4/23/16. Adopting Cultural & Linguistic Competency. Promoting Culturally Responsive Services for Diverse Populations in Minnesota: a look inward

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1 1 Adopting Cultural & Linguistic Competency Jonathan Lofgren, Ph.D., LADC MARRCH Board Member MCTC Faculty 2 Promoting Culturally Responsive Services for Diverse Populations in Minnesota: a look inward Goals of ACCBP Training Increase Competence, Proficiency, Responsiveness with Diverse Populations 3 1

2 4 Social Determinants of Health Science generally recognize 5-factors that contribute to a population s/person's current state of health: factors may be biological, socioeconomic, psychosocial, behavioral, or social in nature: Addressing health disparities or the differences in the incidence, prevalence, morbidity, and burden of diseases and other adverse health conditions that exist among specific population groups (TIP 59) 5 Social Determinants of Health Cont. Biology and genetics. Examples: sex and age Individual behavior. Examples: alcohol use, injection drug use (needles), unprotected sex, and smoking Social environment. Examples: discrimination, income, and gender Physical environment. Examples: where a person lives and crowding conditions Health services. Examples: Access to quality health care and having or not having health insurance [3,4]. (Center for Disease Control & Prevention, 2016) 6 Treatment Improvement Protocol #59 2

3 7 TIP #59 cont. Improving Cultural Competence (2014) Introduction to cultural competence Core competencies Culturally responsive evaluation & treatment planning Pursuing organizational cultural competence Behavioral health treatment for racial-ethnic groups Drug cultures and the culture of recovery 8 The Challenges We Face as a Field Income, Geographic Location, Language Managed Care, Medicare/Medicaid Stigma Lack of trust Insurance and related policies System bias and institutional racism Hernandez, M. Nesman, T., Isaacs, M., Callejas, L. M., & Mowery, D. (Eds.). (2006). Examining the research base supporting culturally competent children s mental health services. Tampa, FL: USF, Louis de la Parte Florida Mental Health Institute, Research & Training Center for Children s Mental Health. Online at: 9 Exercise #1 Whacha Think? 1 bad 1 good Write 1 immediate thought about the following images Write 1 immediate feeling/emotion about the following images How do images influence you in context of helping people? Follow-Up Group Discussion 3

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6 Any Aha Moments? Culture Defined The USDHHS Office of Minority Health (2000) defined culture as: integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values and institutions of racial, ethnic, religious or social groups (p. 2), all that influence how we live. 18 Definition Of Cultural & Linguistic Competence Cultural Competence is a set of congruent behaviors, attitudes, and policies that come together in an agency that enables employees to work effectively in crosscultural situations Linguistic Competence is the capacity of an organization and its personnel to communicate effectively in a manner that is easily understood by diverse audiences who possess a broad range of literacy skills and abilities. Hernandez, M. Nesman, T., Isaacs, M., Callejas, L. M., & Mowery, D. (Eds.). (2006). Examining the research base supporting culturally competent children s mental health services. Tampa, FL: USF, Louis de la Parte Florida Mental Health Institute, Research & Training Center for Children s Mental Health. Online at: 6

7 ( 4/23/16 19 Why Is It Important? Striking disparities for culturally/linguistically diverse people in social services despite having similar community rates of social/human service problems and needs Less access to human services and health care than do economic majority (whites in US) Less likely to receive needed care and when they receive it, it is more likely to be poor in quality Importance cont. 20 Sadly, relatively high levels of severity of social and human service problems are required in order for culturallydiverse individuals to overcome their reluctance to seek help from a professional. 21 Summary Of Cultural Competence Continuum Cultural Destructiveness Cultural Incapacity Cultural Blindness Cultural Pre-Competence Cultural Competence Advanced Cultural Competence (Cross, T., Bazron, B., Dennis, K., & Isaacs, M. 1989). 7

8 22 Cultural Competence Continuum Cultural Destructiveness Represented by attitudes, policies, and practices that are destructive to cultures and the individuals within the culture. For example: agencies, institutions that promote cultural genocide: US Chinese Exclusion Laws; KKK and other racial superiority groups. Cultural Competence Continuum Cultural Incapacity Lacks the capacity or will to help minority clients and employees System remains extremely biased, believes in the racial superiority of the dominant group. Maintains paternal posture toward lesser races, for example: lower expectations of minorities and subtle messages that they are not valued. Supports segregation as desirable policy Enforces racial policies and maintains stereotypes Disproportionately applies resources Discriminates on basis of whether people of color know their place Cultural Competence Continuum Cultural Blindness Color or culture make no difference and that all people are the same Ignores cultural strengths Encourages assimilation; thus, those who don t are isolated Blames victim for their problems Views ethnic minorities as culturally deprived 8

9 25 Cultural Competence Continuum Cultural Pre-Competence What can we do? Desire to deliver quality services; commitment to civil rights Realizes its weaknesses and attempts to improve some aspect of their services Explores how to better serve minority communities Agency may believe that their accomplishment of one goal or activity fulfills their obligation to minority communities; may engage in token hiring practices Often only lacks information on possibilities and how to proceed Cultural Competence Continuum (cont d) Cultural Competence Acceptance and respect for difference Expands cultural knowledge and resources Continuous self-assessment Pays attention to dynamics of difference to better meet client needs Variety of adaptations of service models Seeks advice and consultation from the minority community Commits to policies that enhance services to diverse clientele Cultural Competence Continuum (cont d) Cultural Competence Advanced - Proficient Holds cultures in high esteem Agency seeks to add to its knowledge base Agency advocates continuously for cultural competence throughout the system 9

10 Cultural Competence Assessment Scale 28 Culturally Destructive Cultural Incapacity Cultural Denial Cultural Precompetence Cultural Competence Cultural Proficiency Make conscious efforts to destroy cultures that are different from them (because of beliefs, ethnocentricity, traditions, etc) Slogan: We re number one. Unable to be useful or helpful to other cultures (because of values, beliefs, ethnocentricity, traditions, etc.) Slogan We take care of our own Because of values, beliefs, ethnocentricity, traditions, etc. believes that color, culture and dimensions of diversity are unimportant because all people are the same. Realizes inadequacy of response to those who are different and attempts to improve approach to cultural difference and other dimensions of diversity. Nice policies, but limited action. Valuing and embracing differences, self examination, cultural knowledge, cultural skills, adaptation of service to fit the needs of those who are different, commitment to cultural encounters of a different kind, involvement in an inductive learning process designed to expand our knowledge about difference. Mutual adaptation to difference. Mindfully/ willfully are engaging in behaviors, values, traditions, etc. of our own that demonstrate\ a value for other dimensions of diversity. Organization frame of reference is culture. Hold culture in high esteem What is Privilege? Privilege is a way of conceptualizing sociocultural-economic-political inequalities that focuses as much on the advantages that people accrue from society as on the disadvantages that other people experience. Sometimes referred to as White Privilege Peggy McIntosh, unpacking the invisible knapsack, Giant Steps to Cultural Competence 1. Self-awareness Denial, political correctness and professionalism are enemies of transformative inventory We must work to meet in the contradiction of bias and lived experience People are more complex than their perceived cultural attributes (Lofgren, J., Jenkins-Hall, K. 2005) 10

11 31 3 Giant Steps to Cultural Competence 2. Develop a way of knowing Cultural experience and immersion Confront formal, informal and technical learnings that do not align with experience Must overcome fears to achieve (Lofgren, J., Jenkins-Hall, K Giant Steps to Cultural Competence 3. Practice, practice, practice Cultural learning and competence is an evolutionary process If you don t succeed the first time, try, try again Will involve some degree of risk and shared vulnerability between client and practitioner (Lofgren, J., Jenkins-Hall, K. 2003) 33 Attitudes and Behaviors in Practice Respect Acceptance Sensitivity Commit to Equality Openness Humility Flexibility (TIP 59) Validate client view Nonjudgmental Understand racism and discrimination Address bias Earn trust Acknowledge limitations Diversify practices ACCBP 2O11 The ACCBP Project is grant funded through the Minnesota Department of Human Services, Alcohol and Drug Abuse Division 11

12 Essential Elements Of Cultural Competence The culturally competent system of care is made up of culturally competent institutions, agencies, and professionals. Five essential elements contribute to a system s, institution s, or agency s ability to become more culturally competent. The culturally competent system would: Value diversity; Have the capacity for cultural self-assessment; Be conscious of the dynamics inherent when cultures interact; Institutionalize cultural knowledge; and Develop adaptations to adversity Discussion References TIP 59: Improving Cultural Competence. Treatment Improvement Protocol (TIP) Series No. 59. HHS Publication No. (SMA) Rockville, MD: Substance Abuse and Mental Health Services Administration, Cross, T., Bazron, B., Dennis, K., & Isaacs, M. (1989). Toward a culturally competent system of care: A monograph on effective services for minority children who are severely emotionally disturbed. Washington, DC: National Technical Assistance Center for Children s Mental Health. Hernandez, M. Nesman, T., Isaacs, M., Callejas, L. M., & Mowery, D. (Eds.). (2006). Examining the research base supporting culturally competent children s mental health services. Tampa, FL: USF, Louis de la Parte Florida Mental Health Institute, Research & Training Center for Children s Mental Health. Kao, H. S., Hsu, M. T., & Clark, L. (2004). Conceptualizing and critiquing culture in health research. Journal of Transcultural Nursing, 15, Lofgren, J. & Hall, K. (2003). Cultural diversity in the assessment and treatment of substance abuse, part 1. Briefings, Florida Certification Board News Letter (V1, 2003). Masi, R., & Cooper, J. (2006, November). Children s Mental Health Facts for Policymakers. United States Surgeon General Press Release: Sunday, August 26, Center for Disease Control and Prevention (2016), Social Determinants of Health 12

13 37 Identity Exercise Watch Video; Kiri Davis Record your thoughts, feelings, and reactions Discuss with group how this video relates to the importance of being culturally responsive and competent 38 Privilege Exercise Understanding Privilege Watch YouTube Video; Tim Wise, The Pathology of White Privilege, (part 1/6) Write your thoughts, feelings, reactions Partner Up: how does Privilege & White Privilege impact you, your service delivery, and behavioral health in general? Discuss with group 13