1. WELCOME New York State Department of Health HIV Oral Health Regional Resource Center Cheryl Stolarski, DMD Dental Co-Director 914-391-4883crs03@health.state.ny.us Howard Lavigne Program Director 315-477-8479hel01@health.state.ny.us

2. Oral Health Cultural Competency for HIV/AIDS 2010 Cheryl R. Stolarski,DMD Co-Dental Director NY/NJ AIDS Education & Training Centers Elias J. Llerandi, DMD Staff Dentist, U.S. Dept. of Veterans Affairs Consultant, NYS Dept. of Health Attending Dentist, The Brooklyn Hospital Center

3. OBJECTIVES Define and Recognize Fundamental Characteristics of Culture Define and Recognize Fundamental Characteristics of Culture Identify Standards and Steps Towards Cultural Competence Identify Standards and Steps Towards Cultural Competence Discuss the Importance of Understanding Cultural Variation in the Dental Setting Discuss the Importance of Understanding Cultural Variation in the Dental Setting

4. Definition of Culture “Integrated patterns of human behavior that include language, thoughts, communications, actions, customs, beliefs, values and institutions of racial, ethnic religious or social groups” Cross et al (1989)

5. Why is it Important that Oral Health Care Providers be Culturally Competent? Closes disparities between patient and provider Closes disparities between patient and provider Respect of culture and language can bring about positive treatment outcomes Respect of culture and language can bring about positive treatment outcomes Patient behaviors/attitudes Patient behaviors/attitudes Lack of minority providers Lack of minority providers

6. Oral Health Care for HIV/AIDS Patients can include these Populations Racial & Ethnic Minorities Racial & Ethnic Minorities Women Women Substance Users Substance Users Gay/Lesbian/Bisexual/Transgender Gay/Lesbian/Bisexual/Transgender Adolescents Adolescents FemaleFemale MSMMSM

10. Cultural Competence Standards and Steps National Standards on Culturally and Linguistically Appropriate Services (CLAS) National Standards on Culturally and Linguistically Appropriate Services (CLAS)http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=15 Cultural Competence Continuum Cultural Competence Continuumhttp://nccc.georgetown.edu/projects/sids/dvd/continuum.pdf LEARN Model LEARN Modelhttp://www.diversityrx.org/html/MOCPT2.htm

11. Cultural Competence Continuum Cultural Destruction Cultural Incapacity Cultural Blindness Cultural Pre-Competence Cultural Competence CulturalProficiencyCulturalProficiency

12. “LEARN” MODEL LISTEN – Identify Yourself Is Interpreter needed Is Interpreter needed Ask Open ended questions Ask Open ended questions EXPLAIN- Clear and easy language Pictures Pictures ACKNOWLEDGE- Find Common Ground RECOMMEND- Tx that involves both Doctor and Patient NEGOTIATE- Decide on a Plan that is Agreeable to both Doctor and Patient Agreeable to both Doctor and PatientBerlin&Fowkes1989

13. Dental Providers should remember Cultural factors may influence a patients and/or providers views Cultural factors may influence a patients and/or providers views Communication must be on the patients level Communication must be on the patients level -Language barriers -Examples and illustrations might be needed be needed

14. Examples of Cultural Views at the Provider Level HCP are reluctant to offer Tx plan option to pts they believe will be non-compliant HCP are reluctant to offer Tx plan option to pts they believe will be non-compliant MDs are more likely to Rx HAART to those perceived to be likely to be adherent MDs are more likely to Rx HAART to those perceived to be likely to be adherent MDs were more likely to tx African Americans as non-adherent MDs were more likely to tx African Americans as non-adherent (Bogart et al 2001) (Bogart et al 2001)

15. DO NOT LIMIT TREATMENT PLAN CHOICES BASED ON ASSUMPTIONS ABOUT A CULTURAL GROUP…

16. Body Language Speaks Volumes Verbal vs. Non-Verbal Verbal vs. Non-Verbal Touch (What is Appropriate?) Touch (What is Appropriate?) Personal Space Personal Space Eye Contact Eye Contact Be Direct Be Direct Sit at the Patient’s height or below Sit at the Patient’s height or below Shaking Hands Shaking Hands Avoid crossing your arms and legs Avoid crossing your arms and legs

18. Cultural Factors Limiting Compliance Language Language Limited Health Literacy Limited Health Literacy Indigenous Beliefs Indigenous Beliefs Trust in the Medical/Dental Profession Trust in the Medical/Dental Profession Burroughs,et al National Pharm Council & National Medical Assoc. 2002.

19. Health Literacy

20. Dental Providers should Respect differences Respect differences Expand Cultural Knowledge Expand Cultural Knowledge Adapt service modifications: Adapt service modifications: -language barriers -use appropriate terminology -use illustrations when necessary -seek staff who represent the community -develop good patient rapport

21. Linking Communication to Outcomes Communication leads to: Patient Satisfaction Adherence Better Health Outcomes Joseph Betancourt MD. Harvard University

22. Final Thoughts If you miss being understood by laymen and fail to put your hearers in this condition, you will miss reality. Hippocrates Ancient Medicine Adapted from Rose Jones PhD, Medical Anthropologist TX/OK AETC

23. Additional References CULTURE AND CLINICAL CARE EDITED BY JULIENE G. LIPSON/SUZANNE L. DIBBLE UNIVERSITY OF SANFRANCISCO Nursing press ACHIEVING CULTURAL COMPETENCY A CARE-BASED APPROACH TO TRAINING HEALTH PROFESSIONALS, EDITED BY LISA A. HARK, HORACE M. DELISSER. WILEY- BLACKWELL PUBLISHING GUIDE TO CULTURALLY COMPETENT HEALTH CARE, SECOND EDITION, LARRY D. PURNELL