Florida CHIPRA Webinar Cultural Competence in Shared Decision-making September 25, 2012 Suzanne M. Bronheim, PhD

Examining Values and Beliefs Who has “jurisdiction”—is this health? Is health the most important aspect of this issue? Slide Source: National Center for Cultural Competence ©2012

Examining Values and Beliefs What is health? – Absence of disease – Defined by medicine – WHO definition—physical, emotional well-being – Absence of sin/purity – Harmony (within self, with community, with nature) Slide Source: National Center for Cultural Competence ©2012

Making Shared Decisions Need a shared “lens” on: – Is there a problem? – What is the problem? – What are the choices? – What principles guide the choices? – Who are the decision makers? – What are the roles of the “team”?

Is there a problem? What is a problem that needs to be solved? – Physical differences/limitations – Prevention of illness – Life shortening conditions – Behavioral differences – Perceptual/cognitive differences Slide Source: National Center for Cultural Competence ©2012

What is the problem? What causes illness? – Germs – Punishment – Genes – Environment – Imbalances (e.g. hot/cold) – Energy disturbances – Supernatural forces Slide Source: National Center for Cultural Competence ©2012

What is the problem? Child’s acceptance in community Child’s spiritual well- being/wholeness Amount of time family is off from work Child cannot participate in family camping/sporting activities Slide Source: National Center for Cultural Competence ©2012

What are the choices? What helps? – Faith/prayer – Medical treatment – Reestablishing balance (e.g. hot/cold) – Changes in life style – Community cleansing Slide Source: National Center for Cultural Competence ©2012

What are the choices? Living with the situation Seeking public supports Tapping natural networks of support Keeping it secret Slide Source: National Center for Cultural Competence ©2012

What principles guide the choices? Current scientific evidence Family/cultural tradition Financial considerations Child/youth choice Religious laws/beliefs Slide Source: National Center for Cultural Competence ©2012

Who makes the decision? Health/mental health care provider? Parents? Child/youth? Family elders? Community elders/leaders? Public agencies? Courts? Slide Source: National Center for Cultural Competence ©2012

What are the roles of the “team”? Dr. is always in charge? Parents are in charge? Child/youth has a say? Extended family/community? Equals? Slide Source: National Center for Cultural Competence ©2012

Bridging the Gap Slide Source: National Center for Cultural Competence ©2012 Who is on the team? Whom do you need to be involved to make a decision? What is the most important thing to you and those on the team when making this decision? (Family and you!)

Bridging the Gap Slide Source: National Center for Cultural Competence ©2012 E Explanation (How do you explain your illness?) T Treatment (What treatment have you tried?) H Healers (Have you sought any advice from folk/traditional healers?) N Negotiate (mutually acceptable options) I (Agree on) Intervention C Collaboration (with patient, family, and healers) Kleinman A. Patients and Healers in the Context of Culture. Berkeley, California: Univeristy of California Press, 1980.

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