1. Cultural Competence Adam Goodpasture Mitch Montgomery Sara Nelson Kat McNally

2. Cultural Competence can be defined as: a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable that system, agency, or those professionals to work effectively in cross-cultural situations (American Physical Therapy Association) The ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients (Betancourt, et al)

3. Cultural Competence in Physical Therapy Prepare yourself, and educate your colleagues Recognize cultural differences in: Religion Dress Family dynamics Decision making Role of children and elders as helpers/translators/decision-makers Healthcare expectations

4. Educating Colleagues Cultural competence is a team effort Professional responsibilities: Educating yourself (it’s an ongoing process!) Educating others Sharing information Asking when you don’t know

5. Language: The Beginning A language barrier does NOT mean: That either party is less intelligent than the other That you cannot provide treatment That you don’t have options www.dliflc.edu

6. Language A language barrier DOES mean: That you, as a professional, can adapt That treatment may be more difficult, but is not impossible That you can consider your options Learn words in the patient’s language Refer patient to a therapist that speaks their native tongue Refer patient to a facility with a translator

7. Religion Adapting treatment to fit the patient’s beliefs In some religions, it is considered disrespectful to touch someone in a particular area or reveal certain parts of your body. Must respect the beliefs of your patients/clients, even if they are not similar to your own. Understand that some treatments will not be appropriate for certain religions, and will need to be adapted. Religious beliefs can influence patient treatment goals.

8. Dress Different cultures have different expectations for appropriate dress. Some patients/clients will be uncomfortable with revealing certain parts of their bodies, due to their culture or religion hijab (headscarf) skirt (many Christian religions) Yarmulke (Orthodox Jewish faith) Must learn to adapt therapy to maintain patient comfort Museumofbadideas.blogspot.com

9. Family Dynamics Family hierarchy is different in all cultures. Must be willing to respect input from patient’s family Primary decision maker may be different Age or gender may not be a factor www.londonnfp.com

10. Decision Making Based upon: Cultural expectations Religious beliefs Familial expectations Non-scientific or spiritual influences

11. Role of Children and Elders As translators As primary decision makers As mediators As key players in the treatment process latinoleadershipcouncil.wordpress.com

12. Healthcare Expectations May be different from what you think is “normal” Are valid even if they differ from the “norm” Are determined by a conversation Need to be tailored to the individual limitstogrowth.org

13. Socio-economic Status Standard of living versus Quality of treatment

14. Cultural INcompetence Failing to be sensitive to differences Failing to consider patient’s background Treating all patients as similar Treating a language barrier as incompetence

15. Cultural Incompetence: Examples Asking a patient to remove an article of clothing that may violate their religious beliefs Making a negative comment about culture, religion, language, race, etc. Treating a patient as secondary because of a language difference

16. Non-Discriminatory Practice Adaptability Innovation Collaboration Research francis-moran.com

17. Identify with the Patient Patients should know: That their treatment is your first priority That they are involved in the decision making process That their values and beliefs are respected That they can say no if they are uncomfortable with something for any reason

18. Identify with the Patient Patients should never: Feel pressured into doing something they are uncomfortable with Feel unimportant Patients should feel: Unafraid to ask questions Unafraid to share fears, feelings, discomfort, expectations, etc.

19. How to Improve Take the ATPA Cultural Competence Self- Test Experience something outside of your comfort zone

20. Resources http://www.apta.org Your colleagues Community Groups Local Civic and Advocacy Associations Other clinics Hospitals Religious and community leaders

21. Real Life Example

22. References APTA.org. 4/12/2011. American Physical Therapy Association. 6/20/2012.. Betancourt, J.R., Green, A.R., and Carrillo, J.E. 2002. Cultural competence in health care: Emerging frameworks and practical approaches. New York: The Commonwealth Fund.