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

2. 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

3. 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

4. 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”?

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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!)

14. 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.

15. CONTACT US National Center for Cultural Competence http://nccc.georgetown.edu cultural@georgetown.edu The content of and this PowerPoint presentation are copyrighted and are protected by Georgetown University's copyright policies.Georgetown University's copyright policies Permission is granted to use this PowerPoint presentation in its entirety and/or individual slides for non- commercial purposes if:  the material is not to be altered and proper credit is given to the author(s) and to the National Center for Cultural Competence. Permission is required if the material is to be: modified in any way used in broad distribution. To request permission and for more information, contact cultural@georgetown.edu.cultural@georgetown.edu