Developing Cultural Competence An Introductory Look at Cultural Competency in Health Care Presented by Tom Rue, M.A., CASAC, CCMHC – AC II Richard C. Ward Addiction Treatment Center At Core Training – March 2002

“Cultural competence… a journey, not a destination”

Objectives Increase awareness of cultural competence Understand the elements of cultural competence in health care Apply cultural competence mindset to your job/responsibilities

Cultural Norms “Should’s and ought’s of the group. Examples are standards of behavior such as: - productivity norms - equity norms - styles of dress - power and control in relationships - acceptable behaviors, etc.

What is Culture? Culture is the acquired knowledge that people use to interpret experience and generate social behavior.

Cultural Value Orientations Innate Human Nature Relationship to Nature Relationship to Time Purpose of Being Relationship to Other Persons

What is Cultural Diversity? Culture is shared... –Values, norms, traditions/customs –Arts –History, folklore –Institutions Cultural Diversity –Differences in race, ethnicity, language, nationality, religion, other beliefs

Cultural Components Race Country of origin Native language Socio-economic status Education level Religion Mental or physical abilities

More Cultural Components Heritage Acculturation Age Gender Sexual orientation Definition of normality –Such as “mental illness” Responses to abnormality –Stigma vs. Acceptance

Functional Definition Use of knowledge about individuals and groups of people to produce policies practices attitudes specific standards

Awareness and acceptance of cultural differences Self Awareness Understanding of dynamic differences among cultures Basic knowledge about a client’s culture Adaptation Components of Cultural Competence

Cultural Competence in Health Care Set of attitudes, skills, behaviors, policies –Enables organizations and individuals to work effectively cross-culturally –Understands importance of health-related beliefs, attitudes, and practices communication patterns of beneficiaries –Eliminates disparities in health status

Cultural Competence in Health Care A demonstrated awareness and integration of three population specific issues –health-related beliefs and cultural values –disease incidence and prevalence examples: gender, Native Americans, Irish, etc. –treatment efficacy

Cultural Competence in Health Care Responds to demographic changes in US Improves quality –services –health outcomes Meets mandates of credentialing bodies: –Commission on Accreditation of Rehabilitation Facilities (CARF) –Joint Commission on Accreditation of Hospital Organizations (JCAHO) –US Department of HHS, Office of Minority Health

National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS) Main Themes –Culturally competent standards (1-3) –Language access services (4-7) –Organizational support (8-14) Varying Stringency –Mandates (4,5,6, & 7) –Guidelines 1,2,3,8,9,10,11,12,13) –Recommendations (14) Full document is on the website of U.S. Department of Health & Human Services, Office of Minority Health at

Why?

Demographic Statistics 67 million (1 in 4) classified as minority Latinos –Represent almost half of minority Americans –Nearly equal in number to African Americans –Largest racial/ethnic minority population by 2025 People of color –1 in 3 Americans by 2050 Higher birth rates Higher immigration rates

Health Care Statistics Mortality rates higher until age 44 –African Americans –Latinos –Native Americans Infant mortality –Twice as high among African Americans Deaths due to HIV/AIDS –Dramatically increased African Americans Latinos

Individual Cultural Competence Continuum Model

Organizational Cultural Competence A journey, not a destination... Unaware, Competent Aware, Incompetent Aware, Competent Unaware, Incompetent

Journeying to a Culturally Competent Organization Communication is encouraged Staff represent the diversity of community members Leadership is committed and supportive All employees are involved Inclusive organizational structures and policies exist

Our Journey Sharing experiences Progressing along our personal continuum Moving closer to our destination AND always... Improving the quality of health care in the communities we serve

Charlotte Newman & Jan Kelley (2001). Cultural Quality: An Introductory Look into Cultural Competency in Health Care, slide show for the Delmarva FoundationCultural Quality: An Introductory Look into Cultural Competency in Health Care Hope Center for Advance Technologies (2001). Psychology With Sociology, a course developed by faculty from Lawrence Technological University, University of Detroit-Mercy, and Wayne State UniversityPsychology With Sociology Joan Engebretson (2001). Culture and Health Care, class notes for Advance Practice Nursing: Health Promotion, The University of Texas-Houston, Health Science Center School of NursingCulture and Health Care Acknowledgements