CULTURAL COMPETENCE IN STD PROGRAMS

Transcription

1 EXERCISE 1: L AYERS OF CULTURE AND CULTURAL IDENTIFICATION Objective: To learn about cultural identification. This is an example of an exercise to use with staff to develop a shared cultural framework as part of cultural competence building within the STD program The benefits of this exercise include helping to discuss differences within staff, and to learn about each other s cultural backgrounds. This exercise also develops cultural self awareness, by identifying the range of structural, personal and cultural factors that shape behavior of staff and of clients. Primary Cultural Characteristics Ascribed or Home Culture The first way we can identify ourselves consists of characteristics that people are born with, or experiences that they have as infants and children. These are characteristics that seem unchangeable and unconsciously shape our perspective on the world. 1. Place of birth 2. Birth order / location in family 3. Ethnic identity / racial identity 4. Gender identity as labeled by family and society 5. Language(s) 6. Physical abilities and qualities and the values places on them 7. Sexual and affectional orientation 8. Childhood experiences and family influences family religion family structure type of household family social class parents immigration history Secondary Cultural Characteristics Achieved or Chosen Identities The second way we can identify ourselves consists of characteristics or experiences over which individuals may have some control or choice; however, the level of control or choice can vary widely for each characteristic. We may remember learning or choosing some of these identities. 1. Education 2. Geographic location 3. Marital / relationship status and history 4. Military experience 5. Having or not having children 6. Religious practices 7. Work experience 8. Current social class and class status history 9. Political affiliation and perspective 10. Change in gender presentation Adapted from: Communicable Disease Investigator Curriculum, Francis J. Curry National Tuberculosis Center,

2 EXERCISE 1: L AYERS OF CULTURE AND CULTURAL IDENTIFICATION Tertiary characteristics Life Experiences The third way we can identify ourselves is through characteristics that are most unique among individuals and are not shared by all people within a culture. 1. Experiences with immigration, exile, refugee 2. Lifestyle (e.g., New Age spirituality, yuppie/hippy) 3. Degree of acculturation/assimilation 4. Degree of recovery or recreational drug use 5. Housing situation 6. Experience of health or illness, including mental health 7. Jail/prison experience Review the list of primary, secondary and tertiary characteristics. Then, select a total of six or seven different characteristics and describe your cultural identity in the space below. If you have experience with individuals or groups with a different cultural characteristic, note where you have had that experience in the third column. See example below. Cultural characteristic (from lists above) e.g., Religion Your cultural identification e.g., Catholic Your experience with someone from a different cultural group e.g., Attended Buddhist temple with high school friend, or Attended my friend s Protestant wedding Adapted from: Communicable Disease Investigator Curriculum, Francis J. Curry National Tuberculosis Center,

3 EXERCISE 2: MAPPING THE CULTURAL CONTEXTS OF STD & HIV/AIDS CLIENTS AND HEALTH CARE WORKERS Objective: To identify differences and similarities among our own and our clients backgrounds. Place a check mark or write in the cultural characteristic to describe yourself and several of your clients. Complete the culture map by identifying characteristics that apply to you. Mark these characteristics with an S (for self ). Then, think of a client or staff member you have recently worked with and identify his or her cultural characteristics, to the extent they are known. Mark these characteristics with a C (for client or colleague ). Cultural Characteristics You Client 1 Client 2 Client Client 4 Client 5 African African- Asian Asian- Latino/a - Pacific Islander European Euro- Ethnicity Gender (Identity) Country of origin Occupation/ Profession Education level Immigration History Language(s) Sexual orientation Religion/ Spirituality Age (Dis)Ability Family structure Housing situation Adapted from HRSA Toolbox: Transforming the Face of Health Professions Through Cultural and Linguistic Competence Education, p

4 TOOL SUMMARY Tool Promoting Cultural and Linguistic Competency: Self-Assessment Checklist for Personnel Providing Primary Health Care Services (Developed by: Tawara Goode, National Center for Cultural Competence, Georgetown University) Target Group Health care workers Purpose To increase individual awareness of practices, beliefs, attitudes and values that promote and hinder cultural and linguistic competence in the delivery of health care To identify training needs Length of Survey 5 items of a 30-item list concern oral linguistic services (items 5-8 and 10) Distinguishing Characteristics Divided into 3 categories 1. Physical Environment, Materials, and Resources 2. Communication Styles 3. Values and Attitudes Each item is rated on a 3-point scale

5 Self-Assessment Checklist for Personnel Providing Primary Health Care Services Georgetown University Child Development Center-National Center for Cultural Competence This checklist is intended to heighten the awareness and sensitivity of personnel to the importance of cultural and linguistic cultural competence in health and human service settings. It provides concrete examples of the kinds of beliefs, attitudes, values and practices, which foster cultural and linguistic competence at the individual or practitioner level. DIRECTIONS Select A, B, or C for each item listed below. A = Things I do frequently B = Things I do occasionally C = Things I do rarely or never PHYSICAL ENVIRONMENT, MATERIALS & RESOURCES 1. I display pictures, posters, artwork and other décor that reflect the cultures and ethnic backgrounds of clients served by my program or agency. 2. I insure that magazines, brochures, and other printed materials in reception areas are of interest to and reflect the different cultures of individuals and families served by my program or agency. 3. When using videos, films or other media resources for health education, treatment or other interventions, I insure that they reflect the cultures and ethnic background of individuals and families served by my program or agency. 4. I insure that printed information disseminated by my agency or program takes into account the average literacy levels of individuals and families receiving services. 1

6 COMMUNICATION STYLES 5. When interacting with individuals and families who have limited English proficiency I always keep in mind that: *limitations in English proficiency is in no way a reflection of their level of intellectual functioning. *their limited ability to speak the language of the dominant culture has no bearing on their ability to communicate effectively in their language of origin *they may or may not be literate in their language of origin or English. 6. I use bilingual-bicultural staff and/or personnel and volunteers skilled or certified in the provision of medical interpretation during treatment, interventions, meetings or other events for individuals and families who need or prefer this level of assistance. 7. For individuals and families who speak languages or dialects other than English, I attempt to learn and use key words in their language so that I am better able to communicate with them during assessment, treatment or other interventions. 8. I attempt to determine any familial colloquialisms used by individuals or families that may impact on assessment, treatment or other interventions. 9. When possible, I insure that all notices and communiqués to individuals and families are written in their language of origin. 10. I understand that it may be necessary to use alternatives to written communications for some individuals and families, as word of mouth may be a preferred method. VALUES & ATTITUDES 11. I avoid imposing values which may conflict or be inconsistent with those of cultures or ethnic groups other than my own. 12. I screen books, movies, and other media resources for negative cultural, ethnic, or racial sterotypes before sharing them with individuals and families served by my program or agency. 2

7 13. I intervene in an appropriate manner when I observe other staff or clients within my program or agency engaging in behaviors which show cultural insensitivity, racial biases and prejudice. 14. I recognize and accept that individuals from culturally diverse backgrounds may desire varying degrees of acculturation into the dominant culture. 15. I understand and accept that family is defined differently by different cultures (e.g. extended family members, fictive kin, godparents). 16. I accept and respect that male-female roles may vary significantly among different cultures and ethic groups (e.g. who makes major decisions for the family). 17. I understand that age and life cycle factors must be considered in interactions with individuals and families (e.g. high value placed on the decision of elders, the role of eldest male or female in families, or roles and expectation of children within the family). 18. Even though my professional or moral viewpoints may differ, I accept individuals and families as the ultimate decision makers for services and supports impacting their lives. 19. I recognize that the meaning or value of medical treatment and health education may vary greatly among cultures. 20. I accept that religion and other beliefs may influence how individuals and families respond to illnesses, disease, and death. 21. I understand that the perception of health, wellness and preventive health services have different meanings to different cultural or ethnic groups. 22. I recognize and accept that folk and religious beliefs may influence an individual s or family s reaction and approach to a child born with a disability, or later diagnosed with a disability, genetic disorder, or special health care needs. 23. I understand that grief and bereavement are influenced by culture. 24. I seek information from individuals, families or other key community informants that will assist in service adaptation to respond to the needs and preferences of culturally and ethnically diverse groups served by my program or agency. 25. Before visiting or providing services in the home setting, I seek information on acceptable behaviors, courtesies, customs, and expectations that are 3

8 unique to the culturally and ethnically diverse groups served by my program or agency. 26. I keep abreast of the major health concerns and issues for ethnically and racially diverse client populations residing in the geographic locale served by my program or agency. 27. I am aware of the socio-economic and environmental risk factors that contribute to the major health problems of culturally, ethnically and racially diverse populations served by my program or agency. 28. I am well versed in the most current and proven practices, treatments and interventions for major health problems among ethnically and racially diverse groups within the geographic locale served by my agency or program. 29. I avail myself to professional development and training to enhance my knowledge and skills in the provision of services and supports to culturally, ethnically, racially and linguistically diverse groups. 30. I advocate for the review of my program s or agency s mission statement, goals, policies, and procedures to insure that they incorporate principles and practices that promote cultural and linguistic competence. There is no answer key with correct responses. However, if you frequently responded C, you may not necessarily demonstrate beliefs, attitudes, values and practices that promote cultural and linguistic competence within health care delivery programs. National Center for Cultural Competence * 3307 M Street, NW, Suite 401, Washington, DC Voice: or * Fax: * Cultural@Gunet.Georgetown.Edu 4

9 EXERCISE 4: ORGANIZATIONAL SELF-ASSESSMENT STAFF DEMOGRAPHICS AND POSITIONS Indicate how many staff in each position in your organization are from each cultural background. Add additional details below, if possible (e.g., gay or not gay or Asian ethnicity). Also indicate other subcultural groups represented among your staff. Cultural Background Senior Managers Mid-level Managers Clerks/ Reception Epi / Data Management Physicians Nurses DIS Health Educators White, Non- White, Non- Country/ethnicity: African African Asian- Country/ethnicity: Asian- Native Ethnicity: Native Adapted from: Suzanne Salimbene, Inter-Fact Intl. 2002

10 EXERCISE 4: ORGANIZATIONAL SELF-ASSESSMENT STAFF DEMOGRAPHICS AND POSITIONS Indicate how many staff in each position in your organization are from each cultural background. Add additional details below, if possible (e.g., gay or not gay or Asian ethnicity). Also indicate other subcultural groups represented among your staff. Cultural Background White, Non- White, Non- Country/ethnicity: African African Asian- Country/ethnicity: Asian- Native Ethnicity: Native Adapted from: Suzanne Salimbene, Inter-Fact Intl. 2002

11 EXERCISE 5: PLANNING FOR CULTURAL COMPETENCE IN STD PROGRAMS Purpose: Identify specific cultural competence activities, assign staff, and identify resources for building programmatic cultural competence. Step 1 focuses on program assessment, and Step 2 focuses on meeting the needs identified in the assessment. Directions: Review the tables below as examples of activities that are part of a plan to develop programmatic cultural competence. Than, use the blank tables to designate activities, staff, and resources for your program s cultural competence development plan. Key Activity Demographic Profile of Program Region Epidemiologic Profile of Program Region Programmatic Cultural Competence Assessment Individual Cultural Competence Assessment Clinical cultural competence skills Staff Responsible/ Staff Participating Program Manager, epidemiologist, designated staff lead Epidemiologist or Program Manager Program Manager, Designated Cultural Competence Staff Lead Participating: At least one staff representative from every position level Responsible: All Supervisors Participating: Every staff member Clinical Director / All Clinical staff Purpose EXAMPLE STEP 1: Program Assessment Identify current demographic profile and possible future trends Identify populations/ groups most affected by STDs, HIV/AIDS Identify how well elements of services; physical environment; staff composition and skills; outreach priorities and methods; policies and procedures, programmatic and community partnerships; are welcoming of and meet the needs of priority target groups and potential target groups Identify how well skills, knowledge, attitudes meet the needs of priority target groups and potential client groups Adapt patient-centered care approach to include cultural competence Activity / Resource Data Sources: State Dept. of Education/Local School District State Dept. of Finance State/County Refugee Programs Legislative Analyses of Constituents U.S. Census/ Community Survey Migration Information Source DIS staff observations from field Program, state data sources Assessment tools: National Center for Cultural Competence Cultural and Linguistic Competence Policy Assessment (CLCPA) Providers Guide for Quality & Culture Assessment tools: National Center for Cultural Competence Cultural Competence Health Practitioner Assessment (CCHPA) Providers Guide for Quality & Culture Providers Guide for Quality & Culture

12 EXERCISE 5: PLANNING FOR CULTURAL COMPETENCE IN STD PROGRAMS Key Activity Demographic Profile of Program Region Programmatic Cultural Competence Epidemiologic Profile of Program Region Individual Cultural Competence Assessment Clinical cultural competence skills Staff Responsible/ Staff Participating Purpose EXAMPLE STEP 2: Building Programmatic Cultural Competence Program Manager Plan program priorities based on current demographics and begin identifying resources based on projected trends Identify CBOs & MAAs for potential alliances / partnerships / referrals / help with cultural competence learning Identify trained & potential interpreters Program Manager Epidemiologist Program Manager Every staff member Clinical Director / All Clinical staff Build alliances and partnerships with CBOs, MAAs, or advocacy groups with specific cultural competence. Develop policies for assessment, training, and evaluation of program services, staff skills, community outreach Plan priorities for clinical services, screening, prevention & education messages, partner notification, behavioral interventions Develop training and periodically evaluate staff skills, knowledge, attitudes in meeting the needs of priority target groups and potential client groups Adapt patient-centered care approach to include cultural competence Activity / Resource Possible Resources: Other Public Health Programs HIV/AIDS, TB, Family Planning, etc. Other Providers, especially in target communities Other Health and Human Service Providers Schools and educational support programs Possible Resources: Staff CBOs, MAAs, Local Advocacy Groups State/County Refugee Programs Other Public Health or HHS programs Providers Guide for Quality & Culture A Physician s Practical Guide to Culturally Competent Care Think Cultural Health: Bridging the Health Care Gap through Cultural Competency Continuing Education Programs (nurses) Providers Guide for Quality & Culture

13 EXERCISE 5: PLANNING FOR CULTURAL COMPETENCE IN STD PROGRAMS Key Activity Staff Responsible/ Staff Participating Purpose Activity / Resource STEP 1: Program Assessment

14 EXERCISE 5: PLANNING FOR CULTURAL COMPETENCE IN STD PROGRAMS Key Activity Staff Responsible/ Staff Participating Purpose Activity / Resource STEP 2: Building Programmatic Cultural Competence