135th Annual Meeting and Exposition From Cultural Destructiveness to Cultural Proficiency: Increasing Cultural Competence in Working with African Americans 135th Annual Meeting and Exposition November 3-7, 2007 Washington, DC

African American Cultural Competence to Eliminate Health Disparities One-day interactive, skills building course Based on cultural competence continuum that ranges from cultural destructiveness to cultural proficiency

Objectives To provide healthcare workers with the necessary skills needed to recognize health-related beliefs and practices of African Americans To improve the quality of services delivered To understand the vital role cultural competence plays in reducing health care disparities among African Americans

Program Evaluation Data Delivered to 7 community health care organizations 75 % of the participants strongly agreed they learned new skills 75% of the participants strongly agreed their awareness about cultural competence had increased due to the course 87.5% of the participants strongly agreed they could apply the cultural competence skills within the next three months

African Americans and Health Disparities African American women, ages 35-44, have a breast cancer death rate more than twice the rate of White women in the same age group. African American men have about a 60% higher incidence rate of prostate cancer than white men. African Americans are far more likely to rely on hospitals or clinics instead of personal physicians for their usual source of care (16%), than are white Americans (8%). Cancer Facts & Figures for African Americans 2007-2008

Barriers to Healthcare Economic Structural Informational Individual/Cultural

What is Culture? Patterns of human behavior that includes: Thoughts Communications Actions Customs Beliefs Values Institutions of racial, ethnic, religious, or social groups

What is Cultural Competence? A set of congruent behaviors, attitudes, and policies that come together to enable health care providers to work effectively in cross-cultural situations.

Justification for Cultural Competence in Health Care The perception of illness and disease and their causes varies by culture Culture influences “health seeking behaviors” and attitude toward health care providers Health care providers from culturally and linguistically diverse groups are under-represented in the current service delivery system The perception of illness and disease and their causes varies by culture Diverse belief systems exist related to health, healing, and wellness Culture influences “help seeking behaviors” and attitude toward health care providers Individual preferences affect traditional and non-traditional approaches to health care Patients must overcome personal experiences of biases within health care systems; and Health care providers from culturally and linguistically diverse groups are under-represented in the current service delivery system National Center for Cultural Competence (1999)

Health Care Assumptions Provider Assumptions Uneducated Don’t care about health Lazy Client Assumptions Used as a guinea pig Don’t care about my health They don’t understand the challenges in my life

The Cultural Competence Continuum Cultural Proficiency Cultural Competence Cultural Pre-Competence Cultural Blindness Cultural Incapacity Cultural Destructiveness

Cultural Destructiveness The blatant attempt to destroy the culture of a given group The assumption that one group is superior to another Acknowledges only one way of being and purposefully denies any other cultural approach Trainer Notes: Ask participants to give examples of historic events which mirror cultural destructiveness. European ethnocentric attitudes that saw the Native American culture as primitive and actively sought to destroy their cultural values, beliefs and traditions Recent events in Bosnia, Rwanda

Cultural Incapacity An individual or organization lacks the capacity to be responsible to different groups, but this is not intentional. Ignorance and unfounded fear are often the underpinnings of this problem. Failure to recognize when mistreatment is due to cultural differences and thereby perpetuating its occurrence Trainer notes: Stress that this is done more so out of ignorance and is not purposeful Example: an administrator who decides to have the agency's mentally ill clients (who happen to be black) enter through the back door to avoid upsetting other clients. Ignorance of emotional implications of blacks entering through the rear door may cause further isolation to black clients as well as black employees.

Cultural Blindness A blindness or ignorance of cultural differences Individuals perceive themselves as “unbiased” because they feel that “culture makes no difference” in the way a person or group acts or reacts Foster the assumption that we are all basically alike so what works with members of one group will work with all groups. Trainers notes: Cultural blindness occurs when service providers treat all clients/patients one way without recognizing differences affect the client/patient attitudes and perceptions about health and human services. Although well intended, the culturally blind service provider “treats everyone the same”. This sameness is often based on the provider’s own cultural experiences.

Cultural Pre-competence Implies movement toward cultural sensitivity The active pursuit of knowledge about cultural differences and the attempt to integrate this information into the delivery of health care services Learning and understanding of new ideas is encouraged along with solution to improve performances or services Trainer notes: Explain to participants that a service provider who is culturally pre-competent will attempt to demonstrate their knowledge and acceptance of differences by making their work space more welcoming. They may incorporate pictures, magazines and music that represent the population being served into the décor of their workspace. On the organizational level, hiring practices may include ensuring that personnel reflect the makeup of the community being served.

Cultural Competence The capacity to function in an effective manner within the context of the targeted group Acceptance and respect of differences Continual self-assessment Actively seeks advice and consultation

Cultural Proficiency Culture is held in very high esteem Cultural differences are regarded proactively Improved cultural relations among diverse groups are promoted Healthcare providers are regarded as specialists in developing culturally sensitive practices Trainer notes: Most health and human service organizations and programs providing services to individuals, children and families fall between the cultural incapacity and cultural blindness spectrum of the continuum. Cultural proficiency is the ultimate goal for all service providers, however, as the final point of the cultural competence continuum, reaching this milestone requires tremendous effort. Have participants write # 2 on the index card. Ask them to think about where they fall on the continuum and to write in down. Explain that they are not required to share this information unless they want to. Remind them that where they place themselves on the continuum and their ability to progress forward can be directly impacted by their cultural values, beliefs and societal and familial influences.

Achieving the Goal The achievement of cultural competence assures that clients/patients are treated with dignity and that cultural traditions and values that can impact healthcare are identified and treated with respect.

Recommendation Utilizing a developmental process to building cultural competence is recommended as the most effective means to increase cultural competence skills among healthcare providers.