Frances lobos Kathy reyes

5.3.2019 Frances lobos Kathy reyes
Cultural Humility: Working in Partnership with Individuals, Families and Communities Kathy Frances lobos Kathy reyes © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Welcome Kathy Do No Duplicate Without Permision

Jann Murray-Garcia, MD, MPH Melanie Tervalon, MD, MPH
Cultural Humility Versus Cultural Competence: A Critical Distinction In Defining Physician Training Outcomes In Multicultural Education A lifelong process of critical self-reflection and self-critique Redressing the power imbalances in the patient-provider dynamic Developing mutually beneficial partnerships with communities on behalf of individuals and defined populations Advocating and maintaining institutional accountability that parallels the three principles above Kathy This may be review for some of you. I apology if it is, and I know it is important to be clear and explicit about the framework. Jann Murray-Garcia, MD, MPH Melanie Tervalon, MD, MPH Tervalon M, Murray-Garcia J: “Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education, “Journal of Health Care for the Poor and Underserved 1998; 9(2): Slide courtesy of Leanna Lewis, LCSW

© 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission
Together Develop a common understanding of the principles of cultural humility Practice using the principles in our work through activities Summary /Follow –up/ Action Plans Kathy © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Agreements Listen as if the speaker is wise; listen to understand Practice “I” statements when speaking Ok to respectfully disagree Take risks; No pressure to speak Be disciplined about not making assumptions Frances © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Agreements No blaming, no shaming Confidentiality if stories are shared Courage to interrupt if something is going amiss or being left unsaid Voices, thoughts, ideas, experiences welcome Pay attention to what moves you; use oops and ouch Frances © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Expectations Listen and learn Be fully present: attentive to oneself and others Share what you can Not everything will be covered We are perfectly imperfect Frances © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Facilitator Assumptions *
There are always more questions than answers This is an ongoing learning process We are equals – peers- in this learning space Our values, cultural identities, and past experiences matter Conflict is always possible, and conflict is OK and can be transformational We are all prejudiced; prejudice is learned and can be unlearned We are here to learn from each other *From the work of Dr. Veronica Neal Frances © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Growth Model Panic Zone Stretch Zone Comfort Zone
June 2016 Growth Model Panic Zone Stretch Zone Comfort Zone Where disbelief lives, and fear stops all action Where excitement lives, action takes place, and fear disappears Frances – trauma-informed – good stress and bad stress The comfort zone is the place where apathy thrives, where motivation dies and the status quo remains. The panic zone is the place where there is too much pressure, the stakes are too high and living here will burn you out. In between those two areas is the stretch zone, this is the place where we find the right amount of challenge and the right level of pressure. This is where we should monitor our goals, and make sure we carry out an ambitious view on where to set our goals. ~ Dean Seddon Where fear lives, action is limited or sporadic, and excitement wanes Adapted from © Leanna Lewis, LCSW Do No Duplicate Without Permision

The ground on which we stand
Kathy – Lead Facilitator Slides 9-12 provides a general history and describe the events listed here Note context and history –acknowledge many movements The photo features Sylvia Rivera (holding banner) and Marsha P. Johnson (holding cooler) -two trans women who were at Stonewall that night in 1969 and initiated and lead the fight back against the police raid. This photo was taken a few years later in 1973 at the the NYC Pride Parade -Pride was originally started to commemorate the Stonewall Riots. They were both a part of the Street Transvestite (note: this word is considered offensive these days) Action Revolutionaries (STAR). -Important to understand that historical context of the present moment -Inequality and hierarchy are deeply rooted systems in the United States. -Individuals, groups and communities have fought generation after generation for collective rights, freedom and wellbeing –often making huge sacrifices. -We are building upon a rich, deep and long history of peoples movements Do you recognize the photos? -What do they have in common? People most impacted on the front lines People power and Solidarity -Important to know our history, how it repeats, and learn from the challenges and successes

Civil Rights Movement (1960s)
Principles Basic human rights – equal human beings. Voting Access Equal Education Equal Housing Jobs without discrimination Health Facilities Kathy Slides 9-11 © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Title VI of the Civil Rights Act (1964): “No person in the United States shall, on the grounds of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.” Kathy Slides 9-11 Context setting – social justice, equality, equity movements that continue today © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission 12

Immigration, Diversity and Destiny
Culture Identity Difference Race Kathy transition this country is founded on immigrants so often forgotten when we talk across difference. important to remember the contributions of ppl from all across the world Exercise: tell your family immigration or migration story (forced, or internal to the US); remember this is the soil of indigenous people. African peoples in large part, arrived through the slave trade. Take care with language: many African peoples in the US were enslaved. (not slaves) there are African people who arrived in the 16, 17 hundreds who were free people. Pair-share – 2 minute Pay attention to what arises in the debrief – acknowledge all that is presented: sadness, power of the ancestors, what we do not know, the voices that propel us, elements of cultural identity and racial identity. Class, religion and gender as well. Large group debrief – 5 minutes © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

The words we use culture diversity race Equity isms Kathy Leanna – Lead Facilitator Often we use these words without a shared understanding of their meanings will not necessarily go through a "definition" power Gender expression/identity/pronouns privilege © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Exercise Kathy Same as before, go down list in silence with partner
Then instead of volunteers sharing assumptions at front do partner listening dyads: -One minute each to introduce yourself to your partner and share as many of the category identities that you feel comfortable with -no comments on you assumptions and whether or not they were right -want to prevent unintentional harm -whats the first 3 things you notice thinkstockphotos.com

Diversity – Differences - Identity .
Race Religion Ethnicity Nationality Appearance Body structure Physical ability Sexual identity Class Gender Age Primary language Family of origin Immigration status Occupation Sexual orientation Gender identity ….what else Family of origin Immigration status Occupation Sexual orientation Gender identity ….what else Kathy Exercise on assumptions, social identifiers – debrief Notice differences multiple social identities believes and perspectives that team members, co-workers, clients live with every day, and bring to the work place. Imagine together what this means in our work with each other and with clients After 30 seconds, take turns sharing your identities to your partner – take one-minute What was it like for you to be asked to identify this person in front of you? What was it like for you to know someone was identifying you without you telling them your identities? What was it like for you to share your identities? Acknowledge that assumptions are made routinely. Assumptions need to be tested. Otherwise we are acting on our imaginations which can be misrepresenting who the person is. Use curious inquiry. What we see first, why we act on these visual clues of the face: gender, skin color, age Adapted from - Pinderhughes EB: Understanding Ethnicity, Race and Power: The Key to Efficacy in Clinical Practice. New York: The Free Press, 1989, p. 25 © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

What is culture? Frances
7/31/2019 What is culture? Culture is a society’s style, its way of living and dying. It embraces the erotic and the culinary arts; dancing and burial; courtesy and curses; work and leisure; rituals and festival; punishments and rewards; dealing with the dead and with the ghosts who people our dreams; attitudes toward women, children, old people and strangers, enemies and allies; eternity and the present; the here and now and the beyond. Frances Adapted from Mexico and the United States, The New Yorker, September 17, 1979 Translated by Rachel Phillips Belash - Octavio Paz Octavio Paz, original wrote this in Spanish, so this translation may not fully capture the original meaning. Octavio Paz was referring to civilization though we believe this is applicable to what we mean and how we talk about culture certainly in the United States. Ask someone to read it aloud What do people think; does it capture/articulate culture? -Octavio Paz Adapted from Mexico and the United States, The New Yorker, September 17, 1979 Translated by Rachel Phillips Belash Slide Adapted from Melanie Tervalon, MD, MPH Do Not Copy Without Permission Leanna W. Lewis, LCSW Do Not Duplicate without Permission

Culture “Culture” refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious or social groups. Setha Low 1984 Kathy This is the academic definition of culture. Often useful to show this to help participants understand the many dimensions of culture and the fluidity of culture.

So what is culture? Shared systems of values, beliefs, “World lens” Learned patterns of behavior Ever changing, socially framed Expressed in views, attitudes and behaviors Sometimes referred to in categories Often individually defined Frances Want to also point out The culture of medicine, the culture of helpers, the culture of mental health, the culture of education and academia, The culture of our individual organizations. Use examples that you can explain from your own experiences. What examples can you think of? Ways we treat older adults; religion Family traditions, ways we cope with life, stress – positive or not, maybe harmful to ourselves or others Goggles that each of us wear that inform the way we see things Islam’s example – parents weariness of white people © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Examples of Cultural Groups
Ethnic, Religious Age, physical ability Gender and Sexual Orientation Professional/Educational Geographic Formed by social circumstance Homeless, previously incarcerated, veterans Special Interest e.g. sports, arts Socioeconomic Frances Can describe these groups as the facilitator, or ask participants to say what they think about the elements of culture in each group. An exercise: pick on of these groups and talk with another person about why you see yourself as part of this group and what are the distinguishing characteristics. Intersectionality of us © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

The story, principles, and practice
Cultural Humility: The story, principles, and practice Kathy Refer to either the video ( embed it in this section); or the facilitators guide, page 7, 8 for the story. © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

7/31/2019 Cultural Humility A lifelong process of critical self-reflection and self-critique Redressing the power imbalances in the patient-provider dynamic Developing mutually beneficial partnerships with communities on behalf of individuals and defined populations Advocating and maintaining institutional accountability that parallels the three principles above Kathy “Lifelong process of critical self-reflection and self-critique” Respectful and meaningful partnership with patients, their families, and the communities we serve Respectful appreciation and attitude towards diverse lived experiences Institution accountability Tervalon M, Murray-Garcia J: “Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education, “Journal of Health Care for the Poor and Underserved 1998; 9(2): © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission Leanna W. Lewis, LCSW Do Not Duplicate without Permission

Cultural Humility is… not a discreet endpoint, but a commitment and active engagement in a lifelong process that individuals enter into on an ongoing basis with participants, communities, colleagues, and with themselves. - Leland Brown, 1994 “ Kathy Can either read the slide, or use this as a prompt for this exercise: Pause for a moment and write down an example of cultural humility, as you understand the concept, from your work in the last week. Turn to a person you don’t usually speak with and share the example. “ © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Marked by modesty in behavior, attitude or spirit; showing patience, gentleness and moderation about ones own abilities and values Not arrogant or prideful, which in the context of the original article meant curbing the physician drive towards being all right and all knowing in all areas of all things! Why Humility Kathy Take a moment on your own thoughts about the word “humility”. Do you use it? If so when? When was the last time you used the term? Also, you can see the prompts from the facilitators guide on page 31, 32, from other sessions © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Cultural Competence and Cultural Humility
What’s the difference? Cultural Humility Learner/student Fluid Flexible, dynamic Personal, authentic Partnership Evolving Path to Equity Cultural Competence Mastery/expert End point Rigid Technical Hierarchy Linear Status quo Kathy Pg 16, 17 facilitator guide © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Cultural Humility and Cultural Competency Activity
Kathy Cultural Humility vs Cultural Competency Compare and Contrast Handout: page 16-17 Break into groups to review the summary and then work on the exercise.

7/31/2019 Cultural Humility A lifelong process of critical self-reflection and self-critique Redressing the power imbalances in the patient-provider dynamic Developing mutually beneficial partnerships with communities on behalf of individuals and defined populations Advocating and maintaining institutional accountability that parallels the three principles above Frances “Lifelong process of critical self-reflection and self-critique” Respectful and meaningful partnership with patients, their families, and the communities we serve Respectful appreciation and attitude towards diverse lived experiences Institution accountability Tervalon M, Murray-Garcia J: “Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education, “Journal of Health Care for the Poor and Underserved 1998; 9(2): © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission Leanna W. Lewis, LCSW Do Not Duplicate without Permission

Critical Self-Reflection
and Life Long Learning Know your own identity and what you are bringing to an interaction. In what ways are you bringing your identity, power and privilege to the work? Frances Ex of Kathy’s story: My identity as a Latina, born in US provides me with both privileged and subjugated POV. One way this shows up with me at work – working with Latino immigrant communities. My experience is informed by the migration of my family and their experiences as immigrants in the US. My experience affords me both security and is also unfused with a sense of otherness that my family has endured over the years. Example: As a child, I went to the store with my mother where she was mistreated by the grocery clerk who made fun of her in English. She blushed and did not seem to understand what she and her co-worker were saying. I froze, understanding them of course, and felt ashamed. © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Activity Frances Page 14, 15: Self reflection and life long learning exercise – focus on race, power, privilege Use as much or as little of this exercise as you can facilitate and that the group can work with and learn from in a dialogue. 7-10 minutes version: Take a couple minutes to write down your identities – write down 2-4 (race, gender, gender identity, sexual orientation, class, ethnicity, religion, country of birth, skin color, body size, physical ability, language, previously incarcerated, etc.) Now, for each part of your identity, write next to it whether you are in a socially powerful/privileged/dominant position or not in your current role in the work place. Talk about one of those and connect it to a real story that has happened in your work place recently. Would anyone like to share?

Self-Reflection and Life Long Learning
Courageously ask: What do I think about this cultural group(s)? How do I know this to be true? What are my biases? What are they based on? What are the consequences in my relationship with this person, this community, if I act on these biases? What can I learn here? And how? What are my responsibilities? Frances Other notes on self reflection; also, there are more exercises in the guide: pg 26, 27, 28 Think about a client or community member that is different from a cultural group than you. Ask yourself a couple of these questions. © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Power and Privilege Kathy A cartoon to remind us that power and privilege, oppression and anti-oppression models are at the heart of our work for social justice. Make your own comments here that are in sync with the group with whom you are working. © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Client focus Student focus Client as expert Student as expert
Kathy

Client focus Student focus Client as expert Student as expert
Avoid the check list of “cultural traits” Practice respectful, curious inquiry encourage rather than obstruct the telling of the story anticipate multiple cultural identities Kathy Review the slide. Use your own examples © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Client/student-focused interviewing and care
Challenge power imbalances - demonstrate humility: Individual or community as rich expert, teacher on the content of culture, “isms, community life Practitioner as student, partner and facilitator with access to resources and knowledge Determine access to resources, knowledge and services in the best interest of the individual Kathy Review the slide. Use your own examples. Ask for questions or elicit comments. © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Take off the masks …even the most familiar and generally accepted of social practices and traditions often mask an unfairness and inequality that frequently is not recognized or appreciated by those not directly harmed by those practices or traditions. Chief Justice Ronald M. George May15, 2008 “ “ Kathy This quote is from Chief Justice Ronald M. George when the first round at securing the marriage equality act failed in California. What a good reminder for us all that we often can not know what harms others, in no small part, because we have not experienced that harm. © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Mask Activity Kathy Use and have a blank mask handout
On the outside write the social practices and traditions that are expected from your role What is behind the mask? What unfairness and inequality that is hidden behind your role? What are you gatekeeping? What are your intersectional identities behind and within the mask?

Community-based Care and Advocacy
Listen as if the speaker is wise respect the defining health priorities build on existing strengths act as effective students of and partners with community Kathy Review slide. Give examples © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

“Listen as if the speaker is wise.”
To understand what another person is saying, you must assume that it is true and try to imagine what it could be true of. - Miller’s Law Kathy “ Adapted from Dr. Melanie Tervalon

7/31/2019 Cultural Humility A lifelong process of critical self-reflection and self-critique Redressing the power imbalances in the patient-provider dynamic Developing mutually beneficial partnerships with communities on behalf of individuals and defined populations Advocating for and maintaining institutional accountability Frances Slide critical self reflection & lifelong learning “Lifelong process of critical self-reflection and self-critique” Respectful and meaningful partnership with patients, their families, and the communities we serve Respectful appreciation and attitude towards diverse lived experiences Institution accountability Tervalon M, Murray-Garcia J: “Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education, “Journal of Health Care for the Poor and Underserved 1998; 9(2): © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission Leanna W. Lewis, LCSW Do Not Duplicate without Permission

Institutional Accountability
Demonstrate cultural humility in organizational strategies and practices Acknowledgment and assumption of responsibility for actions, products, decisions, and policies including the administration, governance, and implementation within the institution Frances Acknowledgment and assumption of responsibility for actions, products, decisions, and policies including the administration, governance, and implementation within the institution. Cultural Humility is about personal, interpersonal and institutional transformation. They are connected one to the other because human beings are in relationship with each other across each of these dimensions. What’s an institution? Schools, hospital, CBO’s, BHRS Remember what shapes institution – political, social and economic © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Institutions and cultural humility
Hire staff with shared history, heritage, knowledge and skill who can: STOP the particular cultural, social and political practices that reinforce discrimination in access, services and treatment in the health care system and social services system EXPEDITE trust and relationship building that powerfully influences whether individuals and identified communities, fully access and utilize the services that are available Frances Review slide: This can be the most direct way of starting the process of institutionalizing cultural humility. Use examples from your work Tokenization – Not just about direct line staff using CH, but among co-workers, leadership © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

The basics: Community representation in every opportunity, and pay people - key decision making infrastructure committees Match Human Resources practices to deep and careful review for non discriminatory hiring and treatment. Pay attention to small instances where power, privilege and cash override love, health and healing as the motivating social forces. Frances Review slide; Respect for the community wisdom and expertise; consistency at every opportunity with the values and principles of cultural humility. ( page 11) © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Consider a public review of the client experience Humble and courageous self reflection Dialogue with the community and hear their input as expert - in the community venue of choice Work with the power imbalance by distributing the knowledge and decision making often and freely Create “Communities of Dialogue” to work with community members, and clients, and each other on tough issues Frances See facilitator guide with more information about communities of dialogue: page 12 © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Skills: Dialogue and Practice
Kathy

Dialogue versus Discussion*
Kathy Guide Pages next 3 slides © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission * From the work of Veronica Neal, PhD.

Dialogue To learn To hear and understand different perspectives
To offer, reflect and inquire To explore collective thinking and meaning To allow for common ground To discover/create shared visions To seek coherence between thought and action Kathy © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission * From the work of Veronica Neal, PhD.

Discussion To fix To advocate a single perspective
To present a position as "right" To sell, persuade, enlist To succumb to one strong opinion To prove one's own vision Kathy © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission * From the work of Veronica Neal, PhD.

“Listen as if the speaker is wise.”
To understand what another person is saying, you must assume that it is true and try to imagine what it could be true of. - Miller’s Law Kathy This and the next slide are preparation for the “one minute question” exercise “ © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

1. Say hello to your new partner!
2. Decide who will be the first listener. 3. Hear the question. 4. Listen to the response for 1 minute. 5. Say thank you, switch roles and repeat. Kathy 2:10-2:25pm CS 1 minute x 3 plus 2 minutes between the sharing; debrief What is one element of your cultural identity or heritage that surprises people when they first get to know you? How do you act or react when someone makes an incorrect assumption about your cultural identity or heritage? How do you act or react when you learn that you have made an incorrect assumption about someone else’s cultural identity or heritage? Slide and Activity Courtesy of Jme McLean

Culture in Our Work Frances

Review: Diversity – Differences - Identity .
Race Religion Ethnicity Nationality Appearance Body structure Physical ability Sexual identity Class Gender Age Primary language Family of origin Immigration status Occupation Sexual orientation Gender identity ….what else Frances Exercise on assumptions, social identifiers – debrief Notice differences multiple social identities believes and perspectives that team members, co-workers, clients live with every day, and bring to the work place. Imagine together what this means in our work with each other and with clients What we see first, why we act on these visual clues of the face: gender, skin color, age Adapted from - Pinderhughes EB: Understanding Ethnicity, Race and Power: The Key to Efficacy in Clinical Practice. New York: The Free Press, 1989, p. 25 © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Culture in our work In pairs, listen to each other and use dialogue to talk about a time in the recent past where: Your cultural identity played a part in influencing another persons comfort or discomfort with asking for or receiving services. Use your current role at work. Describe how cultural identity made a difference in that episode – positive or negative – in the context of your role. Be ready to share out loud Frances Purpose: to hear out loud how culture operates in the work setting; to hear from colleagues both good and not so good experiences. Draw out the lessons in the examples of: How to curiously and respectfully engage each other and patients about cultural identity and the importance or lack thereof in an interaction How to acknowledge that – “we don’t know if we don’t ask” How to describe the advantage of incorporating cultural elements of identity into service provision at the level of relationships - all relationships – within the clinic setting. © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Cultural Humility - Review
Frances Refer to the Elephant sheet: page 13 for the next several slides. This sheet can be used as a “quick summary” for the cultural humility principles and application

Jann Murray-Garcia, MD, MPH Melanie Tervalon, MD, MPH
Cultural Humility Versus Cultural Competence: A Critical Distinction In Defining Physician Training Outcomes In Multicultural Education A lifelong process of critical self-reflection and self-critique Redressing the power imbalances in the patient-provider dynamic Developing mutually beneficial partnerships with communities on behalf of individuals and defined populations Advocating and maintaining institutional accountability that parallels the three principles above Frances This may be review for some of you. I apology if it is, and I know it is important to be clear and explicit about the framework. Jann Murray-Garcia, MD, MPH Melanie Tervalon, MD, MPH Tervalon M, Murray-Garcia J: “Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education, “Journal of Health Care for the Poor and Underserved 1998; 9(2): Slide courtesy of Leanna Lewis, LCSW

Cultural Humility: Application
Critical Self-Reflection and Life Long Learning: Know your own identity and what you are bringing to an interaction. In what ways are you bringing your identity, power and privilege to the work? Frances © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Client as Expert: Can you listen and respectfully inquire in order to determine how best to meet your client/partner/students where they are? “No laundry list of cultural traits to check off” Choose to be a servant leader; choose humility. Frances © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Community Advocacy and Care: Community is central to the work and we advocate in partnership. Are you listening? – and creating the conditions for community voice? Frances © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Balance the Power Imbalance: Client as rich expert Culture, identity: What is – and is not - important Provider as rich expert Resources; Keys to Kingdoms Servant leader Client and provider in dynamic partnership Determine the course of action in the interest of the individual being served Frances © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Frances Equality = Sameness, Giving everyone the same thing -> it only works if everyone starts from the same place Equity = Fairness, Access to Same Opportunities -> We must first ensure equity before we can enjoy equality Equality = Sameness Giving everyone the same thing -> it only works if everyone starts from the same place Equity = Fairness Access to Same Opportunities -> We must first ensure equity before we can enjoy equality Adapted from © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

Equality is all the same bike Equity is the bike each person needs.
Frances Equality is all the same bike Equity is the bike each person needs.

Equity Equity means just and fair inclusion. An equitable society is one in which all can participate and prosper. The goal of equity must be to create conditions that allow all to reach their full potential. In short, equity creates a path from hope to change. - PolicyLink Frances PolicyLink gives us this definition of equity – as a way to imagine what full opportunity might look like. Leanna © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission For permission to use any or all of the slides in this presentation, please

Transformation: Ideas to action - hope to change
Frances The purpose of our understanding this particular model, and other models for social justice, is to move from ideas to action, from hope to change.

“The Transformation of Silence into Language and Action.”
We can learn to work and speak when we are afraid in the same way we have learned to work and speak when we are tired. For we have been socialized to respect fear more than our own needs for language and definition, and while we wait for that final luxury of fearlessness, the weight of that silence will choke us. The fact that we are here and that I speak these words is an attempt to break that silence and bridge some of those differences between us, for it is not difference which immobilizes us but silence. And there are so many silences to be broken. - Audre Lorde, ( ) Frances Read. And be able to talk about Audre Lorde’s work, and her contributions: activist, feminist, lesbian, intellectual, poetess. Died from the complications of breast cancer. © 2018: Melanie Tervalon, MD, MPH Do Not Copy Without Permission

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