Presented by Mona Lisa Chavez –Esqueda SW 7113 Do Cultural Competency Interventions Work? A Systematic Review on Improving Rehabilitation Outcomes for Ethnically and Linguistically Diverse Individual with Disabilities Rooshey Hasnain, EdD, Diane M. Kondratowicz, PhD, Eugene Borokhovski, PhD, Chad Nye PhD, Fabricio Balcasar, PhD, Nelson Portillo, PhD, Katherine Hanz, MA, MLIS, Tim Johnson, PhD and Robert Gould, MS Presented by Mona Lisa Chavez –Esqueda SW 7113

diverse individuals with disabilities. Summary of Protocol The proposed review will involve the first comprehensive look at the way that elements of culturally adapted competency interventions impact rehabilitation service outcomes for ethnically and culturally diverse individuals with disabilities. The primary objective of the review will be to examine whether or not the effects of such interventions have an impact on rehabilitation outcomes. The second objective will be to examine how the addictive use of culturally adapted interventions results in beneficial outcomes in a wide variety of areas. In fact, Lewis (2007) claims that ethnic and cultural minorities have a disproportionately high rate of disability compared to White, with Blacks and Latinos being particularly overrepresented in disability categories. As a consequence of these marked demographic changes and noteworthy projected trends, rehabilitation and health care practitioners are more likely than ever before to encounter individuals from diverse ethnic and linguistic backgrounds who have disabilities and/or chronic health conditions. Census projections for the foreseeable future, particularly the mid-century point, indicate that the nation will become increasingly diverse, both ethnically and culturally (U.S. Census Bureau, 2008). By 2042, it is expected that minorities will make up 54% of the U.S. population, Regarding the quality of care received, ethnic and immigrant minorities receive a significantly lower quality of care than White Americans, even when they have the same insurance provision and are at the same income level (Smedley et al., 2002).

Question Do culturally adapted competency interventions improve rehabilitation outcomes for ethnically and linguistically diverse individuals with disabilities? If so, for whom and under what conditions do they work?

Cultural Competence in Action Framework suggested and implemented by authors. CA indidivual/provider reflect on personal biases toward people: includes becoming familiar and having knowledge of others beliefs, values, history, etc. SD professional training and development, education, practice and experience to attain cultrural competency OS policies and practices implemented that support staff members to engage and interact with clients in culturally competent way

Keywords Cultural competency Educational Interventions Disability cultur*; cultural competenc*; culturally competent; transcultural*; cultural literacy; cultural awareness; cross-cultural training cultural education cultural characteristics; cultural diversity; cultural sensitivity; ethnic groups Educational Interventions intervention* educat* train* professional education, professional training, educational initiatives Disability disab*, disorder*, disease*, health*

Databases Databases included US, Australia, UK and Canada Interdisciplinary Databases, ProQuest Dissertations and Theses, Academic Premier Other databases such as MEDLINE/PubMed, CINAHL, PsychINFO, Social Work Abstracts, Health Source and REHABDATA ERIC and Web based searches in Google and Yahoo 1)Focus was comprehensive and reviewers desired to include more than US databases 2)focus specifically on health care, disability, mental health, rehabilitation, and the social sciences, 3)Google searches include grey literature

Inclusion Criteria Be published since 1980 in any language Include participants aged 18 and older identified as having a disability Use a culturally adapted competency intervention Conduct the intervention in a rehabilitation, health-care, or community-based setting Include consumer outcome measures Use a randomized controlled trial (RCT) research design Report data that could be used to calculate effect size Explain cultural competency strategies reported Did not include substance abuse interventions

Exclusion Criteria No culturally adapted intervention and/or no control group One group pre- and post-design or quasi experimental design Data are missing or inadequate to enable meta analysis Outcomes are at the level of provider or system rather than client Uses only biological/physiological outcomes Health promotion/preventative studies Unit of analysis is at the family,provider,organizational or systems level Inadequate data are provided to calculate an effect size

Strategies for Data Analysis Date Range: 1980-present Age: 18 and over Type : RCT, Meta analysis, Review Five Categories to consider as Disability Sensory Cognitive/Intellectual Physical Disabilities Chronic Health Conditions Mental Health Conditions Items 2 and 3 include TBI (Traumatic Brain Injury) Item number 4 includes breast cancer, diabetes, HIV/AIDS Item number 5 examples, depression, schizophrenia

Outcome Effect size calculated using standardized mean difference (SMD)

Implications and Conclusions Explore critical components or mechanisms that make cultural adaptations work Understanding moderating variables effects when developing and implementing future interventions Researchers need to account for phenomenon when evaluating programs or services Cultural competence in researchers Address cost effectiveness of cultural competent interventions Positive effects in three of five category Conclude culturally adapted competency interventions can improve rehabilitation and service outcomes Side 1, (1) Educational and behavioral skills, language and communication support, adapted interventions and ethnic match (2) Family and cultural practices (3) cultural competency & delivery of svc (4) gaining skill and understanding to gain trust of minority individuals to have better results