do you know you
  are on the right track?

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Interventions for increasing organizational
cultural competence

• Increase the number of diverse persons in the
  organization
• Develop educational plan for employees, coalition
  members, volunteers, to improve competencies
  required for effective cross-cultural work

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Interventions for increasing organizational
cultural competence

• Identify and re-write policies, practices, and
  structures that limit the full participation of
  diverse communities
• Hold educational events exploring diverse groups
  history, cultural, issues, and strengths

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Interventions for increasing cultural competence

• Assure that the right voices are at the table
• Establish, communicate, and model how the
  mission, vision, goals and values of the
  coalition align with and are served by a diverse
  membership and inclusive practices.

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Section 4

• Building Cultural Competency in your Community
  Coalition

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Why is understanding culture important to build
community?

• Need large number of people to join forces.
• Each group has unique strengths and perspectives
  we can all benefit from.
• Understanding culture will help us overcome and
  prevent racial and ethnic divisions.

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Why is understanding culture important to build
community?

• People from different cultures have to be
  included in the decision-making process.
• Appreciation of culture goes hand-in-hand with a
  just and equitable society.
• Should understand the contributions of all to our
  common history

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Coalition cultural competence community assessment

• Assessment Activities
• Does your community assessment include
  information about the major cultural groups in
  your community?
• Have members of diverse groups assisted the
  organization in analyzing and interpreting the
  data?

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Cultural Assessments

• Values and lifeways
• Religious, philosohical, and spiritual belfeifs
• Economic Factors
• Educational Factors
• Technological Factors
• Kinships and social ties
• Political and Legal Factors
• Source Leninger Conceptualization of
  transcultural Health Care Systems, 1993

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Cultural Assessments

• Values and lifeways
• Religious, philosohical, and spiritual belfeifs
• Economic Factors
• Educational Factors
• Technological Factors
• Kinships and social ties
• Political and Legal Factors
• Source Leninger Conceptualization of
  transcultural Health Care Systems, 1993

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Cultural competence community assessment

• Planning
• Does your strategic plan address needs of
  diverse groups in your community?
• Do your organizational plans incorporate
  cultural competence concepts?

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Organizational cultural competence community
assessment

• Community mobilization
• Does your organization engage all sectors of your
  community in a community-wide prevention effort?
  Are some groups not adequately represented or at
  the table?

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Program Selection

• Who conducted the research, developed the
  program?
• How did the researchers/program developers
  control for cultural competency in the program
  design?
• What groups were included in the studies?

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Program Selection

• Have any replications been done in diverse
  communities?
• Are materials available in languages other than
  English? Who did the translation? Were they
  tested?
• Is the program developer willing to work with
  others to adapt the program?

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Organizational cultural competence assessment

• Implementation
• Have you selected a prevention program that
  needs to be adapted to meet the needs of diverse
  groups?

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Fidelity and Adaptation

• Identify the theory base behind the program
• Employ core components analytic data
• Assess fidelity/adaptation concerns for the
  particular implementation site
• Consult with model program developer

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Fidelity and Adapatation

• Consult with organization and/or community in
  which the implementation will take place
• Conduct focus groups
• Identify other adaptations
• Identify translations, is possible
• Identify local experts for assistance, your state
  SSA, national organizations

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Fidelity and Adaptation

• Develop an overall
• implementation plan
• based on these inputs

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Evaluation Guidelines

• Define the population precisely
• Develop collaborations with the target population
• Encourage buy-in
• Provide timely feedback and results in clear,
  useful formats conveyed through culturally
  appropriate methods

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Evaluation Guidelines

• Consider acculturation and biculturalism in
  interpretation and utilization of data
• Know when to aggregate the within-group data from
  a heterogeneous sample and still maximize
  external validity
• Avoid deficit model interpretations

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Best Practices for Culturally Competent Evaluation

• Develop specific cultural knowledge
• Explicitly examine the theoretical framework that
  is the foundation of your research
• Define and measure ethnicity in a meaningful
  manner

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Best Practices

• Make sure your analyses reflect study question
  and that you have sufficient power to get
  accurate answers
• Interpret results to reflect the lives of the
  people studied.
• Source Guidelines and Best Practices for
  Culturally Competence Evaluations, The Colorado
  Trust, 2002.

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Section 5

• Culturally Proficient
• Behavior

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Culturally proficient behavior

• Value Diversity (name the differences)
• Celebrate and encourage the presence of a variety
  of people in ALL activities
• Assess your culture/claim your identity

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Culturally Proficient Behavior

• Recognize how your culture affects others
• Understand how the culture of your organization
  affects those whose culture is different

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Culturally proficient behavior

• Have in place effective strategies for resolving
  conflict among people whose cultural backgrounds
  and values may be different from your.
• Understand the effect that historic distrust has
  on present day interactions

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Culturally proficient behavior

• Have a training/staff development program that
  provides information and skills that enable all
  to interact effectively in a variety of
  cross-cultural situations and incorporates
  cultural knowledge.

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Section 6

• Resources

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Cultural Competence Resources

• Caldwell, C., Jackson, J., Tucker B., Bowman,
  P. Culturally-Competent Research Methods in
  Advances in African American Psychology, 1999.
• Catalano R., Morrison D., Wells E., Gillmore M.,
  Iritani B., and Hawkins D., Ethnic Differences
  in Family Factors Related to Early Drug
  Initiation Journal of Studies on Alcohol, Vol.
  53, No. 3, 1992.
• Burchum, J., Cultural Competence An
  Evolutionary Perspective Nursing Forum, Vol. 37,
  No. 4, 2002.

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Cultural Competence Resources

• Geron, S. Cultural Competency How is it
  Measured? Does it make a Difference?
  Generations, Fall 2002.
• Luquis R., and Perez, M. Achieving Cultural
  Competence The Challenges for Health Educators
  American Journal of Health Education, May/June
  2003.
• Resnicow, K., Soler, R., and Braithwaite R.
  Cultural Sensitivity in Substance Abuse
  Prevention Journal of Community Psychology,
  Vol. 28, No. 3, 2000.
• Roosa, M., Dumka, L., Gonzalez, N., and Knight,
  G. Cultural/Ethnic Issues and the Prevention
  Scientist in the 21st Century APA, Prevention
  and Treatment, Vol. 5, Art 5, 2002.

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Cultural Competence Resources

• Terrell, D. Ethnocultural Factors and Substance
  Abuse Toward Culturally Sensitive Treatment
  Models Psychology of Addictive Behaviors, Sept.
  1993, Vol. 7, No.
• University of Kansas, Community Tool Box, Tools,
  Chap. 27. Cultural Competence in a Multicultural
  World. http//ctb/ku/edu/tools/en/chapter_1027.htm
  
• Zickler, P.Ethnic Identification and Cultural
  Ties May Help Prevent Drug Use NIDA Notes,
  Research Findings, Vol 14, No. 3, Sept. 1999.

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Cultural Competency Resources

• U.S. Dept. of Health and Human Services, Health
  Resources and Services Administration, Office of
  Minority Health, Conceptualizing Cultural
  Competence and Identifying Critical Domains
  http//www.hrsa.gov/OMH/cultural/sectionii.htm
• U.S. Dept. of Health and Human Services, Office
  of Minority Health, National Standards for
  Culturally and Linguistically Appropriate
  Services in Health Care. Washington, D.C. 2001
• U.S. Dept. of Health and Human Services, Office
  of the Surgeon General, Mental Health Culture,
  Race and Ethnicity. Rockville, 2001